NEWS AND VIEWS
A unique role of care VCNZ’s Seton Butler discusses the legal and other requirements of consultant veterinarians. A ‘CONSULTANT VETERINARIAN’ is a veterinarian who provides a limited range of veterinary services, often treating a particular type of clinical case. They are not uncommon in production animal medicine. A ‘clinical case’ in herd health is concerned with the morbidity patterns of common disease complexes as they relate to a group of individuals (the herd), for example, mastitis, lameness and reproductive disorders. This context is important because consultants need to be clear on the conditions and cases they consult on, as this affects their responsibilities under the Code of Professional Conduct. For example, a production animal consultant may advise on reproduction services, which in many cases consider lameness, nutrition and disease complexes such as milk quality (the incidence and cause of mastitis) due to their significant potential impacts on cycling and conception rates. The code’s expectations of consultancy services in relation to conduct are very specific. Veterinarians must: a) ask the client who their usual general veterinary practitioner (GVP) is b) ask the client for consent to contact this veterinarian and share relevant information while treating the animal(s) c) only authorise the use of restricted veterinary medicines for specific clinical matters they have consulted on d) arrange for 24 hour emergency care in relation to the matters consulted on. Given clients’ propensity to use the services of more than one veterinarian, I believe the onus is on consultant veterinarians to ensure they outline their involvement and the scope of the
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services they’re providing to the other veterinarians involved. It should be evident that it is in the best interests of the owner and the animals that the GVP is kept fully informed on the veterinary care provided. Cooperation will improve the veterinary care of animals as well as help manage any potential risks of treatment. Identify a GVP: Are they the veterinarian who makes the most visits to the farm? or treats the most animals? or authorises the most restricted veterinary medicines (RVMs)? Where this is unclear it may be prudent to ask the owner to assign a GVP. If they would prefer not to, the veterinarians should find a way to work together. It is worth stressing that a client’s decision to decline point b) does not prevent services being provided, but this should be noted in the clinical records. It is important here to explore the treatment risks. The code states that: Farmers should not have any RVM on their farm unless the RVM is linked to a current and valid authorisation. To help farmers, veterinarians must provide information about the products they authorise, and consider what products are already on the farm before authorising more. Before authorising RVMs for future supply, veterinarians should request and review information from the farmer about what stocks of products are already on farm, and the expiry dates of that stock. A consultation should include a review of RVMs being used on farm and their stocking levels, and a check that the owner has a valid authorisation. It should also consider the implications of
concomitant use and potential residues in food-producing animals, and confirm that the products being administered are supervised appropriately. (I suggest that this include RVMs that the consultant has authorised and how they overlap with those authorised by another veterinarian.) Point c) above ensures that a consultant has their client’s consent, and enough information, to provide advice on the cases they are consulting on. This has specific implications under the Agricultural and Veterinary Medicines Act 1997 that include, among other things, the competence of the RVM users, managing adverse events related to RVMs, and ensuring all necessary information is provided to the person authorised to use the RVM. Interestingly d) is the same but different, in that when a consultant veterinarian undertakes a veterinary consultation they remain responsible for making provision for continuous emergency care in relation to the matters they have consulted on. This overlaps with the adverse event reporting responsibilities of an RVM. They can, however, make specific arrangements with colleagues in the area to provide emergency care eg, a nutritional consultant warns the GVP of ruminal acidosis risk with using high starch supplements. Being geographically distant from a client does not absolve a consultant veterinarian from the need to provide emergency care, and there may be a greater need to communicate with the client’s GVP. This communication also helps with follow-up veterinary care they need to provide.
