Dermatologist’s treatment of 12 patients under inquiry

A consultant dermatologist failed to take skin biopsies from a number of his patients and failed to diagnose certain conditions or provide adequate treatments, a Medical Council hearing heard yesterday.

The council has begun a fitness to practise inquiry into allegations made against Dr Adam Jacobus Smith, 65, of the Whitfield Clinic in Waterford, by Munster Dermatology Group.

The 12 patients at the centre of the allegations came under the care of other consultants in Munster Dermatology Group, after being treated by Dr Smith.

One patient, described as Patient A, was referred to Dr Smith in Nov 2008 with a rash on his left leg.

The 63-year-old man told the hearing that Dr Smith examined him for “three or four minutes” but when he asked him what was causing the rash, the doctor said he would write to his GP.

Dr Smith referred him for an MRSA swab but, according to the patient, said he would not do it in the Whitfield Clinic as it would be “too expensive”. The MRSA swab was eventually done in Cork University Hospital where the patient was already on dialysis for a renal condition.

He was diagnosed by consultant dermatologist Dr John Burke in CUH with calciphylaxis, a rare skin disorder, after Dr Burke ordered a biopsy. This condition cleared up with different medication.

Gabriel Gavigan, counsel for Dr Smith, said his client couldn’t have diagnosed the calciphylaxis or ordered a biopsy as he wanted to first ensure there was no skin infection, which is why he ordered the MRSA swab.

Patient B, a 74-year-old man, said he first attended Dr Smith in Jan 2008 with a rash on his chest. He went four more times, two of which were for the removal of moles, but the rash did not clear with medication prescribed by Dr Smith.

Early in 2009, he went to his GP, who referred him to another dermatologist, Dr Gillian Gibson, and, by the time he saw the second consultant, he had blisters on his skin. Dr Gibson ordered a biopsy and diagnosed bullous pemphigoid.

Mr Gavigan asked the patient if Dr Smith had ever seen the blisters. The witness replied that he had not.

According to Mr Gavigan, the blisters were indicative of bullous pemphigoid, also known as ringworm.

Dr Gibson told the hearing that there was “collective concern” among members of the Munster Dermatology Group about patients who had been seen by Dr Smith and her own concern in Patient B’s case was that Dr Smith had not ordered a skin biopsy.

Originally from Zimbabwe, Dr Smith qualified as a doctor in 1973 and practised in South Africa as a dermatologist for 22 years. He registered with the Irish Medical Council in 2005 as a specialist in dermatology.

The inquiry continues.

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