Disciplinary Committee reprimands one vet and suspends another for clinical failings

The RCVS Disciplinary Committee has reprimanded one veterinary surgeon and suspended another for four months, following a joint hearing regarding their professional conduct while they were in practice in Slough, Berkshire in August 2016.

The hearing for Javier Salas Navarro MRCVS and Roman Kristin concluded on Wednesday 11 December having initially commenced on 7 January 2019 with hearings taking place in January, March, September, November and December covering 35 days.

The charges against Dr Navarro concerned his treatment of a kitten named Marnie. The charges (which can be found in full in the Committee's decision) include:

• On 5 August 2016 failing to read the anaesthesia consent form in relation to a surgical spay he performed;
• On 9 August 2016, when Marnie was readmitted for surgery, failing to read the anaesthesia consent form, failing to undertake adequate assessment of Marnie’s condition; performing surgery without adequately considering her condition; subjecting Marnie to anaesthesia without recognising the seriousness of her illness; failing to obtain informed consent from the owners; administering medication which was contra-indicated; and failure to make an adequate record of his involvement in Marnie’s care.

The charges against Dr Kristin (which can also be found in full in the Committee's decision) also related to his treatment of Marnie. These include:

• his failure on 8 August 2016 to undertake an adequate assessment of her condition; failure to recognise and record the fact that Marnie could not pass urine; failure to refer or offer her for specialist treatment; and failure to ensure Marnie received care and treatment overnight;
• on 9 August 2016, when admitting Marnie for surgery, he made a number of clinical mistakes including failure to gain informed consent; and failure to recognise the seriousness of her illness;
• that overnight from 9 to 10 August there were a number of failings in relation to Marnie’s care, including failure to arrange adequate overnight care, failure to monitor and record her condition, and failure to gain informed consent for the overnight care;
• that on 10 August 2016 he failed to advise Marnie’s owners that he suspected her uterers had been ligated during the spay, failed to advise Marnie’s owners that she required specialist veterinary treatment; and advised that Marnie undergo further surgery at the practice in spite of this meaning her having to undergo further anaesthesia in a week and with poor chances of survival;
• that the above conduct was misleading and dishonest.

The Disciplinary Committee found a number of the facts in the charges against both Dr Navarro and Dr Kristin proven (the full details can be found in the Committee's decision documentation).

“As a direct result of Dr Kristin’s acts and omissions, Marnie was left alone overnight on fluids when those fluids had nowhere to go. Had he done his job properly he would have known that and Marnie could have avoided the prolonged suffering caused by the chosen course of treatment that did not address the underlying condition. Every element of Dr Kristin’s behaviour was catastrophic for Marnie, and yet he took no personal responsibility for her welfare and just went home,” Stuart Drummond, chairing the Committee and speaking on its behalf. 

In summary, the Committee found that Dr Navarro breached a number of aspects of the Code of Professional Conduct for Veterinary Surgeons including: making animal health and welfare the first consideration when attending to animals; the provision of appropriate and adequate veterinary care; responsible prescription, supply and administration of medicines; communication with professional colleagues to ensure the health and welfare of the animal; being open and honest with clients and respecting their needs and requirements; effective communication with clients; keeping clear and accurate clinical records; and working with the veterinary team to coordinate the care of animals.

Of the proven charges, the Committee found that his initial failure to read Marnie’s anaesthesia consent form on 5 August did not amount to disgraceful conduct in a professional respect, but that the repetition of this failure on 9 August did amount to disgraceful conduct. It also found that Dr Navarro’s failure to undertake adequate assessment and perform surgery without this assessment amounted to serious professional misconduct. Furthermore, the Committee found that subjecting Marnie to anaesthesia in spite of her being unwell, failure to obtain informed consent and failure to keep adequate records also amounted to serious professional misconduct.

For Dr Kristin, in summary, the Committee found not proven the allegation that he had failed to respond on 5 August 2016 to concerns from Marnie’s owners about her condition while she was recovering from a surgical spay and also all the allegations relating to Dr Kristin’s admission of Marnie to the practice on 9 August on the basis that it was not satisfied so as to be sure that Dr Kristin had been the veterinary surgeon who admitted Marnie on that day.

The Committee found proven the remaining charges and found he breached the following parts of the Code of Professional Conduct for Veterinary Surgeons: making animal health and welfare the first consideration when attending to animals; keeping within area of competence and referring responsibly; providing appropriate and adequate veterinary care; responsible prescribing, supply and administration of medicines; communication with colleagues to ensure the health and welfare of the animal; being open and honest with clients and respecting their needs and requirements; communicating effectively with clients and obtaining informed consent; keeping clear and accurate clinical records; and working with the veterinary team to coordinate the care of animals.

“Although the consequences for Marnie and her owners were clearly devastating, the Committee considered that Dr Navarro’s part in her demise has to be seen in the context of all the evidence. In light of the extensive mitigation, including significant evidence of insight and remediation, the Committee was able to conclude that Dr Navarro did not represent a future risk to animals or the public. In such circumstances, the Committee considered that it was not necessary to restrict Dr Navarro’s registration and that a reprimand was the appropriate and proportionate sanction in his case,” Stuart Drummond. 

Of the proven charges, the Committee determined that his failure to adequately assess Marnie’s health, to obtain a clinical history, to undertake blood tests and recognise that she was seriously ill, amounted to disgraceful conduct in a professional respect and led to “Marnie’s underlying condition going undetected and undoubtedly contributed to her eventual death two days later”.

The Committee also found that Dr Kristin’s decision to hospitalise Marnie without adequate overnight care, place her on IV fluids without monitoring the treatment or her condition, and failure to obtain adequate informed consent – among other things – amounted disgraceful conduct in a professional respect.

Stuart Drummond, chairing the Committee and speaking on its behalf, commented: “As a direct result of Dr Kristin’s acts and omissions, Marnie was left alone overnight on fluids when those fluids had nowhere to go. Had he done his job properly he would have known that and Marnie could have avoided the prolonged suffering caused by the chosen course of treatment that did not address the underlying condition. Every element of Dr Kristin’s behaviour was catastrophic for Marnie, and yet he took no personal responsibility for her welfare and just went home.”

Following its findings on disgraceful conduct in a professional respect, the Committee then went on to consider its sanction for both Dr Navarro and Dr Kristin.

In respect of Dr Navarro, the Committee considered the mitigating factors including previous good character, admissions to some of the facts of the case from the outset; genuine insight and remorse into the seriousness of the actions; his youth and inexperience; and relevant and good-quality testimonials from colleagues. The Committee noted that the testimonials were universally positive and demonstrated that Dr Navarro had reflected on his conduct, had become more mature and confident in his practice and made efforts to rectify the areas in which he had fallen below standards.

Stuart Drummond said: “Although the consequences for Marnie and her owners were clearly devastating, the Committee considered that Dr Navarro’s part in her demise has to be seen in the context of all the evidence. In light of the extensive mitigation, including significant evidence of insight and remediation, the Committee was able to conclude that Dr Navarro did not represent a future risk to animals or the public. In such circumstances, the Committee considered that it was not necessary to restrict Dr Navarro’s registration and that a reprimand was the appropriate and proportionate sanction in his case.”

In relation to Dr Kristin, the Committee took into account positive character evidence from Mr Karel Daniel, a semi-retired veterinary surgeon and Vice-President of the Czech Republic Veterinary Chamber, a similar body to the RCVS in that country, as well as other testimonials on his behalf. In mitigation, the Committee considered Dr Kristin’s previously unblemished career, the fact that it was a single case involving a single animal; some development of insight into his conduct; no evidence of repetition; expressions of remorse; the impact of a family bereavement during the course of proceedings; and his financial position.

“The Committee did consider whether to remove Dr Kristin from the Register. However, in light of the mitigation in this case, the fact that this was a single case in an otherwise unblemished career, together with the unlikelihood he would repeat his disgraceful conduct, the Committee decided that, in all the circumstances, to remove him from the Register would be disproportionate," Stuart Drummond

However, the Committee also took into account aggravating factors including a lack of candour from Dr Kristin when he was giving evidence, demonstrated by a tendency to blame others rather than take responsibility, as well as his recklessness in suggesting a third operation on Marnie that was not in her interests, rather than referring her into specialist care.

The final decision of the Committee on the sanction for Dr Kristin was that, given the seriousness of the misconduct, it was satisfied that this warranted a six-month suspension period. However, given the mitigating factors, the Committee decided that four months was appropriate and proportionate.

Commenting on the sanction Stuart Drummond said: “The Committee determined that it was important a clear message be sent that this sort of behaviour is wholly inappropriate and not to be tolerated. It brings discredit upon the respondent and discredit upon the profession and, most importantly, caused harm to Marnie and great distress to her owners.

“The Committee did consider whether to remove Dr Kristin from the Register. However, in light of the mitigation in this case, the fact that this was a single case in an otherwise unblemished career, together with the unlikelihood he would repeat his disgraceful conduct, the Committee decided that, in all the circumstances, to remove him from the Register would be disproportionate.

“The Committee therefore decided to order that the Registrar suspend Dr Kristin’s registration…. The Committee was satisfied that a period of four months was appropriate and proportionate in all the circumstances.”

The full facts and findings from the case can be found at on the RCVS Disciplinary Committee hearings webpage.