Doctor defends dose

Jane Emerick
Geelong doctor Carl Grace yesterday defended his actions after a coroner ruled that he prescribed an “excessive” amount of morphine to a woman five days before she died.
Dr Grace said ethics and privacy usually prevented doctors speaking out about similar cases but since the coroner’s report was on the public record he wanted to have his say on “the events surrounding and leading up to the demise of Mrs Irene Bryant”.
Coroner Ron Saines handed down his findings on Mrs Bryant’s 2002 death last week, recommending his report be sent to the Medical Practitioner’s Board for further investigation. Dr Grace prescribed Mrs Bryant with 100mg of morphine on January 3, 2002, but other medical witnesses identified 10 to 30mg as an appropriate dose.
Mr Saines said the prescription was consistent with doses for patients who had developed a tolerance to the drug. Mr Saines described Mrs Bryant as a “manipulative” woman who went “doctor shopping” but said the prescription by Dr Grace “could not be justified”.
In a written statement this week, Dr Grace said he was fulfilling his doctors’ hippocratic oath to do his “very best to relieve his patients from pain and suffering” when he prescribed the dose.
“This was my one and only goal with Mrs Irene Bryant. I offer my sincere condolences to her family,” he said.
Dr Grace said that in the two days before she visited his office Mrs Bryant had been to Geelong Hospital’s emergency department four times and Belmont Bulk Billing Clinic for drugs. In the previous 12 months she had received 179 prescriptions from 24 doctors.
Dr Grace said Mrs Bryant was “screaming and swearing” at his clinic on January 3, 2002, when he diagnosed her with severe sciatica. He said Mrs Bryant was “used to” to taking medication and had been given “multiple” pain killers with no relief.
“I elected to give her (morphine-based) MS Contin. The reason for the 100mg dose rather than 15 to 30mg was this patient would have taken more than the prescribed dose to attain the desired affect,” Dr Grace said.
“Many patients take up to 1000mg of MS Contin daily for years.”
Dr Grace said he could not control how quickly Mrs Bryant consumed the prescription after she left.
Mrs Bryant had received additional morphine the night after visiting his clinic from an ambulance driver on the way to hospital. Dr Grace said the hospital released Mrs Bryant the same night despite tests showing she had a serious infection in her urine and blood.
“Surely Geelong Hospital has failed in its duty of care,” he said.
He said the infection could have resulted in the heart condition myocarditis, which the coroner had identified as a cause of her death in conjunction with “multiple drug toxicity”.
“In short, this lady may well have died of a massive infection of her heart,” Dr Grace said.