Expert witness testifies on proper medical procedures in Sylvester Ukabam trial

WARNING: This story includes details of sexual assault allegations.

The sexual assault trial of a former Regina doctor continued on Wednesday when an expert witness took the stand to speak on the proper procedural and examination practices of a gastroenterologist.

Sylvester Ukabam practiced as a gastroenterology specialist in Regina prior to giving up his medical license in 2018. He pleaded not guilty to seven counts of sexual assault levelled against him by five complainants.

Ukabam is accused of inappropriate actions during physical medical examinations of several female patients between 2010 and 2018.

Dr. Barry Lumb, a gastroenterologist and medical professor with 38 years of experience from Ontario, was approved as an expert witness Wednesday morning.

After one day of deliberation, Justice Brian Scherman decided Lumb is qualified as an expert to give opinion in the trial on medical gastroenterology procedures and whether any touching during exams was done for proper or valid medical purposes.

In the judge’s written decision, Scherman said Lumb’s opinions on the “impact upon or the consequences for the complainants” of touching and examinations or procedures that were not conducted for a medical reason will not be admissible into evidence, stating there is no necessity for a gastroenterologist to weight in on those matters.

PROPER PROCEDURE

Several alleged victims accused Ukabam of touching or penetrating their vaginas during rectal exams. Some also accused him of completing exams without using medical gloves.

On Wednesday morning, the Crown had Lumb describe the proper procedure for a rectal exam to the court room.

Lumb said the standard practice is for a doctor to inform patients, particularly female patients, that they have the option of having a family member or chaperone present when being examined in sensitive areas such as the rectum, vagina or breasts.

According to Lumb, it is important for the patient to be in a proper position, which is typically lying on their left side with their knees drawn up. He said on some occasions he has seen patients on their backs with the knees up for a rectal exam, but said it is not the standard in North America.

Lumb said the physician should always verbalize the steps of the procedure to the patient before it begins and during each stage. He said there is a specific hand position that doctors use to avoid penetrating the vagina during a rectal exam.

Lumb told court there is no reason for the vagina to be touched or penetrated during a rectal exam. When asked if it was possible to accidentally touch the vagina, he said although the space between the anus and the vagina is small, the proper hand placement should avoid that.

Lumb said with some conditions, including Crohn’s disease, there are complications that can affect a patient’s genital area. He said in circumstances when a patient is known to have Crohn’s disease, a genital examination could be appropriate. He said if that is the case, the patient should receive a verbal explanation of the exam and it should only be done in cases when it is very clear that the genitals are affected.

“Under no circumstances would a purposeful examination of a vagina happen without a patient being aware that it is going to happen,” Lumb said. He said if it happened accidentally, it should be acknowledged by the doctor and an apology should be issued immediately.

Lumb went over several medical conditions typically treated by gastroenterologists, the medication typically used for treatment and the examination procedures typically completed by doctors. He said if a patient ever declines an exam or asks a doctor to stop during an exam, the doctor must comply.

Lumb also went over the proper practices for procedures including colonoscopies, gastroscopies and chest exams.

He said during a chest exam a patient is generally seated at a 45 degree angle and is examined by the doctor using one hand. He said generally speaking, contact should not be made with a patient’s breast during a chest exam unless specific symptoms are identified by the patient.

Lumb said during colonoscopies, patients are generally sedated. He said during the procedure, detailed notes are taken and should be kept on the record. Details would include the time in and time out, the patient’s vitals during the procedure, if anything abnormal happened during the procedure and sedation details.

He said the patient is on a stretcher and asked to roll on their left side and draw up their knees during a colonoscopy. They would be draped so only the buttocks is exposed.

He said a physician, one or two nurses and sometimes an anesthetist would be in the room.

The first complainant who took the stand in the trial said she underwent a colonoscopy at Ukabam’s practice. She alleged she felt “pressure, jabbing and digging” in her vagina during the procedure. She said she was consciously sedated at the time.

The Crown asked Lumb if, during a colonoscopy, it would be possible for the doctor to penetrate a patient’s vagina without anyone else in the room noticing.

Lumb said yes, due to the set up of an exam room, the positioning of the doctors and nurses and the tasks being completed by the others in the room.

He said touching or penetrating a patient’s vagina would not be normal during a colonoscopy procedure and not medically necessary. He said it certainly should not be performed during the procedure without the patient being aware beforehand.

The Crown asked if it would ever be appropriate for a doctor to give a rectal exam with a patient in a bent over position, and Lumb said no unless it was a male receiving a prostate exam.

Lumb said it would also never be appropriate for a rectal exam to be performed while the patient is standing up or on all fours.

When the Crown asked about his experience of breast examinations, Lumb said he has almost never had to perform one in his line of work. He described how he had been taught to do one during internal medical training, but said a breast exam does not fall under the umbrella of gastroenterology as a specialty. He added it could not be done effectively with a patient wearing a bra. 

CROSS EXAMINATION

During cross examination, the defence asked Lumb to clarify that it is possible for the opening of the vagina to be touched during a rectal exam. Lumb said it is “momentarily” possible.

Lumb said if a patient had received a rectal exam before, it might not be necessary for a doctor to explain the details of what it entails again. However he said it would be necessary to receive consent every time an exam is done.

The defence had Lumb discuss the dosages of conscious sedation drugs given to the complainants during their colonoscopies.

Lumb said it is possible for patients to forget some parts of the procedure, or conversations that happened during it.

He said it is not abnormal for a patient to say the procedure was blurry or foggy for them. However, he said it is very uncommon for a patient to be unable to speak if they wanted to when sedated.

The trial continues Thursday, with no further witnesses being called by the Crown.