Retired doctor fined for endangering patient's safety by giving him pills without pre-prescription tests
SINGAPORE: A retired doctor was fined S$1,500 by a court on Thursday (Feb 10) for endangering a patient's safety eight years ago, when he prescribed pills without arranging for pre-prescription tests and therefore missing the patient's existing medical condition.
Haridass Ramdass, 77, pleaded guilty to one charge of endangering the personal safety of the patient, at Tekka Clinic Surgery in 2014.
The patient, then 28, worked as a construction worker at the time of the incident.
He visited three general practitioners in October and November 2014 after developing rashes over his body, face, arms and legs.
He was diagnosed with psoriasis at each clinic and prescribed different medications, including steroid cream and antihistamines.
When his condition did not improve, the patient visited Haridass' clinic on Nov 24, 2014, where Haridass was the sole doctor.
During the examination, Haridass noted extensive reddish, round lesions all over the patient's body, including his scalp. The patient told him his skin condition had persisted for 20 days and that he had seen three other doctors before him.
Haridass also diagnosed the patient with psoriasis and gave him an injection of dexamethasone. He then prescribed the following medications: 10 tablets of methotrexate (MTX), 10 tablets of prednisolone and 10 tablets of chlorpheniramine.
As the patient did not have enough cash to pay for 10 tablets of MTX, the clinic staff dispensed only six tablets.
MTX is a drug often used in cancer treatment, but can also be used to treat severe psoriasis, the court heard.
The drug, however, can cause serious and life-threatening toxic reactions. It may produce marked depression of the bone marrow and lead to a deficiency in red blood cells, white blood cells and platelets, as well as bleeding.
Deaths have been reported among patients who took MTX for psoriasis, said the prosecutor.
MTX therapy in patients with impaired renal function should be undertaken with extreme caution, because such an impairment decreases the body's ability to eliminate MTX, increasing the potential for MTX toxicity.
Haridass did not arrange for the patient to undergo relevant pre-prescription tests such as renal function, liver function and full blood count before he prescribed the drug, the court heard.
As a result, Haridass failed to discover the patient's pre-existing renal impairment and was not conscious of the potentially increased toxic side effects MTX could cause him.
Court documents did not reveal how the offence came to light.
However, Haridass was earlier given a charge of causing death by a rash act by prescribing the tablets without first arranging for the patient to undergo necessary tests. According to the previous charge, the patient contracted an invasive fungal infection that led to his death.
The charge Haridass currently faces is only for endangering personal safety by a negligent act.
District Judge Eddy Tham asked Deputy Public Prosecutor Timotheus Koh whether the patient finished consuming the MTX pills.
Mr Koh responded that it was unclear if the patient did so, adding that the charge was not for causing a particular reaction, but for endangering personal safety.
The judge then said he wanted to know what the harm caused was. Mr Koh said he did not believe that the prosecution and defence "are in agreement" on the effects MTX caused on the patient, and that the prosecution would "not be asserting a particular set of circumstances in this regard".
Mr Koh asked for the maximum fine of S$1,500, saying medical negligence by medical professionals must be deterred.
Haridass was represented by Senior Counsel Davinder Singh.
"On the question of harm ... the basis on which the defendant agreed to plead guilty is that there is no suggestion of any harm that occurred in this case," said Mr Singh.
"After thorough investigation of the circumstances, the prosecution has opted to charge my client on personal safety, as opposed to the endangering life limb (of Section 336 of the Penal Code). The authorities make it clear that the personal safety limb is at the lower end of the sentencing spectrum," said Mr Singh.
He said there is no risk of Haridass committing the same offence, as he has retired and has not renewed his practising certificate.
He is also "genuinely remorseful and accepts that he was wrong", said the lawyer.
Judge Tham said the court would proceed on the basis that only the personal safety of the patient was endangered, since both sides agreed on the consequences of the negligence.
In the circumstances, he said he would assume that none of the grave circumstances that could come from taking MTX pills had come to pass.
For endangering the personal safety of the patient, Haridass could have been jailed for up to three months, fined up to S$1,500, or both.