TWO OF six allegations being levelled by the Medical Council against a doctor who worked for the SouthDoc GP co-op were dropped at a fitness to practise inquiry yesterday.
The allegations that Dr Eugene Erasmus (71), a South African agency doctor, failed to carry out an adequate examination of English tourist James Taylor when he attended the co-op’s treatment centre in Skibbereen in the early hours of May 4th, 2009, and that he failed to consider Mr Taylor may have had a heart attack were withdrawn by the Medical Council after evidence given by the council’s expert witness failed to support them. Its expert witness, Prof Colin Bradley, professor of general practice at UCC, said the physical examination of the patient carried out by Dr Erasmus seemed to have been “reasonably adequate”. He had taken the patient’s blood pressure and used a stethoscope. He also said there was nothing in the evidence indicating Dr Erasmus failed to consider Mr Taylor may have had a heart attack.
Mr Taylor, from Nottingham, claimed on Tuesday that Dr Erasmus failed to detect he was having a heart attack when he presented with chest pain. He claimed Dr Erasmus, who came to Ireland in April 2009 to work for the Locumotion agency, diagnosed the residue of a chest infection and said his high blood pressure needed to be treated and gave him a prescription for this. In the UK the following day when he went to 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.
In evidence yesterday Dr Erasmus said that when he examined the patient he “did not expect it to be a heart attack” as the classic symptoms of an attack were not there. The heart rhythm was normal, there was no nausea or sweating or shortness of breath, and his chest pain was on both sides. “I couldn’t make a specific diagnosis,” he said, though he recommended treatment for the high blood pressure. He added that given Mr Taylor had a previous heart attack, that there was no ECG machine in Skibbereen – something disputed by SouthDoc – and that he had been advised by Locumotion to refer all patients with chest pain to hospital, he decided to advise Mr Taylor to go to hospital in Cork for an ECG. He said Mr Taylor refused on the basis that he was travelling home later that day. Mr Taylor has already claimed he was never advised to go to hospital.
Earlier Prof Bradley 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.If the patient refused to go to hospital, this should have been documented.
Nicholas Butler SC, for the doctor, questioned the independence of Prof Bradley given his practice is involved in SouthDoc.
The case has now been adjourned to later this month. Dr Erasmus faces four outstanding allegations: that he advised Mr Taylor he may have been suffering from a chest virus and/or that his pain may be caused by high blood pressure in circumstances where there was no clinical justification for same; that he failed to carry out or arrange to carry out all appropriate investigations including an ECG; that he failed to refer Mr Taylor to an appropriately qualified practitioner for immediate review and failed to advise Mr Taylor that he may have suffered a heart attack.