Vet Legislation Reform: 4. Fitness to Practise

RE: Vet Legislation Reform: 4. Fitness to Practise

Alison Clare Hickman — Wed, 17 Feb 2021 20:36:21 GMT

Yep Sal the 1st it's a real crock... that's why I detailed it!

So needs must be shouted about back to RCVS. NO!

RE: Vet Legislation Reform: 4. Fitness to Practise

Sal the 1st — Wed, 17 Feb 2021 19:24:08 GMT

[quote userid="6058" url="~/001/nonclinical/f/life-in-veterinary-practice/32147/vet-legislation-reform-4-fitness-to-practise/176850#176850"]At least, as far as I understand it. Also it safely removes a body from practicing medicine until the case has been adjudged, to protect the 'public' (animals/clients), which under BRD does not happen you can still practice. (Again, as far as I understand it)[/quote]

so not only would a person under investigation have that hanging over them for Gawd Knows how long now they cannot earn a living either - yep can see how that would work, people and practices ruined even if at a later date they are found to be innocent of alleged 'crimes'

RE: Vet Legislation Reform: 4. Fitness to Practise

Alison Clare Hickman — Wed, 17 Feb 2021 11:12:37 GMT

[quote userid="2100" url="~/001/nonclinical/f/life-in-veterinary-practice/32147/vet-legislation-reform-4-fitness-to-practise/176849#176849"]I am not sure where you got this from[/quote]

Been reading too much internet bumpf! So ignore me...

But - as I've l latterly admitted - I just wanted to bring the matter to attention. Have we? (thank you)

RE: Vet Legislation Reform: 4. Fitness to Practise

Alison Clare Hickman — Wed, 17 Feb 2021 11:04:41 GMT

[quote userid="2240" url="~/001/nonclinical/f/life-in-veterinary-practice/32147/vet-legislation-reform-4-fitness-to-practise/176848#176848"]So are we saying for a much lower standard of proof somebody should potentially lose their livelihood[/quote]

Yes, BOP has a lower bar for standard of 'proof', as it relies on 'probabilities' rather than actuals. However what it does do, which BRD does not, is give stages of restoration, rehabilitation, and repair in the event of (non-gross misconduct) 'findings'. At least, as far as I understand it. Also it safely removes a body from practicing medicine until the case has been adjudged, to protect the 'public' (animals/clients), which under BRD does not happen you can still practice. (Again, as far as I understand it).

Clearly in human medicine terms being suspended from practise is usually on full pay - in veterinary terms, probably not. That's the hardship. Therein lies the inherent unfairness.

I do not know why the nurse in the citation you provided was dismissed. In the case of evident gross misconduct neither BRD nor BOP would have saved her, for example...

On reason I bring this particular snippet out of the whole Legislative Reform Consultation to light and discussion is because it is actually an important part of the decision. It needs NOT to be slipped in under the radar. IF you feel strongly that your role should be continued to be better protected in the event of a disaster strike (and let's face it, it can happen) then say something to the RCVS about darned well KEEPING **BEYOND REASONABLE DOUBT**.

There we have it. Have I been playing Devils Advocate? I might have been...

RE: Vet Legislation Reform: 4. Fitness to Practise

Arlo Guthrie — Wed, 17 Feb 2021 09:07:42 GMT

[quote userid="6058" url="~/001/nonclinical/f/life-in-veterinary-practice/32147/vet-legislation-reform-4-fitness-to-practise/176847#176847"]Comparison of 'worth of entity life' (animal/human)[/quote]

Not really. I'm not comparing the worth of a human vs an animal life, but the degree of suffering caused by a failure of care, and therefore the proportionate response. My own daughter has a severely compromised cognitive function, and I sometimes reflect on how that reduces her suffering. She has little concept of time or of her situation (beyond 'I wish the funny turns would go away'). How much worse it would be if she understood how limited her life and future will be, and that she will have to live with her illness for perhaps decades.

A step down the cognitive ladder is a dog, or a horse, or a cat. They have even less ability to rationalise (none, to speak of), so I would argue that their ability to suffer is very much reduced, except in the case of pain, which I suspect we all feel fairly similarly (though humans can suffer in the knowledge that the pain is likely to continue for a time).

Do I personally elevate one life form over another? To a degree, yes. I would be upset if someone considered my life less important than that of an ant!

[quote userid="6058" url="~/001/nonclinical/f/life-in-veterinary-practice/32147/vet-legislation-reform-4-fitness-to-practise/176847#176847"]Whichever 'tool/standard' is used the issue of job protection is not one I am primarily concerned about.[/quote]

It's not the 'job protection' I am highlighting. It is the relative suffering. Should a perhaps innocent person have their lifetime career destroyed, with all the suffering that causes, over an animal?

[quote userid="6058" url="~/001/nonclinical/f/life-in-veterinary-practice/32147/vet-legislation-reform-4-fitness-to-practise/176847#176847"]

However, importantly, I've not said 'punishment of' as I trust BOP uses *development and coaching* even with a *found* decision; this as steps to rehabilitation. No career loss in the bigger picture.

Whereas, historically, BRD always uses punitive measures. Career loss in the bigger picture.

[/quote]

I am not sure where you got this from. The standard of proof is something completely separate to the punishment / censure etc. ie BOP does not use coaching vs BRD uses a jail sentence! BOP and BRD are just standards by which you decide whether someone is guilty. Then, regardless of what standard was used, you move on and decide the penalty, whether punitive or rehabilitative.

So again, my point is that given the low (almost non-existent) risk to the public from veterinary staff, and given that veterinary staff treat animals with a lesser capacity to suffer than humans, we should demand a high standard of evidence before potentially destroying a human life. If that makes sense!

I repeat that does not mean that veterinary professionals should not be held to account for failures of care, just that the evidence should be of a high standard.

RE: Vet Legislation Reform: 4. Fitness to Practise

Sal the 1st — Wed, 17 Feb 2021 08:44:59 GMT

wasnt really sure where to put this? - so if you think it needs moved or removed Arlo please feel free

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1119519/#:~:text=Two%20doctors%20at%20Queen's%20Medical,correct%20route%E2%80%94into%20a%20vein.

I couldn't find the specific article on the case I wanted but had an urgent interest in this at the time as I was undergoing chemo myself. My point of posting this? - the two Drs involved were suspended and are both now back in practice. The nurse involved took the bullet and her career was finished. This is the NHS - can we expect it to be any different for RCVS

my point in posting? the evidence in this case was incontravertible, The patient in the case I am thinking of died, the active participants get off with a suspension whilst the nurse become collateral damage and is expendable

So are we saying for a much lower standard of proof somebody should potentially lose their livelihood

RE: Vet Legislation Reform: 4. Fitness to Practise

Alison Clare Hickman — Wed, 17 Feb 2021 05:52:21 GMT

Okay. So my reply to your second point...

1. Comparison of 'worth of entity life' (animal/human)

2. Comparison of 'protection' (BRD/BOP)

1. When it comes down to it, I do not favour any life form over any life form. Truly. All are equal and some NOT more than others (to misquote one Mr Orwell and in step with Sir David A). So there you have it. Which segues into 2.

2. Whichever 'tool/standard' is used the issue of job protection is not one I am primarily concerned about. It is the matter of animal welfare, and what is right, for the animal, then (as required) consider the ongoing professional development of the vet or nurse, then restoration for the client etc.

However, importantly, I've not said 'punishment of' as I trust BOP uses *development and coaching* even with a *found* decision; this as steps to rehabilitation. No career loss in the bigger picture.

Whereas, historically, BRD always uses punitive measures. Career loss in the bigger picture.

What do you think?

RE: Vet Legislation Reform: 4. Fitness to Practise

Alison Clare Hickman — Wed, 17 Feb 2021 02:56:50 GMT

Still working on my thoughts about your other point..

RE: Vet Legislation Reform: 4. Fitness to Practise

Alison Clare Hickman — Wed, 17 Feb 2021 02:50:58 GMT

Tool and standard are connected. They are the means to a desired end. Something utilised to get a result or a measurement. Example: the standard is to wear a seat belt whilst driving. This is a tool to encourage driver safety compliance.

So in your words, both 'standards' (BRD and BOP) measure the case set before them and in my words they are the 'tools' used to measure them. Does that explain my use of English better?

RE: Vet Legislation Reform: 4. Fitness to Practise

Arlo Guthrie — Tue, 16 Feb 2021 23:18:45 GMT

Alison Clare Hickman I’m slightly confused by your description of ‘Beyond Reasonable Doubt’ and ‘Balance of Probability’ as ‘tools’. I think it might be more accurate to call them ‘standards’, with BRD being the higher standard. I am putting forward the argument that if you are going to ruin someone’s life over an animal, better make sure you prove it to the highest standard.

[quote userid="6058" url="~/001/nonclinical/f/life-in-veterinary-practice/32147/vet-legislation-reform-4-fitness-to-practise/176840#176840"]Cheers Arlo Guthrie I'm enjoying the debate. [/quote]

Me too

RE: Vet Legislation Reform: 4. Fitness to Practise

Alison Clare Hickman — Tue, 16 Feb 2021 18:01:15 GMT

[quote userid="2100" url="~/001/nonclinical/f/life-in-veterinary-practice/32147/vet-legislation-reform-4-fitness-to-practise/176836#176836"]he RCVS quotes other regulatory bodies as saying that the lower standard of proof is necessary because of a risk to the public[/quote]

Quite - Vets and Vet Nurses are not a risk to the public in the same way (if at all in any way) that human doctors and nurses are... so I do agree if that is the sole reason for the change, then it fails. No go from me.

[quote userid="2100" url="~/001/nonclinical/f/life-in-veterinary-practice/32147/vet-legislation-reform-4-fitness-to-practise/176836#176836"]Secondly, I am very conscious of the suffering caused by a disciplinary hearing. In some cases you might say it is deserved, and in others, not. I think the loss of your career is a huge penalty. HUGE. Life destroying. Now it is one thing destroying someone's life because they failed in their care of a human, but quite another if they failed in their care of a dog. [/quote]

Agree 100% losing your job is life destroying. Personal experience of that but this should not detract from the decision of switching from BRD to BOP case handling in my opinion. I still believe correctly and fairly handled BOP is an excellent tool. Although of course, the use of a tool is much affected by the user skill... So, I am going to ask WHO is it (I'm confused now!) that is proposed to sit for BOP case handling? This will sway my final opinion. Thanks.

Cheers Arlo Guthrie I'm enjoying the debate.

RE: Vet Legislation Reform: 4. Fitness to Practise

Arlo Guthrie — Tue, 16 Feb 2021 14:46:50 GMT

[quote userid="6058" url="~/001/nonclinical/f/life-in-veterinary-practice/32147/vet-legislation-reform-4-fitness-to-practise/176835#176835"]So the argument you propose to keep BRD for vets and nurses is for greater job protection? [/quote]

No, that's a misrepresentation!

The RCVS quotes other regulatory bodies as saying that the lower standard of proof is necessary because of a risk to the public. So the first question is whether vets and nurses pose a similar risk, to which the answer is of course not.

Secondly, I am very conscious of the suffering caused by a disciplinary hearing. In some cases you might say it is deserved, and in others, not. I think the loss of your career is a huge penalty. HUGE. Life destroying. Now it is one thing destroying someone's life because they failed in their care of a human, but quite another if they failed in their care of a dog.

So by that logic it could be argued that there should be a greater burden of proof if you are going to kill a person's career, for a dog.

Not saying they should escape punishment, or that the punishment should not be severe, both to protect the reputation of the profession and to protect animal welfare, just that one should be very, very, very sure of guilt, and therefore require the higher standard of proof.

RE: Vet Legislation Reform: 4. Fitness to Practise

Alison Clare Hickman — Tue, 16 Feb 2021 11:58:40 GMT

So the argument you propose to keep BRD for vets and nurses is for greater job protection? I do not like that if that is the sole reason. I am probably wrong and simple but I thought that proving 51% minimum of wrong was sufficiently strict to clear the decks of mis-applied accusation and for job protection that is surely sufficient. Though I do take on board it depends WHO is making those decisions. I needs must have a good think about this further.

RE: Vet Legislation Reform: 4. Fitness to Practise

Arlo Guthrie — Tue, 16 Feb 2021 09:24:55 GMT

Alison Clare Hickman - you said you think the proposed change to a criminal standard of proof is a good thing, because:

The standard of proof in a civil case is lower, yes, with the burden of proof on the claimant. They must claim their case is true and that *on the evidence the occurrence of an event was more likely than not*

There is a very small difference between succeeding and failing on the balance of probabilities for the claimant. If the evidence is such that the claimant can say "we think it more probable than not" the case succeeds but if equal, the case fails. It needs *clear evidence* of 51% or greater to succeed.

This is my understanding of Balance of Probabilities and what I've made my judgement call on. I think it is excellent. I think it is very workable in civil cases and more so than the Beyond Reasonable Doubt, which is an extremely high standard of proof which should, in my opinion at least, be kept aside for criminal cases. Cases which end in a lengthy prison sentence. That is not the intended result in this situation.

Does this help explain my thinking? Have I over simplified it? Happy to discuss it more and be persuaded against it if I am barking like a rabid hound up the wrong tree!!

Forgive me but I think you might barking like a rabid hound

In disciplinary cases, the prosecution, or the 'claimant' is the RCVS, and we are discussing the quality of the evidence that the RCVS needs in order to secure a conviction against a vet or veterinary nurse.

There are two standards in use.

Criminal (as now used by the RCVS) demands that the prosecution proves the case 'beyond reasonable doubt'.

Civil (as proposed for the future) demands that the prosecution proves the case only 'on balance of probabilities'

In other words, it will be easier to find a vet or nurse guilty than it was before, because you no longer have to be beyond any kind of doubt that they did wrong, only that it is likley that they did wrong.

The question I would put to you is whether you think it is right that a vet or nurse should face the loss of their entire career because it was felt 'more likely than not' that they failed to care for a dog. Or, given the suffering caused by the loss of a career, the standard of evidence should be as high as it can be.

The College makes the case that other regulators use the criminal standard of proof because it is not right that medical professionals can still represent a risk to the public because the powers that be were unable to prove the case to the higher standard.

Thing is ... vets and nurses don't represent a risk to the public because a) their patients are not 'the public' and b) there aren't the same opportunities (if you can call it that) for a 'groper'.

So the question is whether the lower standard of proof is necessary or appropriate in the veterinary profession.