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Criminal Case2015

HKSAR v. CHOW HEUNG WING,STEPHEN AND OTHERS

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[2020] HKCFI 2679-EN-2020-10-15

HKSAR v. MAK WAN LING

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HCCC 437/2015

[2020] HKCFI 2679

IN THE HIGH COURT OF THE

HONG KONG SPECIAL ADMINISTRATIVE REGION

COURT OF FIRST INSTANCE

CRIMINAL CASE NO 437 OF 2015

________________________

BETWEEN

 HKSAR 

and

 MAK Wan-lingDefendant

________________________

Before:Hon Barnes J in Court
Date of Hearing and Decision:15 October 2020

_______________

D E C I S I O N

_______________

The application

1.  The prosecution intends to adduce evidence relating to the Good Manufacturing Practices Guidelines for Pharmaceutical Products (GMP Guidelines) against the defendant. The defence objects to its admission.

Prosecution’s stance

2.  The prosecution submitted that the central issue in this case is whether the conduct of the defendant can be characterised as grossly negligent. At the core of an objective analysis by the jury will be the reasonableness of the conduct of the defendant in placing the blood product in the bodies of healthy women, in particular, the deceased. One aspect of the issues that the jury has to decide is whether the defendant should have placed products in the bodies of her patients coming from an unaccredited laboratory. The prosecution confirms that it is not their case that the defendant was responsible for the inner works of the laboratory. The prosecution submitted that the jury is entitled to know what standards are expected of laboratories, and in that context, what she should have considered in whether it was reasonable to accept products from that laboratory, particularly when there were no reports of testing on the products.

3.  The prosecution accepts that a GMP standard is not an accreditation. However, the prosecution referred to paragraph 1 of the GMP Guidelines and submitted it is inconceivable that a laboratory would become accredited without at least adhering to those standards:

“Licensed pharmaceutical products should be manufactured only by licensed manufactures whose activities are regularly inspected by the Pharmacy and Poison Board. These Good Manufacturing Practices (GMP) guidelines should be used as a standard to justify GMP status which constitutes one of the elements of the WHO Certification Scheme on the Quality of Pharmaceutical Products Moving in International Commerce and as a basis for the inspection and licensing of manufacturing facilities.”

4.  As experts will testify as to GMP and its importance, the prosecution is anxious to back that up with documentary material, giving the jury a clear understanding of how these practices are fundamental to their safety and should have been fundamental to the safety of the deceased.

Defence stance

5.  The defence submitted that the GMP guidelines have no relevance to the case against the defendant. With reference to the history of what took place during the first trial, including a Ruling I made on 13 June 2017, subsequent statement and evidence of a particular expert witness: Professor William Chui, the defence submitted it was evident from the transcript references that this Court took the view that it was unfortunate that the GMP Guidelines had been introduced, that the value of the GMP guidelines was no more than a written reflection of what is common sense.

6.  Further, the defence submitted that the cases against Chow Heung-wing, Stephen (D1) and Chan Kwun-chung (D2) were materially different from the case against the defendant (D3). The case against D3 in this retrial is a failure to ensure that “a properly accredited laboratory was responsible for preparing and producing the said blood product”. GMP is not an accreditation, they are guidelines issued by the Pharmacy and Poisons Board of Hong Kong in respect of pharmaceutical products. They have no application to cell therapy.

My consideration

7.  For this re-trial, the particulars of breach alleged against the defendant (D3), after amendment, include the following under (2)(a):

“failing to ensure… a properly accredited laboratory was responsible for preparing and producing the said blood product”.

8.  It is common ground that a GMP standard is not an accreditation. At present, there is nothing concrete before this Court to show that by attaining a GMP standard, it is one step closer towards getting an accreditation for the laboratory in question. It is also of importance that the GMP was for “Pharmaceutical Products” and it is questionable whether this GMP applies to cell products.

9.  Whilst I appreciate the stance of the prosecution, I am not convinced that the rather voluminous 67-page GMP Guidelines is relevant to the issue of whether a laboratory is an accredited one or not.

10.  With reference to the ruling I made in June 2017, it can be seen that I was very much influenced by the fact that both D1 and D2 were well aware of the GMP requirement and I allowed evidence relating to GMP to be given by experts provided their evidence was not based on their interpretation of the Pharmacy and Poisons Ordinance, Cap 138 (PPO). I intentionally left the question of whether GMP Guidelines was relevant and admissible against D3 to be considered at a later stage, which in the end did not materialised.

11.  Even with the amendment adding the issue of an “unaccredited laboratory” against the defendant, I cannot see how details of a GMP Guidelines for pharmaceutical products can be relevant to the case against the defendant, particularly when there is no allegation or suggestion that the defendant was responsible for or had knowledge of, the inner running of the laboratory in question. 

12.  I had indicated during the first trial that much of what was written in the GMP Guidelines amount to common sense. The prosecution submitted that if they are common sense, why can’t the jury be provided with a written version of the common sense. In my view, just because much of what was written amount to common sense does not mean that the GMP Guidelines can automatically be placed in front of the jury. It is not admissible if it is not relevant, no matter how much it makes sense.

13.  For these reasons, I rule that the prosecution cannot adduce the 67-page GMP Guidelines into evidence against the defendant.

14.  Having regard to the need to avoid a substantial risk of prejudice to the administration of justice in the present on-going trial, it is ordered that the publication (in any form) of any report of the proceeding concerning this application be prohibited until the conclusion of this trial or until further order.

 (Judianna Barnes)
 Judge of the Court of First Instance
 High Court

Mr Andrew Bruce SC, leading Mr David CW Cheung, counsel on fiat, and Ms Margaret Lau SPP of Department of Justice, for the Prosecution

Mr Peter Duncan SC, leading Ms Deanna Law, instructed by Howse Williams, for the Defendant

[2020] HKCFI 2424-EN-2020-09-17

HKSAR v. MAK WAN LING

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HCCC 437/2015

[2020] HKCFI 2424

IN THE HIGH COURT OF THE

HONG KONG SPECIAL ADMINISTRATIVE REGION

COURT OF FIRST INSTANCE

CRIMINAL CASE NO 437 OF 2015

________________________

BETWEEN

 HKSAR 

and

 MAK Wan-lingDefendant

________________________

Before:Hon Barnes J in Court
Dates of Hearing:1 and 9 September 2020
Date of Handing Down Decision:17 September 2020

_______________

D E C I S I O N

_______________

The application

1.  The defendant faces one count of Manslaughter, contrary to Common Law and punishable under Section 7 of the Offences against the Person Ordinance, Cap 212. She was originally charged and tried together with two other defendants: Chow Heung-wing, Stephen (D1) and Chan Kwun-chung (D2). The defendant was D3 at the time. The jury was unable to reach a verdict in her case and she has to face a re-trial on her own.

2.  The prosecution applied to amend the indictment.

1st proposed amendments

3.  I will set out the indictment with the 1st proposed amendments:

“PARTICULARS OF OFFENCE

MAK Wan-ling, on the 10th day of October, 2012, in Hong Kong, together with Chow Heung-wing, Stephen and CHAN Kwun Chung, unlawfully killed CHAN Yuen-lam also knowns as CHAN Oi-lin, (‘the said CHAN Yuen-lam lam’) by gross negligence in that-

(i (1) Being a properly registered Doctor responsible for administering to the said CHAN Yuen-lam a product known as CIK/AI therapy on behalf of the DR Esthetic Centre (Causeway Bay) Limited and / or Hong Kong Mesotherapy Centre Limited, both companies being part of the ‘DR Group’, owed a duty of care to the said CHAN Yuen-lam;

(ii (2) In Breach of that duty of care, in the knowledge that the said CIK/AI therapy was based on experimental process for the treatment of cancer and which involved the extraction, manipulation in a laboratory and reintroduction of blood taken from the said CHAN Yuen-lam (“(‘the said blood product”),product’), failed to take reasonable care for the safety of the said CHAN Yuen-lam by –

(a) Failing to ensure that a properly qualified person or a properly accredited laboratory was responsible for preparing and producing the said blood product.

(b) Failing to ensure that all necessary viral and bacteria tests had been carried out on the said blood product and that such had been documented prior to administering it to the said CHAN Yuen-lam so as to ensure the said blood product was free of contamination.

(c) Failing to ensure that the said CHAN Yuen-lam was fully informed of the risks involved in the administration of the said CIK/AI therapy;

(d) Administering the CIK/AI therapy to the said CHAN Yuen-lam without first having obtained a proper consent from the said CHAN Yuen-lam by reason of her failure to properly inform, and advise the latter that;

(i) CIK/AI therapy was still undergoing clinical trial as a modality of treatment for cancer;

(ii) even as a modality for treatment of cancer, the efficacy of CIK/AI treatment was unproven and uncertain;

(iii) the proposed use of CIK/AI therapy for the purpose of improving or enhancing immunity (or as a wellness remedy for health promotion) had not been scientifically proven;

(iv) there was no scientifically proven benefit to be derived from the use of CIK/AI therapy on healthy persons or non-cancer patients such as the said CHAN Yuen-lam;

(v) the preparation of CIK/AI therapy involved culturing of blood cells in a medium exposed to open air over a duration of time thus carrying with it a risk of infection or contamination by bacteria;

(vi) CIK/AI therapy was attendant upon by risks of adverse effects or reactions such as systemic bacterial infection, wound infection, hypotension and hypersensitivity, which could be life-threatening in which case emergency admission to hospital would be necessary;

(vii)there was no medical indication for CIK/AI therapy in healthy persons or non-cancer patients such as the said CHAN Yuen-lam;

(viii) there were various safe and non-invasive alternative means for enhancing or improving immunity in human bodies and the use of CIK/AI therapy for such purpose was not necessary or medically justified;

(e) Being a registered medical practitioner, failed to give any or any sufficient regard for the fact the intended use of CIK/AI therapy on the said CHAN Yuen-lam:

(i) constituted a clinical trial in respect of which no application had been made to (and no approval had been obtained from) the relevant ethics committee of the Medical Council of Hong Kong and the Department of Health as stipulated in s.22 under Part F of the Code of Professional Conduct published by the Medical Council of Hong Kong (in January 1999); or

(ii) constituted an alternative treatment modality within the meaning of s.24 under Part F of the said Code of Professional Conduct;

which ought not have been carried out in the circumstances.

(iii (3) Her aforesaid breach of duty amounted to gross negligence on her part; and

(iv (4) Her aforesaid negligence was a substantial cause of the death of the said CHAN Yuen lam.”

Hearing on 1 September 2020

4.  At the hearing on 1 September 2020, after considering written submissions and hearing oral submissions from both parties, I referred to the transcript of the Closing Speech of the prosecution (which will be set out later here) during the first hearing and made some observations, principally to the prosecution.

5.  I referred to the preamble of section (ii) in the original indictment, which read: “In breach of that duty of care, in the knowledge that the said CIK/AI therapy was based on experimental process for the treatment of cancer…”, I was of the view that the wording “experimental process for the treatment of cancer” already encompassed the proposed 2(d)(i)(ii), with those particulars being further explanation or elaboration of the experimental nature of the treatment. Adding those two particulars might unnecessarily burden the jury and overload the indictment.

6.  I also pointed out that, in my view, particulars 2(d) (iii), (iv), (vii) and (viii) covered the same issue: that there was no proof that CIK/AI therapy would improve one’s immunity. I indicated just having particular (iv) was sufficient to make this point, without overloading the indictment.

7.  I made the point that particulars (v) and (vi) had always been the main thrust of the prosecution case. Having said that, there was indeed an overlap of (c) and (d). I suggested the prosecution to consider deleting (c) altogether, as (d) already covered (c).

8.  As for 2(e) in the 1st proposed amendments, I indicated, with reference to the transcript, that the prosecution case had always been that the CIK/AI treatment should not have been given to any person, including the deceased.

9.  Bearing in mind how the issue of the alleged breach of the Code of Professional Conduct came to be introduced and canvassed by the prosecution rather late in the first trial, and that it was not the main thrust of the prosecution case, I was of the view that adding those particulars would unnecessarily complicate the issues for the jury.

10.  As a result of my indication, the prosecution submitted a 2nd proposed amendments for my consideration.

2nd proposed amendments

“PARTICULARS OF OFFENCE

Mak Wan-ling, on the 10th day of October, 2012, in Hong Kong, together with CHOW Heung-wing, Stephen and CHAN Kwun-chung, unlawfully killed CHAN Yuen-lam also known as CHAN Oi-lin, (‘the said CHAN Yuen-lam’) by gross negligence in that –

(1) Being a properly registered Doctor responsible for administering to the said CHAN Yuen-lam a product known as CIK/AI therapy on behalf of the DR Esthetic Centre (Causeway Bay) Limited and / or Hong Kong Mesotherapy Centre Limited, both companies being part of the ‘DR Group’, owed a duty of care to the said CHAN Yuen-lam;

(2) In breach of that duty of care, in the knowledge that the said CIK/AI therapy was based on experimental process for the treatment of cancer and which involved the extraction, manipulation in a laboratory and reintroduction of blood taken from the said CHAN Yuen-lam (“the said blood product”), failed to take reasonable care for the safety of the said CHAN Yuen-lam by-

(a) Failing to ensure that a properly qualified person or a properly accredited laboratory was responsible for preparing and producing the said blood product.

(b) Failing to ensure that all necessary viral and bacteria tests had been carried out on the said blood product and that such had been documented prior to administering it to the said CHAN Yuen-lam so as to ensure the said blood product was free of contamination.

(c) Failing to ensure that the said CHAN Yuen-lam was fully informed of the risks involved in the administration of the said CIK/AI therapy.

(c) Administering the CIK/AI therapy to the said CHAN Yuen-lam without first having obtained a proper consent from the said CHAN Yuen-lam by reason of her failure to properly inform and advise the latter that:

(i) CIK/AI therapy was still undergoing clinical trial as a means of treatment for cancer and, in that regard the efficacy of CIK/AI treatment was unproven and uncertain;

(ii) there was no scientifically proven benefit to be derived from the use of CIK/AI therapy on healthy persons or non-cancer patients such as the said Chan Yuen-lam;

(iii) the preparation of CIK/AI therapy involved culturing of blood cells in a medium exposed to open air over a duration of time thus it carried a risk of infection or contamination of the patient on whom it was administered;

(iv) the administration of CIK/AI therapy had risks of adverse effects or reactions such as systemic bacterial infection, wound infection, hypotension and hypersensitivity, which could be life-threatening in which case emergency admission to hospital would be necessary;

(v) there were various safe and non-invasive alternative means for enhancing or improving immunity in human bodies and the use of CIK/AI therapy for such purpose was not necessary or medically indicated;

(d) Failing to give any or any sufficient regard for the fact the intended use of CIK/AI therapy on the said Chan Yuen-lam ought not have been carried out in the circumstances.

(3) Her aforesaid breach of duty amounted to gross negligence on her part; and

(4) Her aforesaid negligence was a substantial cause of the death of the said CHAN Yuen-lam.”

11.  One can immediately see that the 2nd proposed amendments did away with the original particular 2(c) and combined the allegation under the original 2(c) with the new 2(c). Further, the proposed particulars under the 1st proposed 2(d) have been pared down to give a more succinct allegation under the new 2(c).

12.  In the new 2(d), the prosecution did away with the reference to “clinical trial” and “alternative medical modality” originally in the 1st proposed amendments and now only alleged a failure on the part of the defendant to give regard for the fact that the CIK/AI treatment should not have been carried out on the deceased in the circumstances.

Section 23 of the Criminal Procedure Ordinance Cap 221

13.  The application was based on Section 23(1) of the Criminal Procedure Ordinance (CPO) Cap 221 which reads:

“(1) Where, before trial or at any stage of a trial, it appears to the court that the indictment is defective, the court shall make such order for the amendment of the indictment as the court thinks necessary to meet the circumstances of the case unless, having regard to the merits of the case, the required amendments cannot be made without injustice.”

Prosecution submission

14.  The prosecution submitted that the purpose of the application to amend the indictment was to provide better particulars regarding the alleged breach by the defendant to the deceased in relation to her failure to inform the deceased of factual information regarding CIK/AI therapy.

15.  The prosecution pointed to evidence already adduced in the first trial and submitted that the amendments would allow parties to focus clearly on their respective cases.

16.  It was submitted that there was no risk of prejudice to the defendant as these were the same issues canvassed during the first trial and the evidence would be adduced by the same prosecution witnesses as in the first trial.

17.  Whilst this case is not a “re-trial” in the sense of one being ordered under section 83E of the Criminal Procedure Ordinance, Cap 221, the prosecution relied on the case of R v Booker[1]in support of their application.

18.  The prosecution also relied on the fact that amendment to the indictment had been granted in Hong Kong, as shown in the case of the retrial of Tsang Yam-kuen Donald[2].

19.  The prosecution submitted that the amendment did not change the prosecution’s underlying case against the defendant.The proposed amendments did not require the prosecution to adduce any additional evidence beyond those adduced during the first trial. The proposed amendments did not impose any additional burden on the defendant but would bring more focus and clarity to the trial.

20.  After paring down the scope of the amendments, the prosecution explained the 2nd proposed amendments were the result of taking on board what the Court had said during the last hearing. The prosecution also referred to the word “necessary” in section 23 of CPO, and to authorities in England and Hong Kong, and submitted that the section was to be approached in a broad manner: R v Smith & Ors[3] and AG v Chan Hung-hoi[4].

Defence stance

21.  The defendant did not oppose to amendment 2(a) in relation to the addition of the words “or a properly accredited laboratory”.

22.  The defence relied on the Australian authority of Mejid Hamzy v R[5] and the cases cited in the judgment: R v Anderson[6] and Gilham v R[7] and submitted that whilst the prosecution might “remould” its case on a retrial, it had to retain the basic factual premises that underline the prosecution’s case. A retrial should not be used by the prosecution to reconstruct, supplement or “patch up” its case.

23.  The defence submitted that proposed amendments not only caused unnecessary complexity to the indictment, they would also result in an unnecessary overloading of the indictment – something which the Courts in Hong Kong had traditionally frowned upon. A number of cases were cited in support: R v Ma Lap Sun[8] citing R v Au Yeung Siu Wai & Another[9] and AG v Wong Sek Shing[10].

24.  The defence also relied on the case of R v Novac[11]on this point.

25.  The defence maintained that adding the additional particulars to the original 2(c), as now shown in the new 2(c) was unnecessarily making the indictment more complex and amounted to an overloading of the indictment.

26.  The defence strongly opposed to the addition of 2(d) in the 2nd proposed amendments, which read: Failing to give any or any sufficient regard for the fact the intended use of CIK/AI therapy on the said Chan Yuen-lam ought not have been carried out in the circumstances.  

27.  The defence submitted that such an amendment would result in the defendant facing a significantly different case from that previously advanced against her. The original indictment did not allege that the therapy should never have been carried out, rather the thrust was that there was failure in various respects in carrying out the therapy.

28.  With reference to the closing speech of the prosecution, while the prosecution had addressed to the jury that the CIK/AI therapy was “an unproven and wholly unnecessary medical procedure…”, the defence submitted that there was a clear difference between therapy that was “unproven and wholly unnecessary” and therapy which “ought not to have been carried out.”

29.  The defence referred to its closing speech to the jury, pointing out that while there was much evidence led by the prosecution as to whether the CIK therapy should have been carried out, it was not an allegation in the indictment that the defendant “breached her duty simply by carrying out the therapy”. The breach of duty alleged was that in carrying out the therapy she failed with respect of the three matters which were clearly set out in the indictment. I was informed that the defence chose not to address this issue as it was a “jury point”.

30.  Further, the defence submitted that only one of the professional experts, i.e. Professor Yuen, who had expressly said that the CIK was a wrong treatment which should not have been done. There was no direct evidence from any other experts that the CIK therapy was “wholly unnecessary” or “ought not have been carried out at all”.

31.  The defence submitted that it was particularly objectionable in the context of a retrial in this case following the inability of the jury to reach a verdict. The prosecution was clearly endeavouring to “patch up” its case by way of reconstruction and/or supplementation, which was not permissible.

32.  Additionally, the defence submitted that the amendments would result in injustice to the defendant in her having to undertake further substantial preparation for her retrial. The defendant had already been through the ordeal of a lengthy trial and had already undertaken significant preparation for the trial. If amendments were allowed, the defendant would need to undertake enquiries with potential medical experts as to whether there was any justification for the proposition that the therapy ought not to have been administered, as opposed to whether it was proven or necessary. The defence submitted that it was an unjustified burden that should not be permitted.

33.  I should point out that the defence also opposed to 1st proposed amendments in relation to the alleged breach of the Code of Professional Conduct. Since the prosecution is no longer applying to add those particulars regarding “clinical trials” or “alternative medical treatments”, there is no need for me to set out the grounds of opposition raised by the defence.

Consideration of the submissions

34.  Since the prosecution replaced the 1st proposed amendments with the 2nd one, I only need to consider the 2nd proposed amendments.

35.  None of the cases cited by both parties are on all fours with the present case. A particular feature of this application is that the evidence already adduced during the first trial covered the particulars proposed. I don’t think any purpose would be served by referring to the facts of the cases cited, save to say that I am in agreement with the principles enunciated.

36.  The trial judge retains a discretion in deciding whether to permit the amendment of the indictment but fairness to the defendant must be central to the decision: Booker. Whilst the prosecution may “remould” its case on a retrial, it must retain the basic factual premises that underline the prosecution’s case. A retrial should not be used by the prosecution to reconstruct, supplement or “patch up” its case: Hazmy and the cases cited therein. In considering the application, the judge is obliged to make such amendment as necessary to meet the circumstances of the case, unless the required amendments cannot be made without injustice: Chan Hung-hoi.

37.  The issue I have to decide is whether the proposed amendments ie. 2(c) and 2 (d) provide better particulars in accordance with evidence already adduced during the 1st trial (which will be adduced again during the re-trial) concerning the case the defendant has to face, or they amount to a “reconstruction” or “patching up” of the prosecution case. More importantly, I have to decide whether to allow the proposed amendments would be unfair to the defendant.

38.  Before considering the proposed amendments, I think it might be useful to see how the prosecution framed its case against the defendants in general in its closing speech (as recorded in the live notes).

“Now, you will recall that at my opening speech, I encapsulated the whole case in one paragraph, and it reads, it is an unproven and wholly unnecessary medical procedure, ie CIK treatment, procured, arranged and administered by one or more of the defendants, who are monitored by – who are motivated by monetary or personal gain involving the infusion of blood product which was improperly prepared, produced and checked prior to infusion, thereby causing the death of the deceased by blood poisoning due to contamination of the blood product by bacteria.” (Day 85, Page 4, line 5 – 15). (Emphasis applied)

39.  I placed emphasis on the words “an unproven and wholly unnecessary medical procedure”. In the original indictment, it was alleged that the defendant, knowing that “CIK/AI therapy was based on experimental process for the treatment of cancer…” did certain acts which the prosecution alleged to be in breach of her duty of care to the deceased. There was of course no mention that the CIK/AI therapy should not have been carried out. It was clearly the prosecution case that the said therapy was “unproven and wholly unnecessary”. The question I have to decide is whether something that is “unproven and wholly unnecessary” is different from something “which ought not have been carried out”, as submitted by the defence.

40.  Now, in relation to the issue of informed consent, the prosecution said this in its closing speech:

“Assuming you were told, ‘In fact CIK treatment is unproven, it is just a theory that it may or may not work, and there are other side effects apart from fever, such as hypotension that could be fatal, and such as anaphylactic reactions, hypersensitivity to the content included in the infusate, and there is also a risk of bacteria contamination. In theory, CIK cells would boost your immunity, but in fact you don’t need it, you can maintain a healthy lifestyle, maintaining a healthy mental balance, that would be the best medicine, or the best method to cope with a balance of your immunity system’, would you still have accepted the treatment and say, ‘I’m willing to try?’” (Day 85 page 78 line 22 to page 79 line 9).

41.  As against D3, the prosecution had this to say, again in its closing speech:

“… it just highlight the fact that within the DR Group the 3rd defendant is almost a front man, because she is a doctor she lends credibility to the sales effort…And that would give an air of professionalism and independence in the eyes of the customers of the DR group. … It was suggested that the doctors are independent, and that’s why the DR group can have no control over the doctors. So that is the scheme of things devised by the 1st defendant in the DR group, and the 3rd defendant is part of the machinery to create this impression of independence or professionalism. And an ordinary person would not know that in fact the advice he or she was receiving from the 3rd defendant is not truly independent.” (Day 88 page 93 line 8 to page 94 line 4)

…

“But coming back to the 3rd defendant, she knew about the Declaration of Helsinki. She knows about the duty of a doctor to act in the best interests of the patient, not to give treatment which is unnecessary. Inform the patients of all the information necessary so that an informed decision can be made, balancing the risk and benefit. Did she discharge her duty?” (Day 88, page 109 line 22 to page 110 line 3). (Emphasis applied)

42.  The prosecution spelt out the breach on the part of D3 as a doctor with reference to her duty as required under the Declaration of Helsinki, and again the emphasis on the unnecessary nature of the CIK/AI treatment, thus alleging that the defendant should not have given the treatment to the deceased.

43.  As acknowledged by the defence, leading counsel in his closing speech to the jury commented that “much evidence was brought by the prosecution to the issue whether the CIK therapy should have been carried out at all”:

“Firstly, much of the prosecution’s focus has been on the question as to whether the CIK therapy should have been carried out at all. Much evidence was brought to your attention by the prosecution in this respect. And my learned friend for the prosecution referred to it time and again during his closing remarks. But, you may well feel that that issue is not critical to the case against Dr Mak. And you may feel that because, as you will have already noticed and as we will see again in a few moments when we go to the indictment, it is not the allegation that Dr Mak breached her duty simply by carrying out the therapy. The breached of duty alleged is that in carrying out the therapy, she failed with respect to the three matters which are so clearly set out in the indictment. That is a very important distinction” (Day 94 page 8 line 7-23) (Emphasis applied)

44.  Indeed, as pointed out by the prosecution, in my summing up to the jury, I said:

“It is the prosecution’s case that the CIK treatment was an experimental treatment for cancer patients at the time, in 2012. No matter what the DR Group called the treatment, it was essentially a medical treatment and a medical procedure; there is no evidence of any health benefit of such a treatment which should never have been administered to a healthy person. And, it is the prosecution’s case that each of the defendants owed a duty of care to the deceased, Chan Yuen Lam, in their own capacity.” (Day 95, page 10, line 7-16) (Emphasis applied)

45.  It can also be seen, from my summing up to the jury, that I have made fairly detailed reference to the evidence of the various medical experts in relation to the issue that the CIK therapy should not be given to a healthy person:

“You of course heard the many experts saying that CIK therapy at the time was for cancer patient, still experimental, and it is not even proven, and shouldn’t be given to a healthy person. You have heard quite a number of experts saying that. I will just remind you who said what… [reference to the evidence given by various prosecution experts]” (Day 95 page 116 line 9 to page 124 line 14) (Emphasis applied)

46.  With these in mind, I will turn to the 2nd proposed amendments.

47.  There is no objection to the amendment to 2(a).

48.  In relation to the deletion of the original 2(c) and the addition of the new 2(c) (which is more succinct as compared to the 1st proposed amendments), I find that the amendments properly reflect, and accord with, the evidence already adduced in the first trial (which will be called again in the re-trial.) Such particulars will assist the jury to address their minds as to the “particulars” of the various alleged breaches on the part of the defendant. I do not find the amendments unnecessarily complicated the issues or overload the indictment.

49.  The main contention is in relation to the new particulars 2(d) in the 2nd proposed amendments: “Failing to give any or any sufficient regard for the fact the intended use of CIK/AI therapy on the said Chan Yuen-lam ought not have been carried out in the circumstances.”

50.  Whilst it may be arguable that something that is “unproven and wholly unnecessary” may not be exactly the same as something which “ought not have been carried out”, that there is a subtle difference, one must look at what actually took place during the first trial. It is correct that only one of the experts (ie. Professor Yuen) expressly said that the CIK therapy should not be done, the stance of the prosecution, as supported by all the medical experts, was that the CIK/AI therapy should not be given to healthy people.

51.  When a therapy is “unproven”, “wholly unnecessary” and “should not have been administered or given to a healthy person”, it could only mean that the said therapy should not have been carried out. As demonstrated by the final speech of the defence and my summing up on this issue, it is clear that both the defence and I understood the medical evidence from the prosecution was to the effect that CIK/AI therapy should not have been given to/carried out on a healthy person, including the deceased.

52.  While that was not specifically pleaded in the indictment, the defence was left in no doubt what the prosecution was alleging. No opposition was raised at the time when the evidence was adduced, during the prosecution closing speech or during my summing up to the jury. I would add that if there had been an application to amend the indictment during the first trial to include this allegation so as to accord with the evidence already adduced, I would have allowed the application.

53.  I have already referred to the closing speech of the defence acknowledging that “much of the prosecution’s focus has been on the question as to whether the CIK therapy should have been carried out at all”. The defence has chosen not to address such evidence but simply said to the jury, by reference to the indictment, that it was not the allegation against the defendant that she breached her duty by simply carrying out the therapy.

54.  Whilst it was for the defence to decide how they want to run their defence, the stance taken by the defence is not something that I should or would take into account in my consideration of the application. By allowing the amendment to the new 2(d), it will just have the effect of making sure that the indictment accords with the evidence already adduced and to be adduced, or to put it in another way, this amendment is necessary to meet the circumstances of the case. I do not accept that the amendment amounts to a “patching-up” of the prosecution case by way of “reconstruction or supplementation”, as submitted by the defence. The defendant would not be asked to meet a significantly different case during the re-trial.

55.  Further, while I appreciate the defendant has already been through a lengthy trial and has to wait for a long time for the retrial, I do not accept that the addition of the new 2(d) will be unfair or will cause injustice to the defendant. The prosecution has not changed its case against the defendant at all. The case against the defendant is exactly the same. The only difference now is that the particulars will accord with the evidence to be adduced during the retrial. The defence chose not to make enquiries during the first trial when this issue was raised or inferred by the evidence of many prosecution experts (as acknowledged by the defence during its closing speech). There is no question of the defence being required to undertake the work of making enquiries at the eleventh hour. In any event, the trial is scheduled to take at least two months to run, starting in October, so there is still time for the defence to make enquires, should the defence wish to do so. 

56.  For these reasons, I allowed the prosecution’s application to amend the indictment as per the 2nd proposed amendments.

57.  Having regard to the need to avoid a substantial risk of prejudice to the administration of justice in the present on-going trial, it is ordered that the publication (in any form) of any report of the proceeding concerning the amendments of indictment be prohibited until the conclusion of this trial or until further order.

 (Judianna Barnes)
 Judge of the Court of First Instance
 High Court

Mr Andrew Bruce SC, leading Mr David CW Cheung, counsel on fiat, and Ms Margaret Lau SPP of Department of Justice, for the Prosecution

Mr Peter Duncan SC, leading Ms Deanna Law, instructed by Howse Williams Bowers, for the Defendant



[1]   [2011] 1 Cr App R 26

[2]   HCCC 484 of 2015

[3]   (1950) 34 Cr App R 168

[4]   [1987] HKLR 969

[5]   [2019] NSWDC 7

[6]   (1991) 53 A Crim R 421

[7]   [2012] NSWCCA 131

[8]   CACC 678/1993, unrep, 26 Oct 1994

[9]   Criminal Appeal No 475 of 1992, unrep

[10]  CAAR 13/1988, unrep, 4 Oct 1988

[11]   (1976) 65 Cr App R 107

[2018] HKCFI 528-EN-2018-03-15

HKSAR v. CHAN KWUN CHUNG

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HCCC 437/2015

[2018] HKCFI 528

IN THE HIGH COURT OF THE

HONG KONG SPECIAL ADMINISTRATIVE REGION

COURT OF FIRST INSTANCE

CRIMINAL CASE NO 437 OF 2015

________________________

BETWEEN  
 HKSAR 

and

 CHAN Kwun-chung2nd Defendant

________________________

Before: Hon Barnes J in Court
Date of Decision: 15 March 2018

________________________

DECISION
(On D2’s Application for Costs)

________________________

Application

1.  This is an application by the 2nd Defendant (D2) for costs against the Prosecution pursuant to s 17 of the Costs in Criminal Cases Ordinance, Cap 492 (CCCO).  D2’s application was based on this Court’s rejection of the Prosecution’s argument that this was a case of “joint criminal enterprise”.

2.  It should be noted that originally counsel for D2 also relied on a second ground: ie a significant portion of time was spent by the Prosecution to adduce evidence irrelevant to the issues at trial.  D2 later abandoned this 2nd ground.

The Law

3.  S 17 of the CCCO provides:

“17. Where at any time in the course of criminal proceedings a court or a judge is satisfied that costs have been incurred in respect of the proceedings by a party to the proceedings as a result of an unnecessary or improper act or omission by or on behalf of the other party to the proceedings, the court or the judge may, after hearing all such parties, order that all or part of the costs so incurred shall be paid to the first‑mentioned party to the proceedings by the other party to the proceedings.”

4.  As to the relevant principle, counsel for D2 referred me to two authorities: DPP v Denning [1991] 2 QB 532 and HKSAR v Au Yeung Lai‑hung, Doris [2013] 3 HKLRD 586.

5.  In Denning, Nolan LJ said (541C‑D):

“.... the word ‘improper’ in this context does not necessarily connote some grave impropriety. Used, as it is, in conjunction with the word ‘unnecessary,’ it is in my judgment intended to cover an act or omission which would not have occurred if the party concerned had conducted his case properly.”

6.  In Au Yeung Lai‑hung the principles stated in Denning was applied (at para 41 of the judgment).

7.  Counsel for the Prosecution relied on what Stock JA (as he then was) described as improper conduct in HKSAR v Wong Wah Yee (No 2) [2001] 3 HKC 1:

“Our attention has been invited to s 17 of the Costs in Criminal Cases Ordinance which permits a court to award costs where in the course of criminal proceedings costs have been incurred as a result of ‘an unnecessary or improper act or omission by or on behalf’ of a party to the proceedings. It is unnecessary to determine whether such circumstances might be invoked in the context of an application for a certificate under s 32, and it is unnecessary because the circumstances envisaged by s 17 is not what the present question is about. The question which we address for present purposes is whether in the ordinary case an unsuccessful application for a certificate may be the subject of a costs order, whereas s 17 addresses particular types of conduct which merit condemnation in costs, such as negligence or specific unreasonable conduct, or improper conduct. Further representations have been made that the s 17 power is directed at matters arising in the course of proceedings rather than in relation to the result of the proceedings, but that too is not necessary to address, for we are satisfied that the section is not directed at the situation with which we are presently concerned.”

D2’s Submission

8.  Counsel for D2 submitted that the Prosecution’s stance that this was a case of “joint criminal enterprise” was “extraordinarily farfetched” and it was “improper” for the Prosecution to present such argument without any factual or legal basis.  In the present case, each of the three defendants faced a separate count, the particulars against each were different and there was no allegation that one defendant was criminally responsible for the particulars of offence laid against the other defendants.

9.  Counsel for D2 submitted that the Prosecution should pay D2’s costs of dealing with this application.

The response of the Prosecution

10.  The Prosecution’s stance was that the Prosecution’s application to admit the evidence of a co‑defendant against another co‑defendant under the doctrine of joint enterprise was not “improper” so as to merit a “condemnation in costs”.

11.  Counsel for the Prosecution submitted that during the hearing, the Prosecution advocated “two routes” during its argument to support the application:

(1) That all three defendants were joint tortfeasors under civil law which co-existed with joint enterprise under criminal law;

(2) The “building‑block” concept – to use the fact of D2’s breach as evidence against the other two defendants.

12.  Further, Counsel for the Prosecution submitted that whilst counsel for D1 and D3 filed their respective skeleton arguments opposing the admissibility of evidence under these two routes, no skeleton argument was filed by counsel for D2.  During the hearing, counsel for D2 merely adopted the submission of D1 and made no substantive submission.

13.  Counsel for the Prosecution submitted that while this Court ruled against the joint criminal enterprise route, this Court allowed the Prosecution to make further submission on the “building‑block” route if and when the issue arose during the course of the trial.

14.  Finally, the Prosecution also submitted that D2’s application for costs was not made “immediately”, this Court can therefore take the delay into account in consideration of how to exercise its discretion on the issue of costs (citing Au Yeung Lai Hung, Doris in support).

My consideration

15.  I set out in my Decision (para 32 – 52) the arguments advanced by the Prosecution in relation to the joint criminal enterprise route and the building‑block route, and my reasons for rejecting the Prosecution’s submission on joint criminal enterprise.

16.  The fact that I rejected the Prosecution’s argument or submission after hearing full arguments does not mean that the submission was “improperly” made.  In fact, it was because of a question raised by this Court: whether the defendants are jointly charged when they each faced a separate count, that necessitated parties to make submissions on this issue.

17.  Further, although I ruled against the Prosecution in relation to the joint criminal enterprise route, I have left open the building‑block route for future argument (though such a scenario never materialised).

18.  Unlike counsel for D1 and D3, counsel for D2 never submitted any skeleton argument on this issue, it was only after counsel for D1 had finished his submission, when called upon by this Court, that counsel for D2 informed this Court that he would adopt the submission of D1’s counsel.  That being the case, even if this Court were to order the Prosecution to pay costs, it would have been extremely difficult, if not impossible, for this Court to assess the amount of award without any reference to actual work done.

19.  As to the question of “delay”, I would mention in passing here that although counsel for D2 did not indicate D2’s intention to ask for costs against the Prosecution when the Prosecution made its intention known (on 13 December 2017), it was made known to this Court soon enough (on 18 December 2017).  I do not consider such a delay significant enough to affect my discretion in relation to the costs application.

20.  For these reasons the Prosecution will not be ordered to pay costs to D2.

 (Judianna Barnes)
 Judge of the Court of First Instance
 High Court
 

Mr Raymond Leung SC, leading Mr Eric Tsoi, counsel on fiat and Ms Margaret Lau SPP of Department of Justice, for HKSAR

Mr Albert Cheung, instructed by Messrs Lam, Lee & Lai, for the 2nd defendant

[2018] HKCFI 526-EN-2018-03-15

HKSAR v. CHOW HEUNG WING, STEPHEN AND ANOTHER

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HCCC 437/2015

[2018] HKCFI 526

IN THE HIGH COURT OF THE

HONG KONG SPECIAL ADMINISTRATIVE REGION

COURT OF FIRST INSTANCE

CRIMINAL CASE NO 437 OF 2015

________________________

BETWEEN  
 HKSAR 

and

 CHOW Heung-wing, Stephen1st Defendant
 CHAN Kwun-chung2nd Defendant

________________________

Before: Hon Barnes J in Court
Date of Decision: 15 March 2018

________________________

DECISION
(On Prosecution’s Application for Costs)

________________________

Application

1.  This is the Prosecution’s application for costs against both the 1st defendant (D1) and the 2nd defendant (D2) pursuant to s 12 of the Costs in Criminal Cases Ordinance, Cap 492 (CCCO).

2.  The Prosecution’s application against D1 is based on the following two grounds:

(1) D1 had unjustifiably put the Prosecution to prove the expertise of various eminent experts in Hong Kong; and

(3) D1 unjustifiably took issue with the undeniable fact that the designation of “DR” represented him in respect of matters evidencing his control over the DR group as well as APSC and Mesotherapy Centre, which was at the core of the trial.

3.  The Prosecution also asks for costs against both D1 and D2 on the following ground:

(2) D1 and D2 had unjustifiably challenged the relevance of the Good Manufacturing Practice (GMP) when they well knew that GMP would be a core theme throughout the trial.

The Law

4.  Section 12 of CCCO provides the power of the Court to award Prosecution costs for indictable offences:

“Where a defendant is convicted of an offence by or before the District Court or the Court of First Instance, the District Court and the Court of First Instance may, in addition to such sentence as may otherwise be passed by law, order that costs be awarded to the prosecutor.”

5.  The general principles for awarding costs can be found in Section 15 of CCCO:

“In any criminal proceedings—

(a) the costs that may be awarded by virtue of an order shall not be punitive but shall be such sums as appear to a court or a judge reasonably sufficient to compensate any party to the proceedings for any expenses properly incurred by him in the course of those proceedings, including any proceedings preliminary or incidental thereto;

(b) a court or a judge may have regard to any assessment laid before it or him for their assistance by any party to the proceedings of the amount of costs properly so incurred by any such party;

(c) an order as to costs shall be such as a court or a judge considers just and reasonable;

(d) the amount to be paid in pursuance of an order as to costs shall, unless an order for taxation is made under section 20, be specified in that order;

(e) the question of whether or not an order as to costs ought to be made in respect of any expenses properly incurred by any party to the proceedings in the course of the proceedings, including any proceedings preliminary or incidental thereto, may be adjourned until the end of those proceedings;

(f)     a court or a judge may take into account any other order as to costs which has been made in respect of those proceedings.”

6.  As to the relevant principles, both counsel for the Prosecution and for D1 referred me to the following two cases: HKSAR v Chan Kwok Wah [1995‑2000] HKCLRT 202 and HKSAR v Chan Kwok Hung [2000] 3 HKLRD 389.  Counsel for the Prosecution also referred me to HKSAR v Cheng Tak Wai [2002] 4 HKC 458 and HKSAR v Hon Ming Kong [2014] 2 HKLRD 710.  Counsel for D2 did not make any specific reference to any authorities.

7.  In Chan Kwok Wah (a case involving the issue of awarding costs to the prosecution in summary proceedings), Patrick Chan CJHC (as he then was) has this to say:

“14. .... A defendant is presumed innocent until he is proved guilty, and the prosecution bears the burden of proving the defendant’s guilt beyond reasonable doubt. This is a fundamental constitutional right enjoyed by a defendant. Accordingly, it is an indirect deprivation of a defendant’s fundamental constitutional right to penalise him in costs merely because his plea of not guilty has rendered it necessary for the prosecution to adduce evidence against him or because his defence has not been accepted by the court. .... In my view, in applying the Costs in Criminal Cases Ordinance, the magistrate must consider whether there have been special circumstances as a result of which the prosecution incurred additional costs. These circumstances may include the defendant’s conduct throughout the trial, for example, by deliberately making difficulties about the prosecution witnesses, intentionally lengthening the trial, or putting the prosecution to proof of insignificant matters or undeniable facts. The Magistrate also has to consider the defendant’s financial condition before deciding whether to order the defendant to pay costs of the prosecution.”

8.  In Chan Kwok Hung, Yeung J (as he then was) called for a common sense approach depending on the facts of each case (at p 393J to 394B):

“Indeed, in my view, an order for costs against the defendant when he pleaded guilty to the charge should not normally be made. An order for costs should not, and could not, be made as a means to impose additional penalty on a defendant or on any other person. An award for costs should normally only be made when in the opinion of the court, the way in which the defendant approaches the investigation and/or the prosecution of the case constitutes an abuse resulting in the prosecution having to incur extra costs which, in the normal course of events, would not or need not be incurred.

Of course, this observation is not meant to be a strait‑jacket approach and an element of discretion or perhaps common sense is called for depending on the facts of each individual case.”

9.  In Cheng Tak Wai, Mayo VP referred to Chan Kwok Wah and stated:

“11. What emerges from this is the necessity for it to be established that there is some feature of the trial indicating that as a consequence of the way in which the defendant conducted his defence unnecessary or additional expenditure has had to be incurred by the prosecution or that the defendant has wilfully wasted the court’s time.”

10.  Counsel for the Prosecution referred to Hon Ming Kong and submitted that a wider consideration for the award of prosecution costs can be seen there, citing the concerns expressed by Stock VP (as he then was) for the taxpayers as a result of the prosecution policy not to seek costs in view of the facts of that particular case:

“12. I started by saying that the waste of public funds in this case was extraordinary; and indeed it was. Many, though not all, of the long and numerous delays were symptomatic of a culture in which the convenience of counsel rules the day. Satellite proceedings were launched which should never have seen the light of day. Teams of counsel were changed time and again. The first applicant has to date enjoyed the benefit of no fewer than eight different leading counsel and, despite the ability which seems apparent therefrom to afford that kind of representation (which is of course his right), no application was made upon conviction of the applicants for the costs of the prosecution, costs which must have been enormous; a lack of action which we were told accords with standard policy – if that be so, it is a policy about which taxpayers should be concerned....”

11.  I am in agreement with the reasons and sentiments expressed in all these decisions and I will consider this costs application accordingly.

Ground 1: unjustifiably challenged the expertise of eminent experts

12.  In my Decision dated 8 June 2017 (Reasons for Decision handed down on 13 June 2017), I set out the experts to whom D1 (and also D3) challenged (see para 2 and 4 of the Decision).

13.  The main ground of objection by D1 and D3 was that whilst those experts were experts in their own discipline, they did not have any “hands‑on” experience in carrying out Cytokine‑induced killer cell therapy (CIK) on human beings and their experience were limited to reading journals or doing study on non‑human subjects.  They had not conducted any study into the administration of CIK.  They had not undertaken research into CIK.  They had not written any articles on the topic of CIK (save for Professor Yuen Kwok Yung but his article was in relation to the women who had received the very CIK involved in this case).  Being experts on Haematology, Oncology, Microbiology, or Immunology did not qualify these witnesses to give expert evidence on CIK (see para 5 of the Decision).

14.  Counsel for D1 also stressed that in this case, the CIK procedure involved was not for any medical purpose, but for health promotion, these witnesses were therefore not qualified to comment on CIK in this particular usage (see para 6 of the Decision).

15.  I agreed with the Prosecution and held that the CIK therapy was essentially a medical procedure notwithstanding the label of healthcare.  Such a procedure falls within the remit of Immunology and Haematology.  I was satisfied that those specialists proposed to be called by the Prosecution, who were trained in and knowledgeable about Haematology, Immunology, stem cell biology/transplantation, and bone marrow transplantation were qualified to give expert opinion on CIK (see para 13 of the Decision).

Prosecution’s Submission

16.  The Prosecution submitted that D1 had unjustifiably put the Prosecution to prove the expertise of the abovementioned experts such that D1 had wilfully wasted the Court’s time:

(1) throughout the hearing for preliminary issues and/or trial, D1 never called any expert to give oral evidence to show that the usage of CIK “forms part of a body of knowledge or experience which is sufficiently organised or recognised to be accepted as a reliable bodyodd knowledge or experience” (The Queen v Bonython (1984) 38 SASR 45);

(2) in the course of the trial, D1 admitted that he understood the administration of CIK was a “medical procedure”.  Contrary to the “healthcare” submission, it was an undeniable fact that D1 knew that the administration of CIK was akin to a form of medical treatment, albeit a “wrong” one as explained by Professor Yuen;

(3) further, the knowledge of D1 as to the nature of CIK is borne out by the deliberate decision not to advertise to avoid detection by the authorities. Internal emails and the admission application form to Hong Kong Science Park show D1’s knowledge as to the international trend of regarding cellular therapy as medicine so that GMP would be required and expected;

(4) it now transpires that D1 had consulted his own immunologist Professor Halpern and haematologist Professor Gregory Cheng on the efficacy of Natural killer (NK) cells.  Regardless of the fact that those 2 experts were not supportive of the efficacy and/or safety of CIK, it lies ill in D1’s mouth to submit that the usage of CIK did not fall within the discipline or expertise of Immunology and Haematology;

(5) D1 well knew that the contrived differentiation between “healthcare” and “medical treatment” would never afford a valid defence.  D1 himself was unable to produce any peer‑reviewed journal to demonstrate that the usage of CIK was for promotion of healthcare.  On the contrary, all the articles (whether produced by D1 or the Prosecution) clearly show that the usage of CIK was still under clinical studies; and

(6) it can hardly be said that D1 was a “CIK expert” when he had only received a day and a half “training” on the usage of CIK in Guangzhou Military Hospital on 7 February 2012.  In the absence of any “CIK experts”, D1 had simply put the Prosecution to proof of insignificant matters.

17.  Accordingly, it was submitted that the unnecessary attendance of the various experts inevitably escalated the Prosecution’s costs and in turn wastage of taxpayers’ expenditure.  The challenge of the various experts was wholly unjustified but calculated to “throw a spanner in the work[s]” resulting in a waste of the Court’s time and that of the experts despite their busy schedules.

18.  At the trial proper, the expertise of the various experts was still challenged in cross‑examination, albeit to a lesser extent.  Further, for reasons best known to D1, he produced 2 experts reports from Professor He and Professor Wu, which were not accompanied by their curriculum vitae (CV).  It is a matter for D1 whether to call his proposed experts. However, the fact of the matter is that the Prosecution was put in an unenviable position of having to grapple with a large volume of medical literature without any focus and was required to anticipate the infinite number of ways in which such medical literature might be deployed.

D1’s response

19.  Counsel for D1 submitted that D1’s challenge to the expertise was fully justified.  Further, the defence had taken a very reasonable approach in this matter, having only cross‑examined Prof Yuen Kwok Yung on matters which were necessary and made no request for further experts to be called, thus not wasting the court’s time.

20.  Counsel reiterated the main grounds of objections raised at the time and submitted that the challenge was within proper limit.  Counsel further submitted that such objective limitation of the expertise required judicial ruling in order to ascertain whether the experts intended to be called were qualified to do so.  It is the duty of the Prosecution to prove expertise, and the defence should not be held liable when there was, and presumably still is, no expert with practical experience in that field in Hong Kong.

21.  Counsel submitted that the expertise of the prosecution witnesses (PWs) in this case was not a subject of “insignificant matters or undeniable facts” and no “unnecessary or additional expenditure” had been incurred.  The challenge was proper and genuine and could not be said to be a “wilful waste of court’s time”.

22.  Further, counsel for D1 submitted that the defence was entitled to challenge the expertise without calling his own expert. Whether those PWs were qualified as experts was a matter for the Prosecution to prove, and not for the defence to disprove.

23.  As to the submission by the Prosecution that D1 had wilfully wasted the court’s time, counsel for D1 submitted that those matters are irrelevant as to whether the PWs were experts: –

(1) Since the Prosecution claimed that the PWs were experts on CIK matters, it is incumbent upon the Prosecution, and not the defence, to establish that CIK forms part of a body of knowledge or experience which is sufficiently organized or recognized to be accepted as a reliable body of knowledge or experience.

(2) Whether or not the CIK therapy was a “medical procedure” or “medical treatment” does not prove one way or the other whether the PWs were CIK experts.

(3) D1’s decision not to advertise CIK and whether D1 knew CIK would be treated as medicine had no bearing as to whether the PWs were CIK experts.

(4) The consultation of Prof Halpern and Prof Gregory Cheng on CIK matters by D1 did not mean that they were CIK experts, still less does it prove that the PWs were CIK experts.

(5) Whether the differentiation between “healthcare and medical treatment” was a genuine one or whether it afforded a valid defence have no bearing on whether the PWs were experts on CIK.

(6) Whether D1 was an CIK expert and whether the defence had called any CIK experts did not detract from D1’s right to challenge the expertise of the PWs on CIK matters.

24.  Counsel for D1 also submitted that it is unfair for the Prosecution to criticize the so-called “challenge” done before the jury, the jury ought to know that these experts did not have hands‑on experience in CIK to enable the jury to decide what weight to give to the experts’ evidence.

25.  Counsel for D1 also submitted there is no substance in referring to matters pertaining to the defence experts.  The reports contained the working and “hands‑on” experience of them in CIK.  There is no standardized form of CV in expert reports.  In any event, the challenge to the expertise of the PWs were raised and decided before the jury was empanelled and the preparation of the Prosecution to deal with potential defence experts had nothing to do with the challenge made before.

My consideration

26.  Having considered the submissions of the Prosecution and D1, I am in agreement with D1 on this matter.  It is a fact that none of the PWs to be called by the Prosecution has “hands‑on” experience in CIK.  There was never any challenge that all these PWs are indeed experts in their own field.  Whether these PWs, by virtue of the expertise in their own field but without any hands‑on experience in CIK, could give expert evidence on CIK was not an insignificant matter.  The defence did no more than necessary to bring out their concern so that this Court could properly consider and decide whether those PWs could give expert evidence on CIK.

27.  Counsel for D1 did act reasonably and in my view, sensibly, by restricting the cross‑examination on Prof Yuen and did not require the Prosecution to call all the other PWs to given evidence.  The time spent on this issue was limited.

28.  It was proper for the defence to bring to the attention of the jury the limitation of the expert evidence (ie without actual “hands‑on” experience on CIK) so that the jury could consider the weight, if any, to be given to such expert evidence.  Again, counsel for D1 acted very sensibly and did not cross‑examine the experts in the presence of the jury more than necessary.

29.  As it cannot be said that it was an undeniable fact that eminent experts in their own fields, but without actual or hands‑on experience in CIK, must be regarded or recognized as experts in CIK, the challenge was properly mounted by D1.

30.  Whether the defence called any defence experts, and whether the defence had provided reports purported to be expert reports to the Prosecution but in the end did not call those witnesses, has no bearing on D1’s challenge on the admissibility of the experts’ evidence.

31.  For these reasons, I find that D1 should not be ordered to pay the Prosecution’s costs on this ground.

Ground 3: D1 unjustifiably took issue with the undeniable fact that “DR” represented him in respect of matters evidencing his control over the DR group as well as APSC and Mesotherapy Centre, which was the core of the trial

32.  As this ground only relates to D1, I will deal with this ground before Ground 2, which concerns both D1 and D2.

Prosecution’s Submission

33.  The Prosecution submitted that while a defendant should be given proper opportunity to defend his case without fear of adverse legal costs, a line should be drawn when the matter contested is clearly unjustifiable or unarguable.

34.  Throughout the trial, D1 contested that he was not the author of some of the documents with the designation “DR”.  In particular, during the course of the Prosecution’s case, it was put to various witnesses that “DR” represented “Dermal Rejuvenator”, the name of a trademark.

35.  Counsel for Prosecution submitted that this is yet another unjustified challenge of putting the Prosecution to proof of undeniable facts resulting in unnecessary time and costs being wasted:

(1) it is noteworthy that D1 had stopped referring to “Dermal Rejuvenator” during the course of the Prosecution’s case after the evidence of Madam Woo Wing‑Yan (Clerk at Prince Edward) (PW38), who clearly stated that DR represented D1;

(2) therefore D1 should never have suggested that “DR” was not him across the board.  This was what he was trying to do initially until his realisation that most of the DR staff clearly identified “DR” as being him in personam;

(3) even on D1’s own case, he never denied that he was the author of some of the documents with the designation “DR”.  He was simply trying to “cherry‑pick” those “DR” documents which were favourable to his defence case.  For example, D1 claimed credits for reminding the staff in the DR notices not to “hurt” customers, when it suited his case;

(4) in the DR notices, all D1 could argue was that not everything in the notices could be attributable to him personally.  However, he well knew that when the notices were properly read in context, his involvement in the matters alluded therein could be discerned and verified against other evidence.  For example, D1 well knew that he was the one who “drilled” the staff to trick disgruntled customers; and

(5)     at the end of the day, the bottom‑line is that D1 approved of and/or had knowledge of the notices and never objected to any of such notices or any part thereof.

36.  The issue of identifying “DR” is clearly unnecessary and irrelevant in the context of D1’s defence (ie defence of honest belief and cut‑throat vis‑à‑vis D2).

37.  It is a complete waste of Court’s time to defend the charge of manslaughter on the false assumption that D1 would be acquitted on the basis that the Prosecution could not identify who “DR” was.  This is at a par with D1’s disingenuous attempt to hide behind the corporate veils of his companies.

D1’s response

38.  Counsel for D1 submitted that the stance of D1 on this matter was to stress that DR does not necessarily refer to him and he might not have personal knowledge of the content of each document.  This is a simple and reasonable approach.  Given that D1’s knowledge was a very important aspect of his defence across so many issues introduced by the Prosecution, it was only fair for him to be allowed to make it clear that DR does not equal to a personal designation for him.  Whether or not it is to be accepted is a matter for the jury.

39.  Counsel for D1 submitted that to grant costs under this heading would essentially mean to punish D1 for running his defence on the aspect of his personal knowledge on relevant matters.  To illustrate the point by way of contrast, D1 had readily accepted that “TEMP” was an email of him.  In any event, the way the defendant dealt with this issue was simply to put D1’s case to the PWs in a short question, and for D1 and his defence witness to tell the jury in a short way what DR in the Notices stand for.  It did not occupy a lengthy part of the trial at all.

40.  Counsel for D1 also referred to the willingness of D1 to agree to the lengthy draft “Admitted Facts” and was the earliest amongst the parties to express such willingness.  It would be unfair for the Prosecution to pick “DR” and leave the “Admitted Facts” and embark upon an unusual course of asking for costs against a co‑operative defendant.

41.  Counsel for D1 also submitted that there were unsuccessful applications made by the Prosecution which occupied a lot of this Court’s time, such as the application to amend the Indictment at the eleventh hour, and the application to revisit this Court’s earlier ruling on the elements of mens rea in gross negligence manslaughter.  D1 had to spend a lot of legal costs to resist these applications which were ruled by this Court to be without merits.

42.  Counsel for D1 also submitted that the Prosecution had laboured on a number of issues which were not really in dispute with great details of evidence.  Again D1 had to bear his own costs on these matters.

43.  Further, counsel for D1 submitted that it has been held that an award of costs against the defendant is part of his sentence (referring to HK Archbold 2018 p 644 para 6‑50).  D1 has been sentenced to 12 years’ imprisonment, which is more than adequate to punish him.  D1 should not be subjected to an additional costs order.

My consideration

44.  Having considered the submissions of both the Prosecution and D1, I agree with the submission of counsel for D1.  Although it was put to a few witnesses that “DR” stands for the trademark and not a reference to D1 personally, D1 never said that he had nothing to do with the daily notices issued to the staff of the beauty centres.  Whether he was in control of the DR group of companies (all limited companies), and if so, to what extent he controlled those companies, was an essential issue to be decided by the jury.  In any event, questions relating to “DR” did not occupy much of the trial time at all.

45.  It is indeed a fact that a lot of the evidence was readily agreed by D1 to be in the admitted facts, which saves a lot of time (even though the trial still took twice as long to try).  Without those extensive admitted facts, the trial would have taken even much longer.

46.  For these reasons D1 should not be ordered to pay the Prosecution costs on this ground.

Ground 2: relevance of GMP

Prosecution’s submission

47.  Counsel for the Prosecution referred to the grounds raised in objection, as summarized in my Decision (para 20).

“20. All counsel questioned the relevance of the GMP Guidelines in this case. I combine all the objections here as some of them overlapped:

(a) whether CIK procedure falls under the definitions of ‘manufacture’ and ‘pharmaceutical product and medicine’ in the Pharmacy and Poisons Ordinance Cap 138 (PPO) is a matter of law, not for Mr Chui to express his opinion on;

(b) there is a real issue whether PPO applies as it is questionable whether CIK falls under the definition of ‘manufacture’ (due to the application to individuals which was expressly excluded in the definition); and whether the preparation in the CIK process amounts to ‘pharmaceutical product and medicine’ (as the CIK was not intended for the use in relation to disease, abnormality or organic function in human or animals, but for the purpose of health care);

(c) if CIK does not fall into either definition, then GMP Guidelines have no application;

(d) if there has to be a decision on whether CIK falls into either definition, there will be a complication as to whether this question should be dealt with by the judge or the jury;

(e) in 2012, there was no legal requirement relating to GMP Guidelines in PPO, the law changed in 2015, with GMP Guidelines being introduced for the first time;

(f) the statement of Mr Chui was only served very late on the defendant (in May 2017), it is unfair to the defence to have to deal with this; and

(g) GMP Guidelines have no relevance to the particulars alleged in the indictment.”

48.  Counsel for Prosecution then referred to my ruling that the relevant GMP Guidelines (1995) issued by the Department of Health was of relevance in this case (para 28 of my Decision):

“28. Bearing in mind that the prosecution intends to rely on the GMP Guidelines as a reference against which one can measure the reasonable standard; that the GMP Guidelines represents the reasonable standard at the material time for the preparation and manipulation of cells in terms of safety, and bearing in mind that the prosecution will adduce evidence of the following two documents:

(a) D1’s application dated 28 April 2009 for APSC to be admitted into the Science Park, in particular the following contents ‘.... [t]he new company will be offering peripheral blood stem cell banking to people from around the world. Furthermore, after obtaining GMP licensure (sic) from Hong Kong Health Department and the EU GMP accreditation it will be offering to patients and their doctors autologous culture of peripheral blood stem cells at a cost‑effective price, which is not currently available in Asia’; and

(b) The internal document prepared by Michael Wah (PW14) and D2, reporting to D1 why the laboratory at APSC had not obtained a GMP licence.

I am of the view that the relevant GMP Guidelines issued by the DH is of relevance in this case as both D1 and D2 had demonstrated knowledge of the GMP requirement....”

49.  Counsel for Prosecution submitted that D1 and D2 had unjustifiably challenge the relevance of GMP when they well knew that the spirit and principles under GMP would be one of the maters at the core of the trial.

50.  The Prosecution also submitted the following:

(1) seeing the challenge on the relevance of GMP had failed, D1 served on the Prosecution 7 volumes of defence bundles (including one translation bundle) on 22 June 2017, which contained a large number of documents concerning GMP;

(2) immediately before D1 commenced to give evidence on 6 September 2017, he produced another volume of defence bundle (VII) again containing large number of documents concerning GMP;

(3) throughout the trial, D2 also produced two defence bundles containing various documents concerning GMP.  Therefore it is an undeniable fact that GMP was relevant in the respective defence case, namely the defence of cut‑throat and/or “honest belief” that the APSC was operating up to GMP standard;

(4) despite their unwarranted submission on the application of PPO (Cap 139), the ordinance never had a part to play in the trial in that D1 and D2 claimed that APSC had achieved GMP standard, albeit not yet accredited, without any consideration of the PPO at the time of the incident.

51.  The Prosecution submitted that it is beyond dispute that D1 and D2 had put the Prosecution to proof of undeniable facts in an attempt to mislead the Court and the jury as to the relevance of the GMP Guidelines.  Despite the inevitable recurring theme pertinent to GMP at the trial, D1 and D2 had chosen to contest the application of GMP when the relevance must be known to them.

D1’s response

52.  Counsel for D1 submitted that the issue of GMP was introduced by the Prosecution together with the application of the PPO which was seemingly relied upon by the Prosecution as the basis to introduce the GMP.

53.  The challenge was hence mainly in relation to the 3rd statement of PW75 Mr William Chui which was dated 20 April 2017 and served to the defence shortly before the trial began.

54.  It was clear that in his statement Mr Chui had gone beyond his expertise and commented that CIK procedure falls under the ambit of the PPO.  This Court’s ruling made it clear that Mr Chui was not permitted to define the law or explain what the section was about.

55.  It is important to recall that there was no law or rules governing CIK therapy and therefore any introduction of a certain standard or guidelines as if it was a legal requirement would be misleading to the jury. It was only when this Court enquired with the Prosecution the purpose of adducing GMP evidence then the Prosecution said that its use was limited to it being a reasonable standard at the material times, based on a common sense approach.

56.  The Ruling of this Court had also imposed a limitation to the relevancy of this area of the evidence.

57.  Counsel for D1 submitted that the challenge was necessary and reasonable, and was partly successful, that if the defence had remained silent and had not made the challenge, the PPO would have been introduced before the jury by the Prosecution in an impermissible way, which would have derailed the whole trial.

58.  Counsel for D1 submitted there was never any claim by D1 that he did not know anything about GMP.  D1’s defence was that there was no statutory requirement for GMP in relation to CIK matters, and yet D1 still aimed at achieving it in order to attain a high standard.  The PWs were cross‑examined and the defence evidence were led along this line.

59.  Counsel for D1 submitted that there was no demand for the Prosecution to do more than following the Ruling and it was up to the Prosecution to elaborate the contents of the GMP by way of live evidence or submissions.  The challenge to the GMP and the relevant evidence were all done within proper limits in accordance with the factual defence ran by D1.

D2’s response

60.  Counsel for D2 referred to the fact that counsel for Prosecution stated for the “very first time” during the hearing that the Prosecution would not rely on the provisions of the PPO to introduce the evidence of GMP guidelines, and the fact that this Court ruled that GMP was relevant and admissible on a limited basis, and submitted that the challenge mounted by D2 was not wholly without merit.

61.  Counsel for D2 submitted that it was the failure on the Prosecution’s part to identify the basis on which GMP was relied upon that led to the lengthy written and oral submissions advanced by the defence.

62.  Counsel for D2 also submitted that D2 only produced the volumes of documents in light of this Court’s ruling, and that most of the documents relating to GMP were produced for the purpose of contradicting allegations made by D1 against D2.

My consideration

63.  The challenge by the defence in relation to GMP mainly aimed at the statement of Mr William Chui and the reference to the provisions of the PPO.  It should be noted that before I made my consideration, upon query by this Court, the Prosecution made its stance clear for the very first time. The Prosecution confirmed that it would not rely on the provisions of the PPO to introduce the evidence of the GMP Guidelines; nor was there any allegation of negligence arising out of any alleged breach of the PPO. The Prosecution intended to rely on the GMP Guidelines as a reference against which one can measure the reasonable standard.  Put another way, the GMP Guidelines represents the reasonable standard at the material time for the preparation and manipulation of cells in terms of safety.

64.  I then made the following observation in my consideration before I made my ruling (para 26 and 27 of my Decision):

“26. Whilst I understand that in his work, Mr William Chui would need to have an understanding of the law in relation to pharmaceutical matters, such as the PPO, I do not think there is any dispute that Mr William Chui is not permitted to give his opinion on the legal definitions of ‘manufacture’ and/or ‘pharmaceutical product and medicine’ under PPO.

27. Mr William Chui’s opinion on the GMP Guidelines (dated 20 April 2017) was based, in my view, wholly on his interpretation of the law in relation to the definitions in PPO.  As the prosecution have clearly confirmed that they are not relying on the provisions under PPO, but that they are relying on the available GMP Guidelines at the time in 2012 (ie GMP Guidelines (1995)) as a guide to demonstrate what a reasonable standard should have been, any opinion expressed by Mr William Chui in relation to the definitions and application of PPO is not relevant and inadmissible.”

65.  The Prosecution had not made clear at the beginning on what basis the GMP guidelines were relied upon.  Instead, the statement of Mr William Chui (provided shortly before the trial) was intended to be used by the Prosecution.  That being the case, it cannot be said that the challenge was improperly mounted.  The defence was in fact successful in obtaining a ruling that Mr William Chui was not permitted to give opinion on the law.  With the concession made by the Prosecution during the hearing of the submissions, it then became clear on what basis the Prosecution intended to rely on the GMP guidelines.  As a result of this Court’s ruling on the limited use of these guidelines, D1 and D2 produced documents relating to GMP guidelines in their defence.

66.  In these circumstances, I do not agree that D1 and D2 had unjustifiably challenged the relevance of the GMP.  D1 and D2 will not be ordered to pay the Prosecution’s costs on this ground.

 (Judianna Barnes)
 Judge of the Court of First Instance
 High Court

  

Mr Raymond Leung SC, leading Mr John Marray, and Mr Eric Tsoi, counsel on fiat and Ms Margaret Lau SPP of Department of Justice, for HKSAR

Mr Wong Man Kit SC, leading Mr Charles J. Chan, instructed by Messrs Day & Chan, for the 1st defendant

Mr Albert Cheung, instructed by Messrs Lam, Lee & Lai, for the 2nd defendant

112741-EN-2017-12-12

HKSAR v. CHOW HEUNG WING,STEPHEN AND OTHERS

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HCCC 437/2015

IN THE HIGH COURT OF THE

HONG KONG SPECIAL ADMINISTRATIVE REGION

COURT OF FIRST INSTANCE

CRIMINAL CASE NO 437 OF 2015

________________________

BETWEEN
 HKSAR 
and
 CHOW Heung-wing, Stephen1st Defendant
 CHAN Kwun-chung2nd Defendant
 MAK Wan-ling3rd Defendant

________________________

Before: Hon Barnes J in Court

Date of Hearing: 18, 19, 22 26, 29 May 2017

Date of Decision: 31 May 2017

Date of Handing Down of the Reasons for Decision: 12 December 2017

________________________

REASONS FOR DECISION
(Ruling on Voir Dire)

________________________


1.  The prosecution intended to adduce evidence of the following against CHAN Kwun-chung (D2) at the trial:

(1) Verbal statements, demonstrations and documents provided to various experts and/or investigating officers by D2 during visits to the Asia Pacific Stem Cell Science Limited (APSC) on various dates between 6 October 2012 and 10 December 2012; and

(2) Two witness statements provided by D2 to the police on 18 and 25 October 2012 respectively, with documents provided by D2 on the latter date.

2.  D2 challenged the admissibility of all the above-stated on the ground that they were not made/given by him voluntarily.  Alternatively, D2 urged this Court to exercise its residual discretion to exclude the above‑stated from evidence on the ground of unfairness.

3.  Having considered the evidence adduced and the detailed submissions, I ruled that I was satisfied beyond all reasonable doubt that D2 voluntarily provided his verbal statements, demonstrations and documents to the experts and/or investigating officers during all the visits to APSC.  I was also satisfied beyond all reasonable doubt that D2 provided the two witness statements and the documents to the police voluntarily.  Further, I ruled that this was not a proper case for me to exercise my residual discretion to exclude these admissible evidence.

4.  I indicated at the time of the Ruling that I would give my reasons later.  This I now do.

Background

5.  On 4 October 2012, two patients were admitted into Ruttonjee Hospital suffering from septic shock. Enquiries revealed that they both had received intravenous CIK‑cultured blood infusion at the beauty parlour belonging to the DR group in Causeway Bay.  Personnel at the Ruttonjee Hospital reported the matter to the Department of Health (DH). Dr Edmund Fong made a report to the police, suspecting there was an “illegal activity of practising medicine without registration”.  The police cordoned off a laboratory belonging to APSC in the evening of 4 October 2012.  On 5, 6, 9, 10, 16, 17 and 26 October 2012, 28 November 2012 and 10 December 2012, the police, together with various experts, visited APSC to carry out investigations.

6.  During the visit on 5 October 2012, a staff member Ho Wai‑yan (Ho) informed the investigating officers that, at the telephone instructions of D2 (who was then not in Hong Kong), she had made 3 serum/saline samples and labelled each one with the name of the 3 patients (who were hospitalized) and passed them to another staff member Manton Cheung (M Cheung) to do endotoxin testing.  Both Ho and M Cheung gave a cautioned statement on 6 October 2012 in relation to the three serum/saline sample.

7.  D2 returned to Hong Kong on 5 October 2012 but he only went back to APSC on 6 October 2012.  He was present when the police and various experts visited APSC on various occasions between 6 October 2012 and 10 December 2012.

8.  On each occasion, the police showed a search warrant to D2 and explained its contents.  All the search warrants referred to the investigation of the offence of “Administering poison, etc. so as to endanger life or inflict grievous bodily harm” (Administering poison).

9.  D2 was not cautioned at any time during these visits, nor when he gave the two witness statements on 18 and 25 October 2012 respectively.  The only time he was cautioned was in relation to the three serum/saline samples which he had allegedly given instructions to Ho to prepare.  The cautioned statement was taken from him on 25 October 2012, prior to his 2nd witness statement of the same date.

Voluntariness

10.  I will first deal with the issue of voluntariness.

11.  It should be borne in mind that Mr Albert Cheung, counsel for D2, had clearly indicated to this Court there was no allegation or suggestion of any impropriety on the part of the police or the experts.  There was no allegation of any force, inducement, or oppression exercised by any one on D2 to make him provide the verbal statements, demonstrations, and documents during any of the visits; or to provide the two witness statements and documents to the police on 18 and 25 October 2012.

12.  The stance of D2 was along the line that in all the circumstances he had no choice but to comply with the requests of the police and the experts to provide the verbal statements, demonstrations and documents during the visits at APSC.  In the same vein, D2 felt that he had no choice but to give the two witness statements.

13.  The circumstances referred to by counsel for D2 can be summarized as follows: D2 was a man of clear record and had never been questioned by the police before; D2 did not know that he has the right to remain silent; when D2 returned to APSC, the place was already under the control of the police; he was shown a search warrant on each occasion and was explained its contents, it was his understanding that the police were investigating an Administering poison offence and he may be arrested if he interfered with the investigation; and, by the time the police came on 6 October 2012, he knew 3 customers had ended up in hospital after receiving CIK treatment, a product he was responsible for making.

14.  Mr Cheung submitted that under these circumstances, it was not surprising that D2 felt he had no choice but to comply with the request of the police to answer questions put by the experts.

15.  D2 in his testimony also mentioned that on each visit, he was singled out by the police even though he had requested the police to make enquiries from his superior Eva Chow.  Eva Chow had told him to answer questions from the police and since he was an employee, he had no choice but to comply.  D2 said he was outnumbered by the number of police and experts and felt obliged to answer their questions and to perform the demonstrations.

16.  D2 also said he did not have the benefit of a lawyer to look after his interest at APSC (the lawyer present was the lawyer of the company who did nothing for him).  Whilst he had arranged for his own barrister to accompany him to the police station to give the statements on 18 and 25 October 2012, he felt that he had no choice but to give the 2nd statement on 25 October 2012 as he was taken alone to see the superior police officer Chief Inspector Wu (CIP Wu) after the completion of the cautioned statement. CIP Wu told him he would be free to leave after answering some questions.

17.  I have carefully considered the evidence of all the prosecution witnesses called for the voir dire, and the evidence of D2.  I have no doubt in my mind, as clearly indicated by Mr Cheung on behalf of D2, that there was indeed no impropriety of any kind on the part of any police officer or experts when they dealt with D2.

18.  I am satisfied beyond all reasonable doubt that D2 was willing to take part in providing the verbal statements, the demonstrations and giving the documents to the experts and the police.  I totally reject D2’s testimony that he has taken part in answering questions, giving demonstrations, providing documents or giving witness statements involuntarily.

19.  It is clear to me that D2 was changing his evidence when he went along.  At the outset, in examination‑in‑chief, he did say that he was unwilling to take part, save for the occasion when Professor Yuen Kwok Yung came to investigate.  He also confirmed quite clearly that he had given the two witness statements voluntarily. When he was asked by his counsel, D2 further explained that he gave the 1st statement voluntarily as it would look strange if he did not give one when all his colleagues had already done so, he also gave the 2nd statement voluntarily as the police told him there were clarifications to be made. D2 then testified he was taken to another room in which the superior officer told him he would be free to go after answering a few questions. D2 then said he felt he had no choice but to answer questions in relation to the 2nd witness statement.

20.  During cross-examination, the scope of his unwillingness was drastically reduced: he was quite willing to explain the process of CIK and to show the various experts the different steps of the processing; he only objected to questions about any documentation or bacterial testing, saying that those had nothing to do with him.  He confirmed during cross-examination that he was notified beforehand and had arranged for his own lawyer to accompany him to give his statements to the police.  He confirmed that he was willing to give them and the contents were accurate.  

21.  However, during re-examination, he changed his evidence again to say that all the verbal statements and demonstrations were not made voluntarily, including those given to Professor Yuen.

22.  I bore in mind that despite his counsel having clearly informed this Court that there was no allegation of impropriety or inducement on the part of the police, D2 testified that after he had given the cautioned statement on 25 October 2012, the officer who had taken the statement from him had told him to go see the officer’s superior, CIP Wu alone.  Though this request was made in front of his own barrister, D2 said his barrister did not say anything and he was taken to see CIP Wu alone.  In the room CIP Wu asked him to answer further questions from an expert or experts.  D2 understood the expert(s) were in the next room and he was unwilling to do so, so he told CIP Wu.  CIP Wu told him then that he had to give a further statement and then he could go.

23.  None of these were put either to the officer who had taken the statement or to CIP Wu.  I find this piece of evidence totally incredible.  I cannot believe that his own barrister, who according to him, was there to look after his interest, would have allowed him to go alone to see the superior of the statement-taking officer without demur.  More interestingly, D2 clearly stated that he had told CIP Wu that he was not willing to answer any more questions from the expert(s).  That is totally at variance with D2’s assertion that all along he felt that he had no choice, that he must comply with the requests of the police and the experts.

24.  I was satisfied beyond all reasonable doubt that D2 was eager and willing to assist the police and experts to find out what had happened and why those women ended up in hospital suffering from septic shock after receiving CIK treatment.  I did not accept his evidence that he had no choice in the matter.

25.  Even if he had indeed harboured such a thought (which I did not accept), it would have been a “self-generated” belief which had nothing to do with any conduct on the part of any person in authority.  There was no doubt in my mind that D2 had provided the verbal statements, the demonstrations and the documents voluntarily, out of his own free will.

26.  I would also add here that during some of the visits, in particular the first one on 6 October 2012, D2 had the benefit of a lawyer provided by the company.  I rejected D2’s evidence that the lawyer just sat there and did nothing.  I was most impressed with the details given by Dr Tonny Ng in relation to this visit and I accepted Dr Tonny Ng’s evidence that the interview was smooth except it was interrupted when the lawyer gave advice to D2 out of the ear shot of those present in the conference room.

27.  Coming to the two witness statements, quite apart from D2’s own testimony that he had given them voluntarily, I bore in mind that the police had forewarned D2 about the statement-taking and D2 saw fit to engage the service of a barrister to accompany him.  I had no doubt that the 1st witness statement was given by D2 voluntarily.  As to the 2nd statement, I bore in mind that by the time D2 gave it, it was after a cautioned statement had been taken from him in relation to the issue of the three serum/saline samples.  D2 exercised his rights not to answer questions posed during the Record of Interview under caution.  By the time the 2nd witness statement was taken, no doubt D2 knew full well he could have chosen not to answer (even without any caution), he chose to answer because he had been asked to provide documents mentioned in the 1st witness statement and he had brought those documents along to give to the police.

28.  I had no doubt in my mind that D2 gave the two witness statements and provided the documents when giving the 2nd statement voluntarily.

Exercise of Residual Discretion

29.  I will now address the issue of unfairness and why I ruled that this was not a proper case for me to exercise my residual discretion to exclude these admissible evidence.

30.  Counsel for D2 placed heavy reliance on the fact that D2 was not cautioned for any offence in relation to the three serum/saline samples until 25 October 2012.  Mr Cheung relied on the fact that both Ho and M Cheung were cautioned on 6 October 2012.  He submitted that the police should have cautioned D2 as they had reasons to suspect that D2 was involved in an offence of Perverting the course of public justice (Perverting justice).  Mr Cheung also relied on the part of the Interim Report of DH after the visit on 5 October 2012 prepared by Dr Tonny Ng and his assistant, in which Dr Tonny Ng referred to the police considering charging the relevant people with offence of Perverting justice.

31.  Further, Mr Cheung submitted that D2 was never cautioned for the offence of Administering poison when it was clear from the evidence that the police were conducting a criminal investigation during the various visits (with reference to the search warrants). D2 should have been cautioned so that he knew he had the right to remain silent.

32.  I accepted the evidence of Senior Inspector Wong (SIP Wong) that at the time when he took over the case, no one really knew what had happened.  It was clear that the various visits to APSC at the beginning was mainly for DH to find out the process of, and to see if anyone else could have been affected by, the CIK treatment.  Hence during the first couple of visits, the questioning was mainly led by Dr Tonny Ng, with SIP Wong listening to D2’s explanation and jotting down medical terms unfamiliar to him.  The later visits were for other experts to see if the source of contamination could be located and to understand more of the process of CIK treatment, in particular in relation to the procedure in the laboratory.

33.  Whilst the police obtained the search warrants on the basis of an investigation into an offence of “Administering poison”, bearing in mind D2 was not the doctor who did the infusion (and in particular D2 was not even in Hong Kong when the infusions took place), and that D2 had been informed of the reason for the search, I did not find that the failure to caution D2 regarding the offence of “Administering poison” has any bearing on D2’s decision to answer questions, to do demonstrations and to provide documents.

34.  As to the failure to caution D2 in relation to the three serum/saline samples, both CIP Wu and SIP Wong had given their reasons.  According to CIP Wu, upon hearing what Ho had said on 5 October 2012, having considered that Ho and M Cheung were the persons who had physically handled the three samples and that D2 was not even in Hong Kong, he gave the instructions to caution both Ho and M Cheung.  He did not think there were reasonable grounds to suspect D2 at the time.

35.  SIP Wong did not consider there were sufficient reasons to suspect D2’s involvement until the test result revealed that there was no human DNA in the three samples.  He then instructed his subordinate to caution D2 on 25 October 2012.  Both denied that on 5 or 6 October 2012 the police were already considering the offence of Perverting justice.

36.  Though I do not doubt Dr Tonny Ng’s evidence that, after the visit on 5 October 2012, he had heard the police mentioning charging those relevant people with Perverting justice, it appears to me that that might have been just an initial view or idea which did not come to fruition.  I formed that view because it was a fact that in none of the cautioned statements the offence of Perverting justice was ever mentioned.  In fact, no specific offence was mentioned in any one of the three cautioned statements (against Ho, M Cheung and D2), just the allegation that D2 had instructed Ho to prepare the three samples of serum/saline in replacement.

37.  In any event, I was in no doubt that the failure of the police to caution D2 earlier made no difference whatsoever to D2’s willingness in answering questions, doing demonstrations and producing documents to explain the CIK procedure.  Quite apart from my findings that D2 was willing to assist to find out what had caused the customers who had received CIK treatment to end up in hospital, the fact that on 25 October 2012, after he was cautioned in relation to the three samples and he had exercised his rights not to answer questions, with the benefit of legal advice, he was willing and ready to provide the 2nd witness statement (having brought along documents to give to the police), further strengthened my findings that D2 was all along willing to assist the police and the experts to understand what CIK treatment was about and what the process involved.

38.  Even if the police should have cautioned D2 earlier and were in breach of the Secretary for Security’s rules and directions, there was no evidence before me from D2 that but for the breach of the rules (in failing to caution him for the three samples), he would not or might not have provided the verbal statements, or the demonstrations, or the documents to the experts and /or investigating officers during any of the visits, or to give any witness statement to the police.  This was a bare assertion of the breach of the rules and was not sufficient for admissible evidence to be excluded (see HKSAR v Chiu Kwok Ho[1]).

39.  Further, in my view, the issue of the three samples was quite separate and distinct from the desire to find out what had taken place and to locate the source of contamination during the visits.  The police were arranging for different experts from different disciplines to try to understand what had happened, and to locate the source of the contamination.  As I had said, D2 was willing to assist in those respects and it did not matter that he had not been cautioned in relation to the three samples until 25 October 2012.

40.  Not only had D2 continued to provide the 2nd statement after he had given the cautioned statement on 25 October 2012, he had also willingly taken part in answering questions and providing demonstrations at APSC during visits after 25 October 2012 (ie on 26 October 2012, 28 November 2012 and 10 December 2012).  These again further strengthened my view that the failure to caution D2 had no effect whatsoever in his willingness to assist.

41.  Criticism had been made by counsel for D2 in the lack of contemporaneous records by the experts and the police, making it difficult for D2 to answer the allegations.  Bearing in mind that D2 was basically repeating what he had already told Dr Tonny Ng on the first few occasions about the process of the CIK treatment and the various steps, I did not find that the lack of any contemporaneous records made by all the experts and/or investigating officers of importance, particularly when Dr Tonny Ng and his assistant had indeed made handwritten notes which were incorporated into a rather detailed interim report.

42.  I did not find there was any unfairness in the treatment of D2 which warranted for the exercise of my residual discretion to exclude admissible evidence.

 (Judianna Barnes)
 Judge of the Court of First Instance
High Court

Mr Raymond Leung SC, leading Mr John Marray, and Mr Eric Tsoi, counsel on fiat and Ms Margaret Lau SPP of Department of Justice, for HKSAR

Mr Wong Man Kit SC, leading Mr Charles J. Chan, instructed by Messrs Day & Chan, for the 1st defendant

Mr Albert Cheung, instructed by Messrs Lam, Lee & Lai, for the 2nd defendant

Mr Peter Duncan SC, leading Ms Deanna Law, instructed by Howse Williams Bowers, for the 3rd defendant



[1]HKSAR v Chiu Kwok Ho [2004] 2 HKC 552 (CA)

112740-EN-2017-06-14

HKSAR v. CHOW HEUNG WING,STEPHEN AND OTHERS

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HCCC 437/2015

IN THE HIGH COURT OF THE

HONG KONG SPECIAL ADMINISTRATIVE REGION

COURT OF FIRST INSTANCE

CRIMINAL CASE NO 437 OF 2015

________________________

BETWEEN
 HKSAR 
and
 CHOW Heung-wing, Stephen1st Defendant
 CHAN Kwun-chung2nd Defendant
 MAK Wan-ling3rd Defendant

________________________

Before: Hon Barnes J in Court

Dates of Ruling: 14 June 2017

________________________

RULING ON
ADMISSIBILITY OF EVIDENCE (General)

________________________


1.  Further to the three areas I have already given my ruling on earlier (8 June 2017), I will give my ruling generally on the following areas to supplement my ruling as shown on the chart to be handed down.

Issues in relation to Cytokine‑induced killer (CIK) cell infusion therapy being an experimental process for the treatment of cancer; CIK should take place in a hospital and not in a clinical setting

2.  Counsel for D1 and D2 opposed to the admissibility of such evidence on the basis that the particulars of the breach of duty pleaded against D1 and D2 had nothing to do with whether CIK was an experimental process.  Whether such process should be done in a hospital and not in a clinic is irrelevant.  The reference to the knowledge in the indictment was only to set out the background to say the respective defendant “failed to take reasonable care”.

3.  The prosecution’s stance is that CIK was only an experimental process for cancer which should not have been introduced to healthy persons.  Having done so the defendants should ensure the blood products are safe.  Evidence about CIK being an experimental process and that it should only take place in a hospital setting are relevant.

4.  Whilst I have already ruled that the knowledge pleaded in the indictment cannot amount to a criminal offence for the purpose of my consideration of the concept of joint criminal enterprise, I disagree with counsel for D1 and D2 that such knowledge forms only the background to say the respective defendant failed to take reasonable care.

5.  I agree with the prosecution that such evidence is relevant and admissible.

Issues relating to safe system of work

6.  Counsel for each defendant made reference to the particulars of the breach alleged against each defendant.

7.  Counsel for D1 submitted that the whole case against D1 was that the death was caused by bacterial contamination.  The particulars of the breach centred on the contamination of the blood product: D1’s failure to ensure a qualified person was responsible for the preparation and production of the blood product, D1’s failure to have a documented protocol which included viral and bacterial testing, and D1’s failure to ensure the blood product had undergone such testing before leaving the laboratory.  The only mention of a safe system was D1’s failure to require D3 to have satisfied herself that such testing was carried out prior to the infusion.  Any evidence falling outside these particulars are irrelevant and inadmissible.  The safe system pleaded does not relate to a safe system in the Asia Pacific Stem Cell Science Limited (APSC) laboratory.  The safe system is only restricted to measures for the detection of bacteria.

8.  Counsel for D2’s submission was along the same vein.  The only mention of a safe system against D2 was his failure to carry out viral and bacterial testing before the blood product left the laboratory.

9.  Counsel for D2 further submitted that any evidence in relation to the management of the laboratory, the re‑agents used, the way the laboratory was used for the handling of the CIK products and the cord blood, and so on, have no relevance to the particulars of the breach alleged against D2 and therefore inadmissible.  Further, the prejudicial effect of the evidence outweighs the probative value.

10.  Counsel for D3 also opposed to evidence in relation to a safe system based on the particulars pleaded against D3, submitting that there was nothing about any safe system.  D3’s alleged breach of duty was her failure to ensure a properly qualified person was responsible for the preparation and production of the blood product; her failure to ensure viral and bacterial testing was done prior to the infusion and her failure to ensure the deceased was informed of the risks involved.

11.  Counsel for the prosecution submitted that the interpretation by counsel for D1 and D2 of the particulars pleaded are unduly restrictive.  Evidence of a safe system is relevant.  As for D3, though safe system is not pleaded, the failure to ensure viral and bacterial testing prior to infusion cannot be said to be irrelevant in relation to D3.

12.  In respect of D1 and D2, I am of the view that in interpreting the particular breach against each defendant, (both being para (ii)(b)): Failing to devise, institute, enforce and maintain a properly documented protocol for the preparation in the laboratory of the said blood product which included viral and bacterial testing, is not to be done so restrictively as submitted by counsel for D1 and D2.  Although the words “safe system” did not appear under this particular, and only under para (ii)(d) against D1 (failure to require D3 to have satisfied herself that viral and bacterial testing had been carried out prior to infusion), and under para (ii)(d) against D2 (failing to ensure viral and bacterial testing was carried out and documented before the blood product left the laboratory, I rule that evidence intended to be adduced by the prosecution in relation to the set‑up of APSC, the procedure adopted, the inventory and so on are all admissible against D2. 

13.  With respect, I disagree with counsel for D2 that the prejudicial effect of the evidence outweighs the probative value.

14.  I also rule that the evidence is admissible against D1 (subject to any evidence that falls foul of the hearsay rule).

15.  As for D3, in view of the particulars pleaded and that the position of D3 is very different from that of D1 or D2, it is my present view that most of the evidence is not relevant to the prosecution case against D3.  However, I rule that evidence concerning her failure to ensure viral and bacterial testing prior to infusion is admissible (subject to such evidence not being hearsay).

16.  I will re‑visit this issue against D1 and D3 at the end of the trial and will consider how to direct the jury on this.

Evidence of staff of laboratory

17.  Evidence to be adduced by staff of the laboratory touching about CIK is being objected to, mainly on the basis of irrelevance and that certain witnesses are not permitted to give opinion evidence as they are not called as such.

18.  I agree with the prosecution that they can, in their position as persons actually employed by the company to carry out work in the laboratory, to express their views why they did not or would not take part in the CIK, which shows their knowledge and state of mind.

Post infusion treatment

19.  As for evidence of post infusion treatment, having regard to my earlier ruling that the prosecution could not amend the indictment to include post infusion treatment, I rule that evidence of what D3 had given to the other surviving clients/patients (including Wong Ching Bor) are admissible to show knowledge and/or foresight of the risks involved.  I would also allow expert evidence of what a doctor in the position of D3 should have recognised and foreseen when dealing with something like a CIK process.

20.  However, I think it will go too far to allow PW78 to give opinion evidence in relation to D3’s management of all the victims post‑infusion.

Re expert opinion

21.  I appreciate counsel’s submission that a witness is not allowed to give evidence which are facts in issue and not part of the expounding study of various witnesses.  I am allowing the opinion evidence at the moment provided the basis of their opinion is supported by evidence to be adduced during the trial.  Should there be no such evidence, then the jury will be directed to disregard the opinion expressed.

Evidence of Ho Wai Yan

22.  As Ho Wai Yan will not be called as a witness, anything she said to any experts or other staff members will be hearsay and inadmissible.  I also reject the prosecution’s submission that her utterances amount to res gestae.  Any act performed by her as observed by the experts is admissible provided no verbal explanation is adduced as to the truth of the contents.

Exhibits seized with labels containing names of the customers, including that of the deceased.

23.  Evidence of various items seized by the police as directed by various experts are admissible.  As to the contents of the labels, however, I am of the view at the moment that such evidence is hearsay as to its truth.  I will re‑visit this issue at the end of the trial and will consider how I will direct the jury on this.

Statements by D2 and D3, not in the presence of other defendants

24.  Any verbal utterance, demonstration by D2 to the police and experts not in the presence of D1 and D3, and any witness statements given by D2 not in the presence of D1 and D3 are hearsay evidence against D1 and D3.

25.  Likewise, any witness statement given by D3 not in the presence of D1 and D2 amounts to hearsay evidence against D1 and D2.

26.  I will re‑consider this issue should there be any change to this position during the trial, and at the end of the trial should there be an application by the prosecution on the basis of the “building‑block” concept.

 (Judianna Barnes)
 Judge of the Court of First Instance
High Court

Mr Raymond Leung SC, leading Mr John Marray, and Mr Eric Tsoi, counsel on fiat and Ms Margaret Lau SPP of Department of Justice, for HKSAR

Mr Wong Man Kit SC, leading Mr Charles J Chan, instructed by Messrs Day & Chan, for the 1st defendant

Mr Albert Cheung, instructed by Messrs Lam, Lee & Lai, for the 2nd defendant

Mr Peter Duncan SC, leading Ms Deanna Law, instructed by Howse Williams Bowers, for the 3rd defendant

 

112739-EN-2017-06-14

HKSAR v. CHOW HEUNG WING,STEPHEN AND OTHERS

HTML content

HCCC 437/2015

IN THE HIGH COURT OF THE

HONG KONG SPECIAL ADMINISTRATIVE REGION

COURT OF FIRST INSTANCE

CRIMINAL CASE NO 437 OF 2015

________________________

BETWEEN
 HKSAR 
and
 CHOW Heung-wing, Stephen1st Defendant
 CHAN Kwun-chung2nd Defendant
 MAK Wan-ling3rd Defendant

________________________

Before: Hon Barnes J in Court

Date of Hearing: 9 June 2017

Date of Decision: 13 June 2017

Date of Handing Down of the Reasons for Decision: 14 June 2017

________________________

REASONS FOR DECISION
(on mens rea for GNM)

________________________


1.  One of the preliminary issues I have to decide is whether, for an offence of gross negligence manslaughter (GNM) in Hong Kong (HK), it is sufficient for the prosecution to prove all the elements in accordance with the guidelines enunciated in R v Adomako [1995] 1 AC 171: ie

(1) the existence of a duty of care by the defendant to the deceased;

(2) breach of that duty by the defendant;

(3) the breach of the duty by the defendant caused the death of the deceased; and finally

(4) the breach of the duty by the defendant being capable of being characterised as gross negligence and therefore a crime (the last element),

with the last element to be proved on the basis of an objective reasonable man test.

2.  As I have already decided, in the case of HKSAR v Lai Shui Yin [2012] 2 HKLRD 639, that in relation to the last element, the test for gross negligence was not only an objective reasonable man test, but the prosecution was also required to prove that the defendant’s state of mind was culpable, the prosecution invited me to re‑visit my decision in Lai Shui Yin, submitting that two cases of the Court of Appeal (CA): (1) Secretary for Justice v Law Siu Kuen [2011] 1 HKLRD 1022 (decided before Lai Shui Yin); and (2) HKSAR v Ngai Hon Kwong [2016] 2 HKLRD 149, (decided after Lai Shui Yin) demonstrated that the “proper application” of Adomako (ie with the objective reasonable man test for the last element) has been adopted in Hong Kong.

3.  The prosecution submitted that as those two CA decisions are binding on this Court, I have to rule in accordance with the two CA judgments and have to, in effect, overrule my own decision in Lai Shui Yin.

4.  The prosecution’s contention was strongly opposed or objected to by counsel for all three defendants, who, in effect, submitted that my decision in Lai Shui Yin was a correct one, and that decision was not affected by the two CA cases relied upon by the prosecution.

5.  After consideration of the submissions, both written and oral, I ruled that the test to be applied for the last element in this case is the same as that decided in Lai Shui Yin.

6.  I indicated at the time that I will hand down my reasons.  This I now do.

What was decided in Lai Shui Yin?

7.  I think it useful to re‑cap, briefly, what was decided in Lai Shui Yin.

8.  In Lai Shui Yin (a case involving GNM), an issue arose as to the effect of the judgment of the Court of Final Appeal (CFA) in Sin Kam Wah v HKSAR (2005) 8 HKCFAR 192 (a case involving Misconduct in Public Office) in overruling the CA’s decision in R v Chau Ming Cheong [1983] HKLR 187 (a case of GNM) in relation to the elements of GNM.  After considering a number of authorities, including the case of Adomako and other English authorities, I came to the conclusion that the effect of such an overruling by the CFA was that the positon in HK is different from that of the United Kingdom (UK).  I ruled that the elements/ingredients of the offence of GNM set out in Adomako are applicable, meaning that the jury has to decide (1) whether the defendant has been in breach of a duty of care towards the deceased; (2) whether that breach caused the death of the deceased; and (3) whether that breach of duty should be characterised as gross negligence and therefore a crime.  However, I ruled that the test as to what amount to gross negligence is not just an objective reasonable man test (as in the case of Akomako, which was adopted in the subsequent case of R v Misra [2005] 1 Cr App R 328 in the UK), but that the prosecution must prove that the defendant’s subjective state of mind was culpable before the defendant can be found guilty of the offence.

9.  I was of the view that the underlying principle expressed by Lord Bingham in R v G [2004] 1 AC 1034, which was soundly approved by the CFA in Sin Kam Wah, was of importance.  This underlying principle was that a conviction of a serious crime should depend not only on what the defendant had done (actus reus), but also whether the defendant’s state of mind (mens rea) was culpable.  I was of the view that by adopting the gross negligence test propounded in Adomako, a person who genuinely did not perceive a risk of death could still be found guilty of manslaughter on a reasonable man test – even when a jury is directed to consider the defendant’s subjective state of mind.  The law should not be such that a person who genuinely did not perceive a serious and obvious risk of death should be exposed to a conviction of such a serious offence.

The prosecution’s stance

10.  Counsel for the prosecution stressed that in GNM, the principles of the law of negligence applies (Adomako).  In the civil law of negligence, when assessing negligence, the personal attribute of the tortfeasor would have already been taken into consideration.  Adomako applied an objective test.  The CA in HK, in the two cases cited, have adopted the “proper application” of Adomako, with the test for the last element being an objective one.

11.  Counsel for the prosecution submitted that my attention was not brought to the CA case of Law Siu Kuen, in which Stock V‑P, in giving judgment of the court, expressly referred to Adomako in its discussion of GNM (in a motor case).  It was submitted that had my attention be drawn to that case, my decision would have been different.  My decision in Lai Shui Yin was therefore per incuriam.

12.  Counsel for the prosecution also referred me to a subsequent CA case of Ngai Hon Kwong in which McWalters JA, giving judgment of the court, referred to a passage in R v Evans (Gemma) [2009] 1 WLR 1999 (CA) which in turn made reference to Adomako.

13.  Counsel for the prosecution submitted that the CA in HK, just like the CA in the UK, has applied the “objective” test for GNM as laid down in Adomako.  As judgments of the CA are binding on this Court, I was bound to rule that the objective test propounded in Adomako is applicable in this case.

14.  Counsel for the prosecution attempted to show what they understood to have been overruled by the CFA in the case Sin Kam Wah in relation to Chau Ming Cheong.  Sin Kam Wah was a case involving the Common Law offence of Misconduct in Public Office.  Sir Anthony Mason NPJ re‑formulated this Common Law offence in light of the decision in A‑G’s Reference (No 3 of 2003) [2005] QB 73 (CA), the latter having taken into account R v G in its consideration of the relationship between “recklessness” and “wilful misconduct”.

15.  It was submitted that although Adomako was not referred to by the CFA in Sin Kam Wah, in light of the subsequent English CA decision in R v Chapman [2015] QB 883 (also a case of Misconduct in Public Office), in which Adomako was left intact as applied in GNM despite the effect of R v G, Sir Anthony Mason NPJ would not have come to the same conclusion had the principles in Adomako been canvassed before him in Sin Kam Wah.

16.  Counsel for the prosecution submitted that in R v G, Lord Bingham stressed that he was only dealing with the interpretation of the word “reckless” in the context of the statute creating the offence of Criminal Damage.  In overruling Chau Ming Cheong (a case of GNM), Sir Anthony Mason NPJ was concerned with the CA’s reference to “recklessness” in its judgment (as in R v Caldwell [1981] 1 ALL ER 961 and R v Lawrence [1981] 1 ALL ER 974 and cited in Archbold), although that was not as explicitly stated by Sir Anthony Mason NPJ as his overruling of the case of R v Dung Shue Wah [1983] 2 HKC 30 (a case involving the statutory offence of Rape).

17.  It was therefore the submission of the prosecution that the CFA did not overrule the “objective” test applied by the CA in Chau Ming Cheong.

18.  Counsel for the prosecution submitted that in the present case – GNM in a “medical context” – a jury direction expressed in the terms as those in Adomako and applied in the subsequent case of Misra (ie an objective test) would be appropriate.

19.  Finally, counsel for the prosecution referred me to the Specimen Directions for GNM and submitted that the position in HK is the same as that in the UK.

Stance of the defence

20.  It is not necessary to set out separately the positions of D1 and D3 as their submissions are basically the same.  Counsel for D2 has adopted the submissions for D1 and D3.

21.  The position of all three defendants is that my judgment in Lai Shui Yin was a correct one.  It is not enough for the prosecution to simply rely on the objective reasonable man test – with the judge directing the jury to take into consideration the subjective state of mind of the defendant, both for and against the defendant.  The prosecution has to prove that the defendant was subjectively aware of the obvious and serious risk of death to the deceased in order to establish manslaughter on the basis of breach of duty.

22.  Counsel for D1 and D3 also pointed out that the two CA cases cited by the prosecution (ie Law Siu Kuen and Ngai Hon Kwong) did not touch upon the issue decided in Lai Shui Yin.

23.  In addition to the above, counsel for D3 also relied on the cases of Gammon (Hong Kong) Ltd v AG [1985] AC1, Hin Lin Yee v HKSAR (2010) 13 HKCFAR 142 and Kulemesin v HKSAR (2013 16 HKCFAR 195 to support their submission that mens rea is presumed to be required to establish criminal liability, in particular where the offence is truly criminal in nature.  Further, counsel for D3 also submitted that the Specimen Directions have no legal effect and the test for the last element does not depend on whether it is a case of GNM in a medical context.

My consideration

24.  I will first consider the two CA judgments cited by the prosecution to consider whether my decision in Lai Shui Yin was per incuriam.

25.  Law Siu Kuen is a case involving a defendant who faced 6 counts of Manslaughter and 6 alternative counts of Dangerous Driving causing Death.  He pleaded guilty to 6 counts of Manslaughter.  The sentencing Judge said it was unlikely that any effective distinction could be made between Manslaughter and Dangerous Driving causing Death for the purpose of sentencing.  The defendant was sentenced to concurrent terms of 6 years’ imprisonment.  The Secretary for Justice applied to review the sentences imposed.  It was in the context of its discussion of the differences between Manslaughter and Dangerous Driving causing Death that the CA made reference to Adomako.  Stock V‑P, who gave judgment of the CA, said:

“ 58. As for manslaughter, it has been said that: ‘… of all crimes, manslaughter appears to afford most difficulties of definition, for it concerns homicide in so many and so varying conditions’ (Andrews v Director of Public Prosecutions [1937] AC 576, 581) but what is required in the context of motor manslaughter is proof of breach of the duty of care towards the victim who has died, that that breach caused the death of the victim, and, importantly for present purposes, that ‘having regard to the risk of death involved, the conduct of the defendant was so bad in all the circumstances as to amount’ in the judgment of the jury ‘to a criminal act or omission.’: see R v Adomako [1995] 1 AC 171 at 187. The defendant's conduct ‘has to be such that it creates a very high degree of risk [of death] before it is to be classed as manslaughter’: see Brown v The Queen [2006] 1 AC 1, 16. The distinction is one which ‘recognises that there are degrees of turpitude which will vary according to the gravity of the risk created by the manner of a defendant's driving’: R v Seymour, p.506. In the case of conscious risk‑taking, of which the instant case is a clear example, it will be appropriate to use the word ‘reckless’ in its ordinary meaning as part of the test and, in that regard, what has to be proved, in the case of motor manslaughter, is an obvious risk of death from the defendant's conduct, objectively assessed, and an indifference to that risk on the part of the defendant, or foresight thereof plus a determination nevertheless to run it: this is an adaptation of the test suggested by R v Lidar (unrep., Court of Appeal, 11 November 1999) , referred to in Archbold 2011, p.1859 para.19‑110.”

26.  Whilst Stock V‑P have cited Adomako, it is clear that in that case, the CA was dealing with a case of “conscious risk‑taking” (which denotes a subjective state of mind).  Stock V‑P did not consider the very issue I had to decide in Lai Shui Yin (ie the test for the last element).  I do not see how the judgment of Law Siu Kuen, if it had been referred to me at the time, would have affected my decision in Lai Shui Yin.

27.  As for the case of Ngai Hon Kwong, the defendant in that case was charged with murder of his long‑term friend.  The prosecution’s case was that the defendant deliberately splashed alcohol on the deceased and set him alight.  The defence was that the deceased died as a result of an accident.  The defendant asserted that he was in a bad temper after arguing with his partner (not the deceased).  He tripped while carrying the bottle of alcohol and spilt the liquid on the deceased, having spilt some onto his own arm.  The defendant then decided to smoke the dangerous drug Ice and he lit a cigarette lighter.  His hand caught fire so he threw away the lighter, which then set the deceased on fire.  The trial judge was concerned about the effect of Ice on the defendant and directed the jury on the alterative charge of manslaughter (by unlawful and dangerous act).  An issue before the CA on appeal was whether the trial judge had failed to direct the jury on GNM.  It was in that context that the CA made reference to Adomako, setting out the four elements of GNM (at para 68):

“ 68. The elements of gross negligence manslaughter were set out by the House of Lords in R v Adomako (John Asare) [1995] 1 AC 171. They are:

1) the existence of duty of care by the defendant to the deceased;

2) breach of that duty by the defendant;

3) the breach by the defendant of the duty causing the death of the deceased; and

4) the breach of the duty by the defendant being capable of being characterised as gross negligence and therefore a crime.”

28.  The CA went on to say:

“ 69. Lord Mackay of Clashfern LC in a judgment with which the other members of the House agreed, said at 187C‑E:

The jury will have to consider whether the extent to which the defendant's conduct departed from the proper standard of care incumbent upon him, involving as it must have done a risk of death to the [deceased], was such that it should be judged criminal.

…

The essence of the matter which is supremely a jury question is whether having regard to the risk of death involved, the conduct of the defendant was so bad in all the circumstances as to amount in their judgment to a criminal act or omission.

70. All four elements are matters for the jury to decide and the Judge's role is merely to determine whether there is evidence capable of establishing each element.

71. In R v Evans (Gemma) [2009] 1 WLR 1999 the Court of Appeal of England and Wales was dealing with a situation where there was a failure to act when a duty to act arose. As to when a duty to act arose Lord Judge CJ, in giving the judgment of the court, said at 2007H:

In our judgment, consistently with R v Adomako [1995] 1 AC 171 and the link between civil and criminal liability for negligence, for the purposes of gross negligence manslaughter, when a person has created or contributed to the creation of a state of affairs which he knows, or ought reasonably to know, has become life threatening, a consequent duty on him to act by taking reasonable steps to save the other's life will normally arise.

72. We are satisfied that in this case there was evidence capable of establishing the existence of a duty of care by the applicant to the deceased. It arose when he splashed inflammable liquid on the deceased, thereby placing him in a life‑threatening situation. That duty would have continued until the applicant removed the risk of harm.”

29.  The CA was only concerned with the question whether GNM should have been left as an alternative to the jury in the particular circumstances of the case.  The CA was not concerned with the test to be applied in relation to the last element.  The reference to Evans(Gemma) was in the context of “when a duty to act arose”, as submitted by counsel for D3.  There was no discussion or consideration on what the test in relation to the last element was, as a result of the CFA overruling Chau Ming Cheong – the very issue that I was called upon to decide in Lai Shui Yin.

30.  With respect to counsel for the prosecution, I disagreed with their submission that my decision in Lai Shui Yin was per incuriam.

31.  In Lai Shui Yin, I explained why I came to the conclusion that, as a result of the CFA in Sin Kam Wah overruling Chau Ming Cheong, the test for the last element of GNM in HK is different from that in UK.  I do not propose to reiterate them here.  Suffice it to say that I am not persuaded by the submission of the prosecution to change my earlier decision.

32.  I wish to emphasize my reasoning in Lai Shui Yin regarding the importance of the underlying principle expressed in R v G and approved in Sin Kam Wah: that is, a conviction of a serious crime should depend not only on what the defendant had done, but whether the defendant’s state of mind was culpable.  The law should not be such that a person who genuinely did not perceive a risk of death should be exposed to conviction of such a serious crime as manslaughter on the strength of what someone else would have appreciated.

33.  Although the cases cited by counsel for D3, (Gammon,Hin Lin Yee and Kulemesin) all concerned with the construction of statutory offences, I agree with their submission that the principles expounded are indeed of general application: the more serious the offence in terms of penalty and social obloquy, the less likely the presumption (that mens rea is required to establish criminal liability) will be held to have been supplanted.  These principles echo my reason for placing such importance on the underlying principle.

34.  The Specimen Directions referred to by the prosecution, while without any legal effect, are indeed very useful guidance for judges in their preparation of the summing up.  The citation of cases such as Adomako thereinare for reference only.  As I have indicated earlier, I have no quarrel with, and indeed endorsed the application of, the four elements enunciated in Adomako.  I only came to the view that the test for the last element is different in HK from that of UK as a result of the CFA in Sin Kam Wah overruling Chau Ming Cheong.

35.  For these reasons, I declined the invitation of the prosecution to depart from my earlier decision in Lai Shui Yin.  I ruled that in the present case, the test for the last element was the same as what I have ruled in Lai Shui Yin, ie the test for gross negligence was not only an objective reasonable man test, but the prosecution is required to prove that the defendant’s subjective state of mind was culpable, that the defendant was subjectively aware of the obvious and serious risk of death to the deceased.

36.  I will add here that the test should be the same for anyone facing a charge of GNM.  It makes no difference that the GNM in this case is in a “medical context”.

 (Judianna Barnes)
 Judge of the Court of First Instance
High Court

Mr Raymond Leung SC, leading Mr John Marray, and Mr Eric Tsoi, counsel on fiat and Ms Margaret Lau SPP of Department of Justice, for HKSAR

Mr Wong Man Kit SC, leading Mr Charles J. Chan, instructed by Messrs Day & Chan, for the 1st defendant

Mr Albert Cheung, instructed by Messrs Lam, Lee & Lai, for the 2nd defendant

Mr Peter Duncan SC, leading Ms Deanna Law, instructed by Howse Williams Bowers, for the 3rd defendant

 

112738-EN-2017-06-13

HKSAR v. CHOW HEUNG WING,STEPHEN AND OTHERS

HTML content

HCCC 437/2015

IN THE HIGH COURT OF THE

HONG KONG SPECIAL ADMINISTRATIVE REGION

COURT OF FIRST INSTANCE

CRIMINAL CASE NO 437 OF 2015

________________________

BETWEEN
 HKSAR 
and
 CHOW Heung-wing, Stephen1st Defendant
 CHAN Kwun-chung2nd Defendant
 MAK Wan-ling3rd Defendant

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Before: Hon Barnes J in Court

Date of Hearing: 2, 7 June 2017

Date of Decision: 8 June 2017

Date of Handing Down of the Reasons for Decision: 13 June 2017

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REASONS FOR DECISION
(on Admissibility of Evidence re CIK, GMP and Joint Criminal Enterprise)

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1.  Different aspects of the evidence intended to be called by the prosecution were being challenged. I decided to first deal with the broad principles in relation to three areas, ie expertise of experts on Cytokine‑induced killer (CIK) cell infusion therapy, relevance of the Good Manufacturing Practice (GMP) Guidelines and whether this is a case of joint criminal enterprise. I gave my ruling on 8 June 2017 and I indicated at the time that I would give my reasons later. This I now do.

Expertise of experts re CIK

2.  Of the experts to be called by the prosecution concerning the subject of CIK, D1 challenged the expertise of the following:

a. Professor Yuen Kwok Yung (PW69);

b. Dr Raymond Liang (PW72);

c. Professor Ng Tak‑keung (PW74);

d. Mr William Chui (PW75);

e. Dr Li Chi‑kong (PW77);

f. Dr Albert Lie (PW78); and

g. Professor Godfrey Chan (PW79).

3.  D2 does not challenge their expertise.

4.  D3 challenged all of them save for Dr Raymond Liang (PW72) and Prof Ng Tak‑keung (PW74).

5.  The main ground of objection by D1 and D3 in this respect is that whilst these witnesses are experts in their own disciple, they do not have any “hands‑on” experience in carrying out CIK on human beings and their experience are limited to reading journals or doing study on non‑human subjects.  They had not conducted any study into the administration of CIK.  They had not undertaken research into CIK.  They had not written any articles on the topic of CIK (save for Prof Yuen but his article was in relation to the women who had received the very CIK involved in this case).  Being experts on Haematology, Oncology, Microbiology, or Immunology do not qualify these witnesses to give expert evidence on CIK in this case.

6.  Counsel for D1 also stressed that in this case, the CIK procedure involved was not for any medical purpose, but for health promotion, these witnesses are therefore not qualified to comment on CIK in this particular usage.

7.  Reference was made to the evidence of Prof Yuen during the voir dire and I will not reiterate them here. Suffice it to say that when I came to my decision, I had fully considered the submissions together with the evidence cited.

8.  The stance of the prosecution can be shortly stated.  No matter what label is given to the CIK – be it for health care or an option for health care, it does not affect the analysis that it is a medical procedure.  As such, the law requires and expects certain standards on those people who prepared and administered the cellular substance for infusion.  There is also no magic in the label “CIK therapy”, it is a form of cellular therapy that doctors such as Immunologists and Haematologists would be able to understand and comment upon.  There is no monopoly for someone who has practised CIK to be considered experts to the exclusion of others who had not actually practised such a procedure.  What the science involved is an understanding of the anatomy of the body, how the blood cells work, an understanding of the claimed theoretical basis of CIK therapy, the effect of the extraction of T‑lymphocyte (T‑cell) and to multiply it by way of cytokine inducement, the claimed effect on the human immunity system, and the preparation and steps taken to ensure safety.  In order to be an expert to give evidence, the expert does not need to have “hands‑on” experience.

9.  All the experts the prosecution intends to call have the relevant expertise to comment on CIK therapy.

The law

10.  I will state in the outset that parties are ad idem as to the relevant law on this subject, as stated in The Queen v Bonython (1984) 38 SASR 45 (per King CJ at 46):

“ Before admitting the opinion of a witness into evidence as expert testimony, the judge must consider and decide two questions. The first is whether the subject matter of the opinion falls within the class of subjects upon which expert testimony is permissible. This first question may be divided into two parts: (a) whether the subject matter of the opinion is such that a person without instruction or experience in the area of knowledge or human experience would be able to form a sound judgment on the matter without the assistance of witnesses possessing special knowledge or experience in the area, and (b) whether the subject matter of the opinion forms part of a body of knowledge or experience which is sufficiently organized or recognized to be accepted as a reliable body of knowledge or experience, a special acquaintance with which by the witness would render his opinion of assistance to the court. The second question is whether the witness has acquired by study or experience sufficient knowledge of the subject to render his opinion of value in resolving the issues before the court.”

11.  It is clear that in the present case, I only have to consider the 2nd question as there cannot be any serious issue in relation to the 1st question when one is considering CIK therapy in this case.

My consideration

12.  Having considered the legal principle enunciated in Bonython, and having considered the submissions (with reference to the particular field various witnesses were specialists of, and their Curriculum Vitae (adduced during the Voir Dire of D2)), I agree with the submission of the prosecution that it is not necessary to have any “hands‑on” experience before these witnesses can comment on CIK therapy.  I do not accept that simply because CIK was not practised in Hong Kong, no one from Hong Kong is qualified to comment on CIK therapy.  I have to decide whether any particular witness has acquired by study or experience sufficient knowledge of the subject to render his opinion of value in resolving the issues before the court.

13.  Notwithstanding what the CIK therapy is labelled, I agree with the view of the prosecution that it is essentially a medical procedure, one involving cellular therapy: the drawing of blood from a person, the isolation of lymphocytes for ex vivo culture and manipulation, the harvesting of cultured cells, the purification by washing with Phosphate Buffered Saline (PBS) and the suspension in PBS and Albumin to make it steady for infusion back to the same person.  Such a procedure falls within the remit of Immunology and Haematology.  I am satisfied that those specialists who specialised in Haematology, Immunology, stem cell biology/transplantation, and bone marrow transplantation are qualified to give expert opinion on CIK.  These witnesses are:

(a) Dr Raymond Liang (PW72) – a specialist in Haematology and Haematological Oncology and Medical Oncology,

(b) Dr Li Chi‑kong (PW77) – a specialist in Paediatric Oncology and bone marrow transplantation,

(c) Dr Albert Lie (PW78) – a specialist on Haematology and Haematopoietic stem cell transplantation, and

(d) Professor Godfrey Chan (PW79) – a specialist in Paediatric Haematology and Oncology.

14.  I would add here that although Dr Albert Lie (PW78) used expression such as “as far as I know” and “to the best of my knowledge”, such expressions does not mean he cannot give expert opinion on CIK therapy.

15.  Whilst Prof Yuen Kwok Yung (PW69) is neither a Haematologist or Immunologist, he is an eminent Microbiologist whose work also involves the fields of Immunology and Haematology.  Bearing in mind his expertise in Microbiology, the overlapping of this field with Haematology and Immunology, and his experience in ex vivo T‑cell expansion in animals (though not humans), I am satisfied that he is qualified to give expert evidence on CIK therapy, even though his involvement initially was to assist the authorities in locating the source of contamination.

16.  I am also satisfied that Prof Ng Tak‑keung (PW74), a Consultant Microbiologist is qualified to give expert opinion on CIK.  It should be noted that although Prof Ng said in his opinion “the indication of applying this potentially high risk procedure for purely cosmetic reasons is not justified from [his] point of view”, bearing in mind that the procedure took place under the umbrella of a beauty centre, I do not find that Prof Ng’s opinion was formed on a wrong basis, as submitted by counsel for D1.  It is clear from the context that Prof Ng is referring to the application of this high risk procedure for non‑medical purpose.

17.  That leaves me with the objection in relation to Mr William Chui (PW75).  I will deal with his evidence in greater detail under the heading of GMP Guidelines.  Bearing in mind his background and expertise (as a pharmacist and pharmacologist), I am of the view that he also possesses the relevant expertise to give opinion evidence on the set‑up of the Asia Pacific Stem Cell Science Limited (APSC) laboratory in relation to CIK procedure.

GMP Guidelines

18.  Prof Ng Tak‑keung (PW74), Mr William Chui (PW75), Prof Godfrey Chan (PW79) and Dr Raymond Liang (PW72) have all made reference to the GMP Guidelines, with Mr William Chui having given the most detailed opinion thereon (in a statement dated 20 April 2017.)

19.  All three defendants challenged the admissibility of evidence relating to the GMP Guidelines.

20.  All counsel questioned the relevance of the GMP Guidelines in this case.  I combine all the objections here as some of them overlapped:

(a) Whether CIK procedure falls under the definitions of “manufacture” and “pharmaceutical product and medicine” in the Pharmacy and Poisons Ordinance Cap 138 (PPO) is a matter of law, not for Mr Chui to express his opinion on;

(b) There is a real issue whether PPO applies as it is questionable whether CIK falls under the definition of “manufacture” (due to the application to individuals which was expressly excluded in the definition); and whether the preparation in the CIK process amounts to “pharmaceutical product and medicine” (as the CIK was not intended for the use in relation to disease, abnormality or organic function in human or animals, but for the purpose of health care);

(c) If CIK does not fall into either definition, then GMP Guidelines have no application;

(d) If there has to be a decision on whether CIK falls into either definition, there will be a complication as to whether this question should be dealt with by the judge or the jury;

(e) In 2012, there was no legal requirement relating to GMP Guidelines in PPO, the law changed in 2015, with GMP Guidelines being introduced for the first time;

(f) The statement of Mr Chui was only served very late on the defendant (in May 2017), it is unfair to the defence to have to deal with this;

(g) GMP Guidelines have no relevance to the particulars alleged in the indictment.

21.  The stance of the prosecution was that it matters not whether the CIK procedure falls under the definition of “manufacture” or “pharmaceutical product and medicine” of PPO, adding that under the definition of the latter, the reference to “symptoms thereof” could be interpreted to cover CIK.

22.  Mr Leung submitted that the case against all defendants was one of Gross Negligence Manslaughter (GNM).  The prosecution needs to prove breach of duty.  CIK involved cellular product or stem cells, anyone engaged in the preparation or production has to reach a particular standard.  The GMP (1995) issued by Department of Health (DH) was in place in 2012.  Whilst it was not a piece of subsidiary legislation, it was introduced to coincide with the licensing condition (as stipulated in the prescribed form for manufacturer’s licence under PPO (pointing to the now repealed Form 3 and Form 4).  GMP (1995) was a reference against which one can measure whether the defendants’ conducts were up to the required standard.

23.  Counsel for the prosecution also submitted that defence was not taken by surprise as references to GMP Guidelines were already made by various witnesses in their statements (in the committal bundle). Mr William Chui did no more than making explanations with reference to GMP documents itself to assist the jury.

24.  Further, D1 in his application dated 28 April 2009 to have APSC admitted into the Science Park had made reference to the GMP Guidelines.  In another document (PP268) prepared by Michael Wah (PW14) and D2 on 12 November 2012, the two reported to D1 why the laboratory at APSC had not obtained a GMP certificate.  These two documents show that both D1 and D2 were aware of the GMP requirement.  The lateness in serving Mr William Chui’s statement posed no prejudice.

25.  Upon query raised by this Court, Mr Leung confirmed that the prosecution will not rely on the provisions of the PPO to introduce the evidence of the GMP Guidelines.  Nor was there any allegation of negligence arising out of any alleged breach of PPO.  The prosecution intends to rely on the GMP Guidelines as a reference against which one can measure the reasonable standard, or put another way, the GMP Guidelines represents the reasonable standard at the material time for the preparation and manipulation of cells in terms of safety.

My consideration

26.  Whilst I understand that in his work, Mr William Chui would need to have an understanding of the law in relation to pharmaceutical matters, such as the PPO, I do not think there is any dispute that Mr William Chui is not permitted to give his opinion on the legal definitions of “manufacture” and/or “pharmaceutical product and medicine” under PPO.

27.  Mr William Chui’s opinion on the GMP Guidelines (dated 20 April 2017) was based, in my view, wholly on his interpretation of the law in relation to the definitions in PPO.  As the prosecution have clearly confirmed that they are not relying on the provisions under PPO, but that they are relying on the available GMP Guidelines at the time in 2012 (ie GMP Guidelines (1995)) as a guide to demonstrate what a reasonable standard should have been, any opinion expressed by Mr William Chui in relation to the definitions and application of PPO is not relevant and inadmissible.

28.  Bearing in mind that the prosecution intends to rely on the GMP Guidelines as a reference against which one can measure the reasonable standard; that the GMP Guidelines represents the reasonable standard at the material time for the preparation and manipulation of cells in terms of safety, and bearing in mind that the prosecution will adduce evidence of the following two documents:

a. D1’s application dated 28 April 2009 for APSC to be admitted into the Science Park, in particular the following contents “… [t]he new company will be offering peripheral blood stem cell banking to people from around the world. Furthermore, after obtaining GMP licensure (sic) from Hong Kong Health Department and the EU GMP accreditation it will be offering to patients and their doctors autologous culture of peripheral blood stem cells at a cost‑effective price, which is not currently available in Asia”; and

b. The internal document prepared by Michael Wah (PW14) and D2, reporting to D1 why the laboratory at APSC had not obtained a GMP licence,

I am of the view that the relevant GMP Guidelines issued by the DH is of relevance in this case as both D1 and D2 had demonstrated knowledge of the GMP requirement.  (I note here that although the EU GMP was mentioned, I have not seen any evidence of such GMP Guidelines and I am not called up to rule on that.)

29.  For these reasons, provided the evidence of the GMP Guidelines to be given by the experts falls under this limited fashion, and not based on their interpretation of the PPO, their evidence is relevant and admissible.

30.  Although I have ruled Mr William Chui cannot refer to his latest statement in relation to GMP Guidelines, I bore in mind that Mr William Chui had given his opinion on the set‑up of the laboratory at APSC in his second statement (dated 29 July 2014).  Should Mr William Chui refer to the GMP Guidelines, I would allow his evidence so long as he does not refer to the PPO.

31.  As I have indicated, I am dealing with the broad principles in relation to the admissibility of evidence at this stage.  Whether GMP Guidelines is relevant and admissible against D3, particularly in relation to the particulars of the allegation of alleged breach of duty against her; whether the US Pharmacology is relevant and admissible; whether the evidence of ASPC not being GMP compliant or not being accredited by the Hong Kong Accreditation Service (HKAS) are relevant and admissible, I will consider all these at a later stage.

Joint Criminal Enterprise

32.  The prosecution submitted that this case is one of joint criminal enterprise so that acts and declarations done by any defendant in furtherance of the joint enterprise is admissible against the other defendants, accepting that the verbal statement, demonstration and witness statements given by D2 do not amount to acts or declarations in furtherance of a joint enterprise.

33.  The prosecution referred to the indictment (in particular the wording “together with [other defendants]” and the particulars in para “(ii)” and submitted that the three defendants are jointly charged with the offence of GNM.  The three defendants are joint tortfeasors under civil law which co‑exists with joint enterprise under criminal law.  The ordinary principles of the law of negligence apply here to ascertain the duty, breach and causation, and upon all these being proved, the jury must then go on to consider whether the breach should be characterised as gross and therefore a crime (citing R v Adomako [1995] 1 AC 171).

34.  In this case, the prosecution says D1 launched a scheme whereby CIK was marketed and sold to customers of the “DR group”.  D1 engaged D2 to make the cellular preparation at APSC and D3 to infuse the same into the relevant customer.  From the perspective of civil law, where negligence is proved, each of D1 to D3 is jointly and severally liable as joint tortfeasors.  D1 to D3 were part of a joint enterprise in that they all participated in a scheme entailing the marketing, preparation, and administration of CIK to patients (including the deceased).

35.  The prosecution relied on the CFA case of HKSAR v Chan Kam Shing (2016) 19 HKCFAR 640 and submitted that “liability is independently based on each defendant’s participation in a joint criminal enterprise with the requisite mental state to constitute the offence relevance to the defendant in question”, which is applicable to the defendants in this case.

36.  The prosecution relied on various cases, including the case of Sze Kwan Lung v HKSAR (2004) 7 HKCFAR 475 and submitted that defendants can be jointly charged with an offence of GNM.

37.  The prosecution also relied on the “building‑block” concept in the case of R v Hayter (Paul Ali) [2005] 1 WLR 605, to support their submission that while D2’s verbal statement, demonstration and witness statements are not admissible against the other two defendants, the jury can be directed to use the fact of D2’s breach, if they so find at the end of the day, as evidence against the other two defendants.

38.  Needless to say, counsel for D1 and D3 strongly objected to this approach of the prosecution.  Without being disrespectful to counsel, I do not think it necessary to reiterate all the arguments here.  I do not think it useful to consider the mens rea in GNM in a joint enterprise scenario as submitted by counsel for D1 (noting that I will have to deal with the mens rea in GNM generally at a later stage).  Nor do I think it useful to consider the concept of “aggregation” here.  Suffice it to say that I am not impressed with the submission of the prosecution that this is a case of joint criminal enterprise.

39.  Whilst accepting that in deciding whether there was any negligence, the ordinary principles of the law of negligence applies, that does not mean that joint tortfeasors under civil law co‑exists with joint enterprise under criminal law.  This is a rather bold statement and I find no support from any of the cases cited by the prosecution.

40.  I am of the view that the observation of Bokhary PJ in Sze Kwan Lung (at para 39) relied on by the prosecution: “just because the prosecution did not seek to put forward a case of manslaughter by gross negligence at the original trial, it does not mean that they are precluded from doing so at the retrial” does not assist me in my task.

41.  The main problem faced by the prosecution in their contention or submission that this case involves a joint criminal enterprise is the word “criminal” in joint criminal enterprise.

42.  When one looks at the indictment, each defendant faces one count of GNM.  They are not jointly charged under one count.  Whilst it is true that in each count, the allegation is that a particular defendant, together with the other two defendants, unlawfully killed the deceased by gross negligence, these three counts do not allege or demonstrate any joint criminal enterprise.  The words “together with” in the three counts serve to allege that the three defendants are joint tortfeasors (jointly and severally liable), but such an expression does not mean or demonstrate that they are members of a joint criminal enterprise.

43.  The prosecution referred to the indictment and read out the alleged duty of each defendant, which are quite different.  Then they referred to the wordings under particular “(ii)” against all defendants, which reads:

“ in breach of that duty of care, in the knowledge that the said CIK/AI therapy was based on experimental process for the treatment of cancer and which involved the extraction, manipulation in a laboratory and reintroduction of blood taken from the said CHAN Yuen‑lam (“the said blood product”) failed to take reasonable care for the safety of the said CHAN Yuen Lam by-....”

and submitted that the indictment demonstrates that there was a joint criminal enterprise.

44.  With respect, I do not agree.  It is a fact that the knowledge alleged is not a criminal offence.  The prosecution is not alleging that having such a common knowledge is a criminal offence.  The allegation against each defendant is that, with the knowledge alleged, they are in breach of their respective duty of care, with both the duty of care and the particulars of the breach being quite different against each defendant.

45.  Contrary to the submission of the prosecution, the indictment does not demonstrate a case of joint criminal enterprise.

46.  Further, I cannot see how, in the particular circumstances of this case, these three defendants can be said to have embarked on a joint criminal enterprise to be grossly negligent.

47.  That being the case, the principle that acts and declarations made by a defendant in furtherance of a joint criminal enterprise being admissible against all other defendants have no application here.

48.  As to the prosecution’s submission that the “building‑block” concept propounded in the unusual case of Hayter is applicable here, I have the following observations to make at this stage.

49.  Firstly, the facts of that case was very unusual.  Three defendants (R, H and B) were jointly charged with the murder of C.  There was independent evidence against B, the wife, who had expressed her wishes to have her husband C killed.  There was evidence of association between B and H (the middleman) and between H and R (the killer).  The Crown conceded that the circumstantial evidence against H did not provide a case to answer unless it could be proved that R was the killer.  The case against R was dependent on his alleged confession to his girlfriend.  In response to a no case to answer submission, the trial judge ruled that if the jury were satisfied on evidence admissible against R that he was the killer, that conclusion was relevant in considering the case against H.  In his summing up the judge directed the jury, in effect, that if they found R guilty they could use the fact of R’s guilt in their consideration of the cases of B and H, but they could not allow any of the evidence of the confession itself to play a part.  H was found guilty and he failed in his appeal in the CA and the House of Lords.

50.  It can readily be seen that the factual matrix of Hayter is very different from the case before me.

51.  Secondly, the three defendants (B, H and R) in Hayter were jointly charged with murder, they had clearly embarked on a joint criminal enterprise.  The case against the three defendants before me is not one of joint criminal enterprise.

52.  Should the prosecution wish to rely on the “building‑block” concept in the absence of any joint criminal enterprise, I will deal with the submission if and when it arises.

 (Judianna Barnes)
 Judge of the Court of First Instance
High Court

Mr Raymond Leung SC, leading Mr John Marray, and Mr Eric Tsoi, counsel on fiat and Ms Margaret Lau SPP of Department of Justice, for HKSAR

Mr Wong Man Kit SC, leading Mr Charles J. Chan, instructed by Messrs Day & Chan, for the 1st defendant

Mr Albert Cheung, instructed by Messrs Lam, Lee & Lai, for the 2nd defendant

Mr Peter Duncan SC, leading Ms Deanna Law, instructed by Howse Williams Bowers, for the 3rd defendant

 

112742-EN-2017-05-24

HKSAR v. CHOW HEUNG WING,STEPHEN AND OTHERS

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HCCC 437/2015

IN THE HIGH COURT OF THE

HONG KONG SPECIAL ADMINISTRATIVE REGION

COURT OF FIRST INSTANCE

CRIMINAL CASE NO 437 OF 2015

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BETWEEN
 HKSAR 
and
 CHOW Heung-wing, Stephen1st Defendant
 CHAN Kwun-chung2nd Defendant
 MAK Wan-ling3rd Defendant

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Before: Hon Barnes J in Court

Date of Hearing: 17 May 2017

Date of Decision: 18 May 2017

Date of Handing Down of the Reasons for Decision: 24 May 2017

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REASONS FOR DECISION
(on the application to amend the indictment)

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The application

1.  There are three defendants in this case.  Each one faces one count of Manslaughter, contrary to Common Law and punishable under Section 7 of the Offences against the Person Ordinance, Cap 212.

2.  The prosecution applied to amend the indictment in relation to D1 and D3 on the first day of hearing, notice having been given some two months before.  After considering the submissions advanced, I refused to grant leave for the prosecution to amend the indictment.  I indicated that I would give my reasons later, this I now do.

The proposed amendment

3.  I will first set out the indictment with the proposed amendment underlined so that one can see clearly what the proposed amendment was about:

“ First Count (against 1st accused only)

STATEMENT OF OFFENCE

Manslaughter, contrary to Common Law and punishable under section 7 of the Offences against the Person Ordinance, Cap.212.

PARTICULARS OF OFFENCE

CHOW Heung-wing, Stephen, on the 10th day of October, 2012, in Hong Kong, together with CHAN Kwun-chung and MAK Wan-ling, unlawfully killed CHAN Yuen-lam also known as CHAN Oi-lin (‘the said CHAN Yuen-lam’) by gross negligence in that –

(i) Being the owner and person in effective control of a number of companies held out as the ‘DR Group’, including DR Esthetic Centre (Causeway Bay) Limited, Hong Kong Mesotherapy Centre Limited and Asia Pacific Stem Cell Science Limited which marketed, prepared and administered to the said CHAN Yuen-lam a product known as CIK/AI therapy owed a duty of care to the said CHAN Yuen-lam;

(ii) In breach of that duty of care, in the knowledge that the said CIK/AI therapy was based on experimental process for the treatment of cancer and which involved the extraction, manipulation in a laboratory and reintroduction of blood taken from the said CHAN Yuen-lam (“the said blood product”), failed to take reasonable care for the safety of the said CHAN Yuen-lam by –

(a) Failing to ensure that a properly qualified person was responsible for preparing and producing the said blood product;

(b) Failing to devise, institute, enforce and maintain a properly documented protocol for the preparation in the laboratory of the said blood product which included viral and bacteria testing;

(c) Failing to ensure that the said blood product had, prior to leaving the laboratory where it had been prepared, undergone viral and bacteria testing and that such had been documented;

(d) Failing to devise, institute, enforce and maintain a safe system requiring the Doctor, MAK Wan-ling, to have satisfied herself that such viral and bacteria testing had been carried out prior to administration of the said blood product to the said CHAN Yuen-lam, so as to ensure the same was free of contamination;

(e) Failing to devise, institute, enforce and maintain a safe system requiring the Doctor, MAK Wan-ling, to ascertain, assess and monitor any adverse reactions exhibited by recipients of CIK/AI therapy and ensuring that timely and appropriate medical intervention would be provided;

(f) Failing to ensure that the said CHAN Yuen-lam was fully informed of the risks involved in the administration of the said CIK/AI therapy;

(iii) His aforesaid breach of duty amounted to gross negligence on his part; and

(iv) His aforesaid negligence was a substantial cause of the death of the said CHAN Yuen-lam.

Second Count (against 2nd accused only)

STATEMENT OF OFFENCE

Manslaughter, contrary to Common Law and punishable under section 7 of the Offences against the Person Ordinance, Cap.212.

PARTICULARS OF OFFENCE

CHAN Kwun-chung, on the 10th day of October, 2012, in Hong Kong, together with CHOW Heung-wing, Stephen and MAK Wan-ling, unlawfully killed CHAN Yuen-lam also known as CHAN Oi-lin (‘the said CHAN Yuen-lam’) by gross negligence in that –

(i) Being the person responsible for the preparation of a product known as CIK/AI therapy on behalf of Asia Pacific Stem Cell Science Limited, which the said CIK/AI therapy was administered to the said CHAN Yeun-lam, owed her a duty of care;

(ii) In breach of that duty of care, in the knowledge that the said CIK/AI therapy was based on experimental process for the treatment of cancer and which involved the extraction, manipulation in a laboratory and reintroduction of blood taken from the said CHAN Yuen-lam (“the said blood product”), failed to take reasonable care for the safety of the said CHAN Yuen-lam by –

(a) Failing to ensure that he was fully qualified to undertake the preparation and production of the said blood product;

(b) Failing to devise, institute, enforce and maintain a properly documented protocol for the preparation in the laboratory of the said blood product which included viral and bacteria testing;

(c) Failing to ensure that the said blood product had, prior to leaving the laboratory where it had been prepared and produced, undergone viral and bacteria testing and that such had been documented so as to ensure the said blood product was free of contamination;

(d) Failing to devise, institute, enforce and maintain a safe system documenting the carrying out of all necessary viral and bacteria tests to accompany the said blood product when it left the laboratory;

(iii) His aforesaid breach of duty amounted to gross negligence on his part; and

(iv) His aforesaid negligence was a substantial cause of the death of the said CHAN Yuen-lam.

Third Count (against 3rd accused only)

STATEMENT OF OFFENCE

Manslaughter, contrary to Common Law and punishable under section 7 of the Offences against the Person Ordinance, Cap.212.

PARTICULARS OF OFFENCE

MAK Wan-ling, on the 10th day of October, 2012, in Hong Kong, together with CHOW Heung-wing, Stephen and CHAN Kwun-chung, unlawfully killed CHAN Yuen-lam also known as CHAN Oi-lin (‘the said CHAN Yuen-lam’) by gross negligence in that –

(i) Being a properly registered Doctor responsible for administering to the said CHAN Yuen-lam a product known as CIK/AI therapy on behalf of the DR Esthetic Centre (Causeway Bay) Limited and/or Hong Kong Mesotherapy Centre Limited, both companies being part of the ‘DR Group’, owed a duty of care to the said CHAN Yuen-lam;

(ii) In breach of that duty of care, in the knowledge that the said CIK/AI therapy was based on experimental process for the treatment of cancer and which involved the extraction, manipulation in a laboratory and reintroduction of blood taken from the said CHAN Yuen-lam (“the said blood product”), failed to take reasonable care for the safety of the said CHAN Yuen-lam by –

(a) Failing to ensure that a properly qualified person was responsible for preparing and producing the said blood product;

(b) Failing to ensure that all necessary viral and bacteria tests had been carried out on the said blood product and that such had been documented prior to administering it to the said CHAN Yuen-lam and/or failing to carry out appropriate viral/bacteria tests herself, so as to ensure the said blood product was free of contamination;

(c) Failing to ensure that the said CHAN Yuen-lam was fully informed of the risks involved in the administration of the said CIK/AI therapy;

(d) Failing to properly ascertain, assess and monitor the condition of the said CHAN Yuen-lam following the CIK/AI therapy by way of infusion of blood product administered by her in the afternoon on 3 October 2012;

(e) Failing to ensure that the said CHAN Yuen-lam was admitted to hospital as a matter of emergency following the CIK/AI Therapy for timely and appropriate medical intervention necessitated by the adverse reactions exhibited by the said CHAN Yuen-lam;

(iii) Her aforesaid breach of duty amounted to gross negligence on her part; and

(iv) Her aforesaid negligence was a substantial cause of the death of the said CHAN Yuen-lam.”

4.  It can readily be seen that the proposed amendment dealt with what can loosely be described as “post-infusion management”.

5.  The application was based on Section 23(1) of the Criminal Procedure Ordinance Cap 221 which reads:

“ (1) Where, before trial or at any stage of a trial, it appears to the court that the indictment is defective, the court shall make such order for the amendment of the indictment as the court thinks necessary to meet the circumstances of the case unless, having regard to the merits of the case, the required amendments cannot be made without injustice.”

6.  There were two main issues which I had to decide: (a) whether there was evidential basis for the proposed amendment; and (b) whether the delay in application cause injustice to the defence.

Prosecution stance

7.  Mr Raymond Leung SC with Mr John Murray, Ms Margaret Lau and Mr Eric Tsoi, in their written submission dated 5 May 2017, with Mr Leung also making oral submission, gave their grounds in support of the application.

8.  The prosecution submitted that the amendment sought was in accordance with evidence to be adduced (relying on HKSAR v Wong Kim Fai[1]).

9.  The Prosecution referred me to the statements of Dr Li Chi Kong dated 23 July 2014 and Dr Albert Lie dated 18 July 2014, and submitted that these two experts had commented on the standards of dealing with post-infusion adverse reactions.  In addition, Mr Leung also referred me to the report of Dr Godfrey Chan in relation to CIK therapy.  The prosecution submitted that they were simply relying on evidence already in the Committal Bundle, which was brought to the notice of D1 and D3.  The amendment was necessary to reflect on the criminal liability of D1 and D3 in dealing with the adverse reactions of the deceased after infusion.

10.  Mr Leung also referred me to the statement of Professor Yuen Kwok Yung dated 3 April 2017, in particular A6 (which dealt with D3’s action of injecting potent antibiotics to one of the clients/patients Wong Ching Bor (WCB) in support of his contention that there should have been a safe system (as reflected by the proposed amendment).

11.  Mr Leung further referred me to the opinion expressed by Professor Yuen in the same statement, in that the delay of hospitalization and investigation leading to the delay of initiation of specific treatment is “likely to cause or contribute to her death” (A13), and that if the deceased had been admitted to hospital immediately on 3 Oct 2012 around mid-night (when another client/patient WCB received the injections from D3), “the outcome of the deceased may not be the same”.

12.  In response to the defence contention (in the written submission) that Professor Yuen’s opinion did not support the prosecution’s claim that the proposed amendment of breach of duty “post-infusion” was a substantial cause of the death of the deceased, the prosecution submitted that when Professor Yuen used those terms (“likely to cause or contribute to her death”, “the outcome of the deceased may not be the same”), such expressions were nothing more than an expert giving his honest opinion.

13.  The prosecution cited the case of R v Bracewell (Michael Geoffrey)[2] (which was applied in R v Tai Muk Kwai[3]), in particular the dictum of Ormrod LJ, in support of their contention that it was not the jury’s duty to judge with scientific certainty.  The jury has to come to its findings of fact based on the evidence.  The medical evidence is only part of the material to be considered by the jury.  The factual matrix of the case together with Professor Yuen’s opinion would form the basis for the jury’s determination whether the proposed breach was a substantial cause of the death of the deceased.  The prosecution submitted that it is not appropriate to “speculate that the scientific causation lacks evidence such that amendment to the charge should not be allowed”.

14.  Further, since the defence was put on notice by the two statements (of Dr Li and Dr Lie) in the Committal Bundle, and by the prosecution alerting them of the application two months ago, no prejudice or injustice would be caused to D1 or D3.  If they were thinking of engaging experts in their defence, they could have done so well before the trial.  Even if they had to seek assistance from expert(s) as a result of the amendment, that could be done as the trial is set down for over 50 days.

15.  In a nutshell, the prosecution submitted that the defence was not taken by surprise; the delay did not cause any injustice or prejudice; and the evidence supported the amendment, this Court should grant the application.

The stance of the defence

D1

16.  Mr MK Wong SC leading Mr Charles Chan for D1, in their written submission dated 5 May 2017, gave their grounds of opposition.  Mr Wong also made oral submission during the hearing.

17.  Counsel for D1 emphasized that the delay in obtaining a further statement from Professor Yuen, and in applying to amend the indictment so close to the trial, caused injustice to D1 as the focus of the defence team would be affected, with insufficient time to prepare for the new allegation.  Counsel for D1 stressed that the prosecution has years to prepare its case and yet they only applied for the amendment at such a late stage.  D1 might have to consider getting expert evidence to answer the new allegation within a short period of time.  While D1 could apply for an adjournment for the preparation, any such adjournment would itself be unjust as justice delay is justice denied.  As D1 did not wish to have the trial postponed, if the amendment was granted, the prejudice to D1 could not be cured.

18.  Counsel for D1 further submitted that the original indictment was only concerned with the process of CIK or the handling of blood products in relation to the prevention of bacterial contamination which caused the death.  The proposed amendment opened a totally new area which had no connection with the other particulars.  This new area caught the defendants totally unprepared.  The inclusion of the proposed amended particulars amounts to a material change of the prosecution case and should not be allowed.

D3

19.  Mr Peter Duncan SC leading Ms Deanna Law for D3 initially did not oppose the proposed amendment to Count 3.  However, in their written submission dated 12 May 2017, there was a complete change of heart.

20.  The main ground of opposition was that according to the evidence to be relied on by the prosecution, there was no evidential foundation upon which a jury could find proved beyond all reasonable doubt that either D3’s alleged omission in post-infusion management of the deceased or the alleged delay in admitting her to hospital was a substantial cause of her death.  The two statements (by Dr Li and Dr Lie) did not provide any evidence of the necessary link between the post-infusion reaction and treatment and the death of the deceased.

21.  Counsel for D3 further submitted that the only witness who addresses such a link was Professor Yuen who gave a statement late in April this year.  However, Professor Yuen used terminologies such as “likely to cause or contribute to [the deceased’s] death”; and “the outcome may not be the same”, Professor Yuen’s evidence was insufficient for any jury, properly directed, to conclude beyond reasonable doubt that the conduct alleged in the proposed added particulars were a substantial cause of the death of the deceased.

22.  Mr Duncan also brought to my attention that the defence were only recently provide with hundreds of pages of hospital notes on the deceased and should the amendment be granted, D3’s defence team would need to seek the assistance of an expert to go through all those records.

My consideration

23.  Having read the two statements by Dr Li and Dr Lie relied on by the prosecution, and the additional statement of Dr Chan, I agree with the submission of counsel for D3 that there was no evidential foundation upon which a jury could find proved beyond all reasonable doubt that either D3’s alleged omission in post-infusion management of the deceased or the alleged delay in admitting her to hospital was a substantial cause of her death.

24.  Whilst Dr Li and Dr Lie both referred to what a proper “post-infusion management” should be, there was no causal link between the “post-infusion” action or treatment and the cause of death of the deceased.  There was nothing to suggest that the delay in either getting the deceased to hospital or initiating treatment was a significant cause of the death of the deceased.  The “link” came from Professor Yuen who was approached recently and gave his opinion only on 3 April 2017.  While appreciating that Professor Yuen might not be able to assert with certainty the outcome had the deceased been sent to hospital earlier, it must be borne in mind that all he could say was that “the delay of hospitalization and investigation leading to the delay in initiation of specific treatment is likely to cause or contribute to [the deceased’s] death” (emphasis applied).  While medical/expert evidence is only a part of the evidence to be considered by the jury, when an expert was only able to use terms such as “likely to cause or contribute to”; “the outcome may not be the same”, I am of the view Professor Yuen’s opinion (considered together with the factual evidence currently available) will not be a sufficient basis for a jury, properly directed, to conclude beyond reasonable doubt that the alleged breach of duty in the proposed amendment is a substantial cause of the death of the deceased.

25.  In coming to this conclusion, I have considered the dictum of Ormrod LJ in the case of Bracewell relied on by the prosecution.

26.  Bracewell was a case involving the applicant Bracewell, who faced one count of Murder together with another man Lockwood.  Bracewell and Lockwood burgled the house of an old man.  The old man was later found dead, with multiple injuries, including bruises in his neck, indicating his neck had been gripped, probably by two hands.  Both defendants denied having anything to do with the old man’s death.  Bracewell’s account was that Lockwood had entered the house before him and it was sometime before he reached the old man’s room.  Upon entry, he found the old man seriously injured and semi-conscious, but was still able to call “help” and moved his hands about.  Bracewell and Lockwood tied the old man up and Lockwood also put a gag in the old man’s mouth.  Lockwood then searched the room while Bracewell stayed with the old man and tried to reassure him.  Lockwood then went downstairs to look around.  The old man made a gurgling sound so Bracewell removed the gag.  He tried to revive the old man but found that he was dead.

27.  The medical evidence of the doctor (Dr Green) was that the cause of death was heart failure due to manual strangulation in an old man who had been suffering from fairly advanced heart disease.  The alternate possibility was that he had died of acute heart failure consequent upon the severe beating he had sustained.  It made little difference to the prosecution whether the old man’s heart had failed as a result of strangulation, or of shock due to multiple injuries.  The difference was important to Bracewell.  If Bracewell’s account was true, there had to be an appreciable interval in time between the removal of the hands from the neck and death (enough time for the two of them to tie up the old man, for Lockwood to put a gag in the old man’s mouth, for Lockwood to search the room and to go downstairs to continue the search).  In Dr Green’s opinion, the death was caused by manual strangulation and not more than about two minutes could have elapsed before death occurred.  Cross-examination by counsel for Bracewell of the doctor was directed to displacing such a conclusion.  Counsel put forward an alternative possibility, namely, that the deceased had been “partially strangled” and then after a lapse of time, had had a “heart attack” as a result of his injuries and died.  Dr Green’s evidence was that he could not, as a scientific certainty, rule out that there was the application of force, partial strangulation, recovery and then a fatal heart attack though he strongly inclined against that view.  The doctor also said he had found no evidence of a heart attack.

28.  The summing up to the jury (in relation to Dr Green’s evidence concerning the alternative possibility) was that the witness was speaking from a scientific point of view and the jury’s duty was not to judge scientifically or with scientific certainty.

29.  On appeal, one of the grounds advanced was that the judge had misdirected the jury on the effect of Dr Green’s evidence.  Ormrod LJ, giving judgment for the court, considered the summing up and said the direction “correctly draws the distinction between … scientific proof … and legal proof.”  Ormrod LJ further commented that what the expert had said in substance was that though he could not exclude an alternative hypothesis (as the available data may be inadequate to prove scientifically that the alternative hypothesis is wrong), the effect of his evidence as a whole can be expressed in terms such as “But for all practical purposes (including the jury’s), it is so unlikely that it can safely be ignored.”

30.  The judgment of the Court of Appeal in Bracewell must be viewed with reference to the particular circumstances of that case.  The facts in Bracewell and the expert medical adduced in that case are very different from those to be adduced in the present case.  I do not find the dictum of Ormrod LJ of use in this case.

31.  Strictly speaking, it is not necessary for me to further consider the issue of delay.  I would nevertheless like to say something about it.

32.  Since there is no causal link between the “post-infusion” action or treatment and the cause of death of the deceased expressed in the opinion of Dr Li and Dr Lie in their statements which are in the Committal Bundle, and bearing in mind the rather detailed particulars already stated in the original indictment, it would not be fair to suggest that the defence had been put on notice that the delay in getting the deceased to hospital or initiating treatment is a substantial cause of the death of the deceased.

33.  It should also be borne in mind that the prosecution had deemed it necessary to obtain a further statement from Professor Yuen for his opinion in relation to “post-infusion” action (or the lack thereof) and the death of the deceased.  This act of the prosecution further strengthens my view that the statements of Dr Li and Dr Lie did not put the defence on notice that the alleged failure to have proper “post-infusion management” was a substantial cause of the death of the deceased.

34.  This case was set down in January 2016 to be heard in 2017, with 55 days reserved.  Clearly the defence would have been preparing their defence in accordance with the allegations in the indictment.  The prosecution’s application to amend the particulars with the introduction of “post-infusion management” must have come as a complete surprise to the defence.

35.  I had no less than 4 pre-trial reviews with parties and it was only at the second PTR on 13 March 2017 that there was an indication of an application to amend the indictment, with a formal notice of the exact amendment being made to parties only on 27 March 2017.

36.  Further, I was informed that over 200 pages of hospital records of the deceased were disclosed to the defence recently.  The defence team of D1 and D3 would need to engage their expert to go over those records should the amendment be allowed.

37.  Had I been satisfied that the evidence to be adduced by the prosecution provided the basis for the jury to consider whether the proposed added particulars substantially caused the death of the deceased, the delay in the application for amendment would have caused injustice to the defence.  The particulars of the original indictment had nothing to do with “post-infusion management”.  The inclusion of the proposed new particulars would have necessitated the defence team to shift or to re-focus their case to meet the added allegation.  Whilst an adjournment would have given the defence time to prepare, in view of the fact that this case was set down back in 2016, it would have been extremely difficult to find new trial dates should there be an adjournment.

38.  In any event, Mr Wong had clearly indicated that D1 would not ask for an adjournment as justice delay is justice denied.  Mr Duncan did not ask for an adjournment either.  Had I allowed the application to amend, the defence team of D1 and D3 would have been forced to deal with the new area while the trial is going on.  It would have been most unfair to the defence.

39.  For these reasons, I refused the application of the prosecution to amend the indictment.

 (Judianna Barnes)
 Judge of the Court of First Instance
High Court

Mr Raymond Leung SC, leading Mr John Marray, and Mr Eric Tsoi, counsel on fiat and Ms Margaret Lau SPP of Department of Justice, for HKSAR

Mr Wong Man Kit SC, leading Mr Charles Chan, instructed by Messrs Day & Chan, for the 1st defendant

Mr Albert Cheung, instructed by Messrs Lam, Lee & Lai, for the 2nd defendant

Mr Peter Duncan SC, leading Ms Deanna Law, instructed by Howse Williams Bowers, for the 3rd defendant



[1]HKSAR v Wong Kim Fai [2010] 1 HKLRD 436 (CA)

[2]R v Bracewell (Michael Geoffrey) (1979) 68 Cr App R 44

[3]R v Tai Muk Kwai [1980] HKC 655 (CA)