GPS UNDER SCRUTINY OVER MORPHINE USE

An Irish health board is calling in external medical experts to investigate
two GPs who it has discovered have prescribed over 2,800 doses of dangerous
drugs in one year alone.

In a letter to pharmacists, the health board warned that the Dr Harold
Shipman case in Britain had raised concerns here over the use of morphine
or pethidine, which is strictly regulated. Last night, the health board
told the Sunday Independent it was still investigating the issue, despite a
decision by the Medical Council not to hold an inquiry into the doctors
concerned. The health board had sought the inquiry and reported the two
doctors last year after its investigations. Both doctors work on their own
as GPs and have insisted that the drug administrations were justified.
Morphine and pethidine are rarely prescribed by GPs. Leading medical
experts said last night that an average GP would only administer between
five and 10 doses a year .

"This matter is not concluded. We have had ongoing correspondence with the
Medical Council since last year and the final response only came back in
recent days," a senior health board official said. "We will be continuing
the investigation."

The health board is not being named for legal reasons, in case that would
identify the two doctors, who are now facing a new investigation.

As the doctors deal with public patients, under contract by the health
board, the board has the power to protect patients if it has
public-interest concerns.

While excessive doses of either drug can kill, there is no suggestion in
this controversy that any patients have died as a result. However, in
correspondence, the health board said that the controversy had raised
concerns, not only about the suspected over-prescribing of these drugs for
patients, but their possible overuse by doc tors themselves.

According to documents obtained by the health website irishhealth.com, one
of the GPs was found to have prescribed around 1,600 doses in 1999; the
other had prescribed around 1,200 in the same year. It is now expected that
the health board will conduct a review of other years.

The Medical Council the policing body for doctors here has ruled that it
could find no prima-facie case for the holding of an inquiry.

It is understood that the two GPs have argued that all of the doses
administered were clinically necessary. They have denied allegations of
over-prescribing the controlled drugs.

They say many of the doses were administered to addicts, some of whom had
travelled from abroad for the morphine or pethidine. However, it is under
stood that the health board claims this does not account for the level of
prescribing. The drugs are pre scribed for severe pain or trauma, serious
coronary conditions and renal colic.

The controversy came to light when other doctors and pharmacists in the
region became alarmed at what they believed was a very high number of
prescriptions for the drugs. Under the Misuse of Drugs Act, GPs who
prescribe these drugs must make a prescription out in the name of a
specific patient.

The GP then personally goes to the chemist to secure a limited supply of
the drugs and administers the injection to the patient. GPs are not permit
ted to secure bulk batches of the drugs from pharmacists.

The health board has not as yet involved the gardai in this new
controversy. The two GPs have strongly denied any wrongdoing on their part.