VN 14. Client confidentiality

Introduction

14.1 The veterinary/client relationship is founded on trust and, in normal circumstances, a veterinary surgeon or veterinary nurse should not disclose to any third party any information about a client or their animal. This includes information given by the client, or revealed by clinical examination or by post-mortem examination. This duty also extends to support staff.

14.2 The duty of confidentiality is important but it is not absolute and information can be disclosed in certain circumstances, for example where:

• the client's consent has been given
• disclosure can be justified by animal welfare concerns or the wider public interest, or
• disclosure is required by law.

14.3 In addition to the duty of confidentiality, the personal data of clients must be handled in accordance with the General Data Protection Regulation (GDPR) (note that animal data falls outside the scope of the GDPR). Under the GDPR, the disclosure of personal data without consent is permitted where it is necessary for compliance with a legal obligation, or for the purpose of a legitimate interest. Accordingly, the GDPR is not a barrier to the reporting of concerns and suspicions to the appropriate authorities.

14.4 In circumstances where there is no client consent for disclosure and a veterinary surgeon or veterinary nurse considers that animal welfare or the public interest is compromised, the veterinary surgeon or veterinary nurse may report relevant client information to the appropriate authorities. The veterinary surgeon or veterinary nurse will have to decide whether the circumstances are serious enough that disclosure of the client’s information without consent can be justified.

14.5 Whether or not to make a report in any given case is a matter for the professional judgement of the veterinary surgeon or veterinary nurse. There is often no right or wrong answer in cases like these, and the RCVS will support any reasonable decision by a veterinary surgeon or veterinary nurse who genuinely believes they are acting on the basis of animal welfare or the public interest.

14.6 For guidance on client confidentiality in the context of social media please see Social Media and Online Networking Forums.

Consent to disclosure

14.7 Whenever practicable, the client’s express consent to the disclosure should be sought.

14.8 Obtaining consent to the disclosure of personal data in accordance with the GDPR is discussed further below.

14.9 The client’s consent to pass on confidential information about their animal (i.e., information other than their personal data) may be express or implied. Consent may be implied from the circumstances, for example where a client moves to a different practice and clinical information is requested, or where an insurance company seeks clarification or further information about a claim under a pet insurance policy.

14.10 Registration of a dog with the Kennel Club permits a veterinary surgeon who carries out a caesarean section on a bitch, or surgery to alter the natural conformation of a dog, to report this to the Kennel Club.

Disclosing client information to the authorities

14.11 Some examples of circumstances where a veterinary surgeon or veterinary nurse may consider that animal welfare or the public interest is compromised and that relevant information should be reported to the appropriate authorities without client consent may include situations where:

• an animal shows signs of abuse or neglect
• a dangerous dog poses a risk to safety
• child or domestic abuse is suspected
• where a breeder in England has presented litters without possessing a licence to breed, or has breached the licence conditions (where applicable)
• where the information is likely to help in the prevention, detection or prosecution of a crime
• there is some other significant threat to public health or safety or to the health or safety of an individual.

14.12 Generally the decision to disclose to an authority should be based on personal knowledge rather than third-party (hearsay) information. The more animal welfare or the public interest is compromised, the more prepared a veterinary surgeon or veterinary nurse should be to release information to the relevant authority.

14.13 Each case should be determined on the particular circumstances. If there is any doubt about whether disclosure without consent is justified, the issues should be discussed with an experienced colleague in the practice before the information is released. Advice can also be sought from your defence organisation, professional association or the authority to whom you are considering disclosing information.

14.14 If practicable, veterinary surgeons and veterinary nurses should discuss the issues with the appointed senior veterinary surgeon in the practice before breaching client confidentiality.

14.15 Any disclosure should be limited to the minimum amount of information necessary in order to protect animal welfare or the public interest.

14.16 Where a decision is made to disclose client information, veterinary surgeons or veterinary nurses should be prepared to justify their decision and any action taken. They should ensure that their decision-making process, including any discussions with the client or colleagues, is comprehensively documented along with their justification for breaching client confidentiality in this instance. Veterinary surgeons and veterinary nurses may find it helpful to cite relevant paragraphs of the Supporting Guidance in their notes to support their decision-making and may consider adding a photo or video evidence to support their decision.

14.17 Veterinary surgeons and veterinary nurses who wish to seek advice on matters of confidentiality and disclosing confidential information are welcome to contact the RCVS Professional Conduct Department on 020 7202 0789. However, there is no requirement to seek permission from the RCVS before making a disclosure and we do not need to log such calls. The RCVS will support any reasonable decision by a veterinary surgeon or veterinary nurse who genuinely believes that the disclosure of client information without consent is justified.

Animal welfare concerns

14.18 Disclosure may be justified where animal welfare is compromised.

14.19 Animal welfare may be compromised where, for example, there is a suspicion of animal abuse, an animal appears to have suffered neglect, or a client has failed to attend follow-up appointments.

14.20 When a veterinary surgeon is presented with an injured animal whose clinical signs cannot be attributed to the history provided by the client, they should include non-accidental injury in their differential diagnosis. ‘Suspected Abuse of Animals and People’ provides guidance for the veterinary team on dealing with situations where non-accidental injury is suspected.

14.21 Where animal welfare concerns arise, in the first instance, where appropriate, the veterinary surgeon or veterinary nurse should attempt to discuss their concerns with the client, provided the delay does not compromise animal welfare. Where follow-up appointments have not been attended, it is also sensible to check that requests for clinical records have not been received as this may indicate that the client has sought veterinary attention elsewhere.

14.22 In cases where a discussion with the client is not possible or would not be appropriate, or where the client’s response increases rather than allays concerns, the veterinary surgeon or veterinary nurse should consider whether the circumstances are sufficiently serious to justify disclosing their client’s information without consent. If so, a report should be made to the relevant authorities:

• the RSPCA (Tel: 0300 1234 999 - 24-hour line) in England and Wales
• the SSPCA (Tel: 03000 999 999 – 7.30am to 9pm) in Scotland
• the Animal Welfare Officer for the relevant local authority in Northern Ireland.

14.23 Such action should only be taken when the veterinary surgeon or veterinary nurse considers on reasonable grounds that an animal shows signs of harm (including abuse and/or neglect), or is at real and immediate risk of harm, which extends to other animals within the client’s care or that they are responsible for – in effect, where the public interest in protecting an animal overrides the professional obligation to maintain client confidentiality, and the legitimate interest in disclosing the client’s personal data overrides the client’s rights to the protection of their personal data.

14.24 Where an animal is already deceased, there can be no immediate risk of harm and as such the animal welfare justification does not apply in this situation. However, veterinary surgeons and veterinary nurses can and should give consideration to the risk to other animals within the client's care.

14.25 Where an animal is already deceased, a disclosure to the authorities may still be appropriate in the wider public interest.

14.26 Veterinary surgeons may decide to retain cadavers for post-mortem examination purposes in cases where client information is disclosed to the relevant animal welfare authority.

Child and domestic abuse

14.27 Given the links between animal, child and domestic abuse, a veterinary surgeon or veterinary nurse reporting suspected or actual animal abuse should consider whether a child or adult within that home might also be at risk. Suspicions of abuse may also be triggered by a separate issue arising out of the relationship with the client.

14.28 Veterinary surgeons and veterinary nurses are not expected to be experts in abuse, but they can use their professional judgement to determine whether the appropriate authorities should be informed. In all cases, the situation should be approached with sensitivity and the impact of any disclosures to the authorities should be considered carefully.

14.29 Where there are concerns that a child is at risk, the veterinary surgeon or veterinary nurse should consider seeking further advice (on an anonymous basis initially if needs be) or making a report to the appropriate authority, for example:

• the NSPCC (Tel: 0808 800 5000 / NSPCC - Reporting Child Abuse)
• the local child protection team; or
• the police.

14.30 Where a disclosure of domestic abuse is made to a veterinary surgeon or veterinary nurse a report should only be made to the appropriate authorities if the victim agrees. If the victim does not agree to the matter being reported, then the veterinary surgeon or veterinary nurse should encourage the victim to approach agencies or organisations through which they can seek help.

14.31 For further information and practical guidance, which can be cited in the veterinary surgeon or veterinary nurse’s notes to support their decision, please see:

• the Links Group guidance ‘Suspected Abuse of Animals and People: Guidance for the veterinary team’ (The Links Group Homepage) and, in particular, the Links Group ARDR protocol for dealing with suspected animal or domestic abuse.

Prevention, detection or prosecution of a crime

14.32 Disclosure of information may be justified where it is necessary for the prevention or detection of an unlawful act and necessary for reasons of substantial public interest. This may include criminal activity, allegations, investigations, and proceedings.

14.33 The police are most likely to request information using this exemption, but practices may receive similar requests from other enforcement agencies with a crime prevention or law enforcement function, such as the RSPCA/SSPCA.

14.34 This exemption does not cover the disclosure of all information in all circumstances and there are limits on what can be released. The exemption allows the release of information for the stated purpose only and only if obtaining consent for releasing the data would prejudice the purposes of preventing or detecting unlawful acts.

14.35 This exemption does not necessarily mean that disclosure should be undertaken. In all cases the authority to release information under the data protection laws has to be considered alongside the duty of confidentiality.

14.36 The decision to disclose information in these circumstances can be complex and often falls to the judgement of the veterinary surgeon or veterinary nurse. Disclosing client information without consent requires serious consideration and a full understanding of the circumstances.

14.37 Before considering whether to release information, the veterinary surgeon or veterinary nurse should:

• ensure the request is in writing so you know who is making the request. The request should be signed by someone with sufficient authority.
• check whether the person asking for the information is doing so to prevent or detect a crime or apprehend or prosecute an offender.
• consider whether a refusal to release the information will prejudice or harm the prevention or detection of a crime or the apprehension or prosecution of an offender.
• ask the authority or organisation seeking the information if the individual has been approached for their consent. If the answer is no, consider whether it is practicable to obtain the client’s consent directly. It may not be appropriate to do so where seeking consent would be likely to undermine the purpose of the disclosure.
• question any requests for excessive or apparently irrelevant information.
• be aware that any disclosure should be limited to the minimum amount of information necessary, in line with the Data Protection Act 2018.

NB: This is not an exhaustive list and further guidance is available from the Information Commissioner’s Office.

14.38 If a disclosure is made, veterinary surgeons and veterinary nurses should make a record of this and the reasons for the decision and the authority requesting the information.

14.39 If a veterinary surgeon or veterinary nurse has genuine concerns about whether disclosing information in these circumstances without client consent is justified, the authority requesting the information may apply for a court order requiring disclosure of the information.

Dealing with suspected illegal imports

14.40 Veterinary surgeons and veterinary nurses may be presented with animals which they suspect have entered the UK illegally, for example, animals may be presented:

• without the necessary paperwork
• with paperwork that appears to be fraudulent or does not comply with pet travel rules
• without rabies vaccination requirements having been met.

A foreign microchip is not necessarily evidence that an animal has been imported illegally. The microchip may have been purchased and implanted in the UK or the animal may have been legally imported into the UK and re-homed.

14.41 In cases of suspected illegal imports there is no legal or professional obligation to inform the authorities, but veterinary surgeons and veterinary nurses may choose to do so in the public interest. Ultimately, the decision to report is for the individual professional following the general guidance on client confidentiality above.

14.42 In cases where the client has bought the animal from a breeder or other seller in good faith, oblivious to the origins of the pet, the rules of pet travel and the implications for them as the owner (e.g. potentially seizure and the cost of quarantine), veterinary surgeons and veterinary nurses may wish to encourage the client to make the report themselves. This is because the client will have the details of the breeder or seller and is likely to have first hand evidence to present to the authorities.

14.43 In Greater London, reports should be submitted to the City of London Animal Health and Welfare Team on 020 8745 7894 (further details are available on the City of London website). Outside of London, reports should be submitted to the local Trading Standards office. General information on the pet travel scheme can be found online.

14.44 While there is no legal or professional obligation to report illegal imports, there is a legal obligation where rabies is suspected. Suspecting that an animal has been illegally imported is not the same as suspecting it has rabies.

Disclosures required by law

14.45 Veterinary surgeons and veterinary nurses must disclose information to satisfy a specific statutory requirement, such as notification of a known or suspected case of certain infectious diseases. Further information on notifiable diseases in animals is available on the UK government website. Rabies is one of the notifiable diseases that must be reported to the Animal and Plant Health Agency (APHA), even if there is only a suspicion that an animal may be affected.

14.46 Where such a statutory requirement exists, a client’s consent to disclosure is not necessary but where practicable the client should be made aware of the disclosure and the reasons for this.

14.47 If a disclosure is made, veterinary surgeons and veterinary nurses should make a record noting the reasons for their decision and that disclosure is necessary for compliance with a legal obligation.

General Data Protection Regulation (GDPR)

14.48 The GDPR permits the processing of personal data where it is necessary for compliance with a legal obligation or for the purpose of a legitimate interest (except where the interests or fundamental rights and freedoms of the relevant individual override this). The processing of special category data (e.g. relating to the individual’s health or ethnic origin) is more restricted: in this context it could be disclosed where necessary for reasons of substantial public interest, for example to:

• prevent or detect unlawful acts
• protect the public against dishonesty, or
• prevent fraud.

14.49 Accordingly, the GDPR is not a barrier to the reporting of concerns and suspicions to the appropriate authorities.

14.50 Where the client’s permission is being relied upon to make a disclosure, the client’s permission to pass on their personal data must be express, specific and informed. Express permission may be either verbal or in writing, usually in response to a request, but if given verbally, a written note should be kept.