… was chatting to a Veterinary Nurse while we watched John Wick suture himself. [“John Wick is a film about embracing classic action movie tropes while simultaneously reinventing them. Its brief scene of self-surgery is no exception.”] I joked that she could do a better job and she recalled that Veterinarians out in rural Victoria would often suture players at the local football match at their request while they happily watched the rest of the match.
My questions are:
1. What provisions would allow or prevent a Veterinarian to practice advanced techniques (basic first aid could be direct pressure and bandage in this context) on humans?
2. How might these relate to the Veterinarians registration and scope of practice?
3. If a patient were to pursue legal action due to iatrogenic injury, would the professional indemnity insurer still provide cover?
I always find it useful to consider extreme circumstances. Consider a major trauma where a person is going to die without active intervention such as suturing to tie off the bleeding artery. The only person there with the skills is a vet. Would there be any law to stop them saving the person’s life? The answer has to be ‘no’ but we can think that in those circumstances the concept of ‘necessity’ and ‘good Samaritan’ legislation would apply if there were any legal repercussions.
Let us then consider the less extreme cases. First the Health Practitioner Regulation National Law works via title protection, not by defining scope of practice. The law stops a person calling themselves a ‘medical practitioner’ but there is no list of skills (such as suturing) that only a doctor or nurse can do.
Equally only a registered vet can hold themselves out as a vet unless they are registered (Veterinary Practice Act 1997 (Vic) s 57). That section also says that it is an offence to ‘carry out any act that is required to be carried out by a registered veterinary practitioner by or under an Act’ (s 57(1)(d)) but there is not a single list of restricted activities. In NSW the Veterinary Practice Act 2003 and Veterinary Practice Regulation 2013 (NSW) list various things that can only be done by a vet, but I’m using the Victorian legislation as that is the jurisdiction referred to in the question.
The first conclusion therefore is that there is nothing in the Health Practitioner Regulation National Law nor the Veterinary Practice Act 1997 (Vic) that rules out the sort of practice that is being suggested. That does not mean it’s a good idea. Vets may be able to deal with all types of animals, and humans are just another type of animal; but clearly vet science and vet practice is not the same as medical practice.
A vet presumably knows about infection control and is probably more used to suturing animals that then run about and fall in a field so he or she may be well qualified and do a good job. But if we assume there are complications then whether a vet would be liable in negligence for injury caused to a person – the footballer in question – would depend on what all the circumstances, including what the footballer knew. If the footballer knew the person was a vet and this was not legitimate vet practice then he or she may be held to have voluntarily accepted the risk.
On the other hand, the test of negligence is whether the defendant’s conduct is reasonable in all the circumstances. The Wrongs Act 1958 (Vic) s 59 says
A professional is not negligent in providing a professional service if it is established that the professional acted in a manner that (at the time the service was provided) was widely accepted in Australia by a significant number of respected practitioners in the field (peer professional opinion) as competent professional practice in the circumstances.
I would suspect that there is not a ‘significant number of respected practitioners in the field’ of veterinary science who would consider suturing footballers at the local match was ‘competent professional [veterinary] practice’ even if they would accept that a reasonably competent vet might take the sort of action required to save a life.
If we turn to the questions:
- What provisions would allow or prevent a Veterinarian to practice advanced techniques (basic first aid could be direct pressure and bandage in this context) on humans?
Remember the general rule that a person can do what they like unless there is a law that says they cannot. There is no law specifically to prevent a vet from using his or her skills to bring a higher level of knowledge and technical skills to the care of a human being. That is not veterinary practice, but people know what they know. They do not commit an offence but they are not medical practitioners and if they cause avoidable harm then their decision to act is unlikely to be accepted as ‘competent professional practice’ by a vet except in extreme circumstances and not where a vet may make it know that he or she is willing to perform the procedures on a regular, rather than emergency basis.
- How might these relate to the Veterinarians registration and scope of practice?
Suturing people or otherwise treating people is not veterinarian practice. It would have nothing to do with ‘scope’ of practice as a vet any more than a doctor or nurse suturing an animal is practicing medicine or nursing.
- If a patient were to pursue legal action due to iatrogenic injury, would the professional indemnity insurer still provide cover?
That would depend on the terms of their insurance policy, but I doubt it. I imagine that the policy applies to professional practice as a vet; and treating people is not veterinary practice.
Somewhat related; as a medical practitioner I have been asked more than once to prescribe for an animal. Recently a vet who was not in the town advised a dog owner see a doctor to prescribe antibiotics for their dog. I suggested the vet could fax a script to the pharmacy and that solved the problem. My usual response is that I’m not registered to treat animals. I reckon that prescribing for animals would be on the list of things that only a vet can do.
Prescribing drugs is the most regulated area of first aid/medicine/vet practice. A vet cannot prescribe medication for a person; a doctor cannot prescribe medication for an animal. Suturing or other measures are a different matter.