DOCTOR BREACHED CODE AND PATIENT DIED

Doctor in breach of Code following antidepressant repeat prescription

Share

                 

A doctor issued a repeat prescription of antidepressants without reviewing the patient, who later committed suicide, the Health and Disability Commissioner says.

Commissioner Anthony Hill this week released a decision criticising the general practitioner (GP) for not having in place an appropriate plan for timely follow-up of the patient after an initial prescription of citalopram, and for providing a further two-month prescription without reviewing him.

The man had a history of depression which was first recognised when he was a teenager, the decision said.

In 2012, the patient, aged in his early 20s, visited an accident and medical centre for a chest infection, but also mentioned he was feeling depressed.

He was referred to a GP and after a physical and psychological examination was found to be experiencing mild depression. The GP noted the patient presented "no suicidal ideation". 

The patient asked for counselling rather than medication, but was told he was not immediately eligible for fully-funded counselling as he was not an enrolled patient at the medical centre. He then agreed to a two-month course of citalopram, at a light dose of half a 20 milligram tablet per day. Citalopram is commonly used in New Zealand for treating adult depression. 

The GP recalled he recommend the patient return for a review at the end of the following month, but to come in earlier if he developed side-effects from the citalopram, the decision said.

Two weeks before his supply of medication was due to run out, the patient called the medical centre and asked for a repeat prescription. The GP was aware he had not reviewed the patient since the initial prescription six weeks earlier, but "balanced his desire to review [the patient] with his view it would be unwise for [him] to be without citalopram", the decision said. 

Later that month, after an evening of heavy drinking, the man committed suicide. 

Following his death, the man's parents complained to the commissioner about the standard of care provided by the medical centre.

Lack of "timely follow-up" was found to be a breach of the Code of Health and Disability Services Consumers' Rights, the decision found. Following an initial prescription of an antidepressant medication, patients should be reviewed within one to two weeks.

The GP said he should not have left the decision to the patient to contact the medical centre if his condition deteriorated or if he developed side-effects; rather, he should have prescribed for a shorter period of time -- such as one month rather than two -- and arranged for a consultation following that period. 

The decision said its findings against the GP "should not be interpreted as having any implication as to the cause of [the patient's] death". 

The identities of those involved have been suppressed. 

 - Stuff