SINGAPORE - A doctor exposed his patient to potentially more serious side effects when he issued him a particular drug to treat his psoriasis without performing the necessary tests that would have alerted him to the patient's renal impairment.
Haridass Ramdass, 77, was on Thursday (Feb 10) fined $1,500 after pleading guilty to one count of endangering the personal safety of his patient, Savarimuthu Arul Xavier, by a negligent act.
Xavier, an Indian national working as a construction worker here, died in December 2014 after developing an invasive fungal infection following treatment.
Haridass, a general practitioner (GP), was originally charged with causing Xavier's death by a rash act, but the charge was later reducedby the prosecution.
The court heard that Xavier, then 28, had visited three different GPs between October and November 2014 after developing rashes over his body, face and limbs.
Each clinic diagnosed him with psoriasis and prescribed medications including antihistamines and steroid cream.
Psoriasis is an autoimmune disease that causes red, itchy and scaly patches on the skin. It has no known cure.
When Xavier's condition did not improve, he visited Tekka Clinic in Little India on Nov 24, 2014.
Haridass was the sole doctor in the clinic.
He noted that Xavier had extensive reddish and round lesions all over his body, including his scalp.
The patient informed him that his skin condition had persisted for 20 days and that he had seen three other doctors before him.
Haridass diagnosed him with psoriasis and gave him an injection of dexamethasone, a steroid used to treat ailments like arthritis and breathing problems.
He also prescribed 10 tablets of methotrexate (MTX), 10 tablets of prednisolone and 10 tablets of chlorpheniramine.
MTX is a drug often used in the treatment of cancer and can also be used in the treatment of severe psoriasis. Possible side effects include life-threatening toxic reactions.
Said Deputy Public Prosecutor Timotheus Koh: "MTX 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 to follow the use of MTX in the treatment of psoriasis... Potentially fatal opportunistic infections, for instance by fungi, may also occur with MTX therapy."
MTX therapy for patients with impaired renal function should be undertaken with extreme caution because the impairment will increase the potential for MTX toxicity.
Haridass did not arrange for Xavier to undergo tests and thus failed to discover the patient's renal impairment.
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Ramdass was previously charged with causing the patient's death by a rash act.
The charge he admitted to on Thursday was for endangering personal safety by a negligent act.
The DPPs sought the maximum fine of $1,500, noting that the sentence must adequately deter negligence by medical professionals.
Haridass' lawyer, Senior Counsel Davinder Singh ofDavinder Singh Chambers, said in mitigation that there was no risk of Haridass committing the offence again as he had retired and did not renew his practising certificate.
"He is genuinely remorseful and accepts that he was wrong," Mr Singh added.
District Judge Eddy Tham said the court would proceed on the basis that only the personal safety of the patient was endangered.
"In these circumstances, I will assume that none of the grave circumstances (from taking MTX pills) had come to pass," he said.
"I would have no hesitation imposing a custodial sentence had significant harm been caused to the patient."
For endangering the personal safety of the patient, Haridass could have been given a maximum penalty of three years' jail and a $1,500 fine.
This article was first published in The Straits Times. Permission required for reproduction.