Defence counsel Paul Leung Chiu-lam replied he had been instructed to express condolences at the end of his oral submissions and reminded the court that the deceased, 32-year-old Josephine Lee Kar-ying, had been one of Kwan’s closest friends.

“No punishment can bring back Madam Lee or compensate for the loss,” Leung continued. “This is a tragic incident. Nobody wanted it to happen, definitely not the defendant.”

But the judge said that Kwan’s conduct at trial did not seem to suggest “someone who feels sorry”, noting she did not cooperate with the investigation or the prosecution, as evidenced by her withholding information about the amount of drugs she administered during the procedure, which remains unclear.

The High Court previously heard that Lee, a dance instructor who weighed 113.5kg before treatment, died after her second liposuction, during which she was heavily sedated to remove fat from her back, at the Regrowth Hair Transplant Centre in Tsim Sha Tsui on June 26, 2014.

Her cause of death could not be ascertained, but experts ruled out overdose of anaesthetics, trauma, haemorrhage and infection.

A jury last month concluded Kwan had failed to take reasonable care of the woman’s safety and that breach amounted to gross negligence which was a substantial cause of death.

In particular, Kwan failed to ensure a properly qualified person – such as an anaesthetist – was present to administer and monitor the sedation, and to follow the Hong Kong Academy of Medicine’s guidelines on procedural sedation.

She also failed to ensure sufficient oxygen supply during Lee’s liposuction, did not provide her with proper and sufficient monitoring, and did not administer adequately timely resuscitation after the procedure.

Kwan is the third Hong Kong doctor in five years to be found guilty of gross negligence manslaughter related to a botched beauty treatment.

Prosecutor Juliana Chow Hoi-ling noted that the government’s Private Healthcare Facilities Ordinance, which took effect on January 1, regulates what procedures could be performed in private settings and stipulates that liposuction must take place in a licensed clinic.

Doctor left heavily sedated liposuction patient in care of untrained assistants, court hears

In mitigation, the court heard Kwan graduated from the University of Hong Kong and developed a keen interest in cosmetic surgery, prompting her to leave the Hospital Authority and join a private practice as a general practitioner in 2007.

Leung said she learned the ropes from experienced surgeons in the field and attended courses in Korea, Thailand and mainland China, before joining the centre in 2012.

But the judge questioned whether that was enough to qualify her for the surgeries involved, as she had not been properly trained in a recognised and reputable institution, university or hospital.

“Maybe this should be looked into by the medical profession,” the judge said. “It surprises me that this can happen.”

Leung added the fact that Kwan had performed liposuction without incident on more than 80 occasions, including once previously on Lee, had lured her into a false sense of security, causing her to make a serious error of judgment deserving of criminal punishment in the eyes of the jury.

The defence lawyer also submitted that Kwan’s culpability was “not on the high side”, as there were no aggravating factors such as unlawful treatment, monetary gain or lack of consent.

Since the incident, Leung said, Kwan had ceased performing any procedures that required sedation and became “an average doctor” who helped the disabled and the elderly in care homes.

Leung further revealed that Kwan was diagnosed with cancer in 2018, and was also facing civil claims and a disciplinary hearing, which would likely result in a ban from medical practice.

Kwan will be sentenced on September 21, pending an impact assessment on Lee’s family.