SINGAPORE - An obstetrician and gynaecologist started a caesarean section on a patient without making sure the epidural anaesthesia had taken effect.
She screamed in pain but Dr Lee Kim Kwong continued with the procedure.
On Friday, Dr Lee, in his 60s, failed to quash his conviction for professional misconduct over the procedure he carried out in 2010.
However, the Court of Three Judges, which heard his appeal, reduced his suspension from nine to five months. It will give its written decision later.
Dr Lee, who practises at Lee Women's Clinic & Surgery, was also fined $10,000. He was found guilty of professional misconduct last year by a Singapore Medical Council (SMC) disciplinary committee.
Dr Lee appealed and made an issue of the timing the epidural was given and said he made a "test scratch", not a caesarean incision, before the patient screamed.
Dr Lee was scheduled to perform the caesarean section at the Mount Alvernia Hospital at 8am on Aug 17, 2010.
The anaesthetist, Dr Lim Eng Siong, entered the operating theatre at about 7.40am and later administered the epidural on the patient, who was wheeled in earlier.
After Dr Lee came in, the patient told him she still had some feeling in her leg. At about 8.20am, Dr Lee made a cut on the patient's abdomen, which caused her to scream.
Dr Lim immediately gave the patient a mixture of oxygen and nitrous oxide for about a minute to sedate her.
The baby was delivered at 8.23am and the operation ended at 8.45am.
The disciplinary committee found that Dr Lee, as the surgeon, had the ultimate responsibility to check if the epidural had taken effect.
It found that he did not do any test but had made an incision on the patient before checking if the epidural had taken full effect.
Although there was no risk to the lives of the mother and baby, the SMC found it unacceptable for Dr Lee to proceed after the patient screamed.
Dr Lee said the epidural was given at 8am and would have taken effect at 8.20am, when he made the cut. It usually takes effect in 15 to 20 minutes.
Dr Lim said that the epidural was given at 8.10am. Senior Counsel Tan Chee Meng, acting for the SMC, said the evidence supported Dr Lim's record of the time.
He also alleged that Dr Lee tried to "fabricate" records by later telling a nurse to add a handwritten note to hospital records stating the patient was "supine" after anaesthesia at 8am.
Dr Lee's lawyer Lek Siang Pheng said this was not an attempt to alter medical records; his client was trying to clarify with the nurse because there were differences in various records of the time the procedure started.
He said the way in which Dr Lee carried out the procedure may not have been entirely satisfactory but it was not reprehensible enough for a suspension.
This article was published on May 10 in The Straits Times.
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