Patrick’s father Eamon knew something was wrong when they were called in to see the consultant psychiatrist on a Saturday last March.
When they arrived into his office, Dr Ankur Sharma asked if Patrick would like to leave the room. The 13-year-old wanted to stay. Dr Sharma went on to inform Patrick and his father that the boy was being overmedicated.
Patrick had been attending South Kerry Child and Adolescent Mental Health Services (CAMHS) since the age of six and had been diagnosed with attention deficit hyperactivity disorder (ADHD).
Dr Sharma was relatively new to the service, having joined in September 2020, but he quickly became concerned about the prescribing and diagnostic practices of a junior doctor who was no longer working there.
This non-consultant hospital doctor, Dr David Kromer, had prescribed three drugs to Patrick, stimulants Concerta and Medikinet and anti-psychotic Risperidone.
According to Eamon, Dr Sharma was concerned that Patrick had been prescribed Risperidone.
“He informed me this was an anti-psychotic drug, which Patrick shouldn’t have been put on. He told me it was for schizophrenia, bi-polar and severe autism,” said Eamon.
“Once he heard he was overmedicated, the first question my son asked the doctor was: ‘Am I going to die?’ I was cringing inside, wanting to explode, because I could see the pain on my son’s face and he was crying.
“The doctor told him ‘no’, that they caught it.”
Eamon now feels a huge debt of gratitude to Dr Sharma. “Only for Dr Sharma, it wouldn’t have come to light at all,” he said.
The consultant’s concerns about Dr Kromer’s prescribing and diagnostic practices sparked a major “look-back” review of 1,300 cases handled by the service between July 2016 and April 2021. Apologies have since been issued to 200 service users and their families for substandard care. A report on the review is expected to highlight failings across a range of areas and not just with one person or one team.
Eamon said Patrick had issues from a very young age. As a baby, he would bang his head off the wall.
After becoming a patient of South Kerry CAMHS, the consultant there at the time prescribed Equasym, a mild stimulant used in the treatment of ADHD.
But four years later, when Patrick was 10, Dr Kromer changed his medication to Medikinet, another stimulant, according to Eamon.
He said that six months later, Concerta, a drug very similar to Medikinet, was added to the prescription by Dr Kromer.
“I asked him why he was putting him on the same medication that does the exact same thing for ADHD. It didn’t make any sense to me,” said Eamon. “He said the Concerta was a slow release one and the Medikinet was fast release. So, when he would get his Medikinet in the morning, it was ‘boom’. It would kick in straight away. Then when Medikinet was out of his system, Concerta would kick in.”
This continued for a year, but Eamon began to notice behavioural problems. Patrick struggled with concentration.
He said at this point Dr Kromer added Risperidone to the prescription. “It was after this I noticed Patrick started to get withdrawn into himself. There were no smiles, no bubbliness about him when he started going on that drug. He was getting depressed a lot,” said Eamon.
He said when he questioned the prescribing of the drug, Dr Kromer said his son needed to get used to it.
After six months of Patrick being on the drug, Eamon said he told the doctor his son was having dark thoughts.
“I told him Patrick is talking about suicide. That is not right for an 11-year-old,” said Eamon.
The boy’s father said the doctor told him that he suspected Patrick had autism and that he would get a multi-disciplinary team to look at him to diagnose this.
Patrick was kept on the three medications while an appointment was waited for.
Dr Kromer has told the Irish Independent that he never prescribed a drug unless he believed a child needed it and that he had no regrets about his prescribing practices.
After Dr Sharma intervened, Patrick was weaned off the Concerta and Risperidone.
When they went back to Dr Sharma last August, Eamon said the doctor told them he was not allowed to see them any more as he had been moved to administrative duties. “He called me into the office and he said, ‘I am sorry but I have no other choice but to leave because I cannot put up with the abuse I am getting because I blew the whistle on the thing’,” said Eamon.
The Irish Independent put these claims to the HSE but it declined to answer questions about them. Patrick hasn’t seen anyone from CAMHS since Dr Sharma left.
Appointments have been offered, but Eamon said these were all at unsuitable times.
“My son is up and down. He is off medication since March. He won’t go back on it. He had huge withdrawal issues for two or three weeks afterwards. Sweats and shaking,” said Eamon.
He said the medication had suppressed his son’s emotions. “When he got off it, all his emotions started coming back. He is like a child again of six or seven. Because it was suppressed for so long we basically have to try and teach him to cry when he is upset and tell him it is alright.”
The father and son’s names have been changed.