Dermatologist was 'isolated', hearing told

A consultant dermatologist might have had better patient outcomes if he had available diagnostic support and had been invited to join a local dermatologist group, a medical fitness-to-practise inquiry has been told.

Dr Adam Jacobus Smith (65) is facing in excess of 100 allegations of poor professional performance or professional misconduct in relation to 12 patients who attended the Whitfield Clinic, Waterford, from 2006 to 2009.

The inquiry is sitting all this week. It is one of the longest hearings to come before the Medical Council, where the average number of hearing days per inquiry in 2011 was two.

Yesterday expert witness Dr John A Cotterill told the hearing Dr Smith had come to Ireland from South Africa via the Netherlands, and had been concerned about diagnostic support such as histology services. Dr Smith has also been working “without a dermatological friend in the world”, he said.

Dr Cotterill said the Munster Dermatological Group was a forum where specialist advice and opinion and support could be exchanged, “but sadly Dr Smith was never asked to join that forum”.

Dr Cotterill was commenting after barrister JP McDowell, representing the Medical Council, suggested that a common theme was that Dr Smith adopted an aggressive treatment approach, sometimes using powerful drugs, and had failed to monitor properly patient health during treatment.

Lips turned purple

The inquiry has heard evidence that a patient referred to as Patient J (53) consulted Dr Smith and was diagnosed with herpetiformis and prescribed Dapsone. The patient’s ear tips and lips turned purple and he was admitted to hospital where he was diagnosed with the blood condition methaemoglobinaemia, an adverse reaction to Dapsone.

Patient J was referred to consultant dermatologist Dr Colin Buckley, who said he believed Patient J had never had dermatitis herpetiformis. A member of the Munster Dermatology Group, Dr Buckley complained about Dr Smith to the Medical Council.

Dr Cotterill said one would have to have sympathy for Dr Smith, given the “diagnostic difficulties” and having to work “in an isolated condition”.

The hearing continues.