Most of the pressure sores on Lanitola Epenisa’s body could have developed rapidly, likely just hours before his death, a plastic surgeon has testified at the manslaughter trial of Epenisa’s widow.
Former Healthcare NZ carer Malia Li is accused at the Auckland High Court of grossly neglecting her stroke victim husband to the point where he died in October 2016 on a urine-and-faeces-stained recliner next to a rat nest in his decrepit South Auckland bedroom, with some pressure sores deep enough to see muscle and bone.
But Bruce Peat, who has been a reconstructive plastic surgeon at Middlemore Hospital since 1994, told jurors he was surprised the detective in charge of the case didn’t want to use his more benign assessment of Epenisa’s death. He was instead called to testify on the defendant’s behalf.
“These pressure areas would very rapidly have become infected, especially when there’s urinary and faecal incontinence,” he said, adding that nursing notes from Epenisa’s two hospitalisations for strokes two years before his death showed a history of urinary incontinence.
“They would very rapidly have caused Mr Epenisa to become very unwell, especially in the presence of his diabetes and other [health] problems.”
Peat was insistent the sores would not have been there for weeks or months, which he suggested most people would think of when considering neglect. Given Epenisa’s poor health, the timeframe was more likely between 10 hours and three days, and probably closer to the shorter end of that timeframe, he estimated.
“There’s no way he could have survived infection for any length of time,” he said. “He was just too unwell.”
Peat’s testimony contradicted in part that of Dr Joanna Glengarry, a pathologist who was called by Crown prosecutors to testify earlier in the trial. The pressure sores were likely to have developed over “a great deal longer than six hours”, she said at the time.
“There was dirt encrusted onto the skin. There were long, unkempt nails,” Glengarry said.
Peat was also asked about the room’s stench, which multiple witnesses testified about, including a detective who said he had to take frequent breaks while examining the death scene, despite having a stronger stomach than most due to his profession.
“Urinary incontinence is very difficult for a caregiver to deal with and for a person to put up with,” Peat said. “Clothing items require frequent changes. This becomes very tiring to manage.
“It was inevitable that his room would smell of ammonia and urine because he was frequently incontinent.”
Peat suggested that post-mortem photos show pressure sores on Epenisa’s body matched how he was found in the recliner. That suggests, he testified, the sores developed at the same time — after he would have been immobilised for more than six hours, perhaps by another stroke.
“He must have suddenly stopped moving, and then he developed the pressure sores and then he died,” he said.
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