15. Health Protocol

Veterinary surgeons and registered veterinary nurses whose fitness to practise may be impaired because of adverse health

15.1  Many people, including veterinary surgeons and registered veterinary nurses (“Registrants”), will experience, during the course of their lives, health problems that are successfully managed or controlled, and these self-managed health problems will not, on their own be considered to adversely affect any Registrant’s fitness to practise. There may be occasions, however, where there are concerns that a health condition is having an adverse effect on a Registrant’s fitness to practise. The RCVS Health Protocol is designed to deal with such situations in a proportionate and supportive way.

Independent, confidential support is available to veterinary surgeons and registered veterinary nurses with health related issues at Vetlife.

The RCVS Health Protocol may be considered as part of any RCVS investigation where a Registrant experiences a health problem which results in, or forms a significant element of, any of the following:

• Conduct (or alleged conduct) which might reasonably be considered to amount to serious professional misconduct (which includes where a Registrant is unable or unwilling to demonstrate that they are taking reasonable steps to address their adverse physical or mental health)
• Criminal conviction, caution or an adverse finding.

Why the RCVS needs a Health Protocol

15.2  As the regulator of veterinary surgeons and veterinary nurses in the UK, the RCVS has a duty to act in the public interest. This includes safeguarding the health and welfare of animals committed to veterinary care, protecting the interests of those dependent on animals and assuring public health through the regulation of ethical and clinical standards. The RCVS duty to protect the public interest also includes recognition of a Registrant’s own interests (whilst always ensuring that those interests are balanced in a proportionate way with the public interest).

15.3  The RCVS recognises that sometimes concerns about a professional’s conduct will be directly related to a Registrant’s adverse health, and in such cases it may be more appropriate to take a more health-focussed approach, rather than a purely disciplinary one. This means that even though a Registrant’s behaviour, actions or omissions might be considered to represent serious professional misconduct, the nature of their adverse health condition means that the public interest may be better served by supporting and managing them within the Health Protocol, rather than immediately referring them to the Disciplinary Committee (“DC”).

Circumstances in which the RCVS will consider or take action in relation to a Registrant's health

15.4  The Veterinary Surgeons Act 1966 (“the Act”) gives the RCVS regulatory powers regarding veterinary surgeons who are registered with the RCVS. Under the Veterinary Nurse Conduct and Discipline Rules 2014 (“the Rules”), made pursuant to the RCVS Supplementary Charter granted in 2014, registered veterinary nurses are subject to a similar regulatory jurisdiction. Under the Act and the Rules, the RCVS can only take regulatory action regarding a Registrant in the following circumstances:

1. Where a Registrant is convicted in the United Kingdom or elsewhere of a criminal offence that could render them unfit to practise.

The Health Protocol may be considered where a Registrant’s adverse health is directly relevant to a criminal conviction, for example, an alcohol or drug-related offence or an offence in which alcohol or drugs was significantly involved.

2. Where a Registrant’s behaviour, actions or omissions could amount to “disgraceful conduct in a professional respect” (namely serious professional misconduct).

The Health Protocol may be considered where adverse health is relevant to conduct which could be considered to amount to serious professional misconduct (for example very serious or persistent clinical failings, or dishonest behaviour).

3. Where a Registrant’s conduct in relation to their adverse health condition could be considered to amount to serious professional misconduct for one of the following reasons:

• a Registrant fails or refuses to take reasonable steps to address adverse physical or mental health that impairs their fitness to practise, where there is harm, or significant risk of harm to animal health or welfare, public health or the public interest as a result; or
• a Registrant fails or refuses to comply with reasonable requests from the RCVS (for example, by failing to demonstrate that they are taking reasonable steps to address their adverse health, or by failing to undergo a medical examination, or by failing to provide medical reports or give undertakings to the RCVS in relation to the management of their health condition); or
• a Registrant breaches an undertaking that they have given to the RCVS.

15.5  When considering whether a Registrant’s fitness or ability to practise may be impaired because of adverse health, the following are examples of factors that may be taken into account:

• the Registrant’s current physical or mental condition,
• any continuing or episodic condition suffered by the Registrant,
• any condition suffered by the Registrant which, although currently in remission, is capable of recurring.

When concerns about a Registrant's health should be reported to the RCVS

15.6  Anyone, including other Registrants, members of practice staff, clients, and healthcare professionals (for example medical practitioners) who has concerns that a Registrant’s health is impairing their fitness to practise, or could amount to serious professional misconduct, is encouraged to report those concerns to the RCVS as soon as is reasonably practicable. See below for examples of situations where adverse health might impair fitness to practise or amount to serious professional misconduct.

Example 1:

A colleague has suffered an acrimonious relationship break-up and is suffering depression and anxiety as a result. You are aware that they have had trouble sleeping and they have requested a change in shift patterns to accommodate this. They have also contacted their GP and obtained anti-depressant medication, and have been referred for counselling. Their work remains unaffected and the practice manager is aware of the matter and is offering support.

This person is actively managing their condition and taking steps to address the problems. Their work is not affected and they do not appear to pose a risk to animal health or welfare. Unless the situation changes, it would not be appropriate to report them to the RCVS.

Example 2:

A colleague has developed a drink problem. Although their work remains largely fine, they are short-tempered with patients and have been seen to use excessive physical restraint while examining them. Other members of staff have noticed bottles of wine in their colleague’s locker, which their colleague drinks from during the day, and they have been found asleep in their car during breaks. The colleague phones in sick quite often on a Monday. The Clinical Director has taken the colleague to one side to discuss the matter with them, but the person denies that there is a problem and refuses to seek help or support.

This person is failing to take reasonable steps to address their adverse health, despite attempts by a colleague to encourage them to do so. There are potential animal welfare issues and conduct that could amount to serious professional misconduct. It may be appropriate to report the colleague to the RCVS if they continue to refuse to seek assistance.

Example 3:

A colleague has always been a friendly and useful member of staff, but has recently become quite withdrawn. Their manner has become erratic and, while their work remains good, checks on the Controlled Drug Register have led to the discovery of some discrepancies in stock levels. An investigation is undertaken, during which the colleague has been seen on internal CCTV removing medication and secreting themselves in the staff toilets. When questioned, the colleague admitted taking and using opiates and says that they have a drug problem.

This person has stolen controlled substances from the practice, criminal behaviour that is likely to amount to serious professional misconduct. In these circumstances it would be appropriate to report the matter to the RCVS (and possibly other authorities).

15.7  In addition, Registrants who are concerned about a professional colleague’s fitness to practise must also take steps to ensure that animals are not put at risk and that the interests of the public, including those of their colleague, are protected. This may mean reporting them to the RCVS.

How the RCVS deals with concerns that involve a Registrant's adverse physical or mental health

15.8  A Registrant’s adverse health may be relevant to a complaint or a conviction case that is referred to either RCVS Preliminary Investigation Committee or RVN Preliminary Investigation Committee (“PIC”). All investigations that involve health issues will generally follow a similar procedure and timeline as those complaint cases not involving adverse health concerns.

15.9  The PIC conducts a preliminary investigation under the Act or (for RVNs) the Rules.

The PIC decides:

• whether in relation to a Registrant’s conduct there is a realistic prospect of finding serious professional misconduct or a conviction which renders the Registrant unfit to practise; and, if so,
• whether it is in the public interest to refer the case to the DC for a full hearing.

When undertaking both elements of this assessment, the PIC may take into account the adverse health of the Registrant, if relevant. Generally any health issues will be more relevant to the second stage of the assessment, namely whether it is in the public interest to refer the matter to the DC. PIC meetings are held in private and information will be discussed confidentially. 

15.10  When considering relevant issues of adverse health, the PIC may refer the case to a Medical Examiner for consideration and opinion. The Medical Examiner is a suitably qualified practitioner who may, for example, recommend that the registrant should be invited to undergo medical examinations and/or should be invited to give appropriate undertakings, to the PIC (undertakings are described and explained in more detail below). The Registrant will be provided with a copy of the Medical Examiner’s report prior to any PIC decision related to its contents[1]. The PIC will seek the Registrant’s response to the Medical Examiner’s report. The PIC will have regard to the Medical Examiner’s opinion in considering matters. 

The PIC may also have regard to information from other sources (for example, occupational health or other workplace assessments) when considering cases – copies will be sent to the Registrant[2] and the PIC will seek and consider the Registrant’s response to them as part of its investigation and decision making. Generally speaking, medical records are not supplied directly to the PIC, but will go directly to the Medical Examiner if needed. Any confidential information will only be considered by those who specifically need to do so. Where relevant the Medical Examiner may refer to information contained in the medical records as part of any opinion they provide to PIC.

[1] In exceptional cases, redactions might be made to the Medical Report (and other documents) before sending to the Registrant, for example if there is a concern that the Registrant’s health might be adversely affected by reading certain parts of the document in question.
[2] Please see footnote above regarding potential redactions.

What the PIC can decide to do when it is considering a Registrant’s adverse health in the context of a professional conduct concern

15.11  Once the PIC has investigated a case, it may decide in light of all relevant circumstances, including the Registrant’s health, that it is not in the public interest to refer the case to the DC, at least at that time. The PIC may then consider whether to adjourn consideration of the case for a specified period of time.

15.12  In these circumstances, the PIC may also take reasonable steps to protect the public interest. In doing so, it may invite the Registrant to participate in the health protocol, which might include, for example, inviting the Registrant to:

• undergo medical examinations, assessments, or tests (for example, within a particular timeframe or at specific intervals) which may be at their expense;
• provide medical reports to the PIC (or allow such reports to be sent to the PIC by the relevant medical practitioner) which may be at their own expense;
• undertake a course of treatment recommended by a medical practitioner at their own expense; and/or
• give undertakings to the PIC

This is not an exhaustive list.

15.13  As noted above, if the PIC decides that the public interest can be protected by doing so, it may invite the Registrant to give undertakings. Any such undertakings must be proportionate, targeted, workable and measurable. The types of possible undertakings may include, for example (this is not an exhaustive list):

• undergoing treatment by the Registrant’s treating clinician at their own expense;
• supervision by a medical supervisor appointed by the RCVS. The medical supervisor will not be the Registrant’s own treating clinician;
• supervision by a workplace supervisor appointed (or approved) by the RCVS, who may be a suitable colleague in the same practice;
• specific undertakings to address concerns identified by the RCVS or the medical supervisor, for example, relating to the Registrant’s practice or the specific facts of the case;
• undertakings allowing the sharing of information between relevant persons, for example the Registrant’s treating clinician, employer, medical supervisor or workplace supervisor and the RCVS; and,
• submitting to blood, urine or other medical tests at particular times/and or intervals, with the results to be provided to the RCVS for consideration by the PIC.

15.14  An undertaking is a formal promise given in writing and signed by the Registrant. A breach of an undertaking may of itself amount to disgraceful conduct in a professional respect. A breach may also lead to other matters being referred to the DC, such as any original underlying complaint that led to the RCVS investigation. A Registrant who is invited to give undertakings will be reminded that breach of an undertaking could result in referral of that breach to the DC, and that the original concerns considered by the PIC may also be referred to the DC at the same time. The Registrant will be encouraged to seek advice from their legal advisers or indemnity insurers, if appropriate, so that the Registrant has the opportunity to satisfy themselves that they properly understand the nature and implications of what they are signing. 

15.15  When monitoring a held-open or adjourned case, the RCVS adopts a proactive approach to ensure compliance with undertakings. This involves regular liaison between the RCVS, usually a Disciplinary Solicitor, and any relevant individuals, such as a medical supervisor or workplace supervisor. The PIC may also direct, where appropriate, that any reports, test results or similar documents should be submitted and considered by the “Health Sub Group” which comprises a lay and a veterinary surgeon member of the PIC and Chair of PIC, or by a full meeting of the PIC.

15.16  A held-open or adjourned case may be further held open or adjourned by the PIC for as long as it is considered to be necessary in the public interest. Monitoring will be carried out until such time as the PIC considers that the case may be closed or that it should be referred to the DC. In any event, the PIC will formally review individual cases at least once every 12 months.

15.17  On some occasions the PIC, having investigated a concern and having considered any relevant adverse health concern, will nevertheless decide to refer a Registrant to the DC. This will happen if the PIC considers that the concern is so serious that referral to the DC is necessary in the public interest notwithstanding any relevant adverse health concerns.

What happens if a Registrant does not cooperate with the PIC in relation to health-related concerns, or where undertakings are breached, or where further matters arise?

15.18  A failure to cooperate with the PIC, or a breach of undertakings, could each amount to serious professional misconduct. The PIC may refer such cases to the DC, with or without the original case that was considered by the PIC.

15.19  If additional matters, for example, concerns arising from information provided in compliance with undertakings, further conviction(s) or matters potentially amounting to serious professional misconduct come to the attention of the PIC during the course of its management of a held-open or adjourned case, the PIC may decide to refer all or any cases to the DC, following any additional investigation that is considered necessary.