The Proceedings in the District Court
- The charge brought against the applicant at trial related to the death on 8 June 2018 of Chuan Ying Xia. [1] Prior to her death the deceased had consulted the applicant, a registered practitioner of Chinese medicine. Although Ms Xia suffered from diabetes, the applicant was asked to treat her for a skin condition, a form of eczema. He saw her for the first time on 26 May 2018. The Crown alleged at trial that the applicant directed Ms Xia to cease taking the medications prescribed to her by the doctors treating her for diabetes and commence using herbal preparations prescribed by him. In addition, he told Ms Xia to stop following a diabetic diet. When she did these things, her condition began to deteriorate. Ms Xia became too ill to attend the applicant's practice, and he thereafter carried out several home visits, at the request of the deceased's daughter. The applicant expressed the view that Ms Xia's decline was caused by toxins leaving the body and the situation would resolve. The deceased's family continued to consult the applicant, including by sending video imagery of her presentation, but was advised only that Ms Xia should take saffron, potato soup, or other foodstuffs. Nothing else was done about Ms Xia's deterioration until she became so ill that she stopped breathing, prompting her family to call the emergency operator for an ambulance. Ms Xia was admitted to Hornsby Hospital on 8 June 2018 but could not be saved. She died that day. The direct cause of death was given as iatrogenic diabetic ketoacidosis, with a primary cause noted as withdrawal of treatment for diabetes.
- The head of liability relied upon by the Crown for manslaughter was criminal negligence. The Crown contended that, in advising the deceased about treatment connected to her diabetes, the applicant had assumed a duty of care to her, which he breached by continuing to direct her to abandon conventional medication and a diabetic diet in favour of herbal remedies, leading to or accelerating Ms Xia's death. The Crown contended that the applicant's conduct was so grossly negligent as to warrant criminal punishment.
- Drawing from Nydam v R [1977] VR 430 at 445 and The Queen v Lavender (2005) 222 CLR 67; [2005] HCA 37, to prove manslaughter by criminal negligence the Crown was required to prove each of the following elements beyond reasonable doubt:
1. Ms Xia died;
2. The applicant owed her a legal duty of care;
3. He did an act (being his direction to cease conventional treatment for diabetes and failure to secure appropriate medical treatment for her when her condition worsened);
4. The cessation of medication and failure subsequently to secure necessary treatment was a substantial cause of or accelerated Ms Xia's death;
5. The applicant's advice was negligent and he breached the duty of care he owed Ms Xia;
6. His act amounted to criminal negligence and merited criminal punishment for the offence of manslaughter because:
(a) It fell so far short of the standard of care which a reasonable person would have exercised in the circumstances; and
(b) It involved such a high risk that death or really serious bodily harm would follow as a result.
- It is not necessary to refer to the evidence placed before the trial judge in any detail. Suffice to say that the Crown called evidence with respect to the treatment provided by the applicant to Ms Xia, to establish both its asserted gross negligence and a direct link between it and her death. In his case the applicant disputed that he had assumed a duty of care to the deceased, or that the treatment he gave her had caused or accelerated her death. The final element to be proved by the Crown was also in dispute with the applicant contending that nothing he had done in his treatment of Ms Xia was so negligent as to merit criminal punishment.
- In the verdict judgment of 25 March 2022, the trial judge found that the Crown had established each element of the offence of manslaughter by criminal negligence, except for the last. That is, the Crown case failed because his Honour was not satisfied beyond reasonable doubt that the applicant's conduct had been so wicked as to amount to criminal conduct meriting criminal punishment. His Honour found that the evidence establishing that the applicant had told Ms Xia to cease taking conventional diabetes medication was overwhelming. He said:
"In one respect it was completely irresponsible of him at that stage to tell her not to take Western medication. This was not his role as a Traditional Chinese medicine practitioner. Clearly, as outlined by the code of conduct, but also in the evidence of Dr Carolyn Ee which in my view was undisputed in this trial, is that the role of Traditional Chinese medicine is to work in conjunction with Western medicine, and in that respect, he was well outside his skills, his requirements, and it was completely undesirable for him to even be talking about her not taking prescribed medication."
- His Honour was also well satisfied that, accepting the applicant's advice, Ms Xia abandoned the medication regime prescribed to her by medical practitioners for the treatment and management of her diabetes, with the effect that her condition significantly deteriorated. The trial judge found that the applicant was aware of Ms Xia's worsening symptoms and presentation, but failed to realise the seriousness of her condition and maintained his advice to her; he did not take steps to secure treatment for her declining health. In so doing his Honour concluded that the applicant had breached the duty of care that he owed Ms Xia as his patient, a duty at least to do her no harm.
- Neither did Ms Xia or her family seek alternative treatment, despite the dramatic decline. His Honour concluded that Ms Xia and her family had placed complete faith in the applicant's treatment and advice until it was too late. The trial judge accepted the expert evidence as to cause of death, which was directly linked to the cessation of treatment for diabetes. His Honour concluded:
"[…] there is little doubt that the accused played a significant role in this death. Dr Ee was particularly critical of many of the things done by Mr Luo in this matter. He was clearly in breach of many aspects of the code of conduct here, which she pointed to some incredibly unsatisfactory aspects of his work including aspects of his telling her not to take Western medication, his poor record taking in relation to this aspect, that some of his discussions with the daughter about aspects of her condition and what had occurred just seemed to be completely inconsistent with any understanding of even traditional Chinese medicine, that he was reckless in relation to his behaviour in going for home visits in circumstances where clearly traditional Chinese medicine was not an emergency aspect, and she found that his behaviour was significantly poor in many respects.
I do not think that her views are particularly controversial."
- Having concluded that the Crown had established the elements set out above, at [7], (1) to (5), the trial judge concluded that, whilst the applicant's treatment of Ms Xia was "utterly incompetent", he could not be satisfied to the requisite standard that it was criminal in nature. The verdict of not guilty was entered.