Tag: Veterinary Defence Society

  • Stitches

    Stitches

    Legality within the veterinary profession can be a bit of a minefield, especially when it comes to things like drug licensing. This leaves many new graduates in fear of doing something against the law without even realising.

    However, while some veterinary legal principles are complicated but clear, others are genuinely vague, leaving us unsure on where we would stand in a court of law.

    A stab in the dark

    It was recently reported that stab victims, scared of the inevitable police involvement if they were to present at A&E, were turning to vets to have their wounds sutured, albeit at a handsome price of about £200. While the morality of doing a procedure such as suturing on people may be questionable, the legality certainly is.

    bloody knifeThe RCVS clearly states vets are not legally allowed to prescribe pharmaceutical products for people, but they have no specific guidelines on wound treatment.

    It could be argued that, ethically, suturing should involve the use of some form of local anaesthetic (either by a local block or a transcutaneous patch) and, therefore, cannot be allowed as this would involve drug administration.

    However, that’s not to say a person can’t consent to old fashioned gritting their teeth and bearing temporary pain for the sake of saving a four-hour wait in A&E.

    Friend or foe?

    For those who could be potentially incriminated if they sought medical help at a hospital, you can sort of understand why they’d ask someone else, like a vet, for stitches. But they aren’t alone…

    A number of vets who become injured either on the job, or elsewhere, will seek the help of their colleagues, rather than take the majority of a day off to wait for the NHS to achieve a vastly similar result. After all, vets are pretty damn good at suturing and would arguably do a better job than the junior doctor on an emergency ward.

    You could discuss the ethics of whether a vet should help someone who needs medical attention in varying situations and whether they are legally allowed to do so. However, charging for the service is an altogether different matter – stitching up a fellow vet, or even a family member, wouldn’t raise the question of fees, but a stranger who walks in off the street?

    Cash in hand

    A BBC article from 3 March (Stab victims ‘paying vets to stitch up their wounds’) reported the “going rate” to be around £200 – does this not infer the image of an underground medical procedure market, whereby vets can earn a bit of extra cash to extend their services to animals of the two-legged kind?

    You have to admit, when you consider the rough cost of a bitch spay at around £150 (weight and complication-dependent), that figure has quite an impressive profit margin. Once a vet charges for the privilege, it becomes a business venture, not just an act of goodwill.

    stitching
    Stab victims are reportedly turning to vets to have their wounds sutured, in an attempt to avoid police involvement. IMAGE: vzmaze / fotolia.

    And yet the NHS is screaming for help in A&E departments. With average waiting times at an extreme high, it’s begging prospective patients to consider whether their ailments are worthy of the emergency room or whether they could be seen elsewhere – the GP, minor injuries, pharmacy… and now the vet?

    By applying skills used on animals every day, would vets not be easing some of the burden on our struggling NHS?

    Risky business

    But what if something went wrong? An infection of a wound, of which the bearer couldn’t explain who sutured it, should surely raise some eyebrows – and, after all, with vets being legally unable to prescribe drugs to people, the injured party could not return to the surgeon responsible and ask for antibiotics.

    This is where the legal grey area becomes pertinent. Where would a vet stand if sued for wound breakdown? Members of the Veterinary Defence Society are supported for claims against their actions involving animals… but humans?

    There are a lot of unanswered questions that, for me, make conducting procedures such as suturing on members of the public too risky.

    Final decision?

    It may be different if it were a colleague or close family member who understands the trust he or she is putting in you to do a “simple” procedure works both ways. However, even then, it’s not without elements of risk.

    On a wider scale, should we, as a profession, be seen to advocate such practice? Or should our representing bodies be defining the limits of our medical interventions and reprimanding those who see the injured public as a business opportunity?

    But then, would we live in even more fear of being prosecuted just for helping a fellow vet who knows full well what he or she is agreeing to?

  • The consequences of making a mistake

    The consequences of making a mistake

    beef-farm-crop-jordan
    Beef farms in Scotland can be quite picturesque.

    Fertility work makes up a large proportion of cattle veterinary work in the UK and, after spending a month on the farm rotation at university, I can appreciate the importance of getting it right – and how hard it can be.

    Experienced large animal vets make it look easy – they scan the uterus and ovaries, and decide what drug to give to aid getting the cow in calf, all in a minute or two.

    In the meantime, I’m still fumbling about trying to palpate what, I think, may be the uterus or ovaries while the cow squeezes and gradually cuts off the circulation in my arm until I can barely feel my fingers.

    Meanwhile, the vet has zipped through several cows already.

    When things go wrong

    cow-injection-lg
    What happens if you misdiagnose a pregnant cow as negative and administer prostaglandin, or give a cow steroids without realising she’s in calf?

    On one fertility visit this week, we discussed when things go wrong. For example, what if:

    • you misdiagnose a pregnant cow as negative and administer prostaglandin (PGF)?
    • a vet gives a cow steroids for any number of reasons without realising she’s in calf?

    The outcomes of both of these scenarios are almost inevitably abortion, which can have a number of repercussions on the farm – and, potentially, the vet.

    Negligence or misconduct?

    Many new graduates are terrified of being called up for “fitness to practice” for making a mistake such as those aforementioned. However, during a Veterinary Defence Society (VDS) workshop at the SPVS Lancaster weekend earlier this year, it was emphasised a difference exists between negligence and misconduct in the eyes of the RCVS.

    What I took away from this session was, in simple terms, negligence involves making a mistake – such as missing a diagnosis, giving the wrong treatment accidentally, eliciting side effects from something due to missing something in the case history – whereas misconduct is actively doing something you know you shouldn’t – such as trying to cover up a mistake, lying or misleading a client.

    Mistakenly giving PGF to a pregnant cow would be classed as negligence and, on the whole, the VDS would have your back; the farmer may receive some compensation for his losses, but the incident wouldn’t tarnish your career. In the same situation, misconduct would be denying you had administered any treatment.

    In short, you won’t get struck off for easily made, one-off mistakes, but you may if you lie about them.

    In the news

    Our conversation about accidentally aborting cows led us to discuss the case of Honey Rose, the optometrist convicted of gross negligence manslaughter. News reports vary, but, from what I can gather, she failed to diagnose papilloedema (swollen optic discs) in an eight-year-old boy, which would have been an indication of the hydrocephalus he died of five months later.

    It is reported she claimed to have been unable to examine his eyes properly because he had photophobia – a claim considered false by the judge. However, she had also failed to look at retinal photos taken by a colleague, on which the papilloedema was evident.

    Going by the RCVS’ rules, missing the diagnosis or not looking at the retinal photos would be negligent. However, denying she’d been able to carry out a thorough examination, despite written records suggesting otherwise, would be misconduct.

    Rose was found guilty of gross negligence manslaughter and was handed a two-year prison sentence, suspended for two years, and a 24-month supervision order, and was ordered to complete 200 hours of unpaid work.

    In your defence

    VDS logoAs vets, we have the VDS to help us in these situations – and, while it would be truly awful to make a mistake resulting in an animal’s death, we would not be at risk of imprisonment.

    Doctors and dentists also have defence societies that will fight their corner, but optometrists? To my knowledge, an equivalent does not exist – and this was the first case of an optometrist convicted of manslaughter in the UK, which added to the complexity of the legal battle.

    The death of a little boy is devastating, but, as medical professionals know, death is a risk with many procedures, no matter how small the risk may be. It’s frightening to think jail could be a consequence for those in the medical profession.

    So, while I gradually lost the sensation in my right arm as I tried to reach an ovary of the 10th cow in a row, I mulled this over and realised I was extremely thankful for the safety net the VDS provides and would not take working with animals for granted.

    After all, if I’d decided to be a doctor instead, I could be rummaging around in another human’s back end rather than a cow’s!

    • For further details of the Veterinary Defence Society and its services, visit www.thevds.co.uk
  • Work hard, play hard

    Work hard, play hard

    At the end of January I travelled down to Nottingham for the third annual Student Equine Veterinary Association (SEVA) symposium.

    Image: Roman Milert / Fotolia.
    Image: Roman Milert / Fotolia.

    The weekend was crammed with lectures, practicals and seminars relevant to horses in particular, for equine enthusiasts from all UK vet schools – and even some from further afield.

    Auspicious start

    Any congregation of vet students is eventful, and the weekend kicked off with us accidentally setting the toaster on fire before making our way to campus for the first set of lectures.

    It’s always interesting to see other vet schools in their settings: the short journey through the Midlands countryside was quite different from our commute in the West End of Glasgow.

    Sarcoid legend

    Big names in the equine vet world were present to deliver talks on a range of subjects from the emergency colic, orthopaedics, the racing vet and reproduction.

    The British weather was against some of the guest speakers and, after battling the snow to make his plane, Prof Derek Knottenbelt arrived a little later than planned to deliver his lecture on oncology – a highly amusing and informative presentation that proved the renowned sarcoid legend was worth the wait.

    Jonathon Pycock, as well as delivering a talk on reproduction, ran a seminar on the Veterinary Defence Society (VDS) and through the medium of hilarious anecdotes, encouraged students to make use of the VDS in the future should they ever get into a sticky legal situation.

    Practicals covered a wide range of subjects, but I had chosen cardiology and farriery.

    Matters of the heart

    The cardiology practical covered auscultation of the normal horse and localisation of a heart murmur in the abnormal horse, followed by ultrasound scanning of the heart; something I’d never done before.

    We were able to use electronic stethoscopes during the session – the difference they made was incredible (shame I haven’t got a spare £400 to upgrade from the manual one). We then had a related seminar on diagnosing and interpreting heart murmurs from auscultation recordings and ultrasound videos, which was very helpful in trying to distinguish heart sounds more clearly.

    cardiology practical
    Veterinary students taking part in the cardiology practical.

    Local Army Farriers ran a session on farriery, allowing us to practice removing a shoe, putting a shoe on and the approach to an abscess in the foot. We later discussed the use of different remedial shoes for various conditions and urged us to communicate effectively with farriers in order to work together to achieve the best solution to problems of the foot.

    Party on

    Saturday evening played host to a black tie ball, with great food and wine and a live string band, before continuing the party with many of the speakers also dancing among the students until the early hours.

    As with all vet events, I had a fantastic time and would urge other students to go to at least one of these symposiums or congress during their time at vet school.

    Even if it’s revision, I find learning something you think you might know reasonably well in a different format will highlight areas you need to work on and help consolidate things better. While the focus is primarily academic, I think these weekends are still always true to the vet school mantra of “work hard, play hard”, and I always have a fab time.