Saturday 25 November 2017

Skin doctor advised teen to use tan booth, inquiry told

Kevin Keane

A CONSULTANT dermatologist told a teenage patient that he should attend a tanning parlour to treat his skin condition.

The recommendation has been described as "inappropriate" by an expert witness who was called to give evidence in the case of Dr Adam Jacobus Smith (65).

A fitness-to-practise inquiry also heard that the consultant dermatologist started the patient on an unnecessarily high dose of the drug methotrexate.

In doing so, Dr Smith was "putting patients at an unnecessary risk", according to expert witness Dr James Clifford McMillan of City Hospital, Belfast.

He told the inquiry: "We have heard already that there have been deaths from methotrexate and it is incumbent on us as consultant dermatologists to take all measures to avoid those risks."

Dr Smith is before the Medical Council inquiry, accused of poor professional performance and professional misconduct on more than 100 grounds.

These relate to his treatment of the teenager and 11 other patients who attended his surgery in the Whitfield Clinic, Waterford, between 2006 and 2009.

Dr Smith denies that he is guilty of poor professional performance or professional misconduct.

The committee heard yesterday that the 17-year-old patient and his mother attended Dr Smith's clinic in August 2008 as the teenager was about to go on holiday and was self-conscious about his psoriasis.

Gabriel Gavigan SC, representing Dr Smith, suggested that Dr McMillan was coming at the matter from a "conservative" perspective.

He said: "I would have to suggest that going to a sun tan parlour on two occasions for two weeks is no greater a risk than going to the Mediterranean for two weeks on holidays."

In relation to the prescribing of a 15mg weekly dose of methotrexate, Dr McMillan said it was accepted procedure -- although not mandatory -- to initially administer a test dose of the drug. Dr Smith failed to do this.

Dosage

Dr McMillan continued: "Some patients could tolerate a dose of 15mg but you cannot predict. Some patients might have a severe reaction.

"There are deaths related to methotrexate and most of these deaths are preventable and are related to dosage and failure to monitor."

When asked by Mr Gavigan if, in his opinion, it amounted to poor professional performance not to do a test dose, Dr McMillan answered: "I am trying to be fair -- I think yes."

Mr Gavigan replied: "You have a doubt then? I would suggest that it's not."

The case, which was first brought before the Medical Council in April 2012, continues.

Irish Independent

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