REPORT OF AN INDEPENDENT INQUIRY ... - Hundred Families

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“On examination Mr. Sukumaran presented as polite and courteous. His mood was normal,
as was his talk. He told us that he had been taking his Lithium regularly and was well aware
of the consequences if he did not. He gave us a clear account of the reason for his presence
at the ward round and understood perfectly that he was in the process of settling a claim for
his personal injuries which he seemed to think was very acceptable to him. He seemed to
comprehend perfectly the his (sic) situation in life, the details of his illness and the requisites
for further progress with his health and career. He had insight into the nature of the illness
that he had suffered.
“In my opinion, at the present time there is no evidence of mental disorder. Mr. Sukumaran
seems quite capable of giving instructions to his Lawyers and is well aware of what is
happening around him and his situation.”
18. On 27th March 1992, Chandran did not attend an outpatients appointment. Dr Feldman wrote to
Dr Alagrajah saying that he had not attended the outpatients’ clinic and would not automatically
be sent a second appointment. She added the following postscript to her letter:
“This man is on Lithium and needs to have his Lithium Carbonate blood level checked
routinely. I will try to persuade him to come to outpatients but failing this I wonder whether
you could make sure that his Lithium levels are within normal limits. He needs his blood level
to be checked at least every 3 months.”
19. On the same day, Dr Feldman also wrote to Chandran saying she was sorry not to have seen him
at her outpatients’ clinic and explaining the need for his Lithium level to be checked. She said he
should contact either her or his GP. During the course of 1992, Dr Alagrajah appears to have
prescribed Camcolit (Lithium Carbonate) 400mg on 24th February 1992, 30th March 1992, 11th
May 1992 and 9th December 1992. As we have already explained, Dr Alagrajah did not respond
to the Inquiry Panel’s request that he give evidence. There is no note in Chandran’s GP records
that he was, in fact, seen on these occasions when the prescriptions were made but we have been
unable to clarify whether this is the case with Dr Alagrajah. The only pathology report relating
to Litihum levels to be found in his GP records is dated much later on 11th July 1997 and we
have been unable to ascertain whether Chandran’s Lithium levels were checked during 1992.
Comment
Looking at the GP records which record only the issuing of repeat prescriptions and no
information about Chandran’s condition at all, it is possible that Lithium Carbonate was
prescribed on occasions without his in fact having been seen by Dr Alagrajah. We do not
think we can make a definitive finding about this without having had the benefit of hearing
evidence from Dr Alagrajah. However, we observe here that it is not satisfactory, in our
view, to manage a patient with relapsing bipolar affective disorder by issuing repeat
prescriptions without any examination of, or discussion with, the patient. It is important
that a GP plays an active rôle in managing the patient’s condition which may best be done
by remaining in direct contact with him/her but should at the least ensure that the patient’s
condition is being managed within a proper framework of care.