GP ‘surfed the internet as his patients were given killer drug doses’

General practitioner Rajendra Kokkarne arranged for frail patients Beryl Barber, 78, and Eric Watson, 86, to receive morphine sulphate after hearing over the phone from a nurse at the Charlton Centre for Alzheimer’s and Dementia Care in Batley of their suffering – Mrs Barber from painful ulcers on her foot and elsewhere, and Mr Watson, with a urinary infection and mouth ulcers.

Robert Smith, QC, prosecuting, claimed at Leeds Crown Court yesterday that not only was that drug wholly inappropriate for their individual circumstances but the dosage the GP arranged was far in excess of what should have been given to an elderly patient and 10 times greater than the normal starting dose. Both died from morphine poisoning.

He told the jury it was the prosecution’s case that during the afternoon of February 1, 2008, before and after he prescribed the drugs, the GP was “preoccupied” looking as sport and other material on the computer.

When police later interviewed him about the deaths, Kokkarne said in a prepared statement he had intended to prescribe a lower dose and was unaware he had made an error.

He added he had been trying to deal with a difficult case, trying to find a suitable specialist for a patient with a sleeping disorder, when he received the message to contact the home.

Mr Smith told the jury that “regrettably, the prosecution must point out that this was an untrue statement by Dr Kokkarne”. Computer records at the Victoria medical centre in Dewsbury, where he was employed showed he had not looked at that particular patient’s records that day.

“On the contrary, the evidence shows that in between dealing with patients Dr Kokkarne had been watching sport and engaging in e-mails and other searches and contacts using the practice computer.”

Inquiries revealed that prior to the preparation of the prescriptions he used the computer for personal internet banking and opening e-mails, and after arranging the prescriptions to be faxed to the pharmacist used by the home, he accessed news, cricket results from India and “matters of that sort,” said Mr Smith.

Kokkarne, 37, of Fulmar Way, Worksop, denies the manslaughter by gross negligence of Mrs Barber on February 3, 2008 and of Mr Watson on February 4.

Mr Smith told the jury it was the Crown’s case the GP had failed to carry out a clinical assessment of either patient prior to prescribing the drug. Neither had received such a strong pain killer before and were therefore medically “opiate naive”.

He also failed to adhere to established guidelines for administering such pain relief to elderly patients.

The prosecutor added the care home and nursing staff shared some responsibility. The nurses who administered the drug, one dose to Mr Watson and two to Mrs Barber, had not questioned the accuracy of the prescription.

“Equally the pharmacist who dispensed the drugs does not appear to have queried whether the concentration prescribed was appropriate,” said Mr Smith. “Criticism can properly be levelled at all of them.

“The prosecution recognise that Dr Kokkarne was not alone in making mistakes but they submit that the primary responsibility lay with him in his position as a medical practitioner, with detailed and specialist knowledge of the effect of such drugs on patients of this age and who had no established tolerance to the drug.”

The trial continues.