Discussions centred on the absence of a watertight door revealed “systemic deficiencies” among marine authorities in acting without independent verifications, the Coroner’s Court said on Thursday, as it wrapped up an inquest into one of Hong Kong’s worst maritime disasters that claimed 39 lives.

The second day of the oral verdict also addressed several major points of contention in the 2012 Lamma ferry crash, during which relatives of the victims walked out of the courtroom in the middle of the proceeding.

The Lamma IV, which had more than 120 passengers on board for the National Day fireworks display, collided with the Sea Smooth catamaran off Lamma on October 1, 2012.

The Sea Smooth remained afloat and continued its journey, but the Lamma IV sank within minutes.

Addressing an empty bench where family members of the deceased were sitting, Coroner Monica Chow said the court acknowledged the profound loss suffered by them.

“No verdict [or] recommendation can erase that loss, but it is hoped that the findings will provide some measure of understanding and assurance that lessons have been learnt,” she said.

Chow had addressed that the absence of a watertight door between the compartments, which was believed to have reduced the ferry’s ability to stay afloat when damaged, was a conscious choice, in the first day of oral verdict.

Lawyers representing the next of kin previously argued that there were eight missed opportunities during regular inspections to detect the absence of a watertight door, which they said differed from the vessel’s drawings.

The department had noted periodic surveys were aimed at checking the vessel’s condition, but acknowledged that the general awareness of inspections could have been higher at the time.

Chow said it was “impractical and unrealistic” for inspectors to reference drawings during every routine check, saying the purpose of the periodic surveys was not to “re-verify the correctness of the original construction”.

In her concluding remarks, she noted that the significance of the watertight door issue “lies not in the missing door itself but in what it reveals”.

The coroner said there were “systemic deficiencies” in the Marine Department, including a tendency to accept drawings and stability calculations without sufficient checking or independent verification.

“As a result, assumptions replaced confirmation. There was no effective internal safeguard to prevent technical errors from being repeated,” she said.

In a slew of recommendations, Chow urged the department to implement a declaration system requiring vessel owners to confirm whether any alterations have been made before each periodic inspection.

The coroner, separately, raised questions over whether evidence given by one of the witnesses, then-ship surveyor Leung Wai-hok, was truthful as she referred the matter to the Department of Justice.

Alice Leung, who lost her brother in the tragedy, was furious that the relatives’ calls for detailed scrutiny had been called unrealistic.

“[The coroner] told us to sympathise with all Marine Department personnel, but who will sympathise with the family members? We lost our loved ones 13 years ago. It’s not as simple as just losing someone. This imprint is for a lifetime. Even if [the court] gave us a ‘full stop’, this stays forever.”

Leung also thanked the legal team assisting the families and said they would "not give up".

HK Electric, which chartered the Lamma IV, said it fully respects the coroner's verdict and will study it in detail before considering any further necessary measures to improve safety and management practices.

In a statement, the firm stressed that it followed the recommendations of experts and the commission of inquiry 13 years ago to implement "a full suite of enhanced safety and fleet-management measures".

"These include more stringent vessel inspection and acceptance procedures, upgraded equipment and safety standards, improved internal audits and safety protocols, all reflecting our commitment to safeguarding our fleet and its passengers," the company said.

The firm said it wanted to once again extend its deepest condolences to the families of all those who lost their lives in the disaster, which included staff members.