Junior doctor allegedly gave 'inappropriate drugs prescriptions' to young patients

The allegation was made against Dr David Kromer (43), who was attached to the child and adolescent mental health services (CAMHS) unit in South Kerry.

Concerns raised by Dr Ankur Sharma, a locum consultant psychiatrist, about Dr Kromer’s prescribing and diagnostic practices sparked a major “look back” review of 1,300 cases handled by the service between July 2016 and April 2021.

The review report is due to be published this week, but the Sunday World has established around 200 young service users and their families have already received apologies for substandard care from the unit.

Apologies have been given for inappropriate prescribing, insufficient assessment to ensure a comprehensive diagnosis, loss or incompleteness of medical notes, and lack of care.

The report is expected to highlight failings across a range of areas and not just with one person or one team.

In an interview with the Sunday World Dr Sharma said parents reported their child was left “feeling like a zombie” and some patients had “significant medical side-effects”.

He alleged diagnoses of ADHD in children were made without proper assessment, leading to harmful or incorrect clinical management, including the “risky” prescribing of multiple medications. Anti-psychotic drugs were prescribed to children who, he believed, did not need them. In addition, Dr Sharma said he discovered many patient files were missing clinical notes and prescriptions.

A separate HSE investigation is also under way after a teenage service user, deemed by a consultant to be in need of an urgent appointment with South Kerry CAMHS, took their own life last year after the appointment was never arranged. Dr Sharma said he believed the death had been “entirely preventable”. That probe is unrelated to the controversy surrounding Dr Kromer, a non-consultant hospital doctor who worked at the CAMHS unit between 2016 and 2020.

During this time, Dr Kromer occasionally also had a side job giving Botox injections at beauty salons. Dr Sharma said Dr Kromer had no previous CAMHS experience.

Dr Kromer stopped practicing in October 2020, shortly after the concerns were raised about his performance, and said he was awaiting the outcome of the look back review and a potential investigation by the Medical Council.

He said he had always acted “with my best knowledge, with my best attention, my best intentions”. “I do not regret any decision. I would make them again,” said Dr Kromer.

Dr Sharma (40), who came to work in Ireland following a distinguished period of practice in England, alleged Dr Kromer engaged in “risky poly-pharmacy”, the prescribing of multiple medications. Dr Sharma also raised concerns over the level of supervision received by Dr Kromer, who he said had no previous CAMHS experience.

In an internal HSE email, seen by the Sunday World, another consultant said they tried to address concerns about Dr Kromer’s clinical practice, but claimed he “did not actively engage in this process and did not appear to be able to understand our concerns and perspectives”.

The consultant alleged: “He did not come for supervision, instead booking in patients at supervision times.”

Dr Sharma said that in March last year he also discovered 55 South Kerry CAMHS cases that had been “lost to follow-up”. These were cases where medication had been prescribed as far back as 2018, but the patients had seemingly been forgotten about and were not called back for a review of their treatment at any stage.

Dr Kromer said this was an organisational issue. “I could say it was my responsibility but at the same time it was the service’s responsibility,” he said.

Dr Sharma said the combinations of medications in these cases was “cause for alarm”, as was the “lack of medical monitoring”. The discovery was only made after a mother rang in with a query about her child’s medication.

It transpired the child’s file had not been reviewed for 12 to 18 months, even though they had been prescribed an anti-psychotic drug which they had continued to receive on repeat prescriptions. A manual review uncovered the other “lost to follow-up” cases.

Dr Sharma claims that after highlighting the 55 cases, calling for extra resources and telling parents what happened, he was told to take time off and later confined to administrative duties on the basis he was showing signs of burn-out, even though he disputed that he was.

Ultimately, he resigned as he felt his position was undermined and took up a position with a CAMHS team in Co Cork. He has since quit working for the HSE after becoming disillusioned with how mental health services for children are being operated.

He said that while working in South Kerry, the unit had 545 cases but was only resourced for a third of that number.

The alleged failings uncovered by Dr Sharma have left the HSE open to a raft of medical negligence lawsuits.

Coleman Legal, a law firm representing over 70 affected families across Co Kerry, said it had raised the issue of supervision at all meetings with the HSE where clients received apologies. Solicitor Keith Rolls said the firm also suspected many more than 55 cases were “lost to follow-up”.

He said he expected these issues to be documented in the HSE report.  “The over-prescribing of incorrect medication, accompanied by the distinct lack of any diagnosis, patient follow up or monitoring has had a devastating impact on our clients,” Mr Rolls said.

Dr Sharma said that while he was confined to administrative work, the family of one of his patients contacted South Kerry CAMHS. He had warned the family to make contact if the child exhibited certain symptoms. But the family was not put through to Dr Sharma and was instead put in contact with another consultant.

It was agreed an appointment would take place within days. However, an appointment letter did not materialise, despite several further attempts by the family to obtain one, and the teenager died by suicide a month later.

The case is currently the subject of a serious incident review involving personnel from outside Kerry.