Prosecutor Mark Gibson, SC, on Monday told the court Mr Pritzwald-Stegmann saw the group smoking about 7pm as he left the building after finishing his shift. The surgeon went inside to ask reception to alert security, the court heard, at the same time Mr Esmaili went inside to use the toilet. The two men spoke in the lift lobby, Mr Gibson said, and the surgeon was overheard to say: "Did you just spit in my face?" Mr Esmaili was then overheard to say: "I need you to suck my d---." The prosecutor said Mr Esmaili appeared to be getting more angry and annoyed as he spoke to the surgeon, who had his arms down by his side and was not acting aggressively.

"The accused, having given himself a little more space, having opened up his stance, his right arm came back in what could be described as a roundarm, and, with force, punched the victim in the face," he said. Mr Pritzwald-Stegmann suffered a fractured cheekbone and nose, the court heard, and could have been unconscious as he fell backwards. The back of his head cracked the tiled floor, the court heard. There was no sign he braced his fall. CCTV footage played to the court does not show Mr Pritzwald-Stegmann's head hitting the floor. Mr Gibson said there was a gap in the footage attributable to the frames-per-second speed. Loading Replay Replay video Play video Play video Witnesses heard the surgeon's head hit the floor, the prosecutor said.

Darren Haymes, who was visiting a patient, said he came out of a lift and heard two men arguing then saw Mr Pritzwald-Stegmann falling and heard a sound akin to a "a ten pin bowling ball" hitting the floor. But footage shows Mr Haymes rounded a corner away from the lifts when the surgeon was punched. Under cross-examination, Mr Haymes told defence counsel John Desmond he could have subconsciously absorbed information he saw in TV news reports before making his statement. "It could be possible, yes," he said. Mr Haymes also said he heard the word 'spit' and thought it was said by Mr Esmaili and not the surgeon. He conceded he did not see who said the word.

Mr Esmaili is yet to enter a plea but Mr Desmond said his client might argue he acted in self-defence, or raise doubt over what caused the surgeon's fatal injury. The court heard Mr Pritzwald-Stegmann lay motionless for some time after he was punched, but became agitated while being treated by his colleagues. Anaesthetist Gordon Mar said Mr Pritzwald-Stegmann was moving his arms around and trying to push away treating staff. At one point he sat up while on a bed, and also became "combative". He was restrained until he was sedated. Dr Mar said he didn't see his colleague hurt himself while being treated, but couldn't discount the possibility. "I can't rule that out," he said.

Medical specialists were with the surgeon from when he was first treated until he was transferred to The Alfred hospital, the court heard. The hearing continues.