Consultant faces probe for 'giving psychosis drugs to eczema patient'
A GROUP of dermatologists lodged a complaint about a consultant who prescribed anti-psychotic drugs to a patient with eczema.
The Munster Dermatology Group reported consultant dermatologist Dr Adam Jacobus Smith (65) to the Medical Council as there was "collective concern" over the care he had given to 12 of his patients.
Dr Smith yesterday appeared before a Medical Council fitness to practise inquiry which centred on allegations of professional misconduct and poor professional performance.
Originally from Zimbabwe, Dr Smith qualified as a doctor in 1973 and practised in South Africa as a dermatologist for 22 years.
Dr Smith worked at the Whitfield Clinic in Waterford, Aut Even in Kilkenny and Barringtons Hospital in Limerick.
The inquiry heard evidence from Dr Michelle Murphy who was a member of the Munster Dermatology Group. Dr Murphy had given a second opinion on two patients previously seen by Dr Smith.
She told the inquiry that Dr Smith diagnosed one of his patients, known as 'Patient H', with parasitophobia.
This is a rare condition when a patient has a "fixed delusion" that there is something crawling under their skin. Dr Murphy said she had only seen around four people with it in five years.
"Often patients with it have schizophrenia," she said, adding that it is normally easily diagnosed as the patient will tell their doctor that "something is crawling under my skin".
Dr Murphy criticised Dr Smith's diagnosis in the case, and the fact that he prescribed the anti-psychotic drug Pimozoide to the patient without looking for advice from psychiatric colleagues.
"Given such a significant diagnosis, you would need a psychiatric input," she said.
She said she was concerned "the diagnosis was incorrect" before adding, "if you suspect the diagnosis, you should inform psychiatric colleagues".
Dr Smith is also accused of failing to take "any or adequate history" and failing to monitor the patient's condition.
The allegations relate to treatment given to Patient H around the period from July 31, 2006, to February 28, 2008.
Dr Murphy criticised Dr Smith's treatment of another patient, known as 'Patient G'.
In this case, she said Dr Smith had failed to refer his patient to a plastic surgeon after they were discovered to have a "squamous cell carcinoma" -- or form of skin cancer.
Dr Murphy said a "wide excision" was the procedure needed according to best practice. She said that this "wasn't done" and was also critical of the follow-up care received by the patient.
During cross-examination of Dr Murphy's evidence, counsel for Dr Smith, Gabriel Gavigan, quizzed the motivation of the Munster Dermatology Group in making the complaints against Dr Smith.
"Six doctors get together and make a complaint about a doctor in their area. I surely have the right to question their motivation," he said.
None of the 12 patients whose care is under scrutiny at the inquiry are named for reasons of patient confidentiality. The inquiry continues today.