Authored by the group in 2012, The Doctors' protocol for Midazolam was to have two doctors on site, not necessarily present during a procedure, when the drug to be used.
Last week the court heard from Dr Ellis, senior special emergency physician at Hawke's Bay Hospital, who oversaw Lim in a training capacity in the ED.
Dr Ellis told the court the department had an "absolute rule" that two people be present when Midazolam is used for the safety of both the doctor and the patient.
"We would usually have three people be present if that's logistically possible."
Dr Ellis said for a doctor to be alone while administering the drug would go against all of his teaching, which Lim received for three-and-a-half years, and described the protocol followed at The Doctors as "bizarre".
During cross-examination yesterday defence counsel Hannah Stuart put to Dr de Silva that while it might be practical to have a second practitioner present during a procedure it came down to a matter of clinical choice; with which he agreed.
De de Silva said it was about a doctor's own experiences, how comfortable they were with different techniques and the discussion they had with a patient.
Ms Stuart also put to him the techniques employed by Lim, which included moving a sedated patient into a darkened room to sleep and assisting a sedated patient to the bathroom.
Dr de Silva said a darkened room would be a comfortable environment for someone sleeping off the effects of sedation, and that taking a patient to the bathroom may be reasonable if the doctor thought they were at risk of falling over and hurting themselves.
Last Monday the court heard Lim was "overtly gay" and that this had created a situation "ripe for misunderstanding".
"We anticipate that it's likely each of these four young men recognised that when they came into the consultation they knew that he was demonstrably, overtly as I say, a gay person," said defence counsel Harry Waalkens, QC.
The Crown's case is that Lim "took advantage" of the men, whom he was treating for minor ailments, by giving them the drug in an unnecessary manner to render them unable to resist his sexual advances.
"His true intention was not a medical one but rather so he could take advantage of the effects of the sedation on his patients," Mr Manning said.
The trial is continuing.