A JUNIOR doctor has told a coroner she was responsible for up to 90 patients on a busy night when she prescribed an inappropriate drug to a man who later died.
Tani Brown, then a resident medical officer at Sydney's Prince of Wales Hospital, said she had never seen or heard of Cophenylcaine being used in the way she prescribed, and accepted she should never have done so.
Dr Brown was giving evidence at an inquest into the death of George Godden, 74, who suffered a seizure and cardiac arrest shortly after being given the medication for his bleeding gums.
He couldn't be revived, and died on February 22, 2007, the day before he was due to undergo heart surgery.
Eight days earlier, a staff dentist had recommended the removal of Mr Godden's teeth to reduce the risk of infection, which resulted in extensive bleeding of his gums.
Dr Brown, who had no experience caring for post-operative dental patients and had worked at the hospital for only about six weeks, instructed nurses to apply gauze soaked in Cophenylcaine.
The topical spray is used to stem nose bleeds, with the recommended dose set at five squirts per nostril, and a prescribing guide also cautions against using the drug for patients with cardiovascular disease, which Mr Godden had.
Although not indicated for use in gums, Dr Brown told Coroner Carmel Forbes she took no steps to check whether it could used for that purpose.
The inquest heard the manner of Mr Godden's death was toxicity from Lignocaine, an active ingredient in Cophenylcaine.
He was found to have 25.6mg per litre of blood of the substance in his system. Levels of 10mg could result in death, Ms Stern said.
Dr Brown said she agreed with counsel assisting the coroner, Kristina Stern, that she should have checked the label on the bottle, although it was not available to her at the time.
She agreed she was unaware of a specialist on-call dentist and, although she rang a general surgical registrar, he was unable to advise her on a treatment for Mr Godden.
She said she she was unsure why she didn't phone him back to ask if Cophenylcaine was appropriate after making the decision to prescribe it, adding "I was under quite intense time pressure".
"Do you accept now you should never have prescribed Cophenylcaine?" said Ms Stern, who earlier described the dose as inappropriate and dangerous.
"Yes I do," Dr Brown replied.
When questioned by her lawyer, Gary Gregg, she said she was responsible for two or three wards that night, with 20 or 30 patients in each.
"It was a very busy night," she said.
Asked how such an incident could be prevented in the future, Dr Brown told the coroner the Cophenylcaine was "lying around in the emergency ward not kept locked away", and suggested education for staff about certain drugs.
Dentist Paul Nichols, who criticised Mr Godden's post-operative care, said the evidence pointed to a "young doctor who was out of her depth".
The inquest, at Glebe Coroner's Court, is continuing.
