15 December 2016
The Disciplinary Committee has this week decided to postpone judgement for a period of two years on a Hertfordshire-based veterinary surgeon, who was charged with the inadequate care of a dog.
The Disciplinary Committee made its decision regarding Mr Amir Kashiv, from Vets & Pets, Broxbourne, Hertfordshire, on Tuesday 13 December 2016.
At the outset of the hearing, Mr Kashiv denied all aspects of the charges against him. During the course of the inquiry, some heads of charge were not pursued and some he admitted, leaving the remaining heads of charge to be determined [full details are set out in the Notes for Editors, below].
There were a number of fundamental failings in Mr Kashiv’s clinical competence which are required to be addressed during the period of postponement.
Disciplinary Committee
The charges concerned the treatment of a Scottish Terrier, called Tanzy, whose owner, Mrs Greenhill, brought her in to see Mr Kashiv on 5 March 2015. Mrs Greenhill was concerned about blood in Tanzy’s urine and swellings in her mammary glands. After carrying out a cytopathology test, Mr Kashiv advised Mrs Greenhill that Tanzy would require surgery to remove the mammary glands. There were no further tests conducted, and no alternatives to surgery suggested.
On 13 March Mr Viviani, another veterinary surgeon at Vets & Pets, therefore undertook a right-side mammary strip on Tanzy, discharging her the following day. On 17 March Mrs Greenhill brought Tanzy back in for a post-operative check and was seen by Ms Kostadinova, a locum veterinary surgeon, who found her to be in good condition.
On 20 March Mrs Greenhill then became concerned about Tanzy’s deteriorating condition and returned her to see Mr Kashiv. He admitted Tanzy for observation over the weekend but did not conduct any further tests at that stage, apart from radiography on 22 March. The hospitalisation records were of poor quality and substantially incomplete.
On 23 March Mr Kashiv then informed Mrs Greenhill that Tanzy could be discharged, although he recommended an MRI scan to assist in the diagnosis; this was declined on cost grounds. He did not however explain clearly to Mrs Greenhill that Tanzy’s prognosis was bleak, and did not give adequate home care instructions.
Tanzy continued to deteriorate, and on 24 March Mrs Greenhill took Tanzy to the RSPCA Harmsworth Hospital where Mrs Favy, a veterinary surgeon, conducted tests which showed that Tanzy was in renal failure. She then called Mrs Greenhill and recommended that Tanzy was put to sleep, which was then performed in Mrs Greenhill’s presence.
The Committee found that Mr Kashiv had failed to conduct the necessary investigations when Tanzy was admitted from 20 to 23 March 2015, being satisfied that, by the time Tanzy had been hospitalised for a period of three days, it was mandatory for a blood test to have been performed, given her marked deterioration [head of charge 2(a)].
The Committee also found while Mr Kashiv did express his opinion that Tanzy’s prognosis was poor, he did not give the full explanation required in the circumstances of this case to enable Mrs Greenhill to understand fully the prognosis [head of charge 2(c)]. The Committee also considered that Tanzy was not in a fit state to be discharged on 23 March 2015 [head of charge 3], and that he had failed to keep sufficiently clear and/or detailed and/or accurate records [head of charge 4].
After full consideration, the Committee found that Mr Kashiv’s actions amounted to serious professional misconduct, and was satisfied that his actions fell far short of the conduct to be expected of a reasonably competent veterinary surgeon in respect of heads of charge 1, 2 and 3 but not 4.
Although it was concerned “about the culture of care in the practice, in particular not having in place proper protocols and procedures and without necessary support from properly trained staff”, in deciding on appropriate sanction, the Committee was satisfied that there were “a number of serious misjudgements by Mr Kashiv in this case”.
The Committee decided to postpone judgement for a period of two years, whilst recommending that Mr Kashiv agree to undertake a structured programme to benefit his clinical practice including a Personal Development Plan, mentoring, practice visits, additional CPD and regular reports to the Disciplinary Committee [see Notes for Editors for further detail].
Non-compliance with these undertakings may result in the hearing being resumed at a date earlier than the two-year period.
Stuart Drummond, Chairing the Disciplinary Committee and speaking on its behalf, said: “The Committee considers that Mr Kashiv is a dedicated veterinary surgeon, as evidenced by the large number of testimonials, and that he provides a valuable service to the community, particularly with rescue animals.
“Nevertheless, the Committee considers that there were a number of fundamental failings in Mr Kashiv’s clinical competence which are required to be addressed during the period of postponement. For the reasons set out above the Committee considers that Mr Kashiv’s clinical practice will benefit from a structured programme over the period of postponement, whilst protecting the welfare of animals, maintaining public confidence in the profession and declaring and upholding proper standards of conduct.”
Notes for Editors
1) This summary is provided to assist in understanding the RCVS Disciplinary Committee’s decision. It does not form part of the reasons for the decision. The Committee’s full findings and decision is the only authoritative document and is available at (www.rcvs.org.uk/disciplinary).
2) The RCVS is the regulatory body for veterinary surgeons and veterinary nurses in the UK and sets, upholds and advances veterinary standards, so as to enhance society through improved animal health and welfare.
3) RCVS disciplinary powers are exercised through the Preliminary Investigation and Disciplinary Committees. The RCVS has authority to deal with three types of case:
a) Fraudulent registration
b) Criminal convictions
c) Allegations of disgraceful professional conduct
4) The Disciplinary Committee is a constituted judicial tribunal under the 1966 Act and follows rules of evidence similar to those used in a court of law.
5) The burden of proving an allegation falls upon the RCVS, and the RCVS must prove to the standard that the Committee is sure.
6) A respondent veterinary surgeon may appeal a Disciplinary Committee decision to the Privy Council within 28 days of the date of the decision. If no appeal is received, the Committee’s judgment takes effect after this period.
7) Charges:
| Charge | Test | Test |
| 1. Having on or about 5 March 2015 examined Tanzy with the following findings:
(i) a tubular mass extending from the right fourth to right fifth mammary gland; (ii) swelling and/or nodules between the right third and right fourth mammary glands; (iii) swelling and/or nodules to the right groin area; (iv) results of a urine test indicating the presence of blood and protein; suggested to Mrs Greenhill that surgery be performed to Tanzy, in circumstances when you failed to: |
1(a) undertake and/or make arrangements for further investigation, namely blood analysis for renal disease; and/or | Not pursued |
| 1(b) discuss with Mrs Greenhill the options of radiography and/or ultrasonography to assess for metastatic spread; and/or | Admitted | |
| 1(c) discuss with Mrs Greenhill alternative treatment options to surgery, namely palliative care and monitoring and/or euthanasia; and/or | Not proved | |
| 1(d) explain to Mrs Greenhill, sufficiently or at all, the following factors with regards to the surgery which you had suggested to her: |
|
|
| (a) the nature, extent and/or detail of the surgery; |
Admitted |
|
| (b) the risks of the surgery; |
Admitted |
|
| (c) that another veterinary surgeon would be performing the surgery |
Not proved |
|
| (d) what to expect post-operatively |
Admitted |
|
| 2. Having admitted Tanzy as an in-patient at the practice between 20 March 2015 and 23 March 2015, with the following history and/or findings:
(i) diarrhoea and vomiting; (ii) hind leg paresis; (iii) proprioceptive deficits; (iv) absent withdrawal reflexes; (v) lack of deep pain sensation; (vi) failure to walk whilst an in-patient; (vii) failure to eat whilst an in-patient, save by way of syringe-feeding; (viii) no conscious pain sensation on examination;
failed to: |
2(a) arrange for further investigation to determine the underlying condition leading to clinical presentation; and/or | Proved |
| 2(b) provide any or any adequate analgesia, or failed to record the same; and/or | Not pursued | |
| 2(c) discuss with Mrs Greenhill the poor prognosis for Tanzy; and/or | Proved | |
| 2(d) discuss with Mrs Greenhill the treatment option of euthanasia for Tanzy; | Admitted | |
| 3. On 23 March 2015, discharged Tanzy to Mrs Greenhill’s care, when Tanzy was not in a fit state to be so discharged; |
Proved |
|
| 4. Between 4 March 2015 and 24 March 2015, failed to keep sufficiently clear and/or detailed and/or accurate clinical records for Tanzy; |
Admitted | |
8) Undertakings:
Preparation of a Personal Development Plan
(i) To prepare, submit and have agreed by the Royal College of Veterinary Surgeons within 28 days of 13 December 2016 and send to the Chair of the Disciplinary Committee and the RCVS a Personal Development Plan, covering the period of 2 years from 13 December 2016, to address clinical and diagnostic shortcomings with particular reference to the decision given by the Disciplinary Committee in relation to the hearing and the relevant chapters of the Supporting Guidance to the Code of Professional Conduct for Veterinary Surgeons, namely Chapter 1 “Referrals and Second Opinions”, Chapter 2 “Veterinary care”, Chapter 6 “Clinical Governance”, Chapter 8 “Euthanasia of Animals” and Chapter 11 “Communication and Consent”
(ii) To comply with the terms of the Personal Development Plan prepared as above.
Appointment of a veterinary mentor
(i) To appoint within 56 days of 13 December 2016 a mentor, to be approved by the RCVS (Professional Conduct Department), to provide advice and guidance on the practice, for a period of two years from 13 December 2016 (or such of that period as may remain at the time of the appointment), and to provide the mentor with a copy of the decision given by the Disciplinary Committee in relation to the hearing and the Personal Development Plan (prepared in accordance with 1 above) so that the mentor can monitor, review and evidence progress against the plan
(ii) To follow such advice and guidance as may be provided by the mentor during the period of the mentor’s appointment
(iii) To provide to the Chair of the Disciplinary Committee progress reports at quarterly intervals (1 March, 1 June, 1 September and 1 December) throughout the two-year period of these undertakings together with reports from the mentor evidencing compliance with the terms of the Personal Development Plan.
Appointment of a Veterinary Surgeon by the RCVS to report to the Disciplinary Committee
To allow a veterinary surgeon appointed by the RCVS (Professional Conduct Department) to attend the practice at quarterly intervals, by appointment or unannounced, within a period of two years from 13 December 2016 (or such of that period as may remain at the time of the appointment), to review any aspect of my professional practice, including the patient and client records, the records of surgical and other procedures carried out, with details of the outcomes, practice protocols and their application, practice standards and the care of patients, the recording and monitoring of informed consent and to observe Mr Kashiv in consultations with clients and performing surgical and other procedures.
Training and CPD
In addition to the recommended minimum 35 hours annual CPD:
(i) to complete up to a maximum of 35 hours verifiable CPD in total annually in the areas identified in the Personal Development Plan as may be recommended by the mentor and/or the veterinary surgeon appointed by the RCVS.
(ii) to submit quarterly reports of courses completed with details of the course provider, copies of course content and any certificates achieved to the Clerk of the Committee.
Information Employers
To provide a copy of these undertakings to any Employer, Clinical Director and/or Chief Executive of any Employer at any practice where Mr Kashiv may work during the period of the undertakings
Costs
To pay all the costs of complying with the undertakings with the exception of the costs associated with the appointment and performance of the veterinary surgeon appointed by the RCVS
For more information, please contact:
Anna Feeney (020 7202 0750) a.feeney@rcvs.org.uk
Communications Department, Royal College of Veterinary Surgeons