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[2023] NSWDC 572
District Court of NSW
2022-09-30
Mr P
Original judgment source is linked above.
Solicitors: Ms Dawson (Crown) File Number(s): 2020/332557
INTRODUCTION
BACKGROUND
PROCEDURAL BACKGROUND
(A) Applicant's Physical Health
(B) Applicant's Mental Health
(C) Applicant's Cognitive Function
(E) Life Expectancy
DR DAVID WILLIAMS (NEUROLOGIST) REPORT DATED 9 JUNE 2022
DR RICHARD FURST (FORENSIC PSYCHIATRIST) REPORT DATED 27 SEPTEMBER 2022 "Mr O'Neill's psychiatric condition and physical condition have both declined significantly after the death of his wife last year such that the cognitive deficits observed by his wife and noted by Dr Dwyer, together with fitness concerns, are likely to be substantially greater now than they were some 18 months ago lending more weight for the opinions expressed by Dr Dwyer and similar opinions in that respect expressed by Dr Williams after his examination of the accused in May 2022…The most relevant observation of Dr Dwyer and Dr Williams relate to evidence of cognitive impairments 18 months ago and again when he was assessed in May 2022…In light of the extra material reviewed above, I am now of the opinion that it is more likely than not Mr O'Neill has developed a cognitive impairment within the meaning of s 5 of the Mental Health and Cognitive Impairment Forensic Provisions Act 2020 (NSW) as a consequence of his progressive Parkinson's disease and compounded by his psychiatric condition. Further, I am no longer of the opinion that Mr O'Neill is fit to be tried [as expressed in the last five paragraphs at p 3 of my earlier report]. Mr O'Neill has an understanding of what a criminal trial involves and expresses an intention to plead not guilty, however the essential difficulty is that were Mr O'Neill to participate in a criminal trial either in person or remotely via AV link, his anxiety is likely to increase and this would exacerbate his already evident cognitive impairment and lead to confusion as per the opinion expressed by Dr Dwyer…In my opinion, deficits in Mr O'Neill's attention, concentration, and memory, which are evident in the Mini-Mental State Examination of Dr Williams and were reported by his wife 18 months ago, coupled with severe anxiety and his frail condition, would compromise Mr O'Neill's capacity to defend himself and participate in a trial in fair manner. Further aspects of this opinion outlined in my answer to question 2 below… His capacity to concentrate on the questions asked of, and answers given by other witnesses in a trial heard over multiple days, is likely to be significantly compromised and is also likely to fluctuate depending on his level of anxiety such that he could easily become confused and inattentive…Mr O'Neill's cognitive impairment likely to be exacerbated by the anxiety of giving evidence in court, would make it difficult for him to attend to questions, provide appropriate responses to questions, and make his version of events known to the Court both in evidence in chief and in cross-examination."
DR MICHAEL DWYER (CONSULTANT PSYCHIATRIST) REPORT DATED 27 JANUARY 2022 "Mr O'Neill's thinking remains disturbed and his judgment severely impaired. I remain of the opinion that presenting at trial would only serve to worsen Mr O'Neill's mental state with even the prospect of appearing likely to precipitate further suicide attempts. I also remain of the opinion that Mr O'Neill is unlikely to improve enough to be able to present to the Court in the foreseeable future."
JOINT REPORT OF DR MERIMA ISAKOVIC (CLINICAL NEUROPSYCHOLOGIST) AND DIANA LE CLERCQ (PSYCHOLOGIST) DATED 25 SEPTEMBER 2022 "Mr O'Neill's estimated overall intellectual abilities fell in the extremely low range which were significantly and clinically unusually lower that expected (difference found in less than 1% of the population). Mr O'Neill's ability to comprehend language and express himself verbally fell in the very low range which was significantly and unusually lower than expected (difference found in less than 1% of the population). His ability to organise and manipulate visual information fell in the very low range and was significantly and unusually lower than expected (difference found in 1.2% of the population). His verbally based attentional abilities fell within the extremely low range and were significantly and unusually lower than expected (difference found in less than 1% of the population). His ability to work quickly and efficiently with visual information fell within the extremely low range and was significantly and unusually lower than expected (difference found in less than 1% of the population)." "Mr O'Neill meets the DSM-5 diagnostic criteria for 332.0 (G20) Parkinson's disease 294.11 (F02.81) major neurocognitive disorder most likely due to Parkinson's disease without behavioural disturbance that appeared chronic, progressive, and with the onset likely to precede the time of the initial diagnosis." "Major neurocognitive disorder: according to the diagnostic and statistical manual of mental disorders (DSM-5) Mr O'Neill's cognitive functioning had declined from premorbid functioning in several cognitive domains (complex attention, executive function, learning and memory, language, and perceptual motor) which is demonstrated above." "Due to the impact of neurocognitive disorder further escalated by severity of major depression, PTSD, general anxiety, and devastation in adjusting to what he described as lost honour and integrity due to the accusations brought by Mr MC and the subsequent court conviction, Mr O'Neill has suffered widespread deterioration in his cognitive functioning. He has been having significant difficulties with complex attention, executive function, learning and memory, perceptual motor, and language skills and abilities that would best be explained as being a result of his acquired disability. This was evidenced by standardised assessments, clinical observations and collateral information. All of Mr O'Neill's cognitive abilities are identified to be significantly and abnormally lower than his premorbid level of functioning, which means that he will experience significant difficulties keeping pace with other men his age on most tasks or participating in critical situations when he might be expected to articulate well or advocate for himself. Mr O'Neill had significant difficulty demonstrating his verbal abstract reasoning skills. He had difficulties perceiving, integrating and organising visual information. Mr O'Neill took longer to complete tasks, required additional time to learn new material, and was unable to quickly complete two tasks simultaneously. Mr O'Neill presented with difficulty keeping verbal information in mind while performing a task and was unable to maintain his attention whilst filtering out irrelevant information. His ability to sequence digits was an area of weakness on his overall cognitive profile. While Mr O'Neill was able to retrieve verbal and visual information immediately after a presentation, he had significant difficulty recalling this information after 20 to 30 minute delay. Further, Mr O'Neill was unable to use 'cues' to spark his verbal or visual memory."
MEDICAL EVIDENCE 30 SEPTEMBER 2022
Dr Richard Furst
THE REPORT OF DR PROFESSOR GREENBERG DATED 1 MARCH 2022
THE APPLICANT'S SUBMISSIONS
The Applicant's Health
Delay
Public Interest Factors
R v Hakim (1989) 41 A Crim R 372
R v Littler (2001) 120 A Crim R 512
TS v R [2014] NSWCCA 174
Arrivoli v R [2017] NSWDC 112
Subramaniam v The Queen (2004) 79 ALJR 116
DETERMINATION
ORDER
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: 18 December 2023
R
O'Neill
(1989) 168 CLR 23
(1988) 166 CLR 59
(2015) 91 NSWLR 276
(2004) 79 ALJR 116
(1993) 177 CLR 378