A DOCTOR working for the SouthDoc GP co-op who failed to carry out an ECG on a patient who presented with chest pain in the early hours of the morning has been found guilty by a medical council fitness-to-practise inquiry of poor professional performance.
Dr Eugene Erasmus (71), a South African agency doctor, was found guilty despite evidence tendered by a lecturer in general practice at Trinity College who said he believed the majority of GPs in the country would probably not have arranged an ECG for the patient in question.
Dr Erasmus had claimed there was no ECG machine available to him in the Skibbereen treatment centre of the co-op on May 4th, 2009, when the patient presented – something disputed by SouthDoc, which said these were in all centres. Mary Culliton, chair of the fitness-to-practise committee, said the committee believed an ECG machine had been available to him.
The case against Dr Erasmus, which concluded on Saturday evening, centred on his treatment of James Taylor from Nottingham, England, who was on holiday in Glandore, Co Cork, on the May bank holiday weekend of 2009 when he suffered chest pain and called SouthDoc. Mr Taylor, who had had a heart attack 12 years earlier, was examined by Dr Erasmus, who noted no classic signs of a heart attack such as shortness of breath, sweating or nausea, while a normal heart rhythm was observed.
Dr Erasmus, who had come to Ireland in April 2009 to work for the Locumotion agency, diagnosed the residue of a chest infection which Mr Taylor said he had had for some days, and told him his high blood pressure needed to be treated and gave him a prescription for this.
He said that given Mr Taylor’s history, advice given by Locumotion on dealing with chest pain, and there being no ECG machine available, he advised Mr Taylor to go to hospital in Cork for an ECG, but Mr Taylor refused to do this as he was returning to the UK.
Mr Taylor said he was not advised to go to hospital, and that if he had been he would have gone. There was no note in the medical records of Dr Erasmus advising him to go to hospital for an ECG or of his refusal to go. In retrospect, Dr Erasmus said, he should have made a note of this.
In the UK the next day when Mr Taylor saw his GP he was sent by ambulance to hospital and was admitted to a critical care unit. Enzyme levels indicated there had been a cardiac incident.
Prof Tom O’Dowd, professor of general practice at Trinity College and an expert witness called by Dr Erasmus, gave evidence that after reviewing the medical notes he believed Mr Taylor suffered the cardiac event sometime between seeing his own GP in the UK on May 5th and his arrival in hospital. He said if he himself had seen the patient he would not have recommended an ECG. “I think the majority of GPs in this country would probably not have arranged an ECG in this case,” he said.
He claimed Dr Erasmus displayed “adequate competence” in dealing with the patient, but he believed Mr Taylor’s pain, when Dr Erasmus saw him, was what caused his high blood pressure, rather than the other way around.
The three-person fitness-to-practise committee hearing the case found Dr Erasmus told a patient who presented with chest pain that his pain may have been caused by high blood pressure when there was no clinical justification for this, and that he failed to carry out or arrange to carry out all appropriate investigations, including an ECG. They concluded these two counts amounted to poor professional performance, and recommended he be censured in writing.
At an earlier hearing, the medical council’s expert witness, Prof Colin Bradley, professor of general practice at UCC, said if Dr Erasmus was of the view Mr Taylor was at moderate to high risk of having a heart attack and did not carry out an ECG or transfer him to hospital, that would be poor professional performance. Dr Erasmus, who had 40 years’ experience and an unblemished record, said he regarded Mr Taylor as being at low risk of having a heart attack.