SINGAPORE – A doctor who failed to arrange tests before prescribing medication to a patient with a pre-existing condition was fined $1,500 on Thursday February 10 after pleading guilty to endangering the personal safety of the patient.
Haridass Ramdass, 77, was a GP who was running surgery at Tekka Clinic when he saw the patient, a 28-year-old Indian national, who was working as a construction worker, in 2014.
The patient has since died, but it was not due to Haridass’ actions. Haridass was originally charged with causing the patient’s death by a reckless act in 2019, but the charge was changed to endangering the patient’s personal safety by an act of negligence, for which he has pleaded guilty on Thursday.
Now retired, Haridass saw the patient after the latter developed rashes on his body, face and upper and lower limbs prior to October 20, 2014.
The man visited Healthway Medical Clinic in Limbang Mall on October 20, 2014 and was diagnosed with psoriasis. She was prescribed an antiseptic solution of permasol, antihistamines as well as a steroid cream, but her rashes got worse.
He returned to Healthway Medical Clinic on November 7, 2014 and received the same diagnosis. She was prescribed the same medication except for the steroid cream. The man then went to Bless Medical Center at Boon Lay Mall on November 12, 2014 and was diagnosed with psoriasis there.
He was given oral medication and cream, as well as psoriasis oil.
The men traveled to Tekka Clinic and saw Haridass on November 24, 2014. Haridass noted that the patient had large, round, reddish lesions all over his body, including his scalp. The man told the doctor that his skin problem had persisted for 20 days and that he had seen three other doctors.
Similarly, Haridass diagnosed the man with psoriasis and gave him an injection. He also prescribed 10 tablets of methotrexate (MTX) with one tablet to be taken twice a day; 10 tablets of Prednisolone, with one tablet taken twice a day; and 10 tablets of chlorpheniramine, with one tablet taken twice a day.
As the man did not have enough money for 10 tablets of MTX, he only received six tablets.
Haridass did not arrange tests for the patient’s kidney function, liver function, and complete blood count, and therefore did not discover his pre-existing kidney failure, which could have potentially increased the toxic side effects of MTX in the patient. .
MTX is a chemotherapy drug and immune system suppressant used to treat cancer and autoimmune diseases.
Use of MTX could lead to serious and life-threatening toxic reactions as it can produce marked depression of the bone marrow and lead to deficiency of red blood cells, white blood cells, and platelets, as well as bleeding.
Serious, sometimes fatal, skin reactions have been reported following single or multiple doses of MTX and life-threatening infections could occur with MTX treatment, the prosecution said. MTX treatment in patients with renal insufficiency should be undertaken “with extreme caution” because impaired renal function would decrease the body’s ability to eliminate MTX, thereby increasing the potential for its toxicity, a added the accusation.
Haridass attorney, Davinder Singh, pointed out that his client was accused of endangering the patient’s personal safety, rather than endangering his life.
“It’s not even a case of recklessness but of negligence that further roots this to the lower end of the spectrum for conviction,” the attorney said.
District Judge Eddy Tham said the court would only proceed on the basis that the safety of the patient had been endangered, since the prosecution and defense had agreed that no reference had been made as to whether s there were adverse effects of consuming MTX. .
“In these circumstances, I assume that none of the serious consequences (listed in the statement of facts) have occurred. In this respect, I am of the opinion that the custody threshold has not been crossed. Nevertheless , the maximum fine should be imposed.
If significant harm had occurred, he would have had “no hesitation” in imposing a prison sentence in the case, the judge added.
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