Sunday, March 18, 2012

Careful with the Test Tubes, Folks. Ol' Dagget's Lurking About....

Science or Art in Farriery:

 Are They Really Compatible in a Litigious World

Kirk Adkins (in his distinctive hat), Resident farrier: UC/Davis, circa 1993
[image: ajuell]

Seems to be a lot of discussion of late in farriery circles concerning certification, therapeutic principles and techniques -- maps, charts, blueprints on what might or might not constitute competency; proper medical protocol, liaison with other professionals, consistent nomenclature in the workplace...hell, whether it is ethical to warm up a burrito in a gas forge. You know, cross-contamination issues.  Science on the march once again.  Now don't get me wrong.  Science is good.  Research is good.  Cooperation among professionals is good.  Thorny sometimes, but still good.

Part of these debates surround the age-old search for standardization in a business that has few rules and probably doesn't need that many anyway.  That does of course fly in the face of the declared premise behind these trade certification programs, but concurrently may also represent the Achilles heel of any such program.  To be clear, it is a system of self-certification based on what can best be described as an educational system that runs the gauntlet from good to sub-standard, most, if not all offering no accepted mainstream credentials to the student/graduate.  Yes, there are exceptions.  And before you start yelling heresy, let me also say that today's system is a vast improvement over what the previous decades were able to offer.  Better, but still lacking.  And no, not on the day to day skills necessary to shoe a horse adequately or even exceptionally, but the overall reality needed to confront those assumptions accompanying that simple piece of paper:  the certificate.  These are rarely taught and often not even acknowledged.  Why?  Because the ground beneath these issues tends to liquefy in the presence of our legal system. 

Academic medicine (the veterinary variety), is an excellent place to begin a discussion.  Our mutual professions very often rub elbows, perhaps more than we should at times, but we still run in the same circles.  Having some experience in a teaching college (both UC/Davis & WSU) the former in the capacity as a resident farrier (interim), I have observed the development of that profession first hand.  It is long, difficult, complicated and as thorough as possible -- and accredited by the state.  My point here is not to argue the merits of a superior educational system.  That is obvious and not under debate.  My point instead is the nature of the work I performed under the auspices and protection of a teaching hospital in the university system.  Which means I performed very complicated tasks, aided or implemented procedures, conducted surgery (sorry, but if it bleeds, that's surgery), and a host of activities well beyond my job description or personal comfort zone; ethically speaking here, and in relation to the outside, real world.  A world where the only protection you have is common sense and integrity.  Or maybe a lawyer of your own.  The key word here is protection.  I operated under the umbrella of the Veterinary Department.  That allowed a certain degree of perceived (another tricky word), immunity.  It should also be noted here that most teaching hospitals are also the institutions of last resort.  Meaning we get more hopeless cases than hopeful ones and are bound (ethically and legally) to treat these cases.  I'm sure your imagination can extrapolate that sorry scenario into what it was like some days. 

I also worked extensively under both ASHA and FEI rules and additionally was licensed to work on the tracks.  Not terribly important, but different rules and jurisdictions can and will dictate the parameters of how you conduct your business.  This is because these rules, limitations and forced adaptations are your responsibility when it comes to compliance.  And in the end, you are the ultimate insurer of certain potential outcomes you might not even be aware of at the time.  A few examples:  I once contaminated a horse on race day with Lidocaine.  Casual transfer.  Another time I refused to work on a jumper at a show. I was called into the Steward as I was listed as the 'official farrier.'  I had the ability to make the horse visually sound, but I also knew if I did, this would be the horse's last show. And finally, perhaps fittingly to this discussion, just about any laminitic horse you care to point out.  All too often they are the victims of wishful thinking and accepting such a case with little or no veterinary supervision leaves you, the farrier, completely exposed.  And forget about what a nice lady the owner was.  Dead horses tend to change people's persona pretty damn fast.

Now, I've shared a bunch of my dirty laundry for hopefully a good reason.  As I said earlier, science is good...blah, blah, but for all our good intentions, humanitarian principles, our pursuit of continuing education and that pile of expensive and time-consuming certificates -- we are no match for a university education when ol' lawyer Daggett has our sorry ass in the witness chair.  Game over.  I have had some experience in litigation cases involving farriers:  wrongful death, [in]competency claims, property damage or loss of use (do remember that horses represent chattel), and one fascinating case where a farrier was shot by mistake.  And here you thought this job wasn't too complicated.  In some of these cases, I was scheduled to give 'expert testimony' on certain aspects of the trade.  Never saw the court room.  Once the attorneys looked over the (our) accreditation system, education and other aspects of the trade, the trial was over.  Now this certainly isn't always the case, but perhaps it is here where the common sense has to live.  Our perception of what we do and how we do it has absolutely nothing to do with how we are perceived by a jury of our peers.  Because the truth is, they are not our peers.

Where is the line drawn?  I'm sure everyone has an opinion, perhaps worse, an experience, but it would seem to me that given these realities one needs to err toward caution, particularly when emotion or ego start matching strides with common sense.  And that is difficult to determine at times, as very often these decisions are made in the moment, without due consideration on the potential outcome, good or bad.  This can indeed be the point where a person clearly outruns their credentials and no amount of science, good intentions or that hard-earned certificate will save you from the consequences of overstepping your limitations -- such limits decided by a norm not of your making.  Perhaps the best example can be found in the veterinary profession.  Pre-purchase exams in the late 1970's, early 80's had somehow evolved into the realm of soothsaying.  Technology played a role here -- portable radiographic equipment, ultra-sound, etc., and veterinarians were competing heavily in this arena.  You know how it goes.  Buy a new wire welder  and you need to make it pay.  Many veterinarians crossed the ethical line in trying to appease the buyer or seller, the end result, numerous and costly lawsuits.  The backlash was that over the ensuing years, most vets would cover a pre-purchase exam in one sentence:  "Yeah, he's breathing today." 

The solution?  At present, not much.  This profession is a work in progress and many of the pitfalls can only be avoided through personal diligence.  However, schools need to focus a great deal more on the rather intrinsic elements of this 'business,' the under-belly really, that has little to do with the horse, but a great deal to to say about day to day survival.  And associations, or professional groups need to be careful about what they promote, care to certify, or outwardly endorse.  They too can be brought before a judge.  What's to stop an individual from suing an agency or association that certifies your competency?  Nothing really.  But I do think as this profession continues to evolve, maybe gaining greater credibility in the public eye, and perhaps a more well-rounded educational system, staying a little below the radar is not such a bad idea.  And focus on the art by minimizing the value (and inherent risk), associated with scientific standards.  Hell folks, nobody ever sued Van Gogh.




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