Consent key to conscious sedation - specialist anaesthetist testifying about doctor's conduct

Accused: David Lim is on trial for stupefying and indecently assaulting four male patients while working as a GP at The Doctors in Hastings. Photo/Duncan Brown

A medical expert with a career spanning more than three decades has described the conduct of a doctor on trial for stupefying and indecently assaulting his patients as "unusual".

David Kang Huat Lim, 41, is on trial in the Napier District Court after pleading not guilty to five charges of stupefying and eight of indecent assault.

He is alleged to have administered the sedative drug Midazolam to four male patients before sexually assaulting them, while working as a GP at The Doctors in Hastings during 2014.

Yesterday the court heard expert insight into Lim's use of Midazolam from a specialist anaesthetist, Dr Andrew Love, of the Waitemata District Health Board.

Throughout the week four male patients, aged between 18 and 30, have told the jury they were being treated by Lim for minor ailments when he administered Midazolam intranasally without the support of medical staff.

Several complainants said they felt drunk and effectively went to sleep, going on to wake up from the sedation to find their trousers undone, pulled down or removed entirely. Each of the men testified to Lim touching or rubbing their privates.

Medical expert Dr Love, who had used the drug on a weekly if not daily basis, told the court Midazolam could be administered in small doses for the purpose of making patients more relaxed and alleviating anxiety during procedures.

He also said larger doses of Midazolam could be administered to induce patients into a state of conscious sedation where they are effectively put to sleep.

Referring to a position statement set out by the Australian and New Zealand College of Anaesthetists, Dr Love said doctors treating consciously sedated patients should adhere to certain rules to ensure the safety of themselves and their patients.

Crown prosecutor Steve Manning earlier told the court Lim had used the drug in an unnecessary way to sedate his patients and 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."

When examined by Mr Manning, Dr Love raised issue with Lim's conduct in regards to personnel, consent and recovery.

He said conscious sedation generally required at least two people, one for the procedure and another for monitoring the patient, and that Lim had not followed this and therefore put the patient at greater risk.

The court had earlier heard Lim repeatedly rid treatment cubicles of nurses and family members while treating patients, telling them he needed to stay with the patient during recovery.

Dr Love also testified that he was surprised to see Midazolam had been used on an 18-year-old, described by the boy's mother and a nurse as a naturally "relaxed" person, to treat a dislocated finger.

"I think it's a very unusual decision."

He said that using a ring block, which would cut off any feeling in the finger, would have been "perfectly effective" and that Lim's repeatedly not inserting an intravenous cannula while his patients were sedated went against guidelines and was an "unusual practice."

Dr Love also stressed the importance of obtaining written, if not oral, consent before conscious sedation and said he had examined the complainant's' medical records to find little documentation of consent.

Earlier in the week Mr Manning told the court three of the four patients, all of whom are Maori or Pacifica, were not native English speakers which made them "vulnerable to the very attentions that Dr Lim had for them."

Dr Love told the court the Waitemata DHB has a strong recommendation for an interpreter or a family member to explain procedural sedation to a patient who didn't speak English as there were associated risks.

"I think the important part of the consent is not the piece of paper but the discussion, and the discussion should cover the risks and benefits of the sedation and the alternatives to sedation," he said.

When Mr Manning put to him that one patient had been moved to a darkened room by Lim to recover from sedation, Dr Love said that was unusual and that there was actually good reason to put patients in well-lit rooms as it was easier to observe them.

Upon cross-examination Lim's defence counsel Harry Waalkens, QC, posed to Dr Love the difficulty of accounting for all the factors of a situation, including training, preference, experiences and clinical judgement.

He pointed out that while Dr Love's expertise was undeniable, there was great difficulty in making judgment calls and revisiting the circumstances of the particular time.

It is expected the Crown will call its last witness early next week.