Five-year-old Hong Kong girl would not have died of septicaemia if she had not been abused, expert tells murder trial
- Infectious diseases specialist Dr Ho Pak-leung tells High Court child’s condition was worsened by more than 100 injuries on her body
- ‘If early medical intervention was given ... the risk of death would be greatly reduced,’ he says
A top microbiologist testifying at the trial of a Hong Kong couple accused of murdering their five-year-old daughter has concluded that the child would not have died of septicaemia if she had not been abused or neglected.
Dr Ho Pak-leung, a clinical microbiologist and infectious diseases expert, on Friday said the girl suffered a “very serious” infection of Salmonella enteritidis and Staphylococcus aureus, which had “highly likely” caused her death by septicaemia on January 6, 2018.
He explained that the child could have been infected by contaminated food or water one to two weeks before succumbing to a secondary infection in multiple organs, as bacteria from the gut invaded the bloodstream, travelled to the rest of her body, and triggered malfunction.
This condition was exacerbated by the existence of more than 100 injuries on her body, through which bacteria could enter and release toxins into the bloodstream, the High Court heard.
Ho said a healthy child would have recovered from the initial gut infection if his or her immunity system had not been compromised. He agreed with paediatrician Dr Kwan Yat-wah’s observation that the girl’s thymus – a vital organ for fighting infections – was reduced by the effect of abuse, thereby lowering her resistance.
The resulting septicaemia, occurring one to two days before death, caused the child to experience difficulty in breathing, sitting and standing; and made her unresponsive, pale and cold in her limbs, the expert said.
Couple deny murdering daughter, 5, who died after months of ‘torture in hell’
The girl’s 29-year-old father and 30-year-old stepmother have admitted to child cruelty inflicted upon her and her eight-year-old brother over a period of 150 days from August 10, 2017, but denied murdering her. Her 56-year-old step-grandmother denied all four counts of the cruelty charge.
Senior assistant director of public prosecutions Derek Lai Kim-wah said the parents’ prolonged abuse and neglect had indirectly but significantly contributed to the child’s death.
Presenting his case to the expert, Lai asked: “If [she] were not abused and she did not have those injuries, would she have died?”
“She would not have died,” Ho replied.
The prosecutor continued: “Even if she was abused and sustained those horrible injuries, if there were timely medical intervention, would she have died?”
“Likewise, she would not have died,” the doctor replied. “If early medical intervention was given, if antibiotics were prescribed at an early stage, if she was sent to hospital earlier, the risk of death would be greatly reduced.”
On the contrary, he added: “I can almost say for sure the patient will die.”
His findings were based on the autopsy conducted by forensic pathologist Dr Kwok Ka-ki, who concluded the cause of death was septicaemia. Her expert report also revealed that the child had 133 injuries, an unusually small thymus and the two kinds of bacteria in her body.
Ho explained that Salmonella enteritidis was a very common bacteria mainly transmitted through the consumption of contaminated food or water and was considered weak in the sense that healthy individuals could recover even without the prescription of antibiotics; while Staphylococcus aureus was found on the human skin and mucus, only infecting those with compromised health and injury.
The former was found in her small intestine, blood, spleen, cerebrospinal fluid, lungs and right knee tissues; while the latter in her left arm and also right knee tissues.
The doctor said the girl would first experience gastroenteritis, lose appetite and feel tired while the bacteria was still in her gut.
Five-year-old girl allegedly murdered by parents ‘found with 133 injuries’
As the secondary infection developed, bacteria in her lungs caused water retention, causing breathing difficulty and leading to hypoxia, blue lips and unconsciousness; while those in her cerebrospinal fluid led to meningitis, affecting her ability to respond, sit and stand.
He also noticed that she had a “very large” abscess on her right knee, measuring 6cm by 4cm by 4cm, which would have emitted a “very bad odour”.
Based on 25 years of experience in Queen Mary Hospital, Ho said carers seeing those symptoms would have no problem in realising there was a serious condition.
The father’s defence counsel, Alex Ng, however, noted that even doctors could miss the symptoms and cause delay in treatment, even death, let alone a person who was not medically trained.
Ho disagreed, adding that parents could notice something was wrong with their children unless they did not care if they lived or died, and that it was “just very basic common sense for normal people” to understand that the injuries posed a risk of infection, requiring proper treatment.
“It’s the responsibility of the doctor to arrive at the correct diagnosis,” he said. “However, in order to arrive at the correct diagnosis, the first step must be this: the parents or the carers have to take the children to see the doctor.”
He added that the ambulance service was free and “very easy to use”.
“Actually, here in Hong Kong, the problem is the exact opposite,” he observed. “Quite a number of parents will dial 999 and send the children to hospital just for a very small problem.”
None of the defendants or their relatives can be identified due to a gag order from Mr Justice Albert Wong Sung-hau aimed at protecting the identity of the children.
The trial continues.
