A paramedic who found a 77-year-old severely emaciated woman lying dead, covered in her own excrement described her as looking like a "scarecrow".
Ena Lai Dung was in bed on top of a tarpaulin, surrounded by flies, at a Clendon Park address where she was a boarder, when emergency services were called on January 16, 2015.
Her daughter Cindy Melissa Taylor, 43, is on trial before the High Court at Auckland charged with her manslaughter after she allegedly failed to provide her with the necessary care to keep her alive.
Luana Roberta Taylor, 56, and her husband Brian Frank Taylor, 62 - not related to the other defendant - also lived in the same house and are accused of failing to protect a vulnerable adult.
Tristan Sames was one of the first paramedics on the scene and was asked what the odour was like when he entered the bedroom.
"An overpowering smell of stale urine or ammonia; one of the strongest smells, if not the strongest smell, I've had in this line of work. It was enough to start me gagging," he told the court.
"I closed the door and needed a moment to compose myself."
He re-entered, holding his breath to try and block out the stench, as he set about checking the patient's vital signs.
Was she deceased?
"Unquestionably," Sames said.
When asked to describe the setting he told the jury the woman was naked from the waist down and was lying on a dark-coloured tarpaulin.
"The kind of thing you'd stick on the roof if you had a leak," he said.
Another more experienced paramedic Mike Hill was similarly taken aback by the stench in Dung's room and the "greyish blue" colour of her skin.
"The eyes were very very sore and I backed away from the doorway at that point," he said.
The ammonia brought tears to his eyes, "which takes some doing", he told the jury.
He described Dung as "just skin and bone, basically a scarecrow".
When he confirmed the death with Cindy Taylor he said she did not look surprised, "just subdued"
Earlier, the court was played the 111 call made by Luana Taylor just minutes earlier.
"I believe the mother . . . I've got a feeling she's passed. I'm not 100-per-cent sure because I've not gone up there," she told the operator Faye McCann.
With some persuasion, the woman passed the phone on to Cindy Taylor who was instructed to put her mother on the floor.
"There's no space," she said.
"She defecated on the bed. Can I put a towel on the floor?"
The phone ended up with Luana Taylor again who told McCann they were not willing to do CPR because it was "against their religion".
"She's dead, ok. I know the difference between dead and alive," Luana Taylor said, before telling the operator she was "really aggravating".
Crown prosecutor Natalie Walker told the jury in her opening address this morning that the 111 call and a call to a health-advice line a day earlier was just a gesture.
"The Crown says she was already dead and they all knew that," Walker said.
"The 111 call was for appearances' sake to appear they cared enough to call an ambulance."
A pathologist is expected to tell the court tomorrow that Dung died from malnutrition and dehydration.
He will detail the open bedsores and chemical burns from her urine and faeces, as well as fractures to her ribs and sternum.
The trial continues.