A former gas fitter failed to complete several tests that would have prevented the death of one newborn and life-long brain damage to a second baby during an installation mix-up at a Sydney hospital, which a judge ruled fell “so short of expected standards”.
Christopher Turner sat emotionless as he was jailed for nearly three years on Thursday after pleading guilty to the manslaughter of newborn John Ghanem and causing grievous bodily harm by omission to Amelia Khan at Bankstown-Lidcombe Hospital a decade ago. His supporters held each other, with one calling out “I love you dad” as Turner was handcuffed.
The 64-year-old was contracted by BOC Limited to install and test oxygen and nitrous oxide gas lines in an operating theatre in the hospital.
In 2015, he installed the wrong gas, which was released from a wall-mounted panel of medical gases in an operating theatre. The pipelines installed in the hospital in the 1990s were mislabelled in the roof, but Turner failed to test them as required by law.
The fatal mix-up was not uncovered until a year later, when the two newborns were mistakenly given nitrous oxide instead of oxygen.
Amelia’s exposure to the gas occurred in June 2016. She suffered severe brain damage, spent two weeks in intensive care and, to this day, requires constant care.
The court heard she is wheelchair-bound, legally blind and unable to speak; she has been able to attend school with assistance.
“[Her] life span has been diminished,” Judge Nicole Noman SC said.
Less than a month later, on July 13, baby John was mistakenly given the same dangerous gas for 50 minutes during an emergency resuscitation immediately after his birth. Noman said he was “much loved during his short life… [his] death has caused significant anguish”.
Hospital staff notified police and Turner, who lives on the Central Coast, was arrested. He was charged in 2022 over the deaths and spent one night in custody before being granted bail. Facing the prospect of 25 years’ jail, he initially defended the charges, but reversed his pleas ahead of a planned trial last year.
On Thursday, he was sentenced to two years and 10 months’ jail with a non-parole period of 10 months.
Noman said Turner’s crimes, while not intentional, “fell so far short of the standards a reasonable person would expect”, adding that he failed to undertake several tests which “would have prevented the error”.
“It was not that he undertook substandard testing, he failed to test at all,” she said.
Due to the loss of life and such serious injuries, the judge said Turner committed a “high level of harm”.
Noman criticised the 10-year gap between Turner’s error and completion of proceedings. She acknowledged he expressed “deep remorse” and said he “continued to carry weight of what he had done”, but that he took several years to admit guilt.
The court heard Turner suffered various medical issues and that full-time custody would cause “financial harm, stress and anxiety” to him and his family, but no other punishment was appropriate.
“I do not doubt custody would be extremely confronting for an older man,” she said.
Media would ordinarily be legally barred from naming child victims of crime, however, both victims’ families gave permission for them to be made public – a decision Noman said would have been difficult.
A 2021 coronial inquest heard pipelines installed in the hospital in the 1990s were mislabelled in the roof, leading to a mix-up during the installation of neonatal resuscitation gas outlets in 2015. But lawyers assisting the coroner said any deficiencies “would have been obvious” if they were adequately tested and signed off.
Turner was convicted and fined $100,000 in 2021 after pleading guilty in the NSW District Court to failing to comply with a health and safety duty.
BOC Limited, the company contracted to install the lines, was cleared of any charges after Judge Wendy Strathdee found Turner, who was a subcontractor, and a hospital employee had both signed forms declaring they had carried out testing following the works, despite having not done so.
The tragedy, and subsequent campaigning from families, led to changes to NSW legislation requiring tradespeople to be licensed specifically for the installation of medical gas.
Turner will be released on parole on December 24, 2026.
With Angus Thomson and Sarah McPhee
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