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Sudbury psychiatrist given 'advice' over medication dispute with patient

Patient complained he was overprescribed certain medications and developed an addiction as a result, resulting in College of Physicians and Surgeons offering ‘advice’ to Dr. Hanumantha Rayudu Koka on prescribing benzodiazepines
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A Sudbury psychiatrist has been given professional advice over a complaint from a patient who claimed he developed an addiction to certain antidepressant drugs and said his doctor failed to advise of the addictive properties associated with the drugs.

The issue was first dealt with as a complaint by the patient (whose name is being withheld by Sudbury.com) to the Inquiries, Complaints and Reports Committee of the College of Physicians and Surgeons of Ontario (CPSO).

The issue came to light in April 2020 when the patient wrote to the CPSO expressing concern about Dr. Hanumantha Rayudu Koka of Sudbury, whose specialty is psychiatry. 

The hearing was told that in late July 2019, the patient attended the Emergency Department (ER) of Health Sciences North after feeling progressively more depressed, anxious and experiencing panic attacks and sleep disturbances following a change in his medications. He was referred to Koka, who saw the patient on Aug. 9 and Aug. 28, 2019, said the hearing transcript.

During the Aug. 9 appointment, the complaint reads, the patient told Koka that he wanted to be better in time for his return to university studies, and so Koka prescribed the applicant a month’s supply of Prozac, Lorazepam (Ativan) and Temazepam (for short-term treatment of insomnia) and also provided the patient with repeat prescriptions for an additional period of five months, since the patient said he had to attend a university semester out of town. 

In his initial complaint, the patient claimed the following:

  • The doctor over prescribed benzodiazepines to him, resulting in addiction;
  • The doctor failed to inform the patient of the risks associated with benzodiazepines, and;
  • The doctor was dismissive of the possibility of his becoming addicted.

In his response to the complaint, Koka said his consultation was with a 21-year-old student who had already been on Prozac for roughly four years, but his family physician changed the prescription to Citalopram and then Zoloft, which are also antidepressants. The patient said he was experiencing symptoms of depression, anxiety, panic attacks, brain fog, loss of appetite, difficulty concentrating, loss of confidence, lack of energy, and sleep issues.

Koka also told the hearing he switched the patient back to Prozac, since it has proven effective in the past. Also, as per his standard practice when prescribing a medication to the patient, risks, side effects, and benefits of Prozac were reviewed with the patient. 

Koka said he further advised the patient that antidepressant medication such as Prozac typically takes time to work, such that he may not feel any appreciable benefit prior to departing for school in a few weeks.

Given the patient's time concerns, Koka also prescribed lorazepam (Ativan) as a temporary medication to alleviate the patient's symptoms in the short term, while the Prozac dosage was being optimized and while he waited to see if Prozac would provide sufficient benefit.

Koka said the patient expressed some concern with the possibility of developing a dependency for this medication. However, the applicant also advised that he generally did not like taking pills, said the transcript. 

Given the applicant was alert to dependency issues, had no history of substance abuse, and was being prescribed a low dose of lorazepam and temazepam, Koka's assessment was that the risk of medication abuse and/or developing a dependency was fairly low, said the transcript.

As a result of the initial hearing, the Inquiries, Complaints and Reports Committee issued "advice" to Koka "to be cautious in prescribing benzodiazepines, including considering alternatives, avoiding multiple types of benzodiazepines at once, and avoiding multiple prescription repeats for patients not being seen in follow-up."

In October of 2020, the patient requested a review of the committee's decision, suggesting that the CPSO review was inadequate.

A review was held in November 2021. The appeal review board disagreed with the patient. In a decision released on February 24, 2022, the review board said the first decision to issue advice to the doctor was adequate and addressed all the concerns that were raised by the patient the first time.

Len Gillis is a Local Journalism Initiative reporter at Sudbury.com. The Local Journalism Initiative is made possible with funding from the federal government.


Len Gillis, local journalism initiative reporter

About the Author: Len Gillis, local journalism initiative reporter

Len Gillis is a Local Journalism Initiative reporter at Sudbury.com covering health care in northeastern Ontario and the COVID-19 pandemic.
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