5. Veterinary services

guiding principle veterinarians must deliver evidence based veterinary services of a high standard, appropriate to meet the needs of their clients and the welfare health care needs of the animals under their care, and ensure their clients’ animals have access to emergency care understanding the guiding principle veterinarians are expected to display high standards of expertise and performance in the course of their professional activities veterinary procedures and recommendations should be based on sound evidence based science and practice facilities and equipment must be of a reasonable standard and appropriate for the veterinarian's type of practice staff must have the relevant training to facilitate the delivery of the appropriate veterinary services for the type of practice section 5 1 veterinarians must keep their skills and knowledge up to date by taking part in relevant continuing professional development activities that maintain and develop their competence and performance understanding section 5 1 the vet council's principal purpose is to protect the public interest by ensuring that veterinarians are competent and fit to practise – not just at the time of initial registration, but on an ongoing basis the public has the right to expect that veterinary services are provided in a competent and contemporary manner and that veterinarians will maintain and enhance their professional skills and knowledge clinical standards change over time methods of treatment which may be considered acceptable at one time may not be considered acceptable at a later date clients have the right to expect that veterinarians will keep their knowledge in their field of practice up to date veterinarians must comply with the vet council's requirements for continuing professional development section 5 2 veterinarians must recognise when either their competence or the resources available to them place limits on their ability to perform to an acceptable standard all reasonable steps must be taken to avoid exceeding those limits understanding section 5 2 veterinarians must comply with the vet council's prescribed minimum practising standards which include recency of practice and competence requirements the vet council considers that a competent veterinarian is one who applies knowledge, skills, attitudes, communication and judgement to the delivery of appropriate veterinary services in accordance with their field of veterinary practice veterinarians should be familiar with and comply with the vet council's competency standards and performance indicators for veterinarians docid\ anejoinyjlrzbvheo2tc7 veterinarians should be familiar with and comply with the vet council's recency of practice requirements these state that 'for any person who has not worked as a veterinarian for three consecutive years, or has not worked as a veterinarian for three consecutive years in the area in which they intend to practise', the vet council may examine the person and may if it is necessary place conditions on the person's practising certificate section 5 3 all veterinarians must take reasonable care to ensure that the practice that they are working in is operated to the standard expected in this code understanding section 5 3 the vet councl has a statutory responsibility to ensure that veterinarians are competent to practise under the veterinarians act 2005 , the vet council's functions include the promotion and encouragement of high standards of conduct among veterinarians, and the prescribing of minimum practising standards all veterinarians have a responsibility to maintain ethical, professional and technical standards the vet council does not have jurisdiction over persons who are not veterinarians, which may include the owners of some veterinary practices irrespective of the ownership structure the veterinarians working in the practice are considered to be responsible for ensuring standards are maintained the practice resources must be sufficiently managed in order to meet the minimum standards expected resources include but are not limited to staff, equipment, facility and inventory veterinarians are considered to be responsible for the conduct of their employees, and must take steps to ensure that they work within the standards expected for example ensuring that controlled drugs are managed according to the provisions of paragraph 12 of the 6 veterinary medicines docid\ uuchsu 9cxggi8oounag section of this code veterinarians who believe that premises, equipment or other resources/systems in a practice are below the standard expected should raise those concerns with the practice owners or principals where such concerns are not appropriately resolved they should be brought to the attention of the vet council as well as the expectations set out in this code and explanatory notes, the vet council publishes additional statements and guidance on particular issues refer to statements docid\ r7trhlqi9xl lpddgrhwm and guidance docid\ tbt3b2qry 0m12cqyn8th section 5 4 veterinarians must maintain clear and accurate clinical records the records must be of such detail that another veterinarian could take over the management of the case at any time be retained for periods of time as required by statute or for the duration of time for which they remain relevant to the purpose for which they were recorded not be altered retrospectively unless the changes are marked chronologically on the record, and the additions are dated and noted as being added retrospectively; and be made accessible to clients on request, unless there are justifiable legal reasons to withhold understanding section 5 4 veterinary medical records document the veterinary services provided to clients over time and chronicle the various treatments given to animal patients these records are an integral part of veterinary care and are a legal requirement in order to record the use of restricted veterinary medicines medical records include radiographs or other imaging records, laboratory results, in patient treatment summaries, consent forms and any other ancillary records relevant to the case history veterinary medical records are owned by the practice owner and must be retained as required to comply with legal requirements a number of government bodies (eg ird) may set statutory requirements for how long practice records are kept the limitation act 2010 sets a primary period of six years for claims of contract or tort there is no time limit for complaints to be brought against veterinarians for disciplinary reasons, and pre emptive destruction of records in the face or a forthcoming complaint would be considered unethical in general terms veterinarians are advised to keep patient medical records as long as the information has use or relevance, and in order to comply with statutory expectations on that basis and more specifically, veterinarians should keep patient medical records while the client's animal is still alive and still a patient of the practice, from the date of the first consultation onwards, and for a period of seven years after the date of the last consultation any recommendation in this code on the length of time to retain patient records is subject to any other statutory requirements and it may be prudent for veterinarians to keep records longer if they are known to have continued relevance beyond the recommended period veterinarians have an obligation to maintain medical records which contain enough information to allow another veterinarian to easily take over the case the medical history should be able to be organised and retrieved efficiently, and documented in a legible form the medical record facilitates communication between veterinarians providing treatment records should contain relevant clinical history and findings, decisions made, treatments provided and information provided to clients the record should document relevant communication between veterinarian and client that directly relates to the patient medical records should be created at the time of the events being recorded or shortly after any additions or deletions made at a later time must be done so with clear reference to the date/time that these changes were made this is so that there can be no allegation that the alterations have been made in an attempt to deceive medical records are legal documents and as such must provide a valid and contemporaneous record of the patient's treatment where current veterinary medical records exist but the veterinarian who owns them is no longer practising, those records should be made available where possible to the owners of the animals the expectation is not that the records will be kept and maintained, but that the owners are given the opportunity to uplift the record if they choose to release of records the information contained within the medical record is considered confidential and must not be released unless by the consent of the owner of the animal, or if there is a legal reason to do so (see the privacy commissioner's guidance ) in the interests of openness and transparency and in order to comply with the privacy act 2020 , veterinarians must provide clients access to their animal's records on request, unless there are justifiable legal reasons not to where the practice incurs costs to duplicate records, those reasonable costs can be passed on to the client in order for them to obtain their copies privacy principle 6 of the privacy act 2020 details the rights of persons to enquire whether an organisation holds personal information about themselves, and to request access to that personal information personal information is defined as information about a living human being that is capable of being identified to the individual concerned where an animal is owned by an identifiable individual person, records pertaining to the veterinary treatment of that animal by a veterinary practice have been considered, by the privacy commission, to constitute personal information about that individual veterinarians are obliged under the privacy act 2020 to provide access to the veterinary records of an animal when requested by the animal's owner, unless one of the grounds provided under the act for withholding information applies context is important, and the provisions of the privacy act 2020 may not apply where the animal is owned by a trust or limited liability company access can be provided through a copy of the records or through viewing the records or providing a summary of the information if that is acceptable to the client the privacy act 2020 sets out timelines for agencies to respond to requests for access to personal information the act specifies that an agency has twenty working days to make a decision to provide access to the information most agencies attempt to provide a decision with any information sought within the twenty working days in the interests of facilitating client’s requests, veterinarians should view these time frames as outside limits and not as guidelines on how to respond veterinarians are advised to provide the requested records as soon as is practical where veterinarians are unsure about their legal obligations they should seek advice from the vet council, nzva, the privacy commissioner's office or their lawyer the requirements around records exist regardless of the form in which they are kept records are often made and held in electronic form, and existing paper records converted to electronic media provided the electronic record captures what was in the original paper version, is readable and complies with the requirements of the electronic transactions act there is no need to retain the original section 5 5 veterinarians employed by government or involved in industry, education or research must ensure that employer requirements and contractual obligations do not compromise or override professional standards inform clinical practitioners before providing services affecting their clients this includes public presentations, trial work and investigating aspects relating to products ensure all professional and regulatory requirements are satisfied when undertaking trial, research or investigatory work for an employer understanding section 5 5 the obligations identified in this code apply to veterinarians employed by government and in industry and education institutions section 5 6 in considering the use of alternative or complementary methods of diagnosis or treatment the welfare of the animal is paramount where a veterinarian chooses to use alternative or complementary methods of diagnosis or treatment the client must be able to make an informed decision about whether to proceed therefore the veterinarian making this choice must inform the client of the nature of the alternative treatment offered; and the extent to which it is consistent with conventional medicine understanding section 5 6 complementary and alternative medicine has been defined as a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period complementary and alternative therapies do not usually have the weight of scientific proof of their efficacy and therefore the use of these products and/or services is outside the mainstream of conventional therapy where a client is making a choice between conventional treatment and alternative or complementary therapies, the veterinarian should present the client with the information that a reasonable client, in that client's circumstances, would expect to receive about the treatment the veterinarian is recommending this information includes an explanation of the options available including an assessment of the expected risks, side effects, benefits and cost of each option this allows clients to make an informed choice section 5 7 veterinarians in clinical practice must make an emergency service available at all times this service is required so that their clients’ animals can receive essential veterinary treatment in order to relieve unreasonable or unnecessary pain or distress the emergency service must be sufficiently resourced, so that except in extraordinary circumstances all veterinary emergencies involving clients' animals are attended in reasonable time to ensure the welfare of the animals a decision of what is a reasonable time will take into account the type of practice and the locality those veterinarians on duty and directly responsible for providing the emergency service can refer callers who are not clients to the emergency service provided by the caller's own veterinarian however, if that alternative service is not available and if the veterinarian has the necessary skills and resources required for the particular emergency, the veterinarian must attend the emergency and provide essential treatment understanding section 5 7 veterinarians are the health care professionals for animals the animal welfare act 1999 places legal obligations on the owners and persons in charge of animals requiring them to ensure that ill or injured animals receive, where practicable, treatment that alleviates any unreasonable or unnecessary pain or distress in order that owners and persons in charge can reasonably meet those requirements they need access to veterinary care the animal welfare act 1999 definition of the 'person in charge' is very broad and encompasses every person who is seen to have the animal under their care, control or supervision this definition extends to the animal's veterinarian in situations where the animal is being treated or managed under the specific instructions of the veterinarian, creating a potential legal obligation to respond in an emergency over and above any legal obligation that might exist, veterinarians have an ethical obligation to provide an emergency service in order to protect the welfare of animals whether those animals are under the veterinarian's care or not a veterinary emergency is defined as 'any sudden, unforeseen injury, illness or complication in an animal, demanding immediate or early veterinary treatment to save life or to provide timely relief from unreasonable or unnecessary pain or distress' an emergency is considered to exist when described as such by the person in charge of the affected animal(s) until there has been an opportunity for veterinary assessment assessment may take place over the phone but the veterinarian must be confident that if they decide that the situation is not an emergency they have sufficient information in order to make that assessment accurately when the veterinarian determines the situation is not a veterinary emergency, they should document their decision and reasons a veterinary emergency is not considered to exist and therefore does not need to be attended by a veterinarian if following veterinary assessment the veterinarian decides that in their professional judgement the situation is not a veterinary emergency following discussion between the caller and the veterinarian mutual agreement is reached that emergency veterinary treatment is not required to manage the situation and protect the welfare of the animal for an emergency service to be sufficiently resourced veterinary emergencies must be able to be attended within a reasonable time frame to ensure that affected animals do not suffer unnecessary or unreasonable pain or distress there must be an adequate number of veterinarians and support staff to meet the demand for emergency services that could reasonably be expected from the practice's clients taking into account the size and type of practice for example the number of veterinarians required to be on call in a multi veterinarian dairy practice during calving season might need to be different to what is required in the same practice outside calving season the locality of the practice might also influence what is expected regarding a reasonable time for the veterinarian to attend to the animal (for further discussion refer to (h) below) those persons providing the service must be adequately supplied and equipped, and have the necessary competence to be able to attend the types of emergencies that could reasonably be expected to arise involving the species and classes of animals normally treated by the practice in a veterinary emergency a veterinarian's involvement should be tailored relative to his or her own competence and to the resources available to deal with the particular situation when a veterinarian personally attends an animal in an emergency, and the particular clinical skills required are outside the veterinarian's competence, this must be identified to the person in charge of the animal(s) if an alternative veterinary service is available which can offer the necessary skills and resources this should be offered alternatively, obtaining the appropriate informed consent of the person in charge of the animal before proceeding with treatment will reduce the vulnerability of the veterinarian if the outcome of the emergency is not as expected in an emergency it may not be appropriate or feasible to document the informed consent process at the time, but veterinarians in this situation are advised to document their involvement and the process by which they gained consent as soon as possible when the circumstances permit the emergency service provided by a practice may involve the services of appropriately trained persons (for example technicians and veterinary nurses) who are not veterinarians however, a veterinarian must be readily and directly available at all times to provide the necessary veterinary clinical support and undertake the work legally required to be completed by a veterinarian when planning an emergency afterhours procedure council expects veterinarians to consider the number of trained support staff, including other veterinarians in the practice, that would normally be needed to assist; and whether they can be available in a sufficient timeframe if deciding to proceed without competent support, the person in charge of the animal needs to be advised of this as part of the informed consent process consideration should also be given to whether the animal's welfare warrants referral to another practice which is available and capable of providing the necessary resources practices should consider in advance how these cases will be managed and have a policy in place detailing how appropriate afterhours support can be accessed this code recognises that there will be times when a veterinarian on duty will not be able to attend every emergency in a reasonable time extraordinary circumstances which might potentially prevent the veterinarian from attending (or delay attending) an emergency might include but are not limited to the veterinarian on duty being unexpectedly overloaded with emergency call(s) of a similar or higher priority to the emergency which cannot be attended the veterinarian on duty becoming incapacitated by injury, ill health or excessive fatigue while on duty to a level that compromises his or her ability to provide the level of care expected the veterinarian on duty holding the reasonable belief that attending the particular emergency would place his or her own personal safety or health at risk when extraordinary circumstances prevent a veterinarian on duty from being able to attend an emergency, they must assist the caller (or where that is not possible, arrange for someone else to assist the caller) to access an alternative veterinary service in an emergency where the caller is not a client, the veterinarian on duty is entitled to refer the caller to the emergency service provided by the caller's own veterinarian if that service is not readily available and if the veterinarian on duty has the necessary skills and resources required for the particular emergency, they must attend the animal and provide essential treatment examples of the types of situations where this might apply include when the caller's own veterinarian on duty is busy with another emergency or the caller does not already use the services of another veterinarian, or the caller is travelling and out of the district of their own veterinarian there will be times when it is known by the veterinarian on duty that the caller uses the services of more than one veterinary practice (including specialist referral practices) where the emergency specifically relates to the veterinary services that have been provided by a different practice to that of the veterinarian on duty, the caller can legitimately be referred to the emergency service of that practice examples might include the caller has a dog that had an operation performed by a specialist surgeon and now the dog has developed complications associated with the surgery the veterinarian on duty can refer the caller to the emergency service of the surgeon the caller has a horse that has reacted to medication prescribed by a veterinarian the caller has rung a different practice about the problem the veterinarian is entitled to refer the call to the veterinarian that prescribed the medication the caller has a bull calf that was castrated by a veterinarian and the wound is now infected the veterinarian is entitled to refer the call to the practice that did the surgery it is likely that a caller will have one usual veterinarian who can be considered to be the provider of regular veterinary services (the general veterinary practitioner) for an animal or a particular group of animals owned by the caller the general veterinary practitioner must accept the major responsibility for providing emergency care for those animals where a different practice to that of the veterinarian on duty could reasonably be described as the general veterinary practice of the caller then the veterinarian on duty is entitled to refer the caller to the emergency service of that practice (refer to sections 1 and 2 of the 3 professional relationships docid\ g7umy1lhaknz5u4kno yw for more explanation) if the caller is a client and is known to use the services of more than one veterinary practice, the veterinarian on duty must attend the animal and provide essential treatment this assumes the call is a veterinary emergency and the veterinarian has the necessary skills and resources in all cases if the caller is referred to the emergency service of another veterinary practice and that service is not readily available and if the veterinarian on duty has the necessary skills and resources required for the particular emergency, then they must attend the animal(s) and provide essential treatment in an emergency where the caller identifies that they have economic restraints (or where the client has a poor credit history with the practice), the obligations of the veterinarian remain the same the welfare of the animal is the first priority however, attending the welfare needs of the animal does not commit the veterinarian to undertake treatment beyond ensuring the animal is not suffering unreasonable or unnecessary pain or distress when attending a veterinary emergency, the over riding concern must be the welfare of the animal and the relief of unreasonable or unnecessary pain or distress following initial assessment and first aid, the veterinarian should provide the owner with an assessment of the extent of any problems, a realistic prognosis and the various treatment options available further treatment should be agreed upon taking into account the necessary and available resources, as well as the economic and emotional needs of the owner and the particular circumstances of the animal veterinarians are not obliged to undertake ongoing treatments that cannot be paid for by the owner/person in charge where the necessary ongoing treatment cannot be agreed upon and the animal is deemed to be suffering unreasonably, further treatment may be limited to euthanasia or where appropriate, stabilisation of the animal's clinical condition prior to transport to another source of veterinary care all veterinarians providing clinical services must make provision for an emergency service clients must be informed about the availability of this service by means of a telephone answering service and a notice at the unattended clinic other means can also be used, for example notices in newspapers with the advent of specific emergency after hours clinics it is accepted that some animal owners may have to travel further to receive service the disadvantages of longer travel may be offset by the advantages (eg constant veterinary supervision) associated with the type of veterinary service offered by such clinics the same issue can apply when veterinary practices work together co operatively to share the provision of emergency services when considering referring clients to another clinic for emergencies veterinarians should give thought to what is a reasonable/ acceptable time or distance for their clients to travel taking into account local factors and conditions veterinarians offering particular services (eg embryo transplant) to geographically distant clients must observe the requirement to ensure provision of a continuous emergency service where circumstances are such that the veterinarian cannot personally provide this, specific prior arrangements must be made with colleagues who can do so and provide their colleagues in the area and the mutual client with a specifically arranged emergency service locally this code recognises that people living in remote and inaccessible geographic areas are unlikely to receive the same level of emergency veterinary service as people living in more populated areas in this context remote and inaccessible means areas with low population density where there are few options for veterinary service and where travel may be logistically difficult because of distances required to be travelled, terrain, or weather the more isolated the client/patient is from the veterinarian, the more impracticable it may be to provide comprehensive 24 hour emergency cover, and the more difficult it may be for a veterinarian on duty providing that cover to attend to the needs of an animal that may require immediate first aid or pain relief from time to time in certain districts particular types of veterinary service may not be readily available for example, there may not be enough equine veterinarians in a district to be able to meet the demand for routine equine veterinary services let alone emergency services or there might be a sole veterinary practitioner providing the only veterinary services to a particular geographic district in these circumstances a pragmatic approach is needed in order to protect animal welfare standards and common sense must prevail when interpreting this code in relation to the local veterinarian's obligations regarding the provision of emergency veterinary services in a district where these problems are specifically recognised by the vet council to occur and where a veterinarian in that district is not able to comply with this code in relation to providing emergency services, he/she must seek clarification from the vet council about how their service might be tailored to the particular circumstances in order to meet acceptable standards for those times when an emergency service cannot be provided, either at night, weekend or other off duty periods, or by reason of holidays, sickness or emergencies of any kind, specific prior arrangements must be made with colleagues for an emergency service to be provided it is recommended that this is formalised in a written agreement the obligation on the veterinarian is not therefore, to remain constantly on duty but to ensure that, when off duty, clients are directed to another member of the profession with whom prior arrangements have been made the redirection of out of hours calls to other veterinarians without their prior knowledge and consent is unacceptable veterinarians should when attending veterinary emergencies consider carefully the potential personal risks involved, and take steps to manage those risks there is no expectation that veterinarians should place their personal safety at risk providing an emergency veterinary service outside normal business hours can be more expensive those costs may be fairly passed on to the users of the service 24 hour emergency response flowchart section 5 8 there will be times when a veterinarian who is not currently working in clinical practice, or who is not on duty, is called upon in a veterinary emergency on these occasions, if the veterinarian is unable to attend the animal personally to provide emergency treatment, he/she must make a reasonable effort to assist the caller to locate an alternative source of emergency veterinary care instances will occur where there is no available veterinary service in any such case the veterinarian must provide appropriate advice in order that the person in charge of the animal is able to take the necessary steps to alleviate any unreasonable or unnecessary pain or distress being suffered by the animal understanding section 5 8 section 7 of this part of the code describes the responsibilities of those veterinarians on duty providing an emergency service section 8 describes the responsibilities of all other veterinarians – whether they are a clinical practitioner who is not on duty, or a veterinarian not employed in clinical practice when contacted in a veterinary emergency, those veterinarians in clinical practice and not on duty, and those not in clinical practice, who have the necessary skills and resources and who are willing to attend may choose to attend the affected animals while there is no legal obligation for veterinarians to respond when called upon in a veterinary emergency, veterinarians in this group choosing not to attend the emergency personally, still have an ethical responsibility to respond professionally and help the caller to find a solution so that the animal is not left to suffer unreasonably where possible, the veterinarian must provide reasonable assistance to guide the caller to a suitable and available emergency service where there is no other available veterinary service the veterinarian must appropriately advise the person in charge of the animal(s) how best they can meet their obligations under sections 10 and 11 of the animal welfare act 1999 the person ultimately responsible for ensuring that an animal does not suffer is the person in charge of the animal section 5 9 veterinarians must make provision for the care of animals currently receiving in patient treatment this must be at a level appropriate to the clinical problem being managed and must be communicated to the client understanding section 5 9 in patients are those animals remaining in the veterinary clinic for the purposes of treatment veterinarians have an ongoing ethical responsibility to their patients receiving in patient care this responsibility extends outside normal business hours as well as ethical responsibilities, veterinarians have legal obligations as the person in charge (as defined in the animal welfare act 1999) of their inpatients more specifically sections 10 and 11 of the animal welfare act 1999 set out those requirements veterinarians must make proper provision to manage their in patients appropriately for the clinical condition being treated the owners of in patients must be informed of the level of supervision and clinical management the in patients will be receiving out of normal business hours