Liposuction death: should doctor have taken toilet break?

PHOTO: Liposuction death: should doctor have taken toilet break?

SINGAPORE - If a patient is still under the effects of sedation, should a doctor stay by his side at all times, or should he be allowed a toilet break?

This was the point that was being heavily debated during yesterday's inquiry into the death of CEO of YTL Pacific Star Mr Franklin Heng, The Straits Times reported.

Mr Heng, 44, underwent a liposuction procedure by Mr Jim Wong, 35, at Reves Clinic on Dec 30, 2009. The property management tycoon later suffered multiple holes to his intestines and stomach and died later that day.

The inquest heard that the procedure ended at about 3.50pm. Dr Zhu Xiu Chun, who assisted Dr Wong during the procedure, left the room after the surgery ended.

Dr Wong stayed with the patient and dressed the wounds with the help of his nurse. At 4.05pm, he left the room for a five minute toilet break.

During the inquiry, Dr Wong said at that point, Mr Heng responded to verbal stimuli, indicating the patient was moderately sedated, and his vital signs were normal.

After he came back, he noticed Mr Heng was pale and unresponsive. Mr Heng was later pronounced dead at about 6pm. Dr Wong is being sued by the family of Mr Heng for his role in the patient's death.

The lawyer representing the bereaved family, Ms Kuah Boon Theng, questioned Dr Wong on why he did not document his toilet break in the medical records and if he should have waited until his patient was fully conscious before he went to the washroom.

To the first, Dr Wong said he had only stepped out for a few minutes and had instructed his nurse to observe the patient.

To the second, Dr Heng said he found the patient to be stable and in a moderate state of sedation, and that he "really needed to use the bathroom."

Ms Kuah countered that Dr Wong could have gone before Dr Zhu left. Dr Wong replied that he cannot recall when he felt the urge to go to the loo.

The lawyer suggested to the court that Dr Wong should not have left his patient and gone out of the clinic premises to the washroom before Mr Heng had fully awoken from the effects of sedation, as he had undertaken the task of observing the patient.

The lawyer also grilled Dr Wong for not complying with guidelines in administering Propofol, a sedative used in the procedure to achieve light to moderate sedation.

The guidelines of the American Society of Anesthesiologists (ASA) state that patients receiving Propofol should receive the same care given for those in deep sedation, which includes electrocardiographic (ECG) and exhaled carbon dioxide monitoring, said the lawyer.

Dr Wong said this is true according to ASA guidelines, but not according to Ministry of Health (MOH) guidelines.

When asked if he caused the punctures to Mr Heng's intestines, Dr Wong replied "yes."

Dr Wong said that Mr Heng previous liposuction procedure left fibrous scars in his abdomen, which made it difficult to feel the tip of the liposuction steel tube.

He also explained that the tube moves in a fan-like motion during the melting and sucking out of the fat, thus it is possible for a single entry point to create multiple punctures.

The inquiry is a fact-finding exercise and will hear the testimonies of 17 witnesses until Nov 4, 2011.