… The test in R v Presser is directed to the minimum requirements for a fair trial. So long as the accused can understand and follow the proceedings in each of its facets, can give appropriate instructions, and can present a proper defence to the charge, he or she is to be regarded as fit to be tried. The fact that the accused may have done so in a better way, had suitable medical treatment or medication been provided, or had that accused possessed greater intelligence or acuity of mind, does not seem to us to be relevant to the question of fitness."
144 The Court concluded at [301] that the question of fitness to be tried related to the "essential requirements" as stated in Presser.
145 The history of the appellant seeking to put his fitness to be tried in issue is as follows. On 8 May 2003, the appellant's matter was listed before Blanch CJDC for "mention" (Appeal book 56). It had been adjourned from a previous date, on which occasion the appellant's trial date of 12 May 2003 had been vacated. The purpose of setting the date for mention was in the expectation of obtaining medical reports in respect of the appellant's medical condition.
146 The appellant was examined by Dr Dale Kong at the request of the Commonwealth Director of Public Prosecutions on 2 May 2003. At that examination, the appellant complained of five medical problems: hypertension; sleep apnoea; obesity; right ankle pain and left leg shortening; and multiple cutaneous lipoma.
147 Dr Kong considered that the appellant was "reasonably impaired by his sleep apnoea … reflected in his daytime sleepiness and poor concentration". Dr Kong noted that the appellant was currently undergoing investigation and treatment in respect of the condition. Dr Kong concluded that the severity of the condition was such as to prevent the appellant from being able to fully concentrate over the period of the proposed trial, and concluded that he was not "medically fit" to attend such a trial, as he might "develop recurrent sleep episodes during the period of the trial".
148 Dr Kong did not consider that the other medical conditions would prevent the appellant from court attendance. Having regard to the proposed treatment for the appellant's sleep apnoea, Dr Kong expressed the opinion that he expected the appellant to be fit to attend trial six to eight weeks after commencing successful treatment. (Appeal book 58-62)
149 On 4 April 2003, the appellant's matter was listed before his Honour Blanch CJDC on the appellant's application to vacate the trial date set for 12 May 2003. The appellant supported his application with an affidavit sworn 4 April 2003. In that affidavit, he stated that he suffered from "several conditions that affect my health and impact on my capacity to stand trial on 12 May 2003". The appellant outlined his various health problems, including sleep apnoea.
150 The appellant then referred to correspondence between himself and the Commonwealth Director of Public Prosecutions. In that correspondence, in a letter dated 25 March 2003, he asked that his health concerns be noted and sought consent to the vacation of the trial date of 12 May 2003. The Commonwealth Director of Public Prosecutions responded, stating that it would oppose the vacation of the trial date if it was not provided with a full medical report in advance of the mention on 4 April 2003. The appellant responded by a further letter, setting out details of his health problems and agreeing to consent to the Commonwealth medical officer making material available to the Commonwealth Director of Public Prosecutions.
151 The appellant concluded his affidavit by seeking an order vacating the trial date of 12 May 2003 "and [allowing] the matter to be mentioned again in July 2003 to consider my capacity to stand trial" (Appeal book 55).
152 The matter was listed before Blanch CJDC on 8 May 2003. On that occasion, the appellant informed his Honour that treatment had commenced. Accordingly, on the Crown's application, the matter was adjourned for a further eight weeks, to enable an assessment to be made as to the appellant's condition. The appellant agreed with that proposal (Appeal book 56).
153 In my opinion, the appellant's application on 4 April 2003 did not "put in issue his fitness for trial" in the Presser sense: see appellant's submission 1.6 (Appeal book 3). On 8 May 2003, his Honour made no finding in relation to the appellant's fitness for trial. Rather, he acceded to an application for adjournment in circumstances where he was informed that the appellant had a medical condition in respect of which he had commenced treatment.
154 Accordingly, grounds 1 and 2 of the Notice of Appeal should be dismissed.
155 The appellant next complains that on 29 January 2004, Solomon DCJ erred in law and fact in not dealing with the offences pursuant to the Mental Health (Criminal Procedure) Act.
156 Following the adjournment on 8 May 2003, the matter was mentioned on several occasions before Blanch CJDC, up to and including 23 January 2004. On that day, the appellant informed his Honour that his treatment had not proved successful and that he remained "unfit for trial". The appellant said he was likely to remain unfit for the foreseeable future. His Honour indicated that he would require further medical reports and the appellant informed his Honour that he was in the process of having those prepared. The appellant said that the Court might be "aided by some submissions from counsel as to what course the matter should now take". He said that he had had difficulty organising that over the holiday period and he was seeking another mention date. His Honour thus stood the matter over to 29 January 2004, which was the occasion on which the matter came before Solomon DCJ.
157 On 28 January 2004, the appellant filed a Notice of Motion, seeking directions for the further conduct of the trial. The Notice of Motion was supported by an affidavit dated 28 January 2004, in which the appellant again raised his medical conditions. He stated at para 5 of his affidavit that the matter had been adjourned by Blanch CJDC on 8 May 2003 because the appellant was "then unfit to be tried". The appellant then stated "I remain unfit to be tried" (Appeal book 73). The appellant set out his various medical conditions. At para 21, he stated that the treatment that he had had at Royal Prince Alfred Hospital's Sleep Disorders Clinic had been ineffective and that his symptoms persisted. He said those symptoms included frequent daytime micro sleeps that would see him "effectively black out for periods as long as 20 minutes". The appellant concluded his affidavit seeking directions as to the future conduct of the proceedings (Appeal book 82).
158 The appellant made written submissions to his Honour on that occasion, in which he raised the provisions of the mental health legislation. In particular, he referred the Court to ss 8 and 10 of the Mental Health (Criminal Procedure) Act.
159 Solomon DCJ observed that he only had one medical report on file, namely, that of Dr Kong of 2 May 2003. Accordingly, his Honour made directions relating to the obtaining of further medical evidence and allocated another mention date on 26 March 2004. The appellant agreed to that. (Appeal book 70-79)
160 Thereafter, there were a number of mentions of the matter. On 6 August 2004, the matter was listed before Hosking DCJ, who set the matter down for a two week trial commencing 15 November 2004.
161 On 5 November 2004, the matter again came before Blanch CJDC, pursuant to an application filed on 28 October 2004 and supported by an affidavit of the appellant's solicitor, who had recently been retained. The Notice of Motion sought the vacation of the hearing date on 15 November 2004 and for the matter to be listed for mention in May or June 2005. An order was also sought that the Notice of Motion be further adjourned sine die to be brought on for hearing on seven days notice.
162 The Notice of Motion was supported by an affidavit of the appellant's solicitor. In her affidavit, the solicitor recorded the history of the matter as she understood it, including that Blanch CJDC had not considered the effect of the mandatory provisions of Pt IB Div 6 of the Crimes Act (Cth) or Pt 2 of the Mental Health (Criminal Procedure) Act when the matter was before him on 8 May 2003. The appellant's solicitor also stated that her instructions were that Solomon DCJ also had not dealt with the application on the basis of those provisions when the matter was before him on 29 January 2004.
163 The solicitor stated that medical appointments had been made for the appellant commencing on 4 November 2004 and concluding on 14 March 2005. Those medical appointments related to a pre-anaesthetic appointment at St Vincent's Hospital on 4 November 2004; surgery on 9 November 2004 by Dr Quain, Orthopaedic Surgeon; examinations on 16 November 2004 and 31 January 2005 by Dr Westmore, Psychiatrist, and Mr Borenstein, Psychologist, respectively; examination on 14 February 2005 by Dr Ong, Endocrine Specialist; surgery on 7 March 2005 by Dr Gallagher, ENT Surgeon, and a post-surgery consultation with Dr Gallagher on 14 March 2005. The appellant's solicitor also said that she had not received the medical reports requested at that stage and, in the absence of the medical evidence and the transcript of prior proceedings to assist in the appellant's defence, she stated that she believed the appellant was not ready to proceed to trial and, therefore, sought the orders made in the Notice of Motion. (Appeal book 135-138)
164 On 5 November 2004, the appellant was represented by Mr Brezniak of counsel, who submitted to his Honour that the question of fitness to stand trial had already been determined and conceded by the prosecution (Appeal book 120). He submitted that his Honour Hosking DCJ erred in setting the matter down for hearing. Mr Brezniak informed his Honour that the matter was not an application for a stay on the basis of unfitness to stand trial, although he acknowledged that that might be a "derivative application" available to the appellant. Rather, it was an application seeking to invoke the regime prescribed by the Mental Health (Criminal Procedure) Act.
165 His Honour rejected the application. Unfortunately, there was a malfunction of the transcript tape, so that there is only a portion of his Honour's reasons available for consideration. In the material that is available, his Honour stated specifically that he had not, when the matter was before him on 8 May 2003, found that "the trial should be delayed because the appellant was unfit to plead or to stand trial in the Presser sense". His Honour then said (Appeal book 140):
"… the inquiry which has to be made in these cases is whether or not, in the conventional sense there is any evidence to raise the issue of fitness to plead or fitness to be tried. In support of that proposition I need to quote no more than the authority of Kesavarajah ."
166 His Honour also referred to the decision in Mailes. I have already dealt with that decision above. It was at that point that the tape malfunctioned.
167 In my opinion, a question had not arisen as to the appellant's fitness to be tried, as that concept is properly understood, in any of the applications made prior to the date that the trial was set down for hearing on 15 November 2004. The fact that a person makes an application to the Court in which it is contended that Pt 2 of the Mental Health (Criminal Procedure) Act applies is not necessarily sufficient for the question of a person's fitness to be tried to arise. There has to be a question as to whether the person is able to satisfy the minimum requirements stated in Presser. Up until 15 November 2004, the only evidence before the Court on the applications made by the appellant was that of Dr Kong, who gave evidence of a medical condition from which the appellant was suffering. That evidence is set out above. There is no doubt from that evidence that the appellant had the capacity to understand each and every aspect of the Court proceedings. The only question is whether he was "able to make his defence … by giving any necessary instructions and by letting his counsel know what his version of the facts is …". The Court, by granting an adjournment, must have accepted Dr Kong's opinion as to the appellant's likely inability to concentrate and the likelihood of sleep episodes during the trial.
168 However, that, in my opinion, gives rise, not to questions of "unfitness to be tried" but to the question whether, given a medical condition for which the appellant was then requiring treatment, it would have been fair, in the common law sense of that word, for the trial to proceed at that time. In that regard the position is no different from the man with the broken leg who was being intravenously fed or medicated.
169 There was no indication at that time in the medical evidence that the appellant had any cognitive impairment caused by or as a result of his sleep apnoea. Indeed, Professor Grunstein, a specialist in sleep and respiratory medicine, in his report dated 1 June 2004, said that in order to assess the appellant's "fitness to stand trial", his cognitive impairment would need to be assessed. In a report dated 8 July 2004, Professor Grunstein said he was of the opinion the appellant would be able to stay awake during proceedings.
170 Even if I am wrong in the above and a question had arisen as to the appellant's fitness to stand trial, in the proper meaning of the phrase, as at 8 May 2003, or on 29 January 2004, the fact is, he did not stand trial. This is relevant, because the consequence of a person standing trial where a question of unfitness arises and is not dealt with is a nullity: see Eastman; Maile; Rivkin. But, as I have said, he did not stand trial at that point, so there is no question of any trial being a nullity arising. That is not to say that the appellant was without a remedy. The appellant, during the period in which the Court granted successive adjournments of both the trial and the Notices of Motion, could have sought prerogative relief. He did not do so.
171 As I have said, the trial was set down to commence on 15 November 2004. On that day, the appellant filed a further Notice of Motion seeking a stay of the proceedings. The Notice of Motion was supported by his affidavit of the same date, in which the appellant stated that Dr Gallagher had scheduled surgery for him in March 2005 for his sleep apnoea. The appellant stated that his sleep apnoea manifested itself in micro sleeps frequently and intermittently during the day. He said this had a debilitating effect, including lack of concentration, short periods of functioning, and vague memory. He also said his cognitive reasoning abilities were affected. The appellant said he suffered from poor memory retention and general disorientation. He also said that he experienced sleep episodes involving total paralysis. The appellant also referred to his other medical conditions.
172 At the commencement of proceedings on 15 November 2004, the appellant's counsel, who was then Mr Lowe, moved on the application for a temporary stay (Appeal book 141). Counsel tendered the medical reports of Drs Kong and Grunstein to which I have already referred. In addition, he tendered reports of Dr Westmore, dated 11 November 2004, Mr Borenstein, dated 9 November 2004 and Dr Gallagher, dated 12 November 2004.
173 I have already referred to the opinions and conclusions of Dr Kong and Professor Grunstein. Dr Westmore reported that from a psychiatric perspective, there was nothing to indicate that the appellant was unfit to be tried. He stated that questions of the appellant's capacity to remain alert and attentive were matters for other experts.
174 Mr Borenstein, on the basis of his assessment by way of interview, said that the appellant did not suffer any psychological or psychiatric disorder (Appeal book 193). He noted the appellant's "significant history of hypertension and sleep apnoea", and observed that during his own examination, Mr Clarkson's concentration appeared to be intact. Mr Borenstein expressed concern that the appellant's sleep apnoea and hypertension would interfere with his ability to maintain concentration over an extended trial. He commented, however, that he was not an expert in sleep apnoea and said that to fully appreciate the effects of this condition on the appellant's concentration and cognitive status, more thorough neurological testing would have to be undertaken (Appeal book 194).
175 Dr Gallagher stated that he could see "no reason that the patient is not medically fit for trial". He commented that it was certainly possible that a person with severe sleep apnoea could fall asleep during the day, but added:
"I certainly could not comment on the probability of this occurring during a trial. I am in agreement with Professor Ron Grunstein." (Appeal book 196)
176 Dr Gallagher concluded by stating that his overall recommendation was that Mr Clarkson should undergo nasal surgery so as to optimise his nasal airways so he could use the sleep apnoea equipment appropriately. (Appeal book 196)
177 Hosking DCJ reviewed the appellant's affidavit evidence and the medical evidence in detail. He also reviewed an affidavit by Ms Hayes tendered by the Crown, which set out the history of the matter.
178 His Honour also observed:
"I understand the Chief Judge's reference [being a note on the Court file relating to the application before the Chief Judge on 5 November 2004] to the refusal of a fitness hearing to mean that his Honour did not agree that there was any reasonable evidence to suggest that the accused would be today unfit to stand his trial. It will be seen, therefore, that the matter has had a protracted history, all due to this question of the accused's sleep apnoea and whether he will either be fit to stand his trial or can receive a trial which is not unfair." (Appeal book 205-206)
179 His Honour then went on to review the law in respect of applications for stays. His Honour concluded by observing that, on the medical evidence, neither Professor Grunstein, nor Dr Gallagher, considered it a probability that the accused would fall asleep during trial. His Honour reiterated that it was Professor Grunstein's opinion that the appellant should be able to maintain appropriate vigilance during court hours and the appellant's own doctor, Dr Gallagher, did not disagree.
180 His Honour refused the application.
181 In my opinion, there was no error in his Honour so doing. The medical evidence available to the Court at that time was all to one effect, namely, that the appellant was fit to stand trial, subject possibly to a suggestion that neurological testing should be undertaken. That suggestion was made by a person not expert in the field of sleep apnoea. That is not sufficient, in the face of relevant expert evidence of fitness, in the Presser sense or under the Mental Health (Criminal Procedure) Act, to raise a question of unfitness to be tried.
182 Before leaving this point, reference should be made to one other matter. The appellant contends that his Honour Judge Hosking also erred because he relied upon the decision of the Chief Judge in his determination on 5 November 2004, that the appellant was not unfit to be tried. I have set out the relevant passage above. In my opinion, Hosking DCJ was merely recording what had happened in the various pre-trial applications that had been made by the appellant, including that of 5 November 2004, that had been determined by the Chief Judge. In my opinion, there is nothing in his Honour's reasons to indicate that his Honour considered that the Chief Judge's determination on that day otherwise precluded his own consideration of the matter.
183 The applications before the Court on 5 and 15 November 2004 were, of course, different. The application on 15 November was for a stay. The appellant's counsel did not raise the question of the appellant's fitness to be tried in the Presser sense, so as to engage the provisions of the Mental Health (Criminal Procedure) Act. Had it been apparent to his Honour that there was such a question, properly understood, he would have been required by the legislation to have dealt with it. However, as I have explained, the appellant's counsel did not raise the matter, nor did that question arise out of the medical evidence that was before Hosking DCJ, except to the extent that it either refuted any question of the appellant's unfitness (see Drs Westmore, Grunstein and Gallagher) or, alternatively, indicated that there was insufficient evidence to know whether that was the case (see Mr Borenstein), with which I have already dealt.
184 It follows, therefore, that grounds 7 and 8 should be rejected.