R v Sandhu - [2015] SADC 114

DISTRICT COURT OF SOUTH AUSTRALIA
(Criminal)
R v SANDHU
[2015] SADC 114
Reasons for Decision of His Honour Judge Slattery
4 August 2015
CRIMINAL LAW - PROCEDURE - ADJOURNMENT, STAY OF PROCEEDINGS OR ORDER RESTRAINING PROCEEDINGS - ADJOURNMENT - GROUNDS FOR GRANTING OR REFUSING
Defendant charged with dishonesty and money laundering offences – whether the proceedings against the defendant should be stayed on the basis that he is suffering from an advanced form of cancer and the pain, medication and treatment associated with the condition would render the defendant mentally unfit to stand trial – whether the proceedings should be stayed on a humanitarian basis – whether the Court should make Orders under Part 8A of the Criminal Law Consolidation Act 1935 in relation to the defendant's mental fitness to stand trial.
Held: Order for an investigation of the defendant's mental fitness to stand trial under s269J of the Act.
Criminal Law Consolidation Act 1935 Part 8A, s269H, s269J, s269K s289(1), referred to.
ICAC v Cuneen [2015] 89 ALJR 475; R v Jacobi [2012] SASCFC 115; Roma v District Court of South Australia (1995) 63 SASR 223; Police v Makrou (2008) 103 SASR 364; Barton v The Queen (1980) 147 CLR 111; R v Abdulla (2005) 93 SASR 208; R v Sexton (2000) 77 SASR 405; R v Hakim (1989) 41 A Crim R 372; R v Liddy [2010] SADC 80; R v Athanasas [2014] SASCFC 14, applied.

R v SANDHU
[2015] SADC 114
JUDGE SLATTERY

The issue that arises in this application is whether an Information containing four Counts involving dishonesty offences and money laundering alleged against the accused should be stayed or whether the Court should make Orders under Part 8A of the Criminal Law Consolidation Act 1935 (the Act).
The basis for the application is that as a result of an advanced form of cancer suffered by the accused, the drug therapy and the treatment for that condition, the pain suffered by the accused and the sequelae of those circumstances considered separately or together, it would offend common humanity to require the accused to answer the charges.
Alternatively and for the same reasons, it is submitted that there are reasonable grounds to suppose that the accused is mentally unfit to stand trial.
For the reasons set out hereunder I have formed the view that there are reasonable grounds to suppose that the accused is mentally unfit to stand trial and it is appropriate to order an investigation into his mental fitness to stand trial.
The accused is charged on the Information dated 30 September 2013 with the following offences:-
INFORMATION
Amarjit Singh Sandhu is charged with the following Offences:
First Count
Statement of Offence
Dishonestly Dealing with a Document (Section 140 of the Criminal Law Consolidation Act 1935).
Particulars of Offence
Amarjit Singh Sandhu on the 30^th day of March at Parafield Gardens and other places, dishonestly used documents knowing them to be false, namely a mortgage application, intending to deceive Bendigo and Adelaide Bank Limited, in the sum of $120,000.
Second Count
Statement of Offence
Dishonestly Dealing with a Document (Ibid).
Particulars of Offence
Amarjit Singh Sandhu on the 30^th day of March 2006 at Parafield Gardens and other places, dishonestly used documents knowing them to be false, namely a mortgage application, intending to facilitate the deception of Homeloans Limited, or another lender, and by that means to cause a detriment to Homeloans Limited, or another lender in the sum of $115,000.
Third Count
Statement of Offence
Money Laundering (section 138(1) of the Criminal Law Consolidation Act, 1935).
Particulars of Offence
Amarjit Singh Sandhu on the 3^rd day of July 2006 at Adelaide, engaged in a transaction involving property, namely money of a value of $42,300, knowing that the property was tainted.
Fourth Count
Statement of Offence
Money Laundering (ibid).
Particulars of Offence
Amarjit Singh Sandhu on the 11^th day of July 2006 at Adelaide, engaged in a transaction involving property, namely money of a value of $56,065, knowing that the property was tainted.
The alleged factual background for these Counts is that the complainant owned the freehold of home premises in which he lived. The complainant met the accused some time in early 2006 and after that meeting, the accused assisted the complainant to complete his taxation returns for the financial year ending 30 June 2005. At that time, the complainant gave to the accused some of his personal documents. Implicitly these were associated with financial records connected to the completion of the taxation returns for that financial year. Some of them included his banking records. At that time the complainant banked only with the Commonwealth Bank of Australia Limited. The accused also held a bank account but with Westpac Bank Limited in the name of Mr A Sandhu trading as BFG Developments, GPO Box 1007 Adelaide SA 5001.
In relation to Count 1, the allegation is that on 30 March 2006, the accused made an application for a loan to be given to him in the amount of $120,000. The application was made to the Bendigo and Adelaide Bank. It is alleged that the security offered on the application was a mortgage on the complainant’s property. The bank received from the accused a home loan application allegedly signed by the complainant however the complainant claims that he did not authorise the loan application, did not have any knowledge of the transaction and did not provide any personal documents to the accused for the purposes of any such loan application.
The second Count relates to an event alleged to have occurred on 30 March 2006. On that date, the accused is alleged to have made an application for a loan of $115,000 to Homeloans Limited. The loan application allegedly offered as security a mortgage on the property owned by the complainant. Homeloans Limited is a mortgage facilitator and it placed the loan application with a provider of loans, in this instance Perpetual Limited. A home loan application, purportedly signed by the complainant was allegedly submitted through Homeloans Limited to Perpetual Limited. Other identification documents belonging to the complainant were also allegedly submitted at the time of the application for this loan. The complainant did not authorise the loan application, had no knowledge of the application and did not willingly provide his personal documents for that purpose. It is alleged that the accused was not authorised expressly or impliedly to use the complainant’s documents for that purpose.
The loan application in respect of Count 1 was approved in the amount of $75,000 but the loan was not used. The loan application under Count 2 was approved in the amount of $115,000. On 20 June 2006, it is alleged that the accused opened two further Westpac Limited banking accounts namely an Everyday Account in the name of the complainant and a cheque account in the name of the complainant care of BFG Developments GPO Box 1007 Adelaide SA 5001. The signatory on both accounts was in the name of the complainant however the complainant alleges that he did not sign any relevant documents for the establishment of those accounts.
Under the third Count it is alleged that on 3 July 2006 a cheque in the amount of $42,300.00 was drawn on the Everyday Account in the name of the complainant with Westpac Limited and those funds were then deposited into the account in the name of the complainant with BFG Developments by the accused.
On Count 4 it is alleged that on 11 July 2006, the sum of $56,055.00 was withdrawn from the Everyday Account in the name of the complainant and was deposited into the account in the name of the complainant care of BFG Developments.
On 22 February 2013 the accused was arrested. At that time, police allegedly found documents including loan documents, bank and investments documents regarding the complainant and his property in the possession of the accused.
The trial of this matter was initially set for 7 October 2014. On 16 September 2014, an Application to Vary Bail was granted. The Court was informed by Mr Grant the solicitor for the accused that the accused had then been unwell with various (apparently unspecified) conditions. The matter was next before the Court on 27 September 2014. Although the matter had been listed for trial, an Order was made by Judge Chivell to take the matter out of the trial list because the complainant had suffered injuries in a significant car accident. The parties sought a further trial date. The date of 17 August 2015 was set and at the time, the parties requested the Court to set a hearing time of 8 days. There were two considerations informing the setting aside of such a comparatively long period of trial time. The first was the injuries suffered by the complainant and the second, the accused’s physical condition. The Court was then informed that the accused was in the process of very active chemotherapy treatment for the cancer that he was suffering and that he may need some accommodation at the trial.
During an appearance before Judge Tilmouth on 30 June 2015, the Court was informed by the accused’s Counsel that he continued to be treated for cancer, that his condition was deteriorating and the Crown had been told that the accused was seeking a medical report as to his current condition. It was suggested to the Court that it may be necessary to manage the 8 day trial in a slightly different way.
The treating Oncologist of the accused is Dr Thean Hsiang Tan. Dr Tan is a staff medical Oncologist at the Royal Adelaide Hospital. On 13 August 2014, Dr Tan provided a report to the accused’s solicitors in which he said that the accused is a patient at the RAH Cancer Centre with a diagnosis of advanced prostate cancer. He was then currently receiving lifesaving docetaxel chemotherapy.
Dr Tan also reported that the accused’s overall health was poor with some other complications involved with a pre-existing type 2 diabetes mellitus which was complicated by hyperglycaemia arising from the ingestion of steroids which are part of his cancer therapy. In terms of his prognosis, Dr Tan said that the accused’s cancer therapy was indefinite with a total of six months of therapy at least followed by maintenance with a second line oral agent to keep his cancer at bay. Absent therapy, the accused’s life expectancy would be significantly shortened.
In June 2015 a letter was sent from the solicitors for the accused to Dr Tan setting out a series of questions to be answered by him. Dr Tan was informed that the accused was due to attend a trial of the charges on the Information in this matter commencing August 17^th. Dr Tan was informed that a trial was a stressful environment, that there are many complex financial documents to be considered by the accused and that it would be necessary for the accused to concentrate at all times during the course of the trial so as to follow the case and to provide instructions. It would also be necessary for the accused to be mentally alert throughout the trial to comprehend the evidence and that would require a lead up time of preparation for trial. This would include a review of documents which may number 2000 in all. That preparation would take place over a number of conferences with solicitors and Counsel.
Dr Tan was asked to opine on a number of matters including the accused’s current condition, prognosis, treatment and medication. He was then asked the following questions:-
9. Whether, in your opinion, undertaking a trial as outlined above would compromise his medical condition and, if so, how; and
10. Whether the treatment and/or medication he will likely be undertaking from now until the end of August will affect his:-
1. ability to concentrate; or
2. his energy levels; or
3. any other function that might impair trial preparation or participation.
11. If the defendant’s abilities were likely be impaired are there any other steps that a Court could take to assist the defendant.
The letter of request of the accused’s solicitors of 25 June 2015 (Exhibit D4) was responded to by a letter from Dr Tan of Monday 6 July 2015 (Exhibit D5). Dr Tan reported that the accused is suffering from castrate resistant prostate cancer with associated pain from his bony secondaries and neurological involvement. Dr Tan set out the chemotherapy treatment and drug treatment received by the accused. He summarised his current condition as follows:-
4. His current condition is poor at the moment with easy fatigability, unable to stay up for more than 90 minutes at a time, requiring frequent rests, alteration of bowel habits and significant perineal and pelvic pain (currently admitted to hospital for investigation). In addition he is unable to sit for prolonged periods of time given the rectal pain from his prostate cancer. His analgesic regimen will likely be increased and therefore compromising his alertness. As it stands, his concentration is slightly impaired already with the current analgesic regimen.
5. He may require further change of treatment (such as radiotherapy and chemotherapy). Palliative care involvement pending.
6. His prognosis is poor, approximately at 6 months.
7. Chemotherapy will be ongoing to maintain control of his cancer. We do not recommend treatment break at any time unless the patient deteriorates further on therapy.
8. It is very unlikely that he will be fit enough to ever stand trial in view of his deteriorating medical conditions. He is quite housebound at the present time and does require frequent rests.
9. Being in a trial situation where there could be potential risks with sick people could pose a significant infective risk to him especially in the context of immunosuppression from chemotherapy/bone marrow failure from cancer.
On the basis of that opinion, the accused brought an Application for Directions in which he sought the following Orders:-
1. …
2. That the matter be permanently stayed on the basis that the defendant is not and will never be fit to stand trial in terms of s269H(c) of the Criminal Law Consolidation Act; and
3. In the alternative that it would be contrary to the interest of justice for the trial not to be stayed given the current medical condition and prognosis of the defendant; and
4. In the alternative that the trial date be vacated and that an alternative date be set which allows for the physical limitations of the defendant in terms of concentration spans, the need to rest and limiting exposure to others.
In addition to the material from Dr Tan, the accused relied upon further evidence placed before the Court. Exhibit D2 is a copy of an email from Mr Grant of the firm of solicitors Rodney Oates Lawyers to Mr Crocker of Counsel. It is dated 20 July 2015. It reports a conversation between Mr Grant and Dr Tan in which Dr Tan advised that the accused had been released from hospital about a week ago but there are continuing pain issues, (he had) no energy and that the accused has remained in bed from the time of his release. Dr Tan advised that the accused was currently on hormonal therapy, that the accused’s immune system was already compromised and that his life expectancy was about six months. Although the accused had an appointment with Dr Tan at the Cancer Clinic in the week of 27 July, Dr Tan considered that the accused was currently just well enough to come into the Clinic for the appointment but would have to return home for bed rest. Dr Tan did not have any different view about the accused’s ability to actively take part in the trial.
Preparatory to the hearing before me, a meeting took place between Mr Grant, solicitor and Dr Tan in an attempt to obtain a form of updated report about the accused. The results of the meeting are recorded in Exhibit D1. It is appropriate that these reasons disclose the whole of the content of Exhibit D1. That document is attached as Appendix A to these reasons. Dr Tan opines that the accused’s ability to concentrate is very poor based on his observations of the past five days. It was constantly necessary to repeat simple instructions. The accused cannot recall conversations and often needs emphasis from a second person. His ability to retain important information is compromised. He has continual areas of pain including rectal pain from the prostate cancer which means that he cannot sit still and would be likely to require further chemotherapy when his condition is improved. The side effects of the drugs that he is receiving are fatigue, hot flushes, lack of vitality and there is a moderate impact on his ability to concentrate and take in information. Dr Tan repeated that the accused’s expected lifespan was somewhere in the order of 6 to 9 months and if his condition deteriorates, the accused would go straight to palliative care. The likely impact on his memory and concentration of the escalation of morphine as a pain killer is that the accused’s memory would eventually become very poor. Dr Tan opined that in relation to an 8 day trial on 17 August 2015, he thought that the accused did not have a capacity to sit through the trial and that his mental capacity was reduced by cancer and chemotherapy which has caused fatigue and pain. The accused could not meet to provide detailed instructions and he could not respond rationally in the Court at the trial. Dr Tan thought that if the accused was required to attend a trial, then an ambulance should be on standby. He thought that the accused’s concentration span could last no more than 1 hour at a time maximum and he would have poor concentration and memory. In my opinion, despite the submissions of the Prosecution, at page 6 of the document Exhibit D1, Dr Tan repeated what he considered to be the threat to the health of the accused of being in a room with say, 20 other people, due to cross infections that must be expected in that environment in August.
The submissions of the accused were that the trial listed for 17 August 2015 should be permanently stayed or postponed or that if the current date was to be retained, the hearing hours should only be from 10.00am until 1.00pm. The postponement of the trial date was sought under s289(1) of the Act. As the argument developed, the accused did not place significant emphasis on this application and I will leave it to one side. The accused also did not make any significant submissions on the question of the amendment of the hearing times for the trial. The focus was upon whether or not the trial should be permanently stayed. The submissions of the accused were that having regard to what is known of the nature of the trial, the physical infirmities suffered by the accused, his physical condition, his ongoing pain and his drug therapy, then he is mentally unfit in terms of s269H of the Act. He is also unable to prepare adequately for the trial, a prolonged attendance in a courtroom would pose significant health risk and a lengthy trial would take up a significant part of the small remaining lifespan of the defendant.
Section 269H of the Act reads as follows:-
269H—Mental unfitness to stand trial
A person is mentally unfit to stand trial on a charge of an offence if the person's mental processes are so disordered or impaired that the person is—
(a) unable to understand, or to respond rationally to, the charge or the allegations on which the charge is based; or
(b) unable to exercise (or to give rational instructions about the exercise of) procedural rights (such as, for example, the right to challenge jurors); or
(c) unable to understand the nature of the proceedings, or to follow the evidence or the course of the proceedings.
The forms of expression in s269H appears to be drafted in a deliberately broad way. There is no suggestion in the drafting method that they are to be read down in any way; they are to be given their natural and ordinary meaning consistent with the purposive approach to statutory interpretation: see ICAC v Cuneen [2015] 89 ALJR 475 at 483.

For s269H, a person’s mental fitness to stand trial is to be presumed unless it is established on an investigation under Division 3 of Part 8A of the Act that the person is mentally unfit to stand trial.
A Court may make an Order for investigation of a person’s mental fitness to stand trial under s269J. Under s269K of the Act, a Court is also entitled to require a preliminary prognosis of a defendant’s condition.
Section 269J(1) relevantly reads as follows:-
269J—Order for investigation of mental fitness to stand trial
(1) If there are reasonable grounds to suppose that a person is mentally unfit to stand trial, the court before which the person is to be tried may order an investigation under this Division of the defendant's mental fitness to stand trial.
Section 269K(1) relevantly reads as follows:-
269K—Preliminary prognosis of defendant's condition
(1) Before formally embarking on an investigation under this Division of a defendant's mental fitness to stand trial, a court may require production of psychiatric or other expert reports that may exist on the defendant's mental condition and may, if it thinks fit, itself have a report prepared on the defendant's mental condition.
The submissions of the accused focused upon the fact that his extremely weakened condition, his inability to concentrate, his inability to retain information and his inability to focus upon matters except for a short period of time meant that there were reasonable grounds to suppose that the accused was not mentally fit to stand trial. The accused submitted that this was a sufficient basis to order a stay of the prosecution. The attitude of the Prosecution on that application was that there was insufficient information before the Court in the form of medical reports or evidence to establish the existence of any form of abuse of process justifying the imposition of a stay of proceedings. Rather, the appropriate process was to use s269J of the Act to enquire as to the mental fitness of the accused. On that matter the Prosecution submitted that there was as yet insufficient information before the Court to justify an enquiry pursuant to s269J of the Act. The Prosecution also submitted that it was possible to make arrangements to accommodate the accused’s current medical condition. The submissions of the Prosecution then focussed upon the relevant factual material standing behind the allegations made against the accused, the current state of the accused’s health and then the general legal principles.
I accept the submissions of the Prosecution that there is insufficient information before me in the form of medical reports or evidence to establish the existence of what may be described as an “abuse of process” justifying the imposition of a stay of proceedings. I do not think that the heavy onus upon the accused to establish an abuse of process has been discharged. The accused was excused from the hearing and recent Directions Hearings and he did not give evidence in support of this application in the form of an affidavit. I have not seen him in evidence and so I have not had any opportunity to make observations of him. The relevant principles are well known and do not need to be discussed further here.[1]
[1] Jago v District Court of New South Wales (1989) 168 CLR 23 especially at page 34; Roma v District Court of South Australia (1995) 63 SASR 223; Police v Makrou (2008) 103 SASR 364 at [73]; Barton v The Queen (1980) 147 CLR 111.
As the application evolved, the focus upon the submissions of both the Prosecution and the accused rested on Part 8A of the Act. The relevant principles which inform the operation of that Part are generally well understood and they are as follows:-
1. It will be necessary to ensure that a trial would not be rendered unfair by reason of the inability of an accused person to participate in a trial in an appropriate manner;[2]
2. Abuse of process has little relevance in circumstances where Part 8A of the Act has application.[3]
[2] R v Abdulla (2005) 93 SASR 208 at 214.
[3] Ibid at 228; R v Sexton (2000) 77 SASR 405 at 418; R v Hakim (1989) 41 A Crim R 372 at 376-377.
In R v Jacobi[4] the Court of Criminal Appeal considered an appeal from a decision of Judge Soulio of this Court where his Honour refused an application for permanent stay of proceedings on the ground that the continuation would constitute an abuse of the Court’s process. The appellant Mr Jacobi had been charged with 13 counts of sexual offences against three brothers between 1976 and 1989. The ill health suffered by Mr Jacobi consisted of cardiac failure due to atrial fibrillation, drug therapy which leads to frequent urination and incontinence problems; depression; severe shaking of hands as a manifestation of anxiety; suicidal ideation due to severe depression; and osteoarthritis of both hips and knees severely limiting his mobility. Mr Jacobi’s treating General Practitioner expressed his concern that his ability to attend lengthy Court proceedings in light of the combination of his physical and mental health problems. There was no deficit of Mr Jacobi’s memory although concentration was affected by pain from osteoarthritis and depression. The medical evidence was that Mr Jacobi’s memory and recall of events was quite good.
[4] [2012] SASCFC 115.
Gray and Sulan JJ held[5] that a permanent stay may be granted in an appropriate case where it will offend common humanity to require the accused to stand trial. In the balancing of the public interest and the effect of a malady or maladies upon an individual accused, it will only be in a rare case that an intervening illness or physical or mental condition of the accused would justify that conclusion.
[5] At [22].
Gray and Sulan JJ concluded at paragraphs [32] and [33] as follows:-
[32] In our view, the medical conditions of the defendant are not so serious as to render a trial unfair, by reason of a lack of common humanity. We consider the circumstances in Hakim to be far more compelling than those in the defendant’s case. In Hakim, the defendant had already been in a gaol hospital for six months. His prognosis was poor, with not only physically deteriorating factors but neurological and psychological problems also.
[33] The alleged offences are serious offences. There is a legitimate public interest in the determining of charges of this kind to maintain public confidence in the administration of justice. In our view the trial Judge was correct in his assessment of the medical evidence, and further, the measures that could be taken to ensure the effective participation of and comfort of the defendant, with respect to his ability to concentrate. It has not been demonstrated that the proceedings would involve an unjustifiable or unacceptable degree of oppression to the defendant. We consider that the discretion did not miscarry.
The Prosecution emphasised the public interest in the matter proceeding to trial and relied upon well settled authority.[6]
[6] R v Athanasas [2014] SASCFC 14.
It is a correct observation that all of these cases turn on their peculiar facts. The physical condition of the accused under consideration in Hakim was quite different to the physical condition of the accused in Jacobi and in turn was quite different to the physical condition of the accused in R v Liddy.[7]
[7] [2010] SADC 80.
These are all questions of fact and matters of judgment.
I have already referred to s269H, s269J and s269K of the Act. Based upon a consideration of the whole of the medical evidence of Dr Tan and the other evidence before me (limited though it is), there are reasonable grounds to suppose that for s269H and s269J of the Act, the accused is mentally unfit to stand trial, sufficient for me to order an investigation of his mental fitness to stand trial. I have power under s269J to order an investigation into the defendant’s mental fitness to stand trial. Alternatively, I may make an Order under s269K before formally embarking on an investigation under the Division (under s269H and s269J) for the production of psychiatric or other expert’s reports that may exist on the defendant’s medical condition and I may require a report to be prepared on the defendant’s medical condition. I have formed the view that it is appropriate here to require production of a report under s269J of the Act.
Having regard to the conclusions that I have already expressed, I am satisfied that there are reasonable grounds to suppose that the accused is mentally unfit to stand trial. I order that under s269J(1) of the Act an investigation be undertaken of the accused’s mental fitness to stand trial.
During submissions, Counsel for the accused suggested that the provider of the report should be a neuropsychologist. I agree with that suggestion. As the view that I have formed is based in part upon the pharmacological effect of the drug treatment given to the accused and the effect of pain on his mental state, it may become necessary to obtain a report of a palliative care specialist who is familiar with pharmacology. That is a matter that can await the report of the neuropsychologist.
APPENDIX A
Meeting with Dr Thean Hsiang TAN on 30 July 2015 at 8am re: Amarjit Singh Sandhu
Mr Sandhu’s Current Physical Condition
Main Diagnosis:
·What is ‘castrate resistant prostate cancer”
no longer sensitive to hormonal manipulation/treatment
when diagnosed with this 18 months life expectancy. Diagnosed 12 months ago.
·What is ‘associated pain from his bony secondaries and neurological involvement’
Right Hand Side – cancer in lumbar – sciatic pain down leg
Bi-lateral painful tingling in feet
Other Conditions and their impact on his condition
·What is ‘Type II diabetes mellitus’
not major
not contributing
·What is ‘Steroid induced hyperglycemia’
on steroids at the moment
not a major problem – sugar levels can be a bit high
When Dr Tan last saw him in Clinic
Saw on Tuesday – discharged after admitted for 5 days. 2^nd admission in last month
This one for pain management and sever constipation.
Dr Tan’s Assessment of Mr Sandhu’s Condition

Energy Levels
Pretty poor
50% resting
·Fatigueability
Very easy to fatigue. No scale but your observations.
ECOG
0.   (no symptoms)
1.   Symptoms – but close to normal
2.   Can do things but 50% or less resting/sleeping
3.   50%+ rest/sleep (this is Mr Sandhu)
4.   Bed bound
5.   Dead
*ECOG stands for Eastern Cooperative Oncology Group – see

·Ability to Concentrate
Very poor – based on observations of past 5 days. Constantly repeating simple instructions
·Ability to follow conversations
on medications for long time – but cannot remember them. Often need a second person to emphasize it.
·Ability to remember important information
Cannot retain it – even if simplified it is challenging for him.
·Pain Levels
Can’t sit or stand for long. Restless from pain.
Made worse by back and foot pain.
·Main areas of pain
anal pain – prostate cancer – pain around there – cannot sit still.
will likely have chemotherapy to treat this when his condition improves.
·Activites that exacerbate pain
If he doesn’t take painkillers.
Sitting for a long time
·General Quality of Life
No quality of life.
Current Medication
·Hormonal Therapy – what is it
stay on this until die.
Implant to reduce testosterone level.
Abiraterone – inhibits production of testosterone via adrenal gland – causes fatigue and ankle swelling
·Side effects of these druges
Fatigue
Hot flushes
Vitality
Libido
Mr Sandhu experiencing these
·Analgesics – Morphine
Targin - contains    (a) oxycontin – morphine derivative
  (b) naloxone – help manage constipation
Lyrica – nerve pain (sciatic pain/pain anus/foot pain)
Prednisolone (steroid) – (navicular bone break 2014) (R) chronic pain
Docetaxel – Chemo – affected ability to heal bone break
·Impact on ability to concentrate, take in information
Moderate impact
·Any other side effects relevant to Mr Sandhu
Constipation
·Any other medication currently taken
Nexium for epigastric pain
·Likelihood of chemotherapy or radiotherapy and the impact on his physical condition
If well enough will have chemotherapy
Prognosis
·Likely Life Span
Approximately 6-9 months
·Quality of life in that time
Very poor
·Likely treatment changes if condition deteriorates
If goes downhill withdrawl of all treatment. Introduction of palliative care.
·Likely impact on memory and concentration if condition deteriorates
If escalation of morphine then memory very, very poor.
In Relation to an Eight Day Trial in mid-August 2015
Based on your observations of Mr Sandhu and assessment of his current medical condition and associated conditions:
Ability to provide instructions to legal team on many hundreds of pages of financial and legal documents such as loan application and legal agreements for a number of years ago
does not have capacity to on current condition.
mental capacity reduced by cancer and chemo – fatigue and pain
cancer causes fatigue AND insomnia – problem.
Ability to meet on a numerous occasions for several hours at a time to provide detailed instructions
seriously doubt it
Ability to understand legal advice given to him and respond rationally to it in the course of a trial
Will not be able to do this
Will need an ambulance on standby
Ability to maintain concentration through an eight (8) day trial sitting from 10am to 4.30pm with lunch from 1pm to 2.15pm and short breaks at around 1145am and 3.30pm
Cannot last more than 1 hour at a time maximum
Ability to follow the evidence in the course of proceedings through an eight (8) day trial sitting from 10am to 4.30pm with lunch from 1pm to 2.15pm and short breaks at around 1145am and 3.30pm
Very hard due to poor concentration and memory.
Will Mr Sandhu be able to recall evidence from early in the day or from a previous day if necessary
No – very poor short term memory and memory retention.
Impact of an Eight Day Trial on Mr Sandhu’s Health
Is his immune system currently compromised in any way and, if so, how
To a certain extent due to cancer. Had radiotherapy and chemo. Cannot assess numerically.
If it is, based on your observations and treatment of cancer patients undergoing similar treatment, would exposure to up to 20 people in a courtroom setting for days pose a significant risk of infection and, if so, why
Not negligible – not overwhelming
·If he catches an infection in a weakened state, what are the possible outcomes
Febrile neutropenia is considered a medical emergency due to high risk of death
·The likely impact on his current energy levesl and quality of life generally of a lengthy trial
Reduce quality of already compromised life.
Mr Sandhu – compliant with medical advice.