The Bella Moss Foundation's response to It Shouldn't Happen at a Vet's

The BBC recently aired a Panorama program called It Shouldn't Happen at a Vet's. (For the next few days you can see this program here.)

The following is a letter from The Bella Moss Foundation in response to the program:
The BBC’s programme on Medivet (It Shouldn’t Happen At A Vet’s) not only made grim watching for all of those who care about the health and welfare of companion animals, but  confirmed for those of us who have had bad experiences from their services that the issues go far deeper than isolated incidents of poor care or small-scale fraud.

In declaring our interest, The Bella Moss Foundation was created in 2005 after Bella, a 10 year-old Samoyed, became the first publicly reported canine death from MRSA. The Hendon branch of Medivet was intimately involved in that case and two of the vets there were the subjects of complaints and investigated by the RCVS. The complaints were not upheld because they concerned clinical issues rather than issues of professional behaviour. The Bella Moss Foundation provides support and information to pet owners and collaborates with the Veterinary profession on training for vets and vet nurses and with the Government on animal welfare policy.

1. With regard to trainee nurses, and in response to the criticism that unqualified staff undertook clinical procedures, the Medivet website attempts to reassure owners that a structured training programme for unqualified staff is in place. However, the programme clearly contradicted a key element of the website statement because the responsible vet - the one supposed to be providing the guidance and supervision to the trainee in inserting a catheter - was so unconcerned or unaware that they were not even present: and this is supposed to be the professional clinician responsible for the procedure. One has to ask where the RCVS is on this one. Furthermore, the attempt by an unqualified trainee to train another trainee in a technically difficult clinical procedure without proper supervision appeared to be done so casually as to show that this could not have been an isolated incident. What was seen in the broadcast demonstrated that even if there is a structured programme of training within the system, it is treated with contempt by the staff at Hendon, one of its flagship practices. How reassuring this must be to owners having their pets treated there.
2. Whilst it was appalling to see the conditions in which animals were kept at the Watford practice during the building work, it perhaps should not really surprise anyone. Maximising income cannot allow for practices to close during such times, even though the effect on animals already in strange and unsettling conditions cannot be calculated. However, this has les importance to the organisation than making sure the money keeps coming in. In addition, although  it may say on the Medivet website that ‘We seek to charge a fair fee for what we do.’, it is beyond coincidence that the undercover reporter filmed the only occasion that Medivet staff defrauded an insurance company or used half a bag of blood but billed for the whole. For the first, as the voice said on the soundtrack, this was ‘clever’, and too considered to have been thought up on the spur of the moment. Therefore, it is hard to believe it was just an isolated episode. As for the blood, Mr Levy, himself a very senior partner in the organisation, decided not to discard the unused blood but to keep it for further use if necessary and still bill for it. This is the reprehensible bit, and it begs the question; how many other times have these things been done without cameras present? Well, probably many and perhaps the RCVS should take another look at Mr Levy’s practice.

The Medivet philosophy is clearly stated on the website where, in addressing prospective partners, it speaks of ‘...avoiding referring... valuable source(s) of...practice revenue to referral hospitals’).In other words, if we keep the patient in the system, whatever their clinical need, we keep the money in the system.  We can believe that not only have Medivet vets manipulated bills in order to maximise income, they have, and will continue, to discourage owners from taking pets to specialist referral hospitals in order to prevent the money leaving the system. This is a clear example of how the Medivet philosophy puts the income of partners above the welfare of its patients and the requirements of the RCVS who, in addressing our complaint about the care received by Bella at the Hendon practice specifically criticised the statement on the website and the philosophy it espouses; yet there it remains, just as important.

1. The comments on the website concerning Kafir Segev are intriguing; the statement on the website expresses ‘disappointment’ in his conduct; but then it is clear that Medivet’s concern was only because they had been notified by Panorama that Segev was acting as a vet after being struck from the register and not for anything else. This clearly indicates two things; 1) that no significant oversight of his work took place and he was pretty much left on his own to do what he wanted, (hardly a way of helping him with his ‘rehabilitation’) and 2) that his behaviour in twirling animals through the air whilst administering injections was not worthy of note (unless, of course, this is accepted veterinary practice – but at Medivet it may well be). The reality is that anyone who had been on the receiving end of his, at times appalling, practice would not have been the least surprised with what he was found to be doing both clinically and professionally.
2. Lastly, along with the Government, the RCVS has to look long and hard not only at the general regulation of vets, but also at the status and regulation of veterinary nurses. Vets at present are supposed to take responsibility for their staff, but there is no sanction if they do not, and clinical incompetence cannot be dealt with unless it constitutes ‘disgraceful professional conduct’ whatever that is.  As one vet put it to us, “A vet can treat your pet appallingly, but unless he lies about it there’s actually very little you as an owner can do.” This really has to change because being clinically competent ought to be just as important as being truthful and honest.

As for nurses in vet practices, improvement would begin by adopting the model of registration and regulation used in Nursing, and by giving the title Veterinary Nurse statutory recognition. To anyone who has qualified as either a veterinary nurse or human health nurse, the ‘title’ trainee nurses is disingenuous - a trainee nurse in this context is a care support worker by any other name and should not have access to the designation ‘nurse’: and, whilst there is at present no definitive list of duties that such staff may undertake, there should be a list of things they should not, under any circumstances, perform; and invasive clinical procedures should be at the top of that list.

Was the programme sensationalist? Yes; was it accurate? Within the context of the programme, yes; does it harm the veterinary profession? As a whole probably not, but it does tell us there is something seriously wrong with the corporate approach to the provision of veterinary care in the UK and with the regulation of professional vets and their staff.

Those wishing to refresh their memory of Medivet’s responses should go to; http://www.medivet.co.uk
For Bella’s story www.thebellamossfoundation.com

Jill Moss, President; Mark Dosher, Secretary; The Bella Moss Foundation
Footnote from Jill Moss

Jill Moss in 2009 discovered that Kafir Segev after being struck off by the RCVS was still working without an appeal in place. At that time Panorama approached Jill to be involved in the programme. Jill declined, but helped the panorama team prepare to film Kegev undercover at the Stanmore practice and Jill Moss is glad that he is no longer working as a vet but she is very  disappointed in the RCVS’s decision to not take action against him in 2004 when the original complaint re Bella’s clinical care was investigated. In Jill Moss’s opinion it is the staff at the Hendon Medivet practice that refused a critically ill Bella to an outside specialist that allowed the MRSA to become systemic and fatal. BMF sees animals with serious infections recover successfully with early treatment. Medivet denied this and Jill Moss holds Medivet entirely responsible for Bella’s death.

Jill Moss would also like to state that in the 8 years of being a medivet client her insurance company paid out over £40,000.00. Whereas other vets BMF now knows through our work would have charged a small proportion for the same conditions diagnosed.