WARNING: GRAPHIC CONTENT
A COURT has heard the man charged with the manslaughter of his fiancee was struggling to care for her needs while respecting her "refusal to engage in treatment".
Neil Douglas Morris remains on bail and will be sentenced in November for the death of his Nundle partner after she died in Tamworth hospital in July 2017.
The court heard the post mortem found the cause of the victim's death was "chronically infected bedsores", but there was no doubt that the victim "didn't want to go to the hospital".
Morris, flanked by family, appeared in Tamworth District Court for the second day of his sentencing hearing after having pleaded guilty to manslaughter.
The court is examining if Morris was negligent in failing to access medical care for his partner, without forcing her to do something against her wishes - which also could have been a criminal offence.
Judge Jeffery McLennan is examining the criminal responsibility of Morris in the three days prior to her death: whether he was negligent by not calling an ambulance.
"What contribution to her death, did his failure to act ... make to the death of [the victim]?" he said.
Crown prosecutor Brian Costello argued the woman, who had not moved for several days from a chair, was exposed to faecal matter and urine, and her bedsores were moist.
"Those conditions are likely to have exacerbated those injuries," he submitted to a medical professor who gave evidence. She agreed, but added the victim was "not well" by that time.
Judge McLennan said Morris' "level of moral culpability is very low, because he was not a medical professional and two "qualified medical people didn't see fit to call the ambulance" earlier in their assessments.
"Mr Morris was obviously doing his incompetent best," he told the court.
The Crown argued that Morris "didn't take the steps" between July 6 and 13, 2017, "to seek outside medical attention", and the victim had a "plain reduction in her capacity" to think for herself.
Mr Costello said there Morris took "no steps to seek outside medical attention" when it was "self-evident" his partner was unable to make rational decision.
Two experts were called to give evidence on Friday on Morris' mental state at the time.
"The understanding I had from Mr Morris was that he felt overwhelmed as a result of [the victim's] refusal to engage in attending treatment," forensic psychologist Bradley Jones told the court.
Dr Jones said Morris had struggled to meet "everyone's competing needs" with what treatment was required, and wanting to "to meet her needs and not make her upset, or make her angry".
"His partner was quite adamant in refusal of any assistance," Dr Jones said, adding that he was told the victim would be quite distressed and irate "if he called an ambulance".
"She was quite abusive of him when he was trying to actively encourage her to attend treatment or hospital."
The court heard Morris "felt upset, and sad and depressed" but did not have a major depressive disorder.
Judge McLennan found, on the evidence, Morris was in a state of "emotional conflict" and "decisional paralysis".
"What he wanted and what he hoped for and desired to happen was in conflict with what his partner wanted," Dr Jones said.
What he wanted and what he hoped for and desired to happen was in conflict with what his partner wanted.Forensic psychologist Bradley Jones
Forensic psychiatrist Jonathan Adams said that, when he assessed Morris, he was "clear in his description to me that he did the best he could do" and had "continued to offer the best care I could".
Judge McLennan said he was looking for an explanation, as the victim's health declined in the three days before she went to hospital, as "to why he might not have made that phone call" to the ambulance.
As part of the sentencing, he is examining any evidence of Morris' impaired decision-making capacity during that time.
The court heard the victim "consistently refused medical intervention" and "she disliked it historically" if Morris instigated her admission into hospital.
"She made him feel guilty about that," Dr Adams said.
She made him feel guilty about that.Forensic psychiatrist Jonathan Adams
He said Morris wanted to "respect her wishes" and "he was very clear ... for a significant period of time before her death" that this "was an issue of disagreement".
"Mr Morris attempted to avoid disappointment," Dr Adams said.
The court heard Morris cared for the victim for six years, largely in isolation in Nundle, and "genuinely loved and cared for his partner".
Dr Jones said that in the weeks prior to her death, Morris had reported his partner was "relatively well".
A medical professor, also called to give evidence and an expert report, told the court on Friday the extent of the victim's pressure sores and injuries.
She said it was obvious the victim had been in a state of delirium that had "developed perhaps a few days earlier".
She was in shock when the ambulance arrived, was obese, was suffering from diabetes, had a high heart rate and blood pressure, and was "one very unwell lady at the time".
When asked whether keeping the woman's bedsores dry, and allowing her to have some level of mobility, between July 6 and 13 would have altered the outcome, the professor said: "The pressure injury would have not progressed to the level it was."
But she said she was "not game to answer" whether the woman would have lived if she had been taken to hospital three days earlier.
"A week or two weeks before, then maybe the outcome would have been different," the professor said, adding she "probably" would have survived.
The woman died just a few days after being rushed to hospital on July 13.