A young prostitute who died after a drug-fuelled sex session with a Sydney neurosurgeon had a history of nose bleeds and chest pains, a court has been told.

Suresh Surendranath Nair is charged with the manslaughter of 22-year-old Victoria McIntyre, who died in February 2009 after being called as an escort to the accused's Elizabeth Bay apartment.

She was one of five prostitutes hired by Nair on the night.

A post-mortem examination determined she died from cocaine toxicity.

Some of the other women present on the night have told Nair's committal hearing he supplied them with cocaine.

The court has heard Nair had a large amount of the drug which he was snorting with a rolled-up $50 note.

On Wednesday, Dr Rianie van Vuuren (RIANIE van VUUREN) who performed the autopsy on Ms McIntyre's body, confirmed that “at first” she was unable to determine what caused the death, having “excluded” other possibilities.

But on receipt of toxicology results, she determined that cocaine toxicity was the cause of death.

“Did you know that the deceased … had suffered from nose bleeds and lethargy in December 2008?” Nair's barrister Peter Hamill, SC, asked Dr van Vuuren.

“Would that have been a relevant element to look at when excluding causes of death?”

Dr van Vuuren said she was not aware of the past conditions and had come to her conclusion using “limited” medical history.

“Were you also aware that on February 3, 2009 – four days before the examination – that the deceased told her mother she was having chest pains?” Mr Hamill continued.

“That would be a pretty relevant thing to know, would it not?” he asked.

The doctor replied: “It could be”.

But Dr van Vuuren maintained cocaine toxicity was the cause of Ms McIntyre's death.

“There is nothing else in my post-mortem (examination) or in the limited history I had that would indicate a cause of death,” she said.

Nair is also charged with the November 2009 murder of escort Suellen Domingues-Zaupa, 23, who was found to have died from cocaine toxicity.

Ms Domingues-Zaupa died in the company of co-worker Carmen Hernandez-Zaupa and Nair at the same Elizabeth Bay apartment.

In evidence, Ms Hernandez-Zaupa said she tried to phone for help when she saw her friend convulsing, but Nair took her phone and she became scared.

The pair began to perform CPR on Ms Domingues-Zaupa but, the court was told on Wednesday, Nair should have known the importance of calling for medical help.

Emergency department doctor Timothy Green, from Sydney's Royal Prince Alfred Hospital, who examined Ms Domingues-Zaupa's body, said any medical practitioner would have known an ambulance was needed.

“… at the first sign of seizure any medical practitioner would recognise that that is something of grave significance and call an ambulance”.

“… there would be no point doing CPR unless you had summoned the help of paramedics at the earliest opportunity,” he said.

The hearing before Magistrate Carolyn Barkell continues.