A Co Dublin doctor failed to diagnose a cancerous swelling on a patient's jaw on three separate occasions over six months, a Medical Council fitness-to-practise Inquiry has been told.
Dr Derek Graham of Newcastle, west Co Dublin, is facing a range of allegations of professional misconduct or poor professional performance arising out of his treatment of a patient between February 12th and August 03rd, 2010.
Outlining the case this morning, Patrick Leonard BL, instructed by McDowell Purcell solicitors for the Medical Council, said there was considerable disagreement between the patient and Dr Graham over the nature of the patient's initial presentation.
Mr Leonard said it would be the patient's evidence that he attended Dr Graham on February 12th, 2010, complaining of flu-like symptoms and a slight swelling under his left jaw line. The patient claimed he returned again to Dr Graham on March 1st to check the swelling, but was told by Dr Graham a gland was infected and the swelling would take time to reduce.
However, Mr Leonard said the patient's wife was concerned about the increasing size of the swelling and the patient returned to Dr Graham a third time, on August 3rd. Mr Leonard said the patient again claimed he was told the swelling was an infection which required time to heal.
Alternative doctor
On a fourth appointment on September 15th, Dr Graham was unavailable and the patient saw an alternative doctor who was immediately concerned about the possibility of lymphoma cancer, and referred the patient to a specialist, John Kinsella.
Mr Kinsella determined it was not lymphoma, but a squamous cancer. The patient was treated for this and received chemotherapy and radiation "and is now hopeful it will not return", Mr Leonard said.
Mr Leonard agreed with Cathal Murphy BL for Dr Graham, instructed by Matheson solicitors, that there was considerable disagreement between the patient and Dr Graham.
Mr Murphy said it would be Dr Graham's evidence that the patient arrived on February 12th with a single complaint of flu-like symptoms, and did not make any reference to a swelling on the jaw line. Medical notes will support this contention, Mr Murphy said.
Mr Murphy also said the second visit was again a single complaint, this time referring to an acne-like rash over much of the body. Again, he said, this would be supported by the doctor's notes.
Dr Graham is also claiming that on the patient's third visit, the sole point of the visit was to get a repeat prescription for the rash-like symptoms. As the rash was reducing, Dr Graham decided to proceed with the treatment and renewed the prescription, Mr Murphy said.
Dr Graham is facing a range of allegations including that he failed to take an adequate history from the patient and/or failed to carry out a proper examination.
It is also alleged that Dr Graham failed to provide adequate treatment to suit the patient's symptoms or condition; failed to carry out or arrange for adequate investigations to include a biopsy; and failed to give adequate consideration to the possibility of an underlying pathology and/or failed to refer the patient to an appropriate specialist.
