DC reprimands Lincolnshire vet for poor aftercare

The RCVS Disciplinary Committee has issued a reprimand to a Lincolnshire-based veterinary surgeon while finding no misconduct against another in a hearing relating to allowing a dog to remain at practice overnight without adequate monitoring and/or post-operative aftercare.

The hearing for the two respondents – Ms Julia Louise Creese MRCVS and Ms Elizabeth Sing May Law MRCVS – took place between Tuesday 18 June and Wednesday 26 June 2019.

There were three charges against Ms Creese, all pertaining to the period between 1 July 2016 and 8 November 2017. The first charge was that Ms Creese failed to ensure that there were adequate systems and processes in place for out of hours’ care for in-patients.

The second charge against Ms Creese was that she publicised that the practice had “24 hour care provided by our vets at our practice” and/or “Care 24/7 for your pets” on its website, which suggested that staff were present at the practice 24 hours a day when they were not and as such publicity was dishonest and/or misleading.

The third charge against Ms Creese was that she failed to ensure that the owners of Kiwi, a German Shepherd/Wolfhound-cross dog, were informed about arrangements at the practice for out of hours’ care for in-patients.

There was one charge against Ms Law which stated that, having performed surgery to Kiwi on 7 November 2017 to address gastric dilation volvulus (GDV), she failed to obtain informed consent to the entirety of the surgical process and management, to include post-operative aftercare.

The charge also states that she failed to provide adequate analgesia to Kiwi before, during or after the surgery; failed to provide appropriate and adequate fluid therapy to Kiwi; failed to offer an appropriate and adequate post-operative care plan and/or post-operative transfer for Kiwi to another practice; and failed to inform the owners that there would be nobody present at the practice to provide post-operative monitoring and aftercare for Kiwi for approximately seven hours during the night of 7 to 8 November 2017.

Finally the charge states that Ms Law allowed Kiwi to remain at the practice overnight from 12:30am to 07:45am on 8 November 2017 without adequate monitoring or post-operative aftercare.

At the outset of the hearing, Ms Creese denied all the charges against her. Ms Law admitted some of the charges against her, including that she had failed to obtain informed consent; failed to offer an appropriate and/or adequate post-operative care plan; failed to inform the owners that there would be nobody present at the practice; and allowing Kiwi to remain at the practice overnight without adequate monitoring and/or post-operative aftercare. However, she denied that she failed to provide adequate analgesia to Kiwi and that she failed to provide appropriate and/or adequate fluid therapy to Kiwi.

With regards to the charges against Ms Creese, the Committee, after hearing evidence from relevant witnesses, considered that the practice did have in place systems and processes for out-of-hours care for in-patients and that there was no evidence of repeated or ignored failures of these systems and processes. The Committee therefore found the charges against Ms Creese not proved and all three were dismissed.

“The Committee considers that the respondent (Ms Law) has insight into the serious mistake that she made in failing to ensure that Kiwi was checked or monitored overnight. The Committee has found that this was a single isolated incident, which involved a serious lapse of clinical judgement, which will probably stay in the mind of the Respondent for the rest of her career."

The Committee separately considered the charge denied by Ms Law and found all of the charges proved, with the exception of failing to provide adequate analgesia during the perioperative period.

Having considered the facts, the Committee then moved on to consider whether the admitted and proven charges against Ms Law amounted to serious professional misconduct, taking into account any aggravating and mitigating factors. The aggravating features were that, as a result of Ms Law’s failures in relation to analgesia and fluid therapy, there was either actual injury to Kiwi, or a risk of such injury.

In mitigation, the Committee considered that she promptly and accurately diagnosed GDV, and proceeded to perform the necessary emergency surgery. The Committee considered that the charges related to a single isolated incident and that Ms Law has had an unblemished career to date. They also noted that Ms Law had made open and frank admissions as to the majority of the charges.

The Committee found that the conduct of Ms Law set out in the majority of the charges did not amount to serious professional misconduct. However, in the judgement of the Committee, Ms Law’s conduct in allowing Kiwi to remain at the practice overnight without adequate monitoring or post-operative aftercare did amount to serious professional misconduct.

“The Committee considers that this sanction, coupled with the findings of fact and disgraceful conduct made against the respondent, is sufficient to maintain public confidence in the profession and uphold proper standards of conduct. The Committee does not consider it necessary to issue a warning to the respondent about her future conduct, on the basis that the Committee has concluded that there is no risk of repetition.”

In deciding the question of sanction Jane Downes, who chaired the Committee and spoke on its behalf, said: “The Committee considers that the respondent (Ms Law) has insight into the serious mistake that she made in failing to ensure that Kiwi was checked or monitored overnight. The Committee has found that this was a single isolated incident, which involved a serious lapse of clinical judgement, which will probably stay in the mind of the Respondent for the rest of her career.

“The respondent has been in practice for some nine years now, and apart from this incident, there is no suggestion that the respondent has fallen short of the standards expected of her on any other occasion. The Committee does not consider that there is a risk that the respondent is likely to leave an animal overnight after major surgery again, without ensuring that it is checked during that time, and, as such, the Committee considers that there is no future risk to the welfare of animals so far as the respondent is concerned.”

The Committee considered that the finding of disgraceful conduct in a professional respect in this case is too serious for no further action to be taken, having regard to the need to maintain public confidence in the profession and declare and uphold proper standards of conduct.

The Committee concluded that the appropriate sanction in this case was to issue a reprimand to Ms Law, in relation to the finding of serious professional misconduct.

“The Committee considers that this sanction, coupled with the findings of fact and disgraceful conduct made against the respondent, is sufficient to maintain public confidence in the profession and uphold proper standards of conduct. The Committee does not consider it necessary to issue a warning to the respondent about her future conduct, on the basis that the Committee has concluded that there is no risk of repetition,” added Jane Downes.