A DISABLED woman developed “golf-ball-sized blisters” and hair loss during treatment given by a dermatologist facing allegations of professional misconduct, her sister told a Medical Council fitness to practise inquiry yesterday.
Mary, who was not named for privacy reasons, told the inquiry she took her sister, patient L (67), who had a congenital disability, to Dr Adam Jacobus Smith (65), of the Whitfield Clinic, Waterford, in January and March 2011. Patient L had developed a rash on her knee after an operation and the rash had spread to her torso and scalp.
She said Dr Smith was “very pleasant” to her sister but he “only looked at her front” and then diagnosed psoriasis. He prescribed a series of injections of a biological agent, Stelara. Patient L’s condition deteriorated and she was prescribed antibiotics by a GP.
Mary, who became emotional when describing what her sister had gone through, said she returned to Dr Smith after patient L developed “golf-ball-sized blisters” on her hand. “Her skin was red raw and sore. As well as that, her hair was falling out,” Mary said.
She told JP McDowell, solicitor for the Medical Council, she had expected her sister would be sent to hospital, but Dr Smith told her they should wait until the antibiotics were finished and then carry out the second injection of Stelara.
A few days later, after her condition had become even worse, patient L was sent to Waterford Regional Hospital, where she was diagnosed with pemphigus vulgaris (PV), a rare autoimmune disease. She required huge doses of steroids, autoimmune suppressants and antiviral drugs to bring the condition under control, her sister said. Afterwards, patient L developed cold sores all over her body and needed further hospitalisation.
“She was in such pain she couldn’t be touched; she was put on morphine for two weeks,” Mary said. Her sister had since recovered but has been left with problems including complications caused by steroid-induced weight gain.
“She’s the strongest person I know, because if it was me I would have just keeled over, but she never did,” Mary said.
Under cross-examination by senior counsel Gabriel Gavigan for Dr Smith, Mary agreed the consultant had examined her sister’s scalp. She also said there may not have been blisters on her skin, an indicator of PV, when she attended his offices.
Dr Colin Buckley, consultant dermatologist who treated patient L and who complained about Dr Smith to the Medical Council as part of the Munster Dermatology Group, said there was a clear distinction between psoriasis and PV.
When he examined patient L “there were no features consistent with psoriasis”, he said. He also said that even if patient L had psoriasis, she should not have been treated with Stelara in the first instance. He criticised Dr Smith’s failure to take a biopsy which would have helped diagnose her condition.
More than 140 allegations of professional misconduct and poor professional performance have been brought against Dr Smith in relation to 12 patients he treated between March 2006 and May 2009. The case will resume in the autumn.
