Brief Summary

The hearing focused on issues relating to record keeping, communication with clients, and the administration of an unknown substance to racehorses.

Dr. Van Arem owns the Toronto Equine Hospital (TEH), is licensed with the Alcohol and Gaming Commission of Ontario (AGCO) and subject to the rules of racing. Dr. Vatcher is also licensed with AGCO and works at the TEH. In this matter, Dr. Vatcher was the client’s primary veterinarian until Dr. Van Arem took over in September 2018. The complainant in the matter is a horse owner with horses stabled at Woodbine Racetrack.

Allegations of Professional Misconduct

Dr. Van Arem

• failed to make or keep proper records required by the Regulation 
• failed to maintain the standard of practice of the profession 
• an act or omission relevant to the practice of veterinary medicine that, having regard to the circumstances, would be regarded by members as disgraceful, dishonourable or unprofessional

Dr. Vatcher

• failed to make or keep proper records required by the Regulation 
• failed to maintain the standard of practice of the profession 
• an act or omission relevant to the practice of veterinary medicine that, having regard to the circumstances, would be regarded by members as disgraceful, dishonourable or unprofessional 
• failed to discuss or disclose his proposed or likely professional fees in advance of providing veterinary services

Decision

The Panel found the members engaged in professional misconduct in failing to keep proper records as required by the Regulation.  Further, the Panel found the members engaged in professional misconduct in that their conduct would be regarded by members as disgraceful and dishonourable.  In addition, Dr. Vatcher failed to communicate fee estimates to his clients and/or failed to document any such communication and failed to provide evidence of informed consent for procedures.

Penalty

Dr. Van Arem

• Reprimand
• The member’s licence is suspended for one month, served during the racing season at Woodbine Racetrack.
• Completion of a half-day assessment to evaluate the member’s knowledge regarding professional fees and record-keeping.
• Completion of the College’s learning module on informed client consent.
• Completion of the College’s learning module “Foundations for medical record keeping – Food Producing Animals, Equine and Poultry” 
• Completion of a half-day assessment on knowledge following the completion of the conditions
• Completion of four unannounced record reviews.
• The member must pay costs to the College of $24,634.95.

Dr. Vatcher

• Reprimand
• The member’s licence is suspended for two months, served during the racing season at Woodbine Racetrack.
• Completion of a half-day assessment to evaluate the member’s knowledge regarding professional fees and record-keeping.
• Completion of the College’s learning module on informed client consent.
• Completion of the College’s learning module “Foundations for medical record keeping – Food Producing Animals, Equine and Poultry” 
• Completion of a half-day assessment on knowledge following the completion of the conditions
• Completion of four unannounced record reviews.
• The member must pay costs to the College of $36,449.92.

Panel's Reasoning

Fees & Record Keeping

The Panel found both members’ practices were woefully deficient. In many instances the records were missing key pieces of information to ensure continuity of care and the safety of the horses. The members failed to abide by basic record-keeping requirements.

The deficient records led to problems with confirming informed consent and client discussions about care, treatment management and costs.  The medical records must adequately reflect treatment, communication with clients, medications, and fees. The records must also be easily accessible and available in case another veterinarian or clinic needs to access them. Failure to do so puts the animals at risk and makes it challenging to justify a treatment or procedure.

The Panel noted the members minimized the problems with their record keeping. While they admitted to the misconduct, they did not seem to grasp the significance of the behaviour. The Panel concluded it was appropriate to impose a sanction that would make it clear their conduct was not appropriate, and it could have had negative consequences for animals in their care.

A client must be aware of the potential cost of a procedure or service before they are able to provide informed consent. Failure to communicate fee estimates and/or failure to record any such communication in the patient’s records is problematic. While the Panel accepts it may not have been necessary to provide an estimate for routine medications or procedures, Dr. Vatcher should have communicated clearly about treatment or services outside of the normal care plan.

 Veterinarians are required to get informed consent from owners before completing any procedure. Any verbal communication with the owner or agent must be recorded in the medical record with a summary of the communication between client and veterinarian. The members indicated they had informed consent documents but could not produce them. The Regulations require that all medical records must be kept for five years. The Panel concluded either the signed informed consent forms never existed, or the members failed to keep the medical records in accordance with Regulation. Both are serious failures.

Use of Pre-Race Explosion

Following review of the evidence, the Panel was not satisfied Dr. Vatcher had administered the pre-race substance on the clients’ racehorses. The Panel was troubled by the reliability of much of the evidence. The Panel found Dr. Vatcher’s evidence to be reliable as he admitted he accepted the pre-race substance from the client on more than one occasion and he acknowledged that he allowed the client to believe the substance was being administered. The Panel also found the veterinary technician to be credible and she indicated she would have noticed an illicit or unknown substance in Dr. Vatcher’s vehicle. The Panel was not satisfied that Dr. Vatcher was more likely than not to have administered the Pre-Race Explosion as alleged.

In summary, the Panel found both members engaged in dishonourable and unprofessional conduct. Their record keeping shows a serious and persistent disregard for their professional obligations. As experienced members of the profession, they knew or ought to have known their record keeping fell below the standards.

The Panel found Dr. Vatcher’s actions regarding the pre-race substance would also be regarded by members of the College as dishonourable and unprofessional. Dr. Vatcher should have advised the client he would not (or could not) administer the Pre-Race Explosion.

Penalty: The brief suspension, reprimand and remedial terms will satisfy the principles of penalty, including protecting the public and deterring the members and the other veterinarians from engaging in this conduct in future. The Panel included a provision to allow for unannounced inspections of the members’ records so there is ongoing oversight and public protection.

The Panel was satisfied the penalty is in-line with case law from this College and other regulated health colleges. The Panel reviewed several cases which indicated a suspension is reasonable with findings of misconduct relating to record-keeping.

Costs: In determining whether to order costs, the Panel considered the seriousness of the misconduct, the relative success of the College in proving the bulk of the allegations, the length of the hearing, and the need for a fully contested hearing.  A full hearing was required because the members chose not to admit to the relevant underlining facts and minimized their misconduct. The Panel was satisfied this was an appropriate case for cost. 

The Panel ordered Dr. Van Arem to pay $24,634.95 in costs and Dr. Vatcher to pay $36,449.92 in costs, as there were more allegations that needed to be prosecuted against him.  

The members appealed the matter to Divisional Court. The appeals were dismissed. The Courts directed the members to pay an additional $5,000.00 in costs.