AS most of you reading this will be aware, another vet has been struck off for not doing a home visit quickly enough.
The facts of the case are well known and as I have limited space here I would direct you to the Royal College’s website and the Vets Now website news section for background if you are not already familiar with the case.
In this “Cross-words” column I have an interview with Richard Dixon, founder and group managing director of Vets Now, Mr Chikosi’s ex-employer. (I also contacted the RCVS but by the time of writing this had received no reply.)
Gareth Cross. Firstly, we need to get out of the way whether he was struck off when following Vets Now policy (of not leaving the practice unattended by a vet) which it would appear he was.
Richard Dixon. For the avoidance of any doubt, it is absolutely not Vets Now policy that house visits can only be performed after a second vet has been called in or that the practice must never be left unattended.
However, given the wording in the DC [disciplinary committee] judgement, we fully appreciate why people would assume it is and this is one of several major concerns we have about the decision and subsequent comments.
‘Ultimate decision must be made by the vet on the ground at the time’
Our house visit policy certainly indicates that the duty vet should try and obtain cover for the clinic to handle in-patients and other emergencies, etc. But it is absolutely clear that the ultimate decision on how best to handle the requests (which includes whether to stay or go) must be made by the vet on the ground at the time.
In the house visit policy we also provide a flow-chart to aid rapid decision making by the vet. This also makes it explicit that the vet can choose to leave the premises if the clinical situation demands it.
No policy can or should try and define every eventuality and we have staff perform house visits in the absence of a second vet every year, when they deem it the right thing to do in the circumstances.
It is pretty galling that the DC can make public statements on our policies with no right of representation during proceedings and no right of reply. This is neither fair nor transparent and it is particularly frustrating when it isn’t even accurate.
‘We do not see that the policy is inconsistent with the RCVS Code’
GC. Is Vets Now amending its policy or is it appealing the decision?
RD. Our policies are reviewed every 12 months or thereabouts. The latest version of our house visit policy was updated in May 2012. We have been awaiting the Chikosi decision to decide if a further review is required. However, we do not see that the policy is inconsistent with the RCVS Code and have concluded there is no reason to make any substantive changes.
However, in the spirit of trying to be as co-operative as possible, last week I sent the latest version of the policy to the RCVS asking for any further opinion. I eagerly await a reply, albeit I personally cannot see why any material changes would be necessary.
GC. I was surprised to see a member of Vets Now is on the DC; I assume he wasn’t dealing with this case.
RD. No, Chris [Gray] noted a conflict of interest and so was not involved in any of the disciplinary hearing. My comments on DC inevitably reflect those individuals who oversaw this particular case.
[I had contacted Chris and received the following reply: “As a member of RCVS DC I had to declare a conflict of interest in this case, and therefore was not involved in the specific hearing. The detail of the DC findings is available at www.rcvs.org.uk/documentlibrary/chikosimunhuwepasi-june2013-decision/. “As you will no doubt know, Mr Chikosi did in fact attend the injured dog, and I am confident that the Vets Now policy does not prevent home visits being carried out whether or not a backup vet is immediately available. I do therefore believe it is erroneous to say that Mr Chikosi was struck off for following company policy.”]
GC. The whole issue of home visits is fairly well trodden (and having just been called out to a lurcher that “cannot possibly be moved”, only to get to their street and receive a call from the owner to tell me it’s fine, he’s up and they don’t need me, I am well aware of their drawbacks). Do you have anything aside from the usual to add?
RD. I actually think there is a really critical point to make on house visits. The case and DC comments are being discussed as if they are specifically an OOH issue, but as you know, they are not.
The issue of how to handle house visit requests (including what is a tolerable delay in performing the visit) applies just as much to a vet in practice at 11am with a busy surgery as it does to a vet working in the evening or overnight, and again irrespective of whether they are working for a dedicated OOH service or whether they just happen to be the vet on duty that night in the practice.
So, this topic is relevant to every MRCVS working in every practice where house visit requests may come in. We must and should assume and expect that the DC will hold MsRCVS to a consistent standard of behaviour irrespective of what time of day or night it is or who they are employed by at the time.
To represent the issue as an OOH issue would do it a disservice: it is about house visits and RCVS expectations.
GC. Next, the DC made specific comment about moving an RTA dog on a blanket. Now every vet and practice will do this. Stretchers often panic dogs who try and do a corkscrew roll to get off them, and as you can’t tell them to stay still and sedating a recently run over dog can be fatal, swaddling them up in a blanket is very useful and entirely normal practice.
This seems to be based more on human emergency medicine than veterinary. It is one point that has been widely commented on with dismay on the professional online forums and press.
RD. I share the dismay! The suggestion that blankets should not be used for transporting injured animals is nonsense. Vast swathes of the profession recognise that this is a sensible, practical way to move injured patients to the surgery.
If the DC now think that serious trauma patients need to be immobilised in situ before being transported then the practical implications are vast numbers of patients, not receiving prompt care and almost undoubtedly longer delays in treatment being received.
I would like to think this was nothing more than a naïve comment by the DC that they will promptly retract.
GC. Similarly, the criticism that no advice was given to make the dog more comfortable…
RD. We have listened to the call recordings, and actually we don’t think he handled them as well as he might have done. So from a customer care perspective, he could have done better.
In terms of any significant change to the animal’s condition or “suffering” we don’t really know what he could have said or done over the phone that would have made any material difference.
So, in the grand scheme of things, I am not sure this is really a key point. But I do agree and entirely accept that he could have been better on the phone.
GC. Will you/Vets Now be appealing?
RD. We don’t have the right to appeal. It has to be Mr Chikosi himself and I suspect his desire to do so will be pretty low. It is a shame that the RCVS doesn’t have an internal process that would enable them to review their decision, if on reflection they think they may have got either the decision or the language in the judgement wrong.
The generic advice from the College to the profession when we make an honest mistake with a client is to promptly hold your hands up, apologise, make amends and move on. Clients invariably appreciate this honesty.
It will be interesting to see if the “new” RCVS thinks it appropriate to follow that advice itself, or if it takes the well-trodden path of battening down the hatches. I very much hope the former.
GC. How much support did you give to Mr Chikosi or had he already left the UK when this came up?
RD. Mr Chikosi was already out of the country when the investigation took hold. We made repeated attempts to contact him (as I understand did the VDS) but he evidently wasn’t particularly inclined to engage in the process.
Whilst presumably this didn’t help his case, the bottom line is that the DC judgement justifies their decision for a number of other unrelated reasons and so one has to assume what they have written is what they believe.
‘This is an issue that affects all vets in all practices’
GC. With the Baird case, a phone survey of DC members revealed that nearly all (bar one) practices owned by DC members refused a home visit. I would be interested in how many DC members outsource their out-ofhours and if any use Vets Now, will they be stopping their contracts?
RD. I am not really sure this is of huge relevance. The point is, as you identified, that this is an issue that affects all vets in all practices. It certainly isn’t a peculiarly OOH issue.
If it is 11am and you are in the middle of a busy surgery and a house visit request comes in, what are the expectations from the RCVS? That is really the issue. Whether its 11am or 11pm is not really the point as far as I can see.
GC. Will vets now be leading a campaign to make the RCVS regard refusal of home visits a nondisciplinary issue? They could at a stroke do this. After all, the 24-hour requirement is simply to “take steps”.
RD. There is perhaps the risk of mixing up two separate issues here. There is the obligation to perform house visits and then there is an entirely separate and largely unrelated professional obligation to provide a 24-hour service.
It so happens that this case occurred at about 8.30pm, but it could just have equally happened at 8.30am. So, I see little reason or mandate for the 24-hour requirement to be opened up and axed, but the issue of whether we should be obligated to provide our services at someone’s home is very much a valid point of debate.
Personally, if after review, the College decided that house visits were no longer mandatory, I have no doubt that the vast majority of vets would both agree and I am equally sure would still make every effort to perform them on the rare occasion that it was actually in the interests of the patient.
The profession is overwhelmingly committed to protecting animal welfare and providing the right care for our patients when it is truly needed. However, to have the fear of a DC investigation every time a house visit request comes in is not what the profession needs or wants.
GC. I agree, fear of the RCVS was the only reason I trekked off to see the lurcher I mentioned at the start. I knew from the ‘phone call it was going to be a wasted trip (lots of drunk people in the background was my first clue). And if it really was that ill it couldn’t get up, I was better equipped to treat it at the clinic (e.g. oxygen therapy, abdominal scanning, etc.).
Lastly then, what about the responsibility of the owner? Surely everyone should be responsible for their pet up to the consulting room door? Especially as in this case the owners were a farmer and son, who have no “little old lady with a big dog” excuse.
RD. This is a non-starter (getting legislators to commit to having owners just identify their dog was hard enough) but it isn’t really the point in any case. This case is really about what the RCVS truly believes the profession should and can be expected to provide, whether by day or by night.
Either the College has decided this particular individual should be struck off and has used some illthought out reasons to justify that decision, or they truly believe what they have written. Neither of these two scenarios can be acceptable to the profession and so the RCVS now needs to unambiguously clarify its position.
‘This is a daytime issue just as much as a night-time one…’
GC. Thanks very much for that; any final comments?
RD. You have no doubt clocked that this is a daytime just as much as a night-time issue, which is at the heart of why the DC comments are so potentially significant to the entire profession, not just those working on call or for an OOH service.
The only other point of real significance that I would consider making is the comment in the DC ruling (section 32) that says: “The Committee considers that the profession should be reminded that providers of emergency out-ofhours services should have in place at all times adequate staff to comply with the requirements of the Guide.”
One assumes (at least I would like to think) that we are judged by the same standards as any other practice/MRCVS and so it is intended to apply to all practices.
If so, then everyone can recognise the ridiculousness of the idea that every practice can have enough staff on hand to deal with any eventuality. Nobody can have multiple layers of staff on site, doing nothing but just waiting for the exceptional crisis.
Fair enough, expect the profession to be reasonably staffed for the typically anticipated workload at any particular time.
But, when three RTAs appear in your morning surgery just as the house visit request comes in, it is certainly not reasonable to expect the practice to have a squad of vets waiting in the wings to get to work.
Everyone needs to use a bit of common sense here, and judge everyone by consistent and sensible standards.