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14. Client confidentiality

Updated 14 April 2016

Introduction

14.1  The veterinary/client relationship is founded on trust and, in normal circumstances, a veterinary surgeon or veterinary nurse should not disclose to any third party any information about a client or their animal either given by the client, or revealed by clinical examination or by post-mortem examination. This duty also extends to support staff.

14.2  The duty of confidentiality is important but it is not absolute and information can be disclosed in certain circumstances, for example where the client’s consent has been given, where disclosure can be justified by animal welfare concerns or the wider public interest, or where disclosure is required by law.

14.3  The client’s permission to pass on confidential information may be express or implied. Express permission may be either verbal or in writing, usually in response to a request. Permission may also be implied from the circumstances, for example where a client moves to a different practice and clinical information is requested or where an insurance company seeks clarification or further information about a claim under a pet insurance policy. However, whenever practicable the client’s express consent to the disclosure should be sought.

14.4  Registration of a dog with the Kennel Club permits a veterinary surgeon who carries out a caesarean section on a bitch, or surgery to alter the natural conformation of a dog, to report this to the Kennel Club.

14.5  For guidance on client confidentiality in the context of social media please see Social Media and Online Networking Forums.

 

Disclosing to the authorities

14.6  In circumstances where the client has not given permission for disclosure and the veterinary surgeon or veterinary nurse considers that animal welfare or the public interest is compromised, client confidentiality may be breached and appropriate information reported to the relevant authorities. Some examples may include situations where an animal shows signs of abuse or is at real and immediate risk of abuse or where the information is likely to help in the prevention, detection or prosecution of a crime.

14.7  If a client refuses to consent, or seeking consent would be likely to undermine the purpose of the disclosure, the veterinary surgeon or veterinary nurse will have to decide whether the disclosure can be justified. Generally the decision should be based on personal knowledge rather than third-party (hearsay) information, where there may be simply a suspicion that somebody has acted unlawfully. The more animal welfare or the public interest is compromised, the more prepared a veterinary surgeon or veterinary nurse should be to release information to the relevant authority.

14.8  Each case should be determined on the particular circumstances. If there is any doubt about whether disclosure without consent is justified, the issues should be discussed with an experienced colleague in the practice before the information is released.

14.9  Veterinary nurses employed by a veterinary surgeon or practice should discuss the issues with a senior veterinary surgeon in the practice before breaching client confidentiality.

14.10  Where a decision is made to release confidential information, veterinary surgeons or veterinary nurses should be prepared to justify their decision and any action taken. They should ensure that their decision making process, including any discussions with the client or colleagues, is comprehensively documented.

14.11  Veterinary surgeons and veterinary nurses who wish to seek advice on matters of confidentiality and disclosing confidential information are encouraged to contact the RCVS Professional Conduct Department on 020 7202 0789.

 

Animal welfare concerns 

14.12  Disclosure may be justified where animal welfare is compromised. 

14.13  When a veterinary surgeon is presented with an injured animal whose clinical signs cannot be attributed to the history provided by the client, s/he should include non-accidental injury in their differential diagnosis. ‘Recognising abuse in animals and humans’ provides guidance for the veterinary team on dealing with situations where non-accidental injury is suspected.

14.14  If there is suspicion of animal abuse (which could include neglect) as a result of examining an animal, in the first instance, where appropriate, the veterinary surgeon should attempt to discuss his/her concerns with the client.

14.15  In cases where this would not be appropriate, or where the client’s response increases rather than allays concerns, the veterinary surgeon should consider whether the circumstances are sufficiently serious to justify disclosing their client’s information without consent. If so, the suspected abuse should be reported to the relevant authorities, for example: the RSPCA (Tel: 0300 1234 999 - 24-hour line) in England and Wales; the SSPCA (Tel: 03000 999 999 – 7am to 11pm) in Scotland; or the Animal Welfare Officer for the relevant local authority in Northern Ireland.

14.16  Such action should only be taken when the veterinary surgeon or veterinary nurse considers on reasonable grounds that an animal shows signs of abuse or is at real and immediate risk of abuse - in effect, where the public interest in protecting an animal overrides the professional obligation to maintain client confidentiality.

14.17  Veterinary surgeons or veterinary nurses may also have animal welfare concerns arising from other issues in practice; for example, where a client has failed to attend follow-up appointments and the veterinary surgeon or veterinary nurse considers that animal welfare may be compromised. In such cases, the veterinary surgeon or veterinary nurse should take reasonable steps to contact the client provided the delay does not compromise animal welfare. It is also sensible to check that requests for clinical records have not been received as this may indicate that the client has sought veterinary attention elsewhere. 

 

Child and domestic abuse

14.18  Given the links between animal, child and domestic abuse, a veterinary surgeon or veterinary nurse reporting suspected or actual animal abuse should consider whether a child or adult within that home might also be at risk. Suspicions of abuse may also be triggered by a separate issue arising out of the relationship with the client.

14.19  Veterinary surgeons and veterinary nurses are not expected to be experts in abuse, but they can use their professional judgement to determine whether the appropriate authorities should be informed. In all cases, the situation should be approached with sensitivity and the impact of any disclosures to the authorities should be considered carefully. 

14.20  Where there are concerns that a child is at risk, the veterinary surgeon or veterinary nurse should consider seeking further advice (on an anonymous basis initially if needs be) or making a report to, for example, the NSPCC (Tel: 0808 800 5000 / www.nspcc.org.uk/what-you-can-do/report-abuse), the local child protection team or the police. 

14.21  Where a disclosure of domestic abuse is made to a veterinary surgeon or veterinary nurse a report should only be made to the appropriate authorities if the victim agrees. If the victim does not agree to the matter being reported, then the veterinary surgeon or veterinary nurse should encourage the victim to approach agencies or organisations through which they can seek help.    

14.22  For further information and practical guidance, please see:

  • The Links Group guidance ‘Recognising abuse in humans and animals: Guidance for the veterinary team’ (www.thelinksgroup.org.uk) and, in particular, the Links Group AVDR protocol for dealing with suspected animal or domestic abuse.

  • The NSPCC leaflet, ‘Understanding the links: child abuse, animal abuse and family violence - information for professionals’ (www.nspcc.org.uk)

 

Prevention, detection or prosecution of a crime

14.23  Disclosure of information in the public interest may be justified where it is likely to help in the prevention, detection or prosecution of a crime. There is an exemption in the Data Protection Act 1998 (DPA) that allows information to be released for these purposes (Section 29 – Crime and Taxation).

14.24  The police are most likely to request information using this exemption, but practices may receive similar requests from other enforcement agencies with a crime prevention or law enforcement function.

14.25  This exemption does not cover the disclosure of all information in all circumstances and there are limits on what can be released. The exemption allows the release of information for the stated purpose only and only if not releasing would be likely to prejudice any attempt by the authorities to prevent or detect a crime or apprehend or prosecute an offender.

14.26  This exemption does not necessarily mean that disclosure should be undertaken. In all cases the authority to release information under the DPA has to be considered alongside the duty of confidentiality.

14.27  The decision to disclose information in these circumstances can be complex and often falls to the judgement of the veterinary surgeon or veterinary nurse. Disclosing client information without consent requires serious consideration and a full understanding of the circumstances.

14.28  Before considering whether to release information, the veterinary surgeon or veterinary nurse should:

  1. Ensure the request is in writing so you know who is making the request. The request should be signed by someone with sufficient authority.
  2. Check whether the person asking for the information is doing so to prevent or detect a crime or apprehend or prosecute an offender.
  3. Consider whether a refusal to release the information will prejudice or harm the prevention or detection of a crime or the apprehension or prosecution of an offender.
  4. Ask the authority or organisation seeking the information if the individual has been approached for their consent. If the answer is no, consider whether it is practicable to obtain the client’s consent directly. It may not be appropriate to do so where seeking consent would be likely to undermine the purpose of the disclosure.
  5. Question any requests for excessive or apparently irrelevant information.
  6. Be aware that any disclosure should be limited to the minimum amount of information necessary, in line with the Data Protection Act 1998.

NB: This is not an exhaustive list and further guidance is available from the Information Commissioner’s Office: www.ico.org.uk.

14.29  If a disclosure is made, veterinary surgeons and veterinary nurses should make a record of this and the reasons for the decision.

14.30  If a veterinary surgeon or veterinary nurse has genuine concerns about whether disclosing information in these circumstances without client consent is justified, the authority requesting the information may apply for a court order requiring disclosure of the information.

  

Disclosures required by law

14.31  Veterinary surgeons and veterinary nurses must disclose information to satisfy a specific statutory requirement, such as notification of a known or suspected case of certain infectious diseases.

14.32  Where such a statutory requirement exists, a client’s consent to disclosure is not necessary but where practicable the client should be made aware of the disclosure and the reasons for this.

 

Dealing with suspected illegal imports

14.33  Veterinary surgeons and veterinary nurses may be presented with animals which they suspect have entered the UK illegally: for example, animals presented without the necessary paperwork, or with paperwork that appears to be fraudulent or does not comply with pet travel rules, or where rabies vaccination requirements have not been met. A foreign microchip is not necessarily evidence that an animal has been imported illegally.The microchip may have been purchased and implanted in the UK or the animal may have been legally imported into the UK and re-homed.

14.34  In cases of suspected illegal imports, veterinary surgeons and veterinary nurses should follow the general guidance on client confidentiality above. There is no legal or professional obligation to inform the authorities, but veterinary surgeons and veterinary nurses may choose to do so.  Ultimately, the decision to report is for the individual professional. The RCVS will support a veterinary surgeon or veterinary nurse who believes they are acting on the basis of animal welfare or public interest. Equally, the RCVS will support a veterinary surgeon or veterinary nurse, who, for various reasons, does not wish to make a report. Veterinary nurses employed by a veterinary surgeon or practice should discuss the issues with a senior veterinary surgeon in the practice before breaching client confidentiality.

14.35  In cases where the client has bought the animal from a breeder or other seller in good faith, oblivious to the origins of the pet, the rules of pet travel and the implications for them as the owner (e.g. potentially seizure and the cost of quarantine), veterinary surgeons and veterinary nurses may wish to encourage the client to make the report themselves. This is because the client will have the details of the breeder or seller and is likely to have first hand evidence to present to the authorities.

14.36  In Greater London, reports should be submitted to the City of London Animal Health and Welfare Team on 020 8745 789 (further details are available online). Outside of London, reports should be submitted to the local Trading Standards office. General information on the pet travel scheme can be found online.

14.37  While there is no legal or professional obligation to report illegal imports, there is a legal obligation where rabies is suspected. Rabies is one of the notifiable diseases that must be reported to the Animal and Plant Health Agency (APHA), even if there is only a suspicion that an animal may be affected. Further information on notifiable diseases in animals is available on the UK government website. Suspecting that an animal has been illegally imported is not the same as suspecting it has rabies.

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