Accused doctor was ‘under pressure’ expert witness tells court

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A DOCTOR accused of negligently causing the deaths of two elderly care home patients when he prescribed them inappropriate doses of a pain relief drug may have been “subconsciously” worrying about managing his time a court heard yesterday.

General practitioner Rajendra Kokkarne of Fulmar Way, Worksop, arranged for patients Beryl Barber, 78, and Eric Watson, 86, to be given morphine sulphate after hearing over the phone from a nurse at the Charlton Centre for Alzheimer’s and Dementia Care in Batley of their severe suffering.

He denies manslaughter by gross negligence.

Mrs Barber had painful ulcers, while Mr Watson had a urinary infection and mouth ulcers.

The prosecution’s case is that not only was that drug wholly inappropriate for their individual circumstances but the dosage the GP arranged was excessive and 10 times greater than the normal starting dose. Both died from morphine poisoning.

Moreover, during the afternoon of February 1, 2008, before and after he prescribed the drugs, the GP was “preoccupied” looking at cricket scores on the computer.

Expert witness, Dr Stephen Hicks said the single-handed GP was “relatively inexperienced” and was dealing with a clinical situation without the support of immediate colleagues. Ideally, he said, doctors would always see patients face-to-face and it would have been “prudent” for the GP to have visited Mr Watson that evening.

In addition, he added that he thought he may have been unknowingly under more pressure than he recognised.

Robert Smith, QC, prosecuting, said at Leeds Crown Court that this was not what Kokkarne had told the jury in his evidence. He said: “He told the jury that he was not under any undue pressure. He could have gone and been there at 6.30pm that evening?”

Dr Hicks replied: “I think the whole question could have been on his mind.” Mr Smith said: “But he has not said that, Dr Hicks, has he?” Dr Hicks replied: “They do make decisions subconsciously.”

Earlier Dr Hicks was asked by Mr Smith about his handling of Mr Watson. Dr Hicks replied: “Certainly there’s a strong argument that he should have asked more questions. In my view I think it would have been prudent to have visited Eric Watson.”

Mr Smith then said: “Had he visited the nursing home to see this elderly patient who was suffering from dementia, can you see what a personal visit might have revealed to Dr Kokkarne which might have made any difference to his prescription?”

Dr Hicks said: “I think it would have been wholly unlikely and probably inappropriate to challenge a qualified, experienced nurse” who had informed him Mr Watson was in severe pain.

Dr Hicks added that an examination would have revealed mouth ulcers.

The case continues.