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Dose concerns ignored before death

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A pharmacist believed the dose of methotrexate prescribed to a man who later died was inappropriate – but her concerns were ignored

Fairfax media outlets have reported on the inquest into the death of 77-year-old Ian Gilbert, who was prescribed methotrexate in 2015 to treat a flareup of psoriasis on his back and legs.

Reporter Aisha Dow writes that when the pharmacist was presented with the script, she became worried that the dose could be lethal, and telephoned the doctor with “extreme concerns”.

The dose was twice daily 2.5mg of methotrexate.

The prescriber told the pharmacist that he did not wish the dose to be changed.

Mr Gilbert, a former real estate agent and father of four, died after being hospitalised and his family says that an autopsy found the cause of death to be complications of methotrexate toxicity.

Through the family’s legal representative, Paula Pulitano from Slater and Gordon, the court heard that Mr Gilbert suffered from a number of chronic illnesses, including a “renal issue”.

The family say he should not have been prescribed the drug, and the pharmacist should not have dispensed it.

Ms Dow writes that the case has “exposed tension” between doctors and pharmacists.

Expert witness Pamela Mathers, a community pharmacist, told the court that she believed a culture existed among prescribers of not always responding to the concerns of pharmacists.

“Some doctors are really awful to deal with,” she said.

“At the end of the day it’s doctors that call the shots.”

However she also said that many doctors were “great to deal with” and always engaged in discussion when contacted.

The inquest is ongoing.

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