Sepsis death from implant a '50-50 call'

·3-min read

Doubt has been cast on claims a client of body modifier Brendan Leigh Russell died of sepsis after a plastic snowflake was implanted in her hand.

The 40-year-old NSW Central Coast man is on trial for manslaughter after the customer's death on April 12, 2017.

A plastic snowflake was implanted under her skin on the back of her hand in late March and became infected, the Sydney District Court has been told.

Two days before her death, Russell reopened the wound, washed it out and reinserted the implant.

The Crown alleges Russell is liable due to gross negligence while Russell has suggested mixed drug toxicity is a possible cause of death.

After examining medical reports and photos from before and after the woman's death, prominent Queensland infectious diseases physician David Paterson said he thought death from sepsis was a "50-50 call".

"My opinion is she died with the infection, rather than from the infection," the University of Queensland Centre for Clinical Research director said on Thursday.

"But I appreciate it is a 50-50 call. She could have died from the infection but I'm really uncertain as to whether that was the case."

Blood cultures - grown from a small amount of blood taken from the body several days post-mortem - returned negative results for sepsis.

That could occur due to antibiotic use or other reasons, the professor said, but the result combined with no observable organ damage and her rapid decline caused him doubt.

Prof Paterson, who was called by Russell to give expert evidence, conceded he was not a forensic pathologist and hadn't been provided with statements from lay witnesses who observed the woman.

The woman covered her hand with her sleeve on April 9 until the "clearly green and yellow" wound was exposed when she reached for food, her mother said.

Other witnesses who later saw the woman spoke of a large amount of pus being squeezed from the wound and the woman complaining of pain and tiredness.

But the professor said significantly, the woman saw two doctors on the 11th about pain and neither "twigged ... (that) something bad is going on".

"I am shocked ... I think it's a very unlikely circumstance that a person was walking and talking, and died of sepsis the next day," Prof Paterson said.

Crown prosecutor Chris Taylor suggested it was reasonable a person would have preferred to not mention the hand pain or, believing the body modification was illegal, avoided mentioning it to a doctor.

"In clinical practice, there is a wide variety of responses. If I'm going to a doctor for pain medications, and the pain is in a particular location, I would have thought a person would mention that to their doctor," Prof Paterson said.

A forensic pathologist called by the Crown to give evidence last week said sepsis was the sole or main contributor to death.

"The problem is, if there is not sepsis here, how to explain those various markers in the setting of a significant infection," Professor Johan Duflou said last week, citing various abnormalities.

Russell has also pleaded not guilty to two lesser charges related to clients he operated on in 2015 and 2016. Part of one woman's labia was excised while another woman received an attempted "tummy tuck".

The trial continues.

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