This is despite the fact that the damage to Adib’s back – resulting in seven left broken ribs – was consistent with being hit in the back by the door of the Emergency Medical Rescue Service (EMRS) van on Nov 27, 2018, pathologist Dr Ahmad Hafizam Hasmi said.

Ahmad, of Hospital Kuala Lumpur (HKL) where Adib’s autopsy was carried out, told the inquest this afternoon that a CT scan by SJMC, where Adib was first admitted, showed his first two left ribs were broken.

However, he found that Adib’s third to seventh ribs were eventually “shattered completely”.

“In my opinion, this is due to ‘manipulation’ against the patient while he was being treated,” he told coroner Rafiah Mohamad.

He said it was possible that Adib, while hospitalised at SJMC and later at IJN, was always placed on his left side given that his right side was seriously injured.

The pressure on the already broken left ribs eventually led to the third to seventh ribs being weakened, and then completely broken, Ahmad, the 24th witness, said.

Asked if the use of dumbbells by Adib while being treated at IJN and being told to raise his hands could have contributed to the fracture, Ahmad said it “would have”.

“In my opinion, whatever manipulation to the patient led to the patient’s rib bones breaking fully,” Ahmad, 40, said when questioned by conducting officer Hamdan Hamzah.

IJN senior cardiothoracic consultant surgeon Dr Mohamed Ezani Md Taib had told the inquest previously that Adib used special weights in what he described as “passive physio” to strengthen his muscles.

Ahmad also said that Adib’s lungs were larger than usual, hardened with consolidated, frozen blood and sticking to the inner thoracic wall, adding that there was “nothing normal” about the lungs.

Elaborating on Adib’s left rib injuries, he said they were consistent with being hit by “something blunt, hard, straight and vertical”.

He said that based on a reconstruction of the scene on Dec 22, where he also spoke to the EMRS driver Adib was sitting next to on Nov 27, it was “most probable” that Adib was outside the van.

He said Adib must have been standing, with his back to the van, and was hit by the left open back door of the EMRS as it was pushed backwards by the reversing fire rescue tender (FRT) truck in front of it.

“The cross-shaped scratch on his left back could have been caused by the friction from being scrapped by the left door handle of the EMRS,” he said, forcing him to fall.

Asked why the back left broken ribs were not originally detected in a CT scan done at SJMC, Ahmad said this was because the damage was “inside the bone itself”.

He said he saw this during the autopsy.

On the injuries on Adib’s right side – where his broken ribs pierced his right lung and caused internal bleeding – Ahmad said this was caused by a “blunt and wide impact”.

He also said that Adib was not beaten based on the pattern of injuries usually seen on such victims.

He said Adib showed no signs of being hit, kicked or punched, nor were there signs of the fireman defending himself.

Ahmad said the injuries on the right side were also consistent with falling after he was hit by the door of the EMRS.

He said Adib would have fallen face first and hit the roadside, breaking most of his right ribs.

“He also had scratches on the underside of his right wrist, left elbow and right knee, which are all consistent with the frictional impact from scrapping against a rough surface following a fall.”

Ahmad, however, could not say for certain if Adib was pulled out of the EMRS or exited himself.

He also said he could not reject the conclusion that Adib sustained his injuries due to being pinned against “two hard surfaces”.

This is likely in reference to testimony earlier this week that Adib may have been pinned against several parked cars by the EMRS after it was rammed into. Adib was later said to be surrounded by rioters.

Later, after Ahmad was shown videos of the FRT ramming into the EMRS – although they did not show Adib – he maintained his view that Adib was “pushed by the EMRS, fell and that is how he got his injuries”.

The inquest was called by the government following conflicting claims on the cause of Adib’s death.

Adib, 24, was part of the EMRS team sent from the Subang Jaya Fire and Rescue station to the Seafield Sri Maha Mariamman temple during the riots on Nov 27.

Ahmad was questioned today by deputy public prosecutor Hamdan Hamzah, who is part of a three-member team from the Attorney-General’s Chambers.

The inquest, which entered its 16th day today, continues on Tuesday.