Director of Public Prosecutions (NSW) v Quinn

Evidence as to placement of the respondent

1. Within the folder of documents marked exhibit A there are a number of letters, statements and reports concerning arrangements that might be made for the care, treatment and rehabilitation of the respondent.
2. The Chief Executive of the Justice Health and Forensic Mental Health Network ("JH & FMHN"), Ms Julie Babineau, has advised that her organisation has managed patients with a severe disability before, and that if the respondent came into custody it would make all reasonable and practicable arrangements to care for his condition. All efforts would be made to provide a level of clinical care equivalent, as much as possible, to the care provided to persons with similar conditions residing within the general community. Advice would be sought from the appropriate clinical and rehabilitation experts within the public health system as to the respondent's needs, and the network would work with the Prince of Wales Hospital, its acute referral hospital, to manage his clinical needs as best as practicable.
3. Ms Babineau's letter was written with cognisance of an earlier letter by Dr Jacques Ette, a staff specialist of JH & FMHN, which expressed serious concern about the ability of Long Bay Hospital to provide appropriate care for the respondent. He claims that its level of staffing, resources and expertise were simply inadequate. In making his point he itemised many issues. Towards the end of his letter he said: "If the above points aren't able to be accommodated, it may result in the deterioration of Mr Quinn's health and possible threat to his life".
4. Dr Philip Snoyman, the Statewide Manager of Specific Needs, Corrective Services NSW, has described the respondent's condition as follows: "Mr Quinn has no movement below his head, ongoing spasticity, which has differing severity and affecting his upper and lower limbs. He is able to move his head. Mr Quinn is completely dependent for all self-care tasks and bowel care. Mr Quinn relies on a power wheelchair, with chin control set up as his main means of mobility, and can independently use a mouth stick for iPad use, with an iPad mount and over bed table."
5. Mr Snoyman referred to difficulties in placement of the respondent elsewhere, that is, other than at the Long Bay Hospital, and referred to difficulties there as well.
6. Dr Geoff Murray, the Director of the Rehabilitation Network for the Illawarra and Shoalhaven Local Health District and Clinical Associate Professor at the University of Wollongong, provided a number of statements. In one he outlined the respondent's current needs which include that he requires two assistants and a hoist for any care that involved manual handling. He made reference to what would be required in terms of placement of the respondent, with a view to him attending court daily for his trial. In short, being at Coledale Hospital daily would pose significant difficulties because of the distance from courts in the Sydney CBD.
7. Dr Murray refers to the respondent, whilst at Coledale, frequently vocalising a desire to die. He referred to an incident in mid 2014 where the respondent exited the hospital and headed down a steep hill towards Lawrence Hargrave Drive. It is believed that the respondent was intending to kill himself by being involved in a road accident. As a result of that incident the wheelchair used by the respondent was demobilised. Dr Murray wrote: "I firmly believe that if Mr Quinn were to be provided with a mobile wheelchair, in a community setting, there is still a risk that he will attempt to harm or kill himself and in doing so there is the real chance that other people - like motorists - will be injured in the process."
8. Dr Murray said that the respondent does not require any further rehabilitation or hospitalisation. He said that the respondent could be housed either with family, in a residential care facility, or in a disability suitable housing situation, with appropriate equipment, possibly being allowed to be alone at night and with carers coming daily. There is a problem with the respondent living with his parents in that at least one of them is a witness in the matter.
9. Dr Murray also made reference to the incident in mid-2014, and described what happened when the respondent was returned to the hospital. He apparently reversed his wheelchair and pinned a nurse against the wall. It was said that he could have caused her significant physical injury.
10. Dr Murray refers to the respondent being highly abusive to himself (Dr Murray) and to staff and other patients. There are a number of statements from staff at the Coledale Hospital about the behaviour of the respondent at that facility. He has made unfounded allegations about Dr Murray and other staff, which caused Dr Murray to have to withdraw from involvement in his care. Two other rehabilitation specialists might have taken over such care, but their medical indemnity insurer advised them to decline. Professor Wilf Yeo has taken over supervising the care of the respondent, but it is said that this is not a sustainable long term solution. Dr Murray wrote, "Effectively the local health district may not be able to provide Mr Quinn with a doctor if he stays at Coledale Hospital".
11. Ms Ann Gilholme, the Director of Nursing and Site Manager, said in the latest risk assessment plan she had conducted, that the hospital cannot reduce the risk of harm to staff, patients, visitors and to the respondent himself any further. She said there remained a real risk of harm to such people, due to the respondent's "reckless disregard for his own health and the lives and safety of others". He was assessed to be violent, non-cooperative, intimidating, offensive and abusive and constantly expressing a desire to kill himself. She referred to an incident of the respondent ramming his wheelchair into a nurse, pinning her against the wall; perhaps the same incident that Dr Murray was referring to. She also said that, "The respondent has some movement in his legs," and there was an occasion when she saw him tilt his chair back and kick at staff.
12. Ms Gilholme sets out various measures that have been taken to deal with the situation, such as staff not being alone, the wheelchair being demobilised, extra external security having to be hired for a period last year, staff remaining out of arm's reach unless attending to the respondent's personal care, goggles and face masks being worn by staff to protect themselves from when the respondent spits at them, and the list goes on.
13. I am not going to itemise all of the other concerns expressed by the other staff members, but the point is well established. For example, Ms Donna Jay, the Acting Nurse Unit Manager in the East Wing of Coledale Hospital described similar behaviour and said: "The respondent remains a real risk of harm to staff, patients, visitors and himself due to his reckless disregard for his own health, and the lives and safety of others."
14. The situation has not been confined to the time the respondent has been at the Coledale Hospital. There is a volume of material within exhibit A that indicates that while he was at the Prince of Wales Hospital, before transfer to Coledale, his behaviour was much the same.

Determination

1. There is concern about the ability of the Long Bay Hospital to appropriately manage the needs of the respondent, but it seems to me to be accepted by both parties that there is no desirable placement for the respondent, and Long Bay Hospital is the "least worst" of the options.
2. I am satisfied that there is an unacceptable risk of the respondent endangering the safety of individuals, particularly hospital staff required to provide care to him, and to other patients, and to visitors of such a facility. For those reasons the application must be granted, and bail is refused.

DISCLAIMER - Every effort has been made to comply with suppression orders or statutory provisions prohibiting publication that may apply to this judgment or decision. The onus remains on any person using material in the judgment or decision to ensure that the intended use of that material does not breach any such order or provision. Further enquiries may be directed to the Registry of the Court or Tribunal in which it was generated. Decision last updated: 10 September 2015