Former Kailua dentist Lilly Geyer had no idea there was a risk 3-year-old Finley Puleo Boyle would stop breathing while under sedation because Boyle’s mother, a registered nurse, failed to disclose that her daughter had recently been diagnosed with a viral upper respiratory infection, Geyer’s lawyer Michael Green told a state jury Thursday.

“This was a recipe for disaster,” Green told the jury. “When (Boyle’s) vocal cords slammed shut and there was no air coming in or out, (Geyer) had no idea what she was up against, and the evidence will show she didn’t know until after they indicted her.”

Geyer, 41, is on trial for manslaughter for recklessly causing Boyle’s death and for recklessly failing to get medical help after the toddler stopped breathing and went into cardiac arrest. She is also on trial for causing the brain damage that put Boyle in a coma and for directing one of her dental assistants to administer the sedative drugs to Boyle after her state license had expired.

Boyle went into cardiac arrest Dec. 4, 2013, after she was given a cocktail of three sedative drugs at Geyer’s Island Dentistry for Children. Her mother, Ashley Puleo, took her there for root canal work.

A city ambulance took Finley Boyle to Castle Medical Center where doctors determined she had suffered brain damage from a lack of oxygen and was in a coma. Boyle was later transferred to Kapiolani Medical Center for Women & Children in Honolulu where doctors determined her prognosis wasn’t good. Her family took her home where she died Jan. 3, 2014.

The city medical examiner determined that Boyle died of complications following cardiac arrest, likely caused by the drugs used to sedate her, and determined the death was an accident.

Green said Boyle’s family stopped off at a lawyer’s office and took the comatose, 3-year-old girl for dental X-rays on the way home from Kapiolani Medical Center.

Deputy State Attorney General Michael Parrish said that when Boyle went into cardiac arrest, and the dental assistant asked Geyer three times if she should get help and call 911, Geyer told the assistant no. The assistant eventually ran across the hall to get help from a pediatric doctor whose office is in the same building.

Parrish told the jury that Geyer was not supposed to direct either of her two assistants to administer drugs because they don’t have licenses to do so. He also said Geyer did not want her assistants to tell anyone that she was not present when one of them administered the sedative drugs to Boyle.

“The defendant’s mindset was that Finley Boyle ruined her life,” Parrish said.

Geyer immediately shut down her practice and is no longer licensed to work as a dentist or to prescribe and dispense drugs in Hawaii. She is facing administrative license violation charges, which are on hold pending the conclusion of the criminal case against her.

Boyle’s parents sued Geyer in December 2013 and later agreed to a confidential settlement.