Gordon Hockey was head of the RCVS professional conduct department before being appointed Head of Legal Services/Registrar. He describes the RCVS disciplinary process from complaint to resolution, while pointing out that complaints about vets are few and far between
Statistics from Altmetric.com
Complaints against vets – facts and figures
In 2011, 17,837 vets were practising in the UK; 747 complaints were received by the RCVS, which held 12 Disciplinary Committee (DC) hearings.
Misconduct has to be serious for a complaint to progress to DC.
Ordinarily, negligence is not within the RCVS's jurisdiction, although if it is serious, or repeated, it may, in appropriate cases, be considered under the Performance Protocol.
Last year, complaints that did not potentially involve an issue of serious professional misconduct took 2.8 weeks on average to close.
At present, the College prosecutes complaints and the DC hears them. Under new legal arrangements presently being sought, the DC will be separated from the College.
IF you are presently the subject of a complaint it is probably cold comfort to hear that last year the RCVS received complaints about fewer than 5 per cent of veterinary surgeons – 747 complaints compared with 17,837 UK practising vets. It might be more reassuring to know that, during the same period, the number of Disciplinary Committee (DC) hearings held was 12 (including three applications for restoration to the Register). These figures have remained broadly constant over time and mean that the vast majority of veterinary surgeons will never be the subject of a DC hearing. However, it is likely that during the entirety of any given veterinary surgeon's career the RCVS is likely to receive a very few complaints about that vet, and each one is handled through our complaints process. So it's worth knowing how this process works – and what you will need to do if you are complained about.
We hear complaints according to the Veterinary Surgeons Act 1966, which means that we must consider whether they involve serious professional misconduct. We can also now, under separate procedures, hear similar complaints about registered veterinary nurses (RVNs). Under the Act, it is the Disciplinary Committee that adjudicates in complaints involving professional misconduct so serious that a sanction may be required to protect animals and the public and uphold public confidence in the veterinary profession. Although the best known sanction available to the DC is to remove a vet from the Register (‘striking off’), it can also suspend a veterinary surgeon's name for a period of time, after which that vet is automatically restored, or reprimand a veterinary surgeon, depending on the particular factors of the case.
The line between professional misconduct and negligence is not always a clear one, but, in general terms, a single mistake, even one that means the death of a much-loved pet, or financially valuable animal, is not usually a matter for the DC. Similarly, the ‘Code of Professional Conduct’ and its supporting guidance offer a benchmark, not a rule book, and a single breach of the code, unless extremely serious, is unlikely to result in a DC hearing.
Gordon Hockey is speaking at the BVA Careers Fair on the subject, ‘Help! I've had an official complaint’, on Thursday, November 15 as part of the London Vet Show. Entrance is exclusive to BVA members
The Disciplinary Committee
The composition of the DC is set by the Act and, at present, comprises veterinary surgeons who also sit on the RCVS Council. This is not ideal, and a challenge was made in 2011 to the Privy Council on the grounds of independence and impartiality in relation to a disciplinary hearing. Their Lordships recognised that the College's regulatory framework was constrained by the existing Veterinary Surgeons Act and ‘support[ed] statutory reform so as to enable members of the disciplinary committees to be chosen from outside the council’; but were satisfied that the College had made ‘strenuous attempts’ to ensure its disciplinary procedures were fair and in accordance with human rights legislation. We are working to achieve the legislative change needed to fully separate the role of the College from that of the DC, which will allow complaints to be heard more quickly (see RCVS News, June 2012, p 2).
Each complaint we receive is processed through a series of stages (see box, right). These stages act as filters, removing complaints that do not involve issues of serious professional misconduct, and making sure only those that are arguable go on to be heard by the DC. If we contact you, it means we will either be assessing whether there is any issue that could be considered serious professional misconduct, or we will have identified such an issue and are investigating further to decide if there could be an arguable case at a DC hearing. Our letter will tell you at which of these stages the complaint is. In either case, if you are a member of the Veterinary Defence Society (VDS), you should contact it, or your alternative professional indemnity insurance provider. If you have questions or are unsure about the complaints process, please also get in touch with our Professional Conduct Department; although they cannot give advice at this point, they can answer practical questions about what you need to do.
If you do receive a letter from us, it sounds obvious, but please do open it. We have had cases where our letter has been received and not opened, which is not in anyone's interest. The letter will usually ask you to reply within 14 days. Meeting our timetable helps make sure that cases that do not raise issues of serious professional misconduct can be closed quickly – on average in less than three weeks – and means that complaints that do go further can progress faster. However, if you need more time to assemble the facts – for example, you want to check with a colleague who is away – then please ask.
Your reply is an opportunity for you to give us the facts that we need to consider the complaint fairly (for example, clinical records) as it is important that we hear all sides to the story. So you might want to consider whether there is someone at the practice who can also help provide facts, for example, a veterinary nurse, another veterinary surgeon, or the practice manager. You can ask them to write to us to give their account of events, or at least tell us their name. We are also likely to contact your employer as part of the fact-finding process.
Your response will normally be shown to the client, and it is best to set out the facts as objectively as you can and avoid any criticism of the client. It may also be helpful to show a colleague the response before you send it, or to sleep on it, particularly if you feel rattled by the complaint. Similarly, if you want to add information, for example, to clinical records, don't amend the record itself as this risks confusion and could be mis-interpreted as an attempt to alter the records dishonestly. Instead, set this information out on a clearly separate appendix or in a letter to us, or if appropriate as an addition to the clinical records with the date that this additional information was added.
Usually, it is best to disclose responses to the client otherwise the non-disclosure can make the client suspicious that the vet wants to hide a crucial piece of information. If clinical information is not disclosed during the complaint process, it can often be obtained subsequently after the complaint is closed if the client makes a subject access request to the RCVS. Sometimes we receive letters sent by vets ‘in confidence,’ and there can be some information, for example, health problems which you have disclosed, that it is appropriate for us to keep confidential if you ask us to.
What happens in the RCVS disciplinary process?
Complaint form received and checked. Complaints may come from owners, but may also come from other veterinary surgeons or members of a practice team.
The complaint is assessed to see if serious professional misconduct may be involved. This involves legally qualified staff, with support from veterinary surgeons. The vet complained about may be contacted. The complaint may be closed, or it may continue.
The complaint is investigated and evaluated to see if a case could be arguable. This stage is directed by the Preliminary Investigation Committee (PIC), and includes veterinary surgeons. The vet complained about will be contacted, and their employer is likely to be. The complaint may be closed, and advice can be given to the vet, or it may progress to the PIC.
The PIC decides whether a case is arguable. The complaint may then be closed, and advice can given to the vet, or it may be sent to the Disciplinary Committee (DC) for a hearing.
DC hearing is held in public. The Committee must find the facts of the case, decide whether these amount to serious professional misconduct, and consider aggravating and mitigating factors.
If the DC finds misconduct to be sufficiently serious, it can order a veterinary surgeon be reprimanded, suspended from the Register, or struck off. It can also dismiss cases against veterinary surgeons.
Following the RCVS Health Protocol introduced in 2010, we have also introduced a Performance Protocol to cover clinical competence (see RCVS News, March 2012). These protocols mean we do not have to send all serious complaints to the DC if there is no public interest in doing so. They mean we can try to ensure that medical problems have a medical answer and those with performance issues (that could result in removal from the Register) can seek help rather than be referred to the DC in appropriate cases. Similarly, although we receive very few complaints about elderly practitioners, it may be that voluntary removal and retirement is an option in some cases. Talk to us and to the VDS if there is a complaint against you and you think any of these may apply.
Although nobody likes being complained about, it is likely that this will happen to you at least once during your working life so try to stay calm, even if you feel the complaint is unfair. How you respond to the complaint can have a bearing both on how quickly it is resolved and sometimes the outcome. Your professional indemnity insurers are there to help, so make sure that you get their advice. We are interested in hearing all the facts, from all involved: DC hearings are only for cases when the professional misconduct involved is serious (or there is another issue covered by the Veterinary Surgeons Act, such as fraudulent registration or a criminal conviction that affects fitness to practise).
The purpose of the complaint process, including sanctions, is to protect animals and the public, and to maintain confidence in the profession, so complaints that do not involve serious professional misconduct will be closed, sometimes with advice to the practitioner. Even if you have done something wrong, try to remember that very few complaints reach a DC hearing, even fewer vets are found not fit to practise, and, consequently, very few vets are removed from the Register.
In an ideal world there would be no complaints; in reality many can be avoided by maintaining standards and communicating well with clients, learning from Preliminary Investigation Committee reports and DC reports of real cases (published in RCVS News), and making sure you know what is in the Code of Professional Conduct.
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