Mum slams system over daughter's fatal overdose

GRIEVING mother Julie Feldhahn has gained solace in the answers a coronial inquest has provided on questions she had over her daughter's death.

Toowoomba sittings of the inquest into the fatal drug overdose of critical care nurse Katie Lee Howman ended yesterday with Coroner Christine Clements adjourning to consider the evidence presented.

Mrs Feldhahn and family members were at the Toowoomba Courthouse for two days of what at times were confronting insights into Mrs Howman's prescription-drug doctor shopping.

At yesterday's conclusion, Mrs Feldhahn said she would love to see real time reporting of doctor shopping to doctors and pharmacists, raising flags as the patient tried to obtain medication.

She believed if the system had been implemented in Queensland when it became available in 2012, her daughter might still be alive.

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Also discussed at the inquest was a change in the drugs tested for when a medical professional's conduct was being monitored by the Australian Health Practitioner Regulation Agency.

All urine drug testing was in July last year made to include screening for opioids oxycodone and Fentanyl.

Mrs Howman died from a Fentanyl overdose in December, 2013, before testing for those drugs became mandatory.

"I'm pretty happy with the way things are going," Mrs Feldhahn said.

"I just feel sad that with the drug testing, they have changed that but it was not in time to save my daughter."

Questions directed at Australian Health Practitioner Regulation Agency Queensland state manager Matthew Hardy also gave insight into how Mrs Howman was able to avoid detection for drug use.

Counsel assisting the Coroner Dr Anthony Marinac asked if Mrs Howman was given the results from her routine drug testing.

Mr Hardy said results were sent to her GP, but on some occasions Mrs Howman had access.

They showed she was using Tramadol, but that did not cause concern because Mrs Howman had prescriptions for legitimate pain complaints.

Mr Hardy was asked whether or not Mrs Howman, with her medical knowledge, would have been able to understand from the results that she wasn't being tested for oxycodone or Fentanyl.

He conceded she could have potentially recognised the loophole and exploited it by continuing to use the opioids while being tested.

Mrs Feldhahn said that was one of the main questions posed by her daughter's death.

"We knew she was having drug testing."

She said it created a false sense of security.

"We had no idea drug testing meant they were only testing for certain drugs."

Mrs Feldhahn wanted her daughter to be remembered as a loving human who cared about everybody.

Mrs Howman grew up in Gatton and moved to Toowoomba aged 17 to study nursing at the University of Southern Queensland.

Her first nursing job was a traineeship at Toowoomba Hospital, where she eventually became a critical care nurse.

She married husband Heath and together they started a family.

Mr Howman detailed memories of his wife.

"Katie was a devoted mother to her two children," Mr Howman said.

"She was a loving wife and the best partner anyone could wish for.

"She was passionate about her nursing job."

He said she always gave 100 per cent of herself to her family, friends and patients.

"Unfortunately, she never let on to anyone about her own turmoil.

"I only hope the inquest will help others who are in a similar predicament to open up and ask for help."

Tests not done due to cost

TOOWOOMBA GP Dr Leslie Dhaniram has told an inquest he had no reason to suspect Katie Howman was abusing opioids in the lead-up to her final overdose.

Dr Dhaniram, who practises at the Lindsay St Medical Centre, began treating Mrs Howman about 2005.

He yesterday described her consultations as frequent.

His overall assessment of her was a fit and healthy person with occasional health problems.

Dr Dhaniram said he prescribed Tramadol for Mrs Howman's various pain complaints as it did not have the level of addiction concerns of drugs like codeine.

Mrs Howman was prescribed the drug periodically between 2003 and 2009.

Dr Dhaniram said after Mrs Howman overdosed on Fentanyl while at work in 2010, she had on two occasions come to him saying she had lost drug prescriptions.

It was not until after her 2013 death that he became aware she was doctor shopping or had become addicted to opioids.

"At no time did I suspect that," Dr Dhaniram said.

Queensland Nurses' Union professional officer Allan Shepherd also gave evidence yesterday.

He detailed the cost of urine drug testing, which could be up to $100 a test, as well the frequency of testing required to comply with varying degrees of professional monitoring.

They ranged from routine testing to random requests for samples.

Mr Shepherd said he understood urine drug tests done on Mrs Howman did not include screening for oxycodone because of the additional cost that would incur.

Counsel assisting the Coroner Dr Anthony Marinac said that at the time Mrs Howman was seriously addicted to oxycodone, the Pharmaceutical Benefits Scheme was paying for the drugs obtained by her doctor shopping, but not the tests meant to detect their use.

Mr Shepherd agreed the scheme should cover drug testing costs.

System could stop doctor shopping

AN IMPASSIONED plea has been made to Coroner Christine Clements for her to recommend Queensland implement a real time monitoring system to prevent doctor shopping.

Counsel assisting the Coroner Dr Anthony Marinac said earlier implementation of the system already used in Tasmania and the Northern Territory could have saved Katie Howman's life.

"In 2012, then Commonwealth Health Minister Tanya Plibersek announced a project for real time reporting of doctor shopping to doctors and pharmacists," Dr Marinac said.

"This software is ready to roll out and it would alert doctors and pharmacists immediately to doctor shopping."

He said prescription shopping was monitored by Medicare and the information was available from Queensland Health's Drugs of Dependency Unit.

"However, they share a crucial weakness. Both rely upon a GP, confronted by an individual patient, taking the step of contacting them to see if the patient has been flagged.

"Your Honour has heard from several witnesses that if a patient is clever enough to arouse no suspicions, the GP will have no cause to investigate further."

He called on the Coroner to recommend to the Queensland Government that the technology be implemented.

"With respect, this is a decision which the Minister could plausibly announce tomorrow and it is very hard to see which stakeholders could possibly object."

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