Anesthesia-induced hallucinations key to dentist's acquittal

A Pennsylvania oral surgeon accused of molesting 17 female patients was acquitted last week in a case that centered on the extreme effects some anesthetics can have on patients.

Allegheny County Judge Anthony Mariani, who presided over the nonjury trial, found Robert Boyda Jr., D.D.S., not guilty on all counts.

The judge's verdict was based on the testimony of expert witnesses -- board-certified anesthesiologists -- who explained that the anesthetics administered to the patients could induce sexual hallucinations, according to Dr. Boyda's lawyer, William Difenderfer.

Dr. Boyda, 44, was charged in January 2008 with several counts of assault, including involuntary deviate sexual intercourse, deviant sexual intercourse, indecent assault, indecent exposure, and corruption of minors.

The original charges were brought against him by four female patients, with others coming forward after his arrest was made public. A total of 17 women accused him of assaulting them while they were fading in and out of consciousness due to anesthesia for a dental procedure.

Following the charges, Dr. Boyda agreed to voluntarily surrender his license while his criminal case was pending in the Allegheny County Court of Common Pleas.

Drug-induced hallucinations

In acquitting Dr. Boyda, the judge said he did not believe the patients had reliable memories as some of the drugs they had been given can cause hallucinations, vivid dreams, and sexual fantasies as per expert witnesses and medical textbooks, Difenderfer said. The witnesses' testimony was consistent with the nature of the drugs, he added.

The drugs used on the patients included nitrous oxide, propofol, Valium, Versed, Pentothal, ketamine, and Brevital. The main culprit was likely propofol, Difenderfer said.

While under the influence of these drugs, external stimuli could have led patients to falsely believe that sexually inappropriate behavior was taking place, he said. Numerous studies have found that propofol in particular can cause sexual hallucinations.

A 2003 study found that agents such as midazolam and propofol are particularly prone to producing sexual hallucinations (Anaesthesia, June 2003, Vol. 58:6, pp. 549-553).

"Some practitioners have been the victims of allegations resulting from the hallucinogenic effects of these drugs," the authors wrote. "Other individuals, including doctors, have used the amnesic effects of midazolam and other drugs to sexually assault victims. Clinicians should be aware of the risks to which they may inadvertently expose themselves if these drugs are not used carefully."

Another study noted that various cases of postoperative sexual hallucination have been associated with the use of propofol since 1987 (Spanish Journal of Anaesthesiology and Resuscitation, February 2000, Vol. 47:2, pp. 90-92). The incidents are characteristically followed by amnesia. The authors noted, that given the legal implications, the presence of someone of the same sex as the patient is recommended when the patient awakens.

A 2008 literature review found that postoperative hallucinations occurring in patients anesthetized by propofol are not exceptional even with low doses (Therapy, March-April 2008, Vol. 63:2, pp: 141-144).

"Most of the hallucinations are described as pleasant with a frequent 'sexual connotation,' uninhibited behavior, or a verbal expression of patient's intimate thoughts," the authors wrote.

The judge said he was astounded that the patients had not been warned about the possible side effects of these drugs, adding that his verdict might have been different if this had been a civil case instead of a criminal one.

"Some in the media saw this as encouragement to file a civil suit," Difenderfer said. "But I think he was trying to appease the victims."

Threatening letter

Difenderfer also said that sexual assault was not possible because office staff members were present at all times during the dental procedures. In addition, Dr. Boyda's office has very small rooms where the doors are never closed and the patients are never alone with the dentist for more than 15 to 20 seconds, he said.

Still, this was a very emotional case, Difenderfer said, and the patients who brought the charges were visibly upset when Dr. Boyda's not guilty verdict was announced. Some plan to file civil suits, according to news reports.

In fact, according to news reports, Judge Mariani was escorted home after the acquittal by a sheriff's deputy, and his house was under guard overnight. A potentially threatening letter sent to Judge Mariani during the trial that claimed to be from more than 500 former students who had attended dental school with the Dr. Boyda at Northwestern University said he had a history of the same behavior then.

The letter stated that if Dr. Boyda was found "anything other than guilty," the authors' issue would be with Judge Mariani, not the defendant.

Dr. Boyda now plans to seek renewal of his license and resume his dental practice. He plans to install a video camera and tape all procedures, Difenderfer said. The videos will be kept private, although patients can have access to them after one year.

Calls to the district attorney's office for comment were not returned.

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