Deanna Law and Nicole Chui represented the Director of Marine in the 46-day inquest into the deaths of 39 persons arising out of the collision between Lamma IV and Sea Smooth on 1 October 2012.
A total of 410 witnesses were listed, of whom 84 gave live evidence during the inquest. Expert evidence was received from naval architects, master mariners, a marine engineer, and a forensic scientist.
The Coroner admitted 364 exhibits, reflecting the breadth of the evidential record placed before the court.
The scope of the inquest was delineated by the six issues identified by the Court of Appeal in Leung Shuk Ling & Ors v Coroner HKCA 904, the first appellate decision interpreting the Coroner’s discretion under section 20(1) of the Coroners Ordinance. Those issues were directed to both the immediate circumstances of the collision and the broader systemic and public‑interest dimensions of marine safety in Hong Kong.
The Coroner found that the 39 deceased were unlawfully killed. The collision was caused by the negligent navigation of the coxswains of the two vessels, with the coxswain of Sea Smooth having been convicted of 39 counts of manslaughter.
Setting a new precedent in Hong Kong, the Coroner applied the civil standard of proof, following the UK Supreme Court case of R (Maughan) v HM Senior Coroner for Oxfordshire [2021] AC 454 which held that all short form conclusions in an inquest including unlawful killing are to be determined by on the balance of probabilities.
On the 6 issues identified by the Court of Appeal:
Issue 1: The Coroner found that Choey Lee Shipyard (“CLS”) did not know from the outset that Frame ½ bulkhead was to be built watertight. The decision that this bulkhead would be non-watertight and no watertight door would be fitted was a conscious design choice rather than an omission or oversight (§293).
Issue 2: Mr. Cheung who was responsible for making the damage stability calculations in 1996 and 1998 for Lamma IV did not deliberately seek to shift the responsibility to Mr. Leizaola. His conduct was consistent with the absence of clear supervisory structure and defined responsibility within CLS at the time (§§315-317).
Issue 3: The Port Bow Plate was not fitted on Sea Smooth at the time of the collision. Had it been in place, it would have had no causal effect on the collision or sinking of Lamma IV. CLS should have, has a matter of prudence and proper practice, informed the Marine Department of its addition (§337).
Issue 4: The 190mm coaming height of the internal door did not breach the applicable regulatory requirement which was fulfilled by the 300mm coaming at the external doors. The height of the internal coaming did not contribute to the sinking or had any material connection with the loss of life (§355).
Issue 5: The Frame ½ Bulkhead was inspected bi-annually. The purpose of the biennial survey was to assess the vessel’s condition, not to re-verify the correctness of its original construction. The absence of the watertight door was inherent to Lamma IV’s approved design and not something a ship inspector would have been required to identify during periodical survey (§388).
Issue 6: Any meaningful reform of working hours of seafarers in the passenger ferry industry requires cooperation of multiple stakeholders and cannot be achieved by the Marine Department alone. The appropriate course is for the Marine Department to continue collaborating with the industry to identify measures that are practical and capable of implementation (§421).
The Coroner noted that the Marine Department had made reforms to its training, licensing, survey and safety practices (§§487-493). Many of the deficiencies exposed by the Inquest related to practices that occurred between 10-30 years ago and substantial progress has since been made (§497).
For Deanna’s full profile, see: https://parksidechambers.com.hk/people/deanna-law/
For Nicole’s full profile, see: https://parksidechambers.com.hk/people/nicole-chui/
See the verdict: https://legalref.judiciary.hk/lrs/common/search/search_result_detail_frame.jsp?DIS=176538&QS=%24%28%5B2026%5D%2CHKCrC%2C1%29&TP=RV
