Case study: Informed consent and the competence assessment process

this case study focuses on a part of the vet council’s fitness to practise process it involves a complaints assessment committee (cac) investigation and resulting recommendation for a veterinarian to undergo a competence assessment what is a competence assessment? the vet council promotes ongoing competence through professional standards and an annual recertification process a cac can recommend that a veterinarian undergo a competence assessment, but it is up to the council to decide if it is needed a competence assessment may be initiated if there are legitimate concerns raised about a veterinarian’s practice competence issues could include a pattern of poor standard of care or performance (with several clients or one client over time) multiple/repeated errors evidence of a significant deficit in knowledge or skill one off serious departures from accepted standards of practice a competence assessment is not disciplinary in nature the process is designed to be evaluative, educational, and rehabilitative it is an information gathering approach and is used if there have been questions about a veterinarian’s competence the assessment includes a practice visit by a competence assessment team (cat), made up of two veterinarians and one lay member one or both veterinarians will work in the same or similar branch of veterinary medicine as the person being assessed while a specific concern may have triggered the process, the cat must consider the veterinarian’s competence at the time of the assessment to determine if they are practising at the required standard the cat work with the veterinarian to agree on the terms of reference and what to expect on the day of the assessment the competence assessment is forward looking and does not involve investigating previous complaints the veterinarian’s competence is measured against the competency standards and performance indicators background a complaint was made to the vet council about a veterinarian and whether they provided an appropriate standard of care to a german shepherd particularly, whether the veterinarian obtained the client’s informed consent, and if their clinical records were of an appropriate standard the dog was taken to the veterinarian, with symptoms including vomiting, lack of appetite and abdominal discomfort the veterinarian performed a physical examination and blood testing, and administered iv fluid therapy an ultrasound was also performed and found no visible obstruction, although some gastric dilation was noted the veterinarian proceeded with an exploratory laparotomy and noted that only a small amount of fluid and air were present in the stomach, which could not be pushed into the duodenum the veterinarian said that they identified a pyloric sphincter blockage they removed a piece of leather and sutured the dog’s stomach closed after the surgery, the veterinarian administered betamox but the dog passed away shortly after a postmortem examination was not performed the veterinarian said that they did not contact the owner to obtain their informed consent before surgery because the situation became urgent the dog’s owner said that they were not aware of the possibility of surgery and that the veterinarian did not explain what the procedure was or the alternatives they said they were not aware of the risks involved the complaint the complaint was referred to the complaints assessment committee (cac) the cac is a preliminary screening body, which decides what should happen after a complaint has been made about a veterinarian the cac can conduct a formal investigation and decide what steps, if any, need to be taken to ensure a veterinarian is fit to practise and public interest is protected the issues before the cac were that the veterinarian did not obtain informed consent for the exploratory laparotomy; did not document the informed consent process; told the client pre surgery that there was no obstruction, and then post surgery said that there was an obstruction due to a piece of leather; and did not document the animal breed, baseline parameters, informed consent, and client communication in clinical records what professional standards are expected the ‘client relationships’ section of the code requires veterinarians to obtain a client’s informed consent before proceeding with a proposed treatment or course of action this includes ensuring that clients are given relevant information in a way they can understand, so that they can make an informed decision about treatment veterinarians should always check their clients’ understanding of the information the code requires informed consent to be adequately documented, usually with a consent form if verbal consent is given, the discussion and the client’s decision should be documented in the clinical records veterinarians must also keep clear and accurate records that contain enough detail for another veterinarian to take over the case management at any time findings in the context of this case, the cac would expect a competent veterinarian to discuss the different treatment options and recommendations for a patient with a suspected abdominal injury or obstruction potential treatment options would likely include surgery performed in house, non surgical management, or a referral ideally, there would be a discussion between the veterinarian and client about the spectrum of care, taking into consideration the client’s perspective and resources this discussion would allow the veterinarian to confirm both their own and the clients’ assumptions, as well as their understanding of the next steps the veterinarian did not obtain the client’s agreement to proceed with an exploratory laparotomy while there was an alleged discussion about surgery being indicated, the veterinarian did not provide the client with enough information to decide whether to proceed with the surgery, or to make an informed decision regarding alternatives informed consent involves the client deciding in partnership with their veterinarian the veterinarian may have believed that an exploratory laparotomy was the only reasonable course of action in the circumstances, however, this should have been explained so that the client could understand the veterinarian’s preference the cac found that the veterinarian did not facilitate an appropriate informed consent process the discussion with the client should have included an explanation about the potential diagnostic or treatment options (which might have included a strong recommendation for exploratory surgery), the risks and benefits, options for referral, and confirmation of the decision the veterinarian should also have documented the informed consent process in the clinical records and/or a separate consent form there was no evidence presented to the cac to indicate that client communication or consent was documented by the veterinarian, which raised serious concerns when measuring the veterinarian’s conduct against these expectations, the cac held that the veterinarian did not facilitate an informed consent process that met the requirements of published professional standards, or the standard expected of the profession the cac was concerned that the clinical records did not adequately document the treatment and care provided, the decision making process, a diagnosis or prognosis, client communication, or consent the clinical records did not contain enough information that would allow another veterinarian to take over the case, and did not meet the standard expected by the code and the competency standards decision the cac decided that the complaint raised concerns about the veterinarian’s competence, as the informed consent process and clinical record keeping fell significantly below expectations the cac was not satisfied that the veterinarian’s current approach to veterinary practice, or any changes made since receiving the complaint, would prevent the same issues happening again the cac accepted that there may have been some time limitations that affected the veterinarian’s decision making, however, it was concerned about ongoing, unmitigated risk in the veterinarian’s approach to veterinary practise and obtaining informed consent the cac recommended to the vet council that the veterinarian undergo a competence assessment focused on client communication, informed consent, and clinical record keeping the veterinary council accepted the cac’s decision and the recommendation that a competence assessment take place for more information, read the vet council’s docid\ xmxxwcrhmctqf8hlcyiow and docid\ anejoinyjlrzbvheo2tc7