Doctor faces disciplinary inquiry over house-call treatment

A locum GP is facing allegations of poor professional performance over his treatment of an elderly patient during an out-of-hours consultation.

Dr Salaheldin Ahmed, with an address in Cavan, faces five allegations relating to his treatment of the late Lewis Kinsella, of Glenageary, Dublin, in April 2017.

Mr Kinsella later died of lung cancer, but the allegations at the Medical Council relate solely to the out-of-hours consultation in his house on that date and not his ultimate cause of death.

Denying the allegations, Dr Ahmed says Mr Kinsella was comfortably asleep when he visited and that he prescribed drugs for rehydration and diarrhoea. He has apologised for any frustration, distress or dissatisfaction felt by the family.

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Mr Kinsella’s wife, Anna, told the inquiry her husband became very ill on April 13th. She rang his GP to ask for a house call but was told no doctor was available and the practice would be closed from that day to the following Tuesday for the Easter weekend. She was advised to ring the Doctor on Duty service.

She rang Doctor on Duty (Mediserve Home Care Group) where the receptionist said they were inundated with calls but she would get a doctor at some point.

When no doctor came, Mrs Kinsella rang again on the Saturday morning. The receptionist promised a doctor would come to her house by lunchtime.

Dr Ahmed arrived at 11.30, she said, and went upstairs. “He went before me, put his bag on the floor, walked around to the other side of the bed and leaned forward and looked at my husband.”

Mrs Kinsella said she told the doctor her husband had diarrhoea and a very bad cough. “Dr Ahmed stood up and said ‘I know him, he has Alzheimer’s’. He said he looked dehydrated, give him this, I’ll write it down for you.”

Sample

She told the doctor she had a urine sample that she had taken that morning, but Dr Ahmed continued over to his bag, got his pad and wrote a prescription for Dialoryte.

“He took another pad, and said ‘sign this’. I signed it and he put it back in his bag. To my amazement, he took up his bag and went off downstairs,” Mrs Kinsella said.

She said she looked at her watch, which said 11.37. “He had not examined my husband, he did not take his blood pressure or pulse, he hadn’t touched him in any way.”

Mr Kinsella’s condition continued to worsen, and the following day his family called an ambulance. He was admitted to hospital, where an X-ray showed evidence of lung cancer, and treatment was discontinued. He died in May 2017.

Dr Ahmed will tell the inquiry Mrs Kinsella told him her husband was asleep when he visited and he was not to be disturbed.

Mrs Kinsella denied this and pointed out she had been waiting for a doctor for two days. “Dr Ahmed didn’t ask me anything, we didn’t really have a conversation,” she said.

David Dodd, barrister, for Dr Ahmed, pointed out the record of his client’s visit showed it began at 11.25 and ended at 11.43 - longer than the seven minutes claimed by Mrs Kinsella.

Expert witness Tom Fahey, a professor of general practice at the Royal College of Surgeons in Ireland, said Dr Ahmed should have taken a history of Mr Kinsella from his wife, and should have measured his pulse and blood pressure, as well as testing his urine.

Although he understood the pressures on-call doctors were under, Prof Fahy said Dr Ahmed did not appear to have kept a thorough, contemporaneous note of the consultation.

It is alleged at the inquiry that Dr Ahmed failed to take any or an adequate history of Mr Kinsella and failed to give consideration to the concerns raised by Mrs Kinsella about her husband’s chest congestion.

It is alleged he failed to take a temperature, measure blood pressure, listen to Mr Kinsella’s heart or chest, examine his eyes and take a urine sample.

It is also alleged he failed to consider alternative diagnoses, or to refer Mr Kinsella to hospital.

The hearing continues on Wednesday.