Methotrexate Blamed for Man’s Death
A heavy-duty medication used to treat a common skin condition has been blamed for the death of a Melbourne grandfather, in a case that has exposed tension between pharmacists and doctors.
Former real estate agent Ian Gilbert, 77, died two weeks after being given cancer drug methotrexate for a flare up of psoriasis on his upper back and legs in 2015.
A coronial inquest heard that the pharmacist who dispensed the medication believed that the dose could be fatal, but handed over the medication anyway after phoning the doctor who wrote the script.
The court was told that the pharmacist called the GP with “extreme concerns”, but the GP insisted that he wanted the dose to remain the same.
Expert witness community pharmacist Pamela Mathers said there was a culture within the medical field that meant doctors sometimes did not respond to pharmacists’ concerns.
“Some doctors are really awful to deal with,” she said.
“At the end of the day it’s doctors that call the shots.”
The family of Mr Gilbert, a father of four, believe he should not have been prescribed methotrexate and that the pharmacist should have acted on her concerns and not filled the prescription.
The script was for twice daily 2.5 milligram doses of methotrexate, a potent immune system suppressant also used to treat severe rheumatoid arthritis and some types of cancers.
The drug has been linked to several deaths and comes with many warnings, including that it should not be used by patients with severe renal (kidney) impairment.
The family’s lawyer, Slater and Gordon’s Paula Pulitano, said Mr Gilbert had a number of chronic diseases including renal issues that should have been tested for.
And in any case, the drug should have never been prescribed by the GP in the first instance, Ms Pulitano said.
“This is a particularly tragic case as we believe [the doctor and pharmacist] missed an opportunity to rectify the over-prescription, which we believe ultimately caused Mr Gilbert’s death,” Ms Pulitano said.
The court heard that while Mr Gilbert had been prescribed methotrexate before, it was several years earlier.
He died in February 2015 after a stint in hospital, with an autopsy listing the cause of death as complications of methotrexate toxicity, according to the family.
Mr Gilbert was a lifelong supporter of the North Melbourne Football Club and had five grandchildren.
Amanda Gilbert, one of Mr Gilbert’s twin daughters, said she could not understand how her father’s death could happen in an era when a patient’s medical history was so easily accessible.
“We hope no other family is forced to endure what we have experienced. Dad trusted his doctor and pharmacist of many years, both of whom we believe failed in their duty of care to him,” Ms Gilbert said.
“Our family has been absolutely devastated by what has been a completely avoidable tragedy.
“Just knowing he should still be here with us is something we will never get over.”
The coronial inquest continues.