SOURCE: Straits Times

A DOCTOR monitoring a liposuction carried out on property management firm boss Franklin Heng said she did not cause his death and cannot be held responsible for his collapse after she left the procedure room.

Dr Zhu Xiu Chun, 48, also known as Dr Myint Myint Kyi, said her monitoring was adequate and that the dosage of propofol – a sedative used in the procedure – was adjusted according to the patient's response.

She conceded, however, that it was unsatisfactory that changes in dosage had not been recorded, according to practice guidelines for safe sedation.

She also agreed with a suggestion by the lawyer for Mr Heng’s family that it would have been better to record the patient’s vital signs – pulse rate, blood pressure, oxygen saturation – every five minutes, instead of 15 as in this case.

The Myanmar-born doctor, who is now a Singapore citizen, took the stand yesterday on the third day of the inquest – a fact-finding exercise rather than a determination of who was to blame – into Mr Heng’s death.

On the morning of Dec 30, 2009, Mr Heng, 44, had gone to the Reves Clinic in Orchard Road for a liposuction and fat-transfer operation.

The doctor conducting the surgery was Dr Jim Wong while Dr Zhu’s role was to monitor the patient’s vital signs.

Dr Zhu told the court yesterday that under Health Ministry guidelines, monitoring of a liposuction procedure can be done by a registered nurse or doctor.

However, she said that when propofol is used, a doctor would monitor the procedure. “We need to observe the patient constantly and we must know when to intervene if there’s deterioration of the patient,” she said.

She added that when she was called by Dr Wong, 34, to help monitor the procedure, Mr Heng, whom she was seeing for the first time, was already in the procedure room.

A nurse was also there to help Dr Wong.

Dr Zhu said that when she went in, Dr Wong had already set up an infusion pump which administers drugs, including propofol, into the patient.

Throughout the procedure which started at 12.30pm and ended at 3.50pm, Dr Zhu said she saw to it that Mr Heng was on continuous oxygen supply and that the equipment measuring his vital signs was in place.

She reported the readings to Dr Wong. She said they were within an acceptable range and there was no snoring or other abnormal respiratory movement to suggest that Mr Heng’s airway was disturbed.

She added that Dr Wong ordered the dosage of propofol to be adjusted during the procedure, according to the patient’s response.

Dr Zhu said that if the patient did not move much, meaning he was quite sedated, the dosage would be adjusted lower.

If he moved or made sounds, and after making sure that the vital-sign readings were stable, the dosage would be adjusted upwards.

She said they checked to see that Mr Heng was responsive to tactile sensation, suggesting that he was in moderate sedation.

After the procedure ended, she left. She was in her consultation room seeing a patient when, 25 minutes later, the clinic’s receptionist knocked on her door to tell her there was an emergency.

Dr Wong had found Mr Heng pale and unresponsive after he returned from a five-minute toilet break.

Ms Kuah Boon Theng, representing Mr Heng’s family, noted that sedatives blunted the normal responses of a patient to stresses such as pain.

She pointed out that Mr Heng suffered multiple punctures in his organs as a result of the liposuction and would have been in excruciating pain from the injuries.

Dr Zhu agreed in theory but said she did not see any signs of pain, such as struggling, during the procedure.

Ms Kuah suggested that the only plausible reason Mr Heng did not show any overt signs of pain was that he had been more than moderately sedated.

When pressed, Dr Zhu conceded that she could not rule out the possibility. She said this point was beyond her expertise and would be addressed by the experts who will testify later.

However, she noted that there had been a report of a case of perforation during liposuction. It was diagnosed only after the procedure as the fluid injected into the body before the procedure, which acted as an anaesthetic, had numbed the area.

Dr Zhu continues on the stand today.