MJ's medical condition
53 Evidence about MJ's medical condition which was not before the sentencing judge included an affidavit by the applicant himself, three reports by Dr Tiley of the Cancer Care Centres at Gosford and Wyong Hospitals and a report by a psychologist.
54 In late November 2009 MJ was diagnosed as suffering from Stage 4 Hodgkin's Lymphoma. He has had a number of sessions of chemotherapy, which are continuing. On three occasions he has had to be taken by officers of the Juvenile Detention Centre to Gosford Hospital for treatment for the side effects of the chemotherapy.
55 The three reports by Dr Tiley were dated 5 January 2010, 1 February 2010 and 16 March 2010.
56 In his first report Dr Tiley commented mainly on the progress to that stage of the courses of chemotherapy MJ was undertaking.
57 In his report of 1 February 2010 Dr Tiley expressed an opinion about MJ's prognosis, which has been superseded by Dr Tiley's last report. Dr Tiley said in his report of 1 February 2010 that it had been difficult to achieve rapid transport of MJ from the Detention Centre to Gosford Hospital.
58 In his report Dr Tiley commented that persons suffering from MJ's illness should monitor their own temperature but MJ had not been provided with a thermometer. Patients should also keep a diary in which they record their symptoms but MJ had not been provided with a diary.
59 In his report Dr Tiley said that it was also almost universal for patients such as MJ to have a psychological reaction to their illness, including anger and frustration, and these emotions were difficult to manage in a correctional facility.
60 Dr Tiley expressed the opinion that MJ's detention was not conducive to MJ receiving optimal therapy, "given the high probability that adverse events will be under-recognised or that appropriate interventions will be delayed. This will increase the risk of treatment failure".
61 In his last report of 16 March 2010 Dr Tiley said:-
"MJ appears to be responding extremely well to chemotherapy at this stage with a PET scan in late January indicating resolution of all previous areas of abnormal uptake suggesting a complete remission. I will be seeking confirmation of this response with repeat scans once he has completed the planned eight cycles of chemotherapy.
With regards to prognosis the likelihood of MJ achieving a complete remission is 80-90% with the majority of these patients, around 80% remaining in remission and alive at five years. He faces some risk of late bone marrow toxicity including acute leukemia in the more distant future although this risk should be low."
62 In her report of 3 February 2010 Susan McConaghey psychologist said:-
"In other words, as well as being "normally" worried and anxious about his health and treatment, MJ carries the added worry about, and lack of confidence in, the facility that is presently responsible for monitoring his health and transporting him to hospital as needed. From a subjective point of view, an institution is no substitute for a family with respect to being able to respond to the emotional demands of this present crisis."
63 The Crown filed an affidavit of 17 March 2009 by Dr Leigh Haysom of Justice Health, who is the medical officer at the Juvenile Detention Centre at which MJ is detained. In his report Dr Haysom said inter alia:-
"MJ has just finished cycle 4 of his chemotherapy treatment, and is well. I see MJ almost every week at the centre to check his progress, monitor for complications of treatment and follow-up on blood tests.
………..
I very strongly feel that MJ has received an excellent level of care from the nursing staff, the clinic, Juvenile Justice New South Wales (JJNSW), and me. There have been some teething issues along the way which were always expected given the fact that MJ is incarcerated in a custodial facility, his transfers out are logistically difficult, and he requires an intensive level of monitoring in an environment that does not have 24 hour nursing care. JJNSW have gone out of their way to get MJ to all of his appointments, and have responded well, but within their staffing abilities, to his episodes of sepsis and illness. At no point has his health been compromised. The kitchen has provided extra nutrition in line with instructions given by the hospital, and the clinic room is made available to house MJ for rest and monitoring when he is more unwell post chemotherapy. MJ has been unwell during his treatment, which was not unexpected given the aggressive chemotherapy he receives. Despite this he has been well supported enough to continue to play some sport, do some work, and participate in activities and day visits. The nursing staff have educated the unit staff about things to be alerted to in MJ's case, and he has access to his own thermometer and can request pain relieving and anti-nausea medication whenever he needs it. The after-hours health staff have also been monitoring his care."
64 In R v Smith (1987) 44 SASR 587 King CJ of the Court of Criminal Appeal of South Australia said at 589, in a passage in his judgment which has been frequently quoted or referred to in this Court:-
"How far should the new information about the appellant's health affect the matter? The state of health of an offender is always relevant to the consideration of the appropriate sentence for the offender. The Courts, however, must be cautious as to the influence which they allow this factor to have upon the sentencing process. Ill health cannot be allowed to become a licence to commit crime, nor can offenders generally expect to escape punishment because of the condition of their health. It is the responsibility of the Correctional Services authorities to provide appropriate care and treatment for sick prisoners. Generally speaking ill health will be a factor tending to mitigate punishment only when it appears that imprisonment will be a greater burden on the offender by reason of his state of health or when there is a serious risk of imprisonment having a gravely adverse effect on the offender's health."
65 In the present case I am satisfied on the evidence that the applicant has been receiving a satisfactory, and indeed a high standard, of care while he is detained in the Detention Centre. According to the most recent report from Dr Tiley, the applicant is responding extremely well to the chemotherapy and there is likely to be a complete remission. Dr Haysom states in his report that, even while the applicant has been suffering from the side effects of the chemotherapy, he has been able to continue to play some sports, do some work and participate in activities and day visits. The evidence does not indicate that there has been any recent need to transport MJ to hospital and, if such a need should arise, it seems to me likely that officers of the Detention Centre, particularly with the benefit of the experience they have gained, will be able to transport MJ to the hospital within a reasonable time.
66 The evidence before this Court does not establish any serious risk of imprisonment having a gravely adverse effect on MJ's health and I do not consider that the additional burden from MJ's ill health, by reason of MJ being in a Detention Centre, is substantial.
67 Having taken into account in MJ's case the additional factors of assistance given to the authorities and his medical condition, I would still consider that a sentence of the length imposed by the sentencing judge would be lenient and that this Court on any re-sentencing should not impose a lesser sentence and on that basis, while giving leave to appeal, I would dismiss the appeal against sentence.