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Singapore. Liposuction patient Franklin Heng suffocated after doctors gave him too much sedative during the operation, a coroner found yesterday.

The property management firm boss was meant to have been conscious during the procedure to remove fat from his back and abdomen.

But in fact, he was given such a big dose of propofol - the controversial sedative that killed singer Michael Jackson - that the effect was almost like a general anaesthetic.

He was so heavily sedated, he was unable to protest when Dr Jim Wong, 36, accidentally punctured his intestines 13 times.

When the divorced father of two responded to the pain by struggling and swinging his arms, the doctors failed to realize he was injured and simply sedated him further.

Unable to support his own airway, Heng eventually died from the effects of asphyxia, said State Coroner Victor Yeo.

His 63-page findings cast doubt on the credibility of Dr Wong as well as that of Dr Zhu Xiu Chun, 48 - also known as Dr Myint Myint Kyi - who played a supporting role in the operation.

He said their testimony about issues, such as the amount of propofol given to the patient, was unreliable, "obviously tailored and an afterthought."

Coroner Yeo said he had "serious reservations" about accepting the evidence of Dr Wong and Dr Zhu, especially with regard to the monitoring of the patient.

Heng, 44, died after the scheduled cosmetic procedure at Reves Clinic in Orchard Road on Dec 30, 2009. The aim was to remove the fat and transfer some of it into his chest.

He was given pethidine as a painkiller and sedated with propofol. This drug is at the centre of worldwide controversy over whether it should be used by only anesthetists, as opposed to general practitioners (GPs) like Dr Wong and Dr Zhu.

When the procedure ended more than three hours later, Dr Wong left the room for a toilet break. When he returned, he found Heng pale and unresponsive. The patient was taken to hospital, where he was pronounced dead.

Coroner Yeo said Dr Wong may have used more force than necessary to move the cannula, the hollow metal tube inserted into the body to suck out fat.

This was because he believed wrongly that Heng had undergone liposuction before - which would have made it harder to carry out the procedure due to scar tissue.

Prominent plastic surgeon Vincent Yeow, an expert witness called by the State, attributed the perforation to extremely poor technique and a lack of experience or awareness.

These multiple perforations alone did not kill Heng, said the coroner. However, they 'precipitated a chain of events that eventually led to his death'.

Coroner Yeo found the opinion of anaesthetist Boey Wah Keong "compelling and convincing." Dr Boey, an expert witness called by the State, said he believed Heng's airway had become obstructed, causing cardiac arrest.

The coroner said it was unlikely that the punctures alone caused the patient's death as there was no massive bleeding, and it takes time for infections to develop in the abdominal cavity.

An autopsy shortly after Heng died found his death was caused by multiple punctures to his intestines inflicted during liposuction.

But Coroner Yeo said the forensic pathologist who supervised it did not disagree that the patient could have suffocated from his tongue falling back. This may not have been detectable at the post-mortem stage.

The coroner added that the way the patient was monitored while under sedation was 'clearly lacking and inadequate'.

Although the doctors claimed 60ml of propofol was given to Heng, he found that they had actually given more.

Coroner Yeo pointed out that in statements to the police, Dr Wong did not mention the amount of sedative. The figure was later tailored to show that Heng was on light to moderate sedation.

The timings in Dr Wong's notes had also been amended. They originally said that Heng's vital signs were last reviewed at 1600 hours. This was later changed to 1610 hours. The time that the patient was found to be pale was also changed, from 1620 to 1615 hours.

Coroner Yeo, who spent two hours reading out the findings yesterday, emphasized it was a fact-finding inquiry, which was not meant to apportion blame. As for the issues of whether GPs should be allowed to perform liposuction, whether the use of propofol should be restricted, and whether existing guidelines are clear or adequate, he said these were best discussed in a separate forum.

Both doctors declined to comment in court. Dr Wong said he was "deeply sorry" and extended his condolences to the patient's relatives.

Heng's family has filed a civil suit against the doctors. A hearing has been tentatively set for March.

When asked if criminal charges will be brought, a spokesman for the Attorney-General's Chambers said: "We are considering our next course of action."

Reprinted courtesy of Straits Times Indonesia. To subscribe to Straits Times Indonesia and/or the Jakarta Globe call 021 2553 5055.