SINGAPORE: A five-year-old boy who was allegedly scalded by both his parents until he collapsed went into shock during surgery and had raw, dirty wounds, a burns specialist testified on Friday (Nov 15).
Dr Gavin Kang Chun-Wui from KK Women's and Children's Hospital took the stand for the prosecution and described how the boy had "an extensive burn injury covering about 70 per cent" of his body.
"This would be considered a clinically ill patient and at high risk of morbidity and mortality even after surgical treatment," said the doctor.
He gave expert evidence on the fourth day of the trial against the victim's parents - 27-year-old Azlin Arujunah and Ridzuan Mega Abdul Rahman, who are accused of murder with common intention by scalding the boy to his death.
The court was shown a PowerPoint presentation on the physical state of the victim before and after the operation at the hospital. He died a day after being admitted to hospital.
The prosecutor took the court through graphic photos of the boy's injuries, asking the specialist to comment on each burn injury.
Pictures of the boy showed him with most of his body covered in red, pink and pale burnt skin, and his parents kept their heads steadily down in the dock when the pictures were shown.
WOUNDS WERE RAW, DIRTY, NOT GIVEN IMMEDIATE ATTENTION
Dr Kang testified that the wounds "appeared dirty with a lot of black debris", which suggested they were not immediately cleansed and that the patient had not received medical attention after he sustained the injuries.
"Looking at the condition of the child’s wounds, which were dirty and appeared to not have been cleansed or even brought for emergent medical attention, it appeared to me that the wounds had not been treated for a lengthy period," said Dr Kang.
He should have been sent to hospital for immediate treatment, or he could go into shock or the wounds could be infected, said the doctor.
Immediate care would "definitely" have made a difference, he said, and without it, the child could suffer multi-organ dysfunction.
The doctor testified that the boy went into shock during surgery and had lung and kidney dysfunction.
The boy was injured at noon on Oct 22, 2016, and taken to hospital only at about 8pm, said Dr Kang.
There was a right blood clot under his scalp, but no brain injury. He also had lacerations over his left cheek, chin, eyebrow, a fractured nose and suffered deep burns over his torso.
The child also had burn injuries over his genitals.
His "entire palm" was burnt, said the doctor, saying it was probable that the appearance matched how a palm blistered by a heated spoon placed on it would look.
The boy's father Ridzuan is accused of placing a heated spoon on his son's palm when he found out the boy had stolen milk powder to eat.
Both parents are also accused of using pliers to pinch the boy's thighs and buttocks, hitting him with a broom or hanger and their bare hands, and keeping him in a cage meant for their pet cat.
SPECIALIST UNABLE TO DATE BURN WOUNDS AS THEY WERE ALL RAW
Dr Kang said he was unable to date the burn injuries as they were all raw wounds.
"All the burn injuries appeared raw and it's hard to tell how long ago they were inflicted," he said, defining a raw wound as a "weeping" wound that still has tissue fluid discharge and that has not been covered with new skin yet.
He said this type of burn would take from a week to a month to show signs of healing, depending on the depth and degree of burn as well as the patient's health.
"Did you see any signs of healing in this deceased?" asked Deputy Public Prosecutor Tan Wen Hsien.
"No, I did not see any," answered Dr Kang.
It is the prosecution's case that the boy was scalded four times in the week before his death and was not given medical treatment until the day he collapsed. This was after his father splashed hot water on his back and calf.
The doctor said the victim's injuries were "very extensive and life-threatening", saying that anything more than 40 to 50 per cent of total body surface burns would be life-threatening.
He estimated the boy to have 70 per cent burns, after performing surgery to clean the wounds.
"In a child, their skin is thinner and their reserves are smaller so they would have proportionately worse outcomes," said Dr Kang. "This means they are at higher risk of morbidity and mortality, with the same extent of burns."
Calling the victim "the poor child", Dr Kang said a child with such extensive burn injuries "would be in distress and pain".
The trial continues.
If found guilty of murder with common intention, Ridzuan would be sentenced to death, or life imprisonment with caning. His wife would face the same penalties but cannot be caned.