Have a chaperone present when patients are sedated

In the past year, the Inquiry Committee has received two complaints from patients alleging improper conduct by physicians while the patients were sedated. Historically, the College has received very few such complaints. It may be that these most recent complaints were brought forward due to heightened concern by the unprecedented case of the Toronto anesthesiologist convicted criminally for sexually assaulting 21 of his female patients while they were semi-conscious on the operating table: http://canlii.ca/t/g4bdq.

While such allegations are infrequent, it is prudent to recognize that sedated patients are potentially vulnerable to harm, and they may misunderstand or misinterpret what is happening to them. Physicians are ultimately responsible for collaborating with other members of the care team to minimize the risk of both.

Complaints of this nature are usually quite easy to resolve when physicians and others ensure that everyone involved in the care of the patient is effectively chaperoned for the duration of the period of depressed consciousness. Occasionally, with the intention of being helpful, physicians will attempt to manage the administration of a sedative without assistance when nurses and others may not be present. In a non-urgent circumstance, this is never a good idea.

Facilities and hospital departments performing procedures under sedation or administering medications that impair consciousness for therapeutic purposes should have policies in place to ensure physicians and others are never alone with patients who are under the influence of sedatives, including ketamine. Registrants should be aware of these policies and adhere to them.