Case study on incitement to unprofessional conduct
Published in the December 2016 issue of Vetboard Victoria's newsletter
The following case study provides an opportunity for general reflection. The case study is based on a complaint about an individual set of circumstances at a particular time. As veterinary knowledge and professional and community standards and expectations change over time, readers should not assume that the Vet Board would make the same decision when presented with a similar complaint.
Dr A was employed as a veterinary practitioner in a veterinary clinic. During the period of employment, the clinic was acquired by a body corporate. Following the acquisition of the clinic by this corporation, employees were directed to refer all emergency or after-hours cases to a specific veterinary emergency facility, except in circumstances where the welfare of the animal was in immediate danger. Previous to the acquisition of the clinic by the corporation, the clinic used the services of other local emergency clinics on a case by case basis.
Dr A alleged that the directive issued by the corporation to only refer patients to a specific veterinary emergency facility was based solely upon the financial interest of the company, and failed to consider either the professional judgement of the treating veterinary practitioner and/or the best interest of the patient and/or client. Dr A further claimed that the directive constituted an offence under section 58A of the Veterinary Practice Act 1997, in that it is a direction or incitement to a veterinary practitioner to do a thing in the course of veterinary practice that could constitute unprofessional conduct.
Dr B was at the time of the incident the general manager of the body corporate. The initial directive to only refer patients to a specific emergency centre was issued by the corporation’s operations manager. The email to employees’ states, 'It is my expectation that we will now use XXX for our emergency care needs – unless the safety of the pet requires the pet to be treated at the closest emergency centre to your clinic. In the event that it is necessary to refer a pet to another emergency care provider I will require a report from the attending vet as to why it was not feasible to refer the pet to XXX.'
This email was followed by a warning letter to Dr A from the operations manager, in which they advised that if Dr A failed to immediately comply with the reasonable policies and directions of the company, his/her employment may be terminated. The letter stated that Dr A must 'ensure that you adhere to the policy of referring pets that require emergency care to XXX, except in those circumstances where the welfare of the pet is in immediate danger.'
Dr B did not become involved in the matter until later, when they met with Dr A to discuss a performance management meeting Dr A had with the operations manager. Given Dr B’s limited involvement in this matter the Panel considered there was insufficient evidence to support the allegation that they directed or incited Dr A to undertake an action which could constitute unprofessional conduct.
Guideline 19.1.1 issued by the Board states that 'Veterinary practitioners are responsible for their own actions and judgements. Allowing professional judgement, integrity, discretion, conduct, or ethical standards to be compromised by any other person in any matter regarding the application of professional knowledge or skill is not a defence against allegations of unprofessional conduct.' [VPRBV NOTE: the context section of current Guideline 22 contains similar wording.]
The Board panel noted that it is not unusual for veterinary businesses to have preferred relationships with providers of veterinary services, such as veterinary pathology providers, drug suppliers, or specialist practitioners. However, it was the panel's expectation that clinical decisions must be based upon the professional judgement of the treating veterinary practitioner, and made in the best interest of the animal and/or client. Any clinic policy or preferred relationship must be framed so as to allow a veterinary practitioner a degree of discretion in making a professional recommendation for the veterinary care of their patients, and must not compromise the welfare of the animal.
While the corporation's referral policy allowed some degree of practitioner discretion, in that patients could be referred elsewhere 'in those circumstances where the welfare of the pet is in immediate danger', and/or '…the safety of the pet requires the pet to be treated at the closest emergency centre to your clinic”, the panel noted that practitioner discretion was limited to situations where the immediate welfare of the animal was at risk. The panel considered that there may be situations where, although the immediate welfare of the animal is not at risk, the professional judgement of the treating practitioner may be that it is in the animal’s and/or client’s best interest to be referred elsewhere, due to such factors as proximity, facilities, staffing levels, specialist knowledge, payment protocols, etc. The panel was of the opinion that in such circumstances the judgement of the treating practitioner was a relevant consideration in recommending options for referral.
Relevant guidelines