A pathologist has told the High Court in Auckland the elderly woman found starved to death in her bed had 14 broken ribs that could've been inflicted by a fall or someone hitting her.
Dr Fintan Garavan is giving evidence at the trial of Cindy Taylor, who denies a charge of manslaughter relating to the death of her 77-year-old mother, Ena Dung.
Her live-in landlady and landlord - Luana Taylor and Brian Taylor, who are not related to Cindy - have also been charged with failing to get Ms Dung help, despite knowing she was in danger.
Dr Garavan said the 14 broken ribs and broken breastbone could be explained by many falls or they could have been caused by someone striking her many times.
He was giving evidence by video link from Miami, which he described as the capital for elderly people, and said he had never seen anything like it before.
The doctor said it would have been painful for Ms Dung to breathe but there were no signs of even basic painkillers - aspirin or paracetamol - in her system.
He has also catalogued chemical burns on Ms Dung's skin, caused by her lying in her own waste for long periods of time, and open ulcers, one of which smelled of gangrene.
Dr Garavan said Ms Dung was in a state of extremely poor hygiene and that reflected poor nursing standards.
When he weighed her during the post-mortem examination, she had no body fat and weighed just 29 kilograms, he said.
Ms Dung had a wasted appearance and was emaciated, Dr Garavan said.
Yesterday, the court heard the 111 call made to the ambulance call centre by Luana Taylor.
The call taker repeatedly asked her and Cindy Taylor to lift Ms Dung off her bed and put her on the floor to give her CPR.
Luana Taylor, who is in a wheelchair, said she couldn't do it. Cindy Taylor came on the phone for a short time and then refused to talk to the call taker.
When the call taker asked to speak to Cindy Taylor again and said she needed to perform CPR, Luana Taylor said it was against their religion and that no one would perform CPR as Ms Dung was dead.
Paramedic Tristan Sames said there were open sores on Ms Dung's body and a strong smell of urine.
He described her as looking emaciated and said her bones were visible through her skin.
Another officer, Lance Hill, has over 20 years' experience, and told the court the scene made his eyes hurt. He described her as looking like a scarecrow and appeared to be just skin and bone.
Ambulance officer Chris Laufale was another officer first on the scene. The smell of urine hit him the moment he got into the house and he couldn't understand how anyone could live in that situation, he said.
Mr Laufale said Mr Hill, a more experienced officer, checked for signs of life.
Mr Laufale said he tried to speak to Ms Dung's daughter, Cindy Taylor, but Luana Taylor kept talking over her, saying Ms Dung was bulimic, anorexic and had refused medical attention.
He said Luana Taylor also asked when the body would be removed.
Crown prosecutor Natalie Walker said Ms Dung was found dead in her bed with broken ribs, a broken breastbone, open sores and lying in her own waste in January 2015.
She told jurors they could be forgiven for thinking the 77-year-old was living alone in the house in Manurewa.
There was food in the cupboards and a working landline but, despite that, the Crown said Ms Dung was left in a T-shirt to starve to death.
There was a strong smell of urine and faeces inside Ms Dung's room, Ms Walker said. There were plates of uneaten food, the windows were closed, despite the January heat, and there were flies in the room.
Medical records showed Ms Dung, who weighed as little as 29kg when she died, had weighed over 70kg in the past, Ms Walker said.
Luana Taylor only made the 111 call after Ms Dung was dead and it was done for appearances' sake, she said.
The prosecutor also detailed additional charges against Cindy Taylor, who has been accused of misusing her mother's EFTPOS card and spending her pension after Ms Dung died.
She has also been accused of using her dead uncle's card and withdrawing his pension.
In total, the Crown said she took over $37,000, withdrawing the money fortnightly as their pensions continued to be paid.
The jurors have also heard short opening addresses from defence lawyers.
Cindy Taylor's lawyer, Peter Kaye, told the jurors that, although the photos they had been shown were disturbing, they must not let prejudice cloud their judgement.
He took the jurors through what the Crown had to prove: the elements of the charge.
Mr Kaye said they would have to decide what the standard of care was for a reasonable person; whether Cindy Taylor did or did not provide it; and whether that caused Ms Dung's death.
Luana Taylor's lawyer, Maria Mortimer, said her client lived in a separate part of the house with her husband. She said, being wheelchair-bound, Luana Taylor relied on care from her husband and could not also care for an elderly woman.
Brian Taylor's lawyer, Louise Freyer, said her client had no frequent contact with Ms Dung and did not know that Cindy Taylor had not cared for her mother.