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InFocus

Protocol ‘could plunge vets deeper into problems’

Dr SHAMS MIR summarises the Vets4BVU response to the Royal College’s draft health protocol

THE draft “Health Protocol”,
according to the RCVS, “aims to
protect animals and the interests of
the public by helping veterinary
surgeons whose fitness to practise
may be impaired because of adverse
health” by dealing with the
“veterinary surgeons suffering from
adverse health without referring a
case to the Disciplinary Committee”.

Whereas the RCVS is
responsible for protecting animals and
the interests of the
public, it is mandatory
for the profession to
protect the interests of
the veterinary
surgeons. With this in
mind, Vets4BVU
conducted an internal
consultation. Based on
this a response has
been presented to the
RCVS, a gist of which
is presented for the
attention of the wider
profession.

The following sections of the
protocol attracted most criticism.

  • “When considering whether a
    veterinary surgeon’s fitness to practise
    could be impaired because of adverse
    health …, the veterinary surgeon’s
    current physical or mental condition will
    be taken into account.”
  • “Anyone coming into contact with
    veterinary surgeons including … medical
    practitioners, who have concerns about
    a veterinary surgeon’s health are
    encouraged to report those concerns to
    the RCVS as soon as is reasonably
    practicable.”
  • “Veterinary surgeons and veterinary
    nurses who are concerned about the
    health of a veterinary surgeon must also
    take steps to ensure that animals are not
    put at risk … This may mean that a
    colleague must be reported to the
    RCVS.”
  • “All investigations follow a similar
    procedure and timeline as complaint
    cases not involving adverse health.”
  • “The Preliminary Investigations
    Committee (PIC) may… invite the
    veterinary surgeon to: (a) undergo
    medical examinations, assessments, or
    tests at his/her expense; (b) agree to be
    visited and interviewed by
    representatives of the RCVS; (c)
    provide medical reports to the PIC at
    his/her expense; (d) embark on a course
    of treatment recommended by a
    medical practitioner at his/her expense;
    and give undertakings to the PIC.
  • “If the PIC decides to invite the
    veterinary surgeon to give undertakings .. the undertakings may include: (a) undergoing treatment from the
    veterinary surgeon’s medical practitioner
    at his/her expense; (b) supervision from
    a medical supervisor appointed by the
    RCVS … will not be the veterinary
    surgeon’s own treating medical
    practitioner; (c) supervision from a
    workplace supervisor appointed by the
    RCVS…; (d) specific undertakings to address concerns identified by the RCVS
    or the medical
    supervisor…; (e)
    undertakings allowing
    the sharing of
    information between
    relevant persons, for
    example the veterinary
    surgeon’s medical
    practitioner, employer,
    medical supervisor,
    workplace supervisor
    and the RCVS; and (f)
    submitting to blood,
    urine or other medical
    tests.”

Observations

By allowing such a free range for
“anyone” to report regarding a vet’s
health could potentially open the gates
for malicious reporting and bolstering
of other complaints by adding a
suspicion or claim of a mental or
physical problem with the veterinary
surgeon.

There is a great concern that the
terms “physical and mental condition”
are too broad and could potentially be
abused when reporting, given the fact
that the problems of stress, anxiety and
depression appear to be quite
widespread in the profession.

Since the protocol does not lay the
requirements of hard evidence for
reporting, it is essentially unfair,
unethical and potentially illegal to put a
veterinary surgeon through an
investigative ordeal and then to have
him/her put up with the bills!

It would be breach of patient-
doctor confidentiality if a medical
practitioner reported a veterinary
surgeon to the RCVS without informing
the patient. It is not unlikely that the
medical profession may have serious
objections to this liability thrown at their
shoulders.

Importantly, vets in dire need of
medical help or advice may avoid seeing
their medical practitioner for the fear of
being reported, which is going to be
completely counterproductive.

The RCVS will hardly have any
options but to act on all reported
veterinary surgeons in order to avoid
potential future liability. Therefore, all
reported vets will have to submit
themselves to the procedures of the
health protocol. This would mean that reported vets will be considered guilty
unless they prove themselves to be
innocent, which flies in the face of
accepted standards of justice.

As it takes from several weeks to
months to go from initial complaint to
resolution with the RCVS, it will just
impose a greater amount of stress and
pressure to the affected vets, especially
those with real health problems.

The protocol involves too many
people – the vet, the RCVS case
manager, vet’s doctor, the RCVS
appointed medical practitioner, the
employer, the workplace supervisor, etc.
– which would clearly raise the
questions of confidentiality with such a
large number of people being involved.

It is hard to understand why the
RCVS thinks it necessary to stipulate
that a medical practitioner other than
the vet’s own medical practitioner
should be involved.

The veterinary surgeons required to
give undertakings will feel under
pressure to accept anything suggested
by the RCVS for fear of facing a charge
of professional misconduct should they
refuse. The protocol does not provide
any provisions to ensure that the
undertakings are suggested on a fair
basis.

It is unjustifiable to shift the
responsibility of welfare of the animals
under the care of a vet with suspected
“adverse health” to other fellow vets
and nurses.

In the absence of any independent
support, if a veterinary surgeon
suffering from mental or other health-
related issues is subjected to the
additional strain of a PIC investigation,
having to undergo dictated medical
assessments from assigned medical
practitioners, deal with a multitude of
people involved in the process, having
to pay for the costs of medical
assessments and treatments, having to
give undertakings to whatever the RCVS
suggests, and to feel forced to comply
with such undertakings, will only
exacerbate the problem and could push
vulnerable individuals over the limits
and may even provoke further tragedies
of suicides in the profession.

Recommendations

  • The RCVS will need to be very
    specific about the problems and
    conditions that might attract necessary
    attention.
  • Only vets and nurses, working
    closely with a veterinary surgeon,
    should be allowed to report on a
    voluntary basis.
  • In the case of employed veterinary
    surgeons, fellow professionals should
    report the matter to the practice
    principal, whereas practice principals
    may be reported directly to RCVS.
  • If the practice principal is satisfied about the validity of the report, he/she
    should speak to the vet concerned in
    confidence and advise him/her to seek
    necessary medical help and monitor the
    progress and take care to support the
    vet and organise for the necessary
    work-related adjustments.
  • In a case where the practice principal
    feels that progress is not being made or
    does not want to deal with it directly,
    the principal should report this to the
    RCVS.
  • The practice principal should
    produce specified evidence to support
    the report; the same should apply to
    the direct report which involves a
    practice principal.
  • The RCVS should ensure that there
    is no conflict of interest involved
    between the reporter and the reported
    vet, for example any pre-existing
    internal disputes.
  • If the PIC is thoroughly convinced
    that the reported veterinary surgeon
    needs help, it should contact the
    concerned vet, seek his/her consent to
    approach the vet’s GP for a medical
    examination, advise the vet about
    work-related adjustments that may be
    deemed necessary and inform and
    advise the practice principal to
    implement such adjustments.
  • The cases reported under the
    health protocol should be dealt with
    on an expedited basis.
  • The entire medical process should be
    operated through the vet’s own GP
    and if necessary the RCVS can request
    the GP to seek further advice from a
    medical consultant.
  • Should the GP confirm that the vet
    needs medical help, arrangements for
    such help should be made in
    consultation with the GP. Any
    programme of treatment should be a
    matter exclusively between the RCVS,
    the vet and the GP concerned.
  • Any monitoring required at the
    workplace should exclusively be the
    responsibility of the practice principal
    on a very confidential basis.
  • Any undertakings required from the
    vet should be in consultation with the
    vet’s GP and that the GP should
    certify all undertakings are strictly
    indispensible.

Conclusion

In its current form the draft protocol is
going to serve as springboard to plunge
the affected vets deeper into their
problems.

However, with modifications in line
with the above submissions, the
protocol will on one hand meet its
objective to “protect animals and public
interest” and on the other it can truly
render the intended “help” to the
affected vets by proactively facilitating
their personal and confidential medical
care.

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