Re Kam
[2002] QMHC 6
•29 November 2002
MENTAL HEALTH COURT
CITATION: | Re KAM [2002] QMHC 006 |
PARTIES: | REFERENCE BY THE DEFENDANT’S LEGAL REPRESENTATIVE IN RESPECT OF KAM |
PROCEEDING NO: | 0192/02 |
DELIVERED ON: | 29 November 2002 |
DELIVERED AT: | Brisbane |
HEARING DATES: | 26 November 2002 |
JUDGE: | Wilson J |
ASSISTING PSYCHIATRISTS: | Dr D A Grant |
FINDINGS AND ORDERS: | 1. That when the alleged offence was committed, the defendant was suffering from unsoundness of mind as described in Schedule 2 of the Mental Health Act 2000; 2. That no forensic order be made. |
CATCHWORDS: | MENTAL HEALTH – DECLARATION OR FINDING OF MENTAL ILLNESS OR INCAPACITY – where defendant charged with dangerous operation of a motor vehicle – whether defendant suffered from unsoundness of mind at the time of the offence – where defendant had no history of psychiatric disorder – where defendant was prescribed anti-nausea medication, and a dosage of anti-depressant medication at the upper end of the clinical dosage range, prior to the offence being committed – where defendant suffered an idiosyncratic reaction to the medication – where defendant suffered from delirium at the time the offence was committed – whether the delirium suffered was a mental disease within the meaning of the definition of unsoundness of mind – whether the delirium itself was of sufficient intensity to deprive the defendant of the capacity to control her actions and to know that what she was doing was wrong – whether unintentional intoxication comes within the scope of unsoundness of mind – whether the extensions to s. 27 of the Criminal Code effected by s. 28 are incorporated into the definition of unsoundness of mind in Schedule 2 – whether a forensic order should be made
|
COUNSEL: | B Devereaux for the defendant |
SOLICITORS: | Legal Aid Queensland for the defendant |
WILSON J: KAM (“the defendant”) has been charged with the dangerous operation of a motor vehicle on 14 May 2001. The matter of her mental condition at the time of the alleged offence was referred to the Mental Health Court by her legal representative on 14 May 2002.
The defendant was born on 4 December 1977. She has no history of psychiatric disorder, apart from mild to moderate depression which commenced during a pregnancy about two years before the alleged offence. She was being treated with antidepressant medication and hormonal therapy for irregular menstrual bleeding.
On 11 May 2001 she was suffering from gastroenteritis. Her general practitioner gave her an injection of 10mg of metoclopramide (otherwise known as maxolon) an anti-nausea drug, to stop her vomiting and prescribed oral maxolon. She had an adverse reaction to this medication, which caused torsion dystonia of her neck with oculogyric crisis – her head kept turning back and her eyes went upwards.
To counteract this muscle spasm, on 12 May 2001 another general practitioner prescribed cogentin 2mg. The doctor’s prescription was for 60 tablets (the standard prescribable quantity of cogentin 2mg tablets), although she was instructed to take one tablet three times daily for two days only. On 14 May 2001 the doctor saw her again and advised her to cease the cogentin. Precisely how much cogentin she took is not known, but there is no evidence of an overdose or that she failed to follow the doctor’s directions.
Shortly after 6.00pm on 14 May 2001 the defendant drove her mother in law and two children to ten pin bowling. Her mother in law found her “a bit odd” and forgetful of the way to the bowling club. After about 9.00pm the defendant drove her mother in law home, and said she was going straight home herself.
A little after 10.00pm the defendant drove her vehicle into the driveway of a police officer’s home. Her two small children were in the back. The vehicle’s lights were on high beam. Then she drove it to a position on the grass verge directly in front of the house, its lights still on high beam and shining directly at the house. Accosted by the police officer, she said, “I’m here to delivery hay.” There was no hay. The police officer’s husband (also a police officer) appeared and asked the defendant what was going on. She revved the engine loudly and drove directly at the man. He was struck on the feet, and rolled on to the windscreen and over the top of the car. The defendant stopped the vehicle. Its windscreen was broken. She shouted, “My children!”
The defendant repeated her story about having hay to deliver to another police officer who arrived on the scene. She explained that she had become frightened because people had shone torches through her car windows. She said she had taken off and had not seen the man her car had hit. She claimed her mother in law was still in the car. She was taken to the police station where she was disorientated in place. She was clearly too unwell to take part in a formal interview.
I am satisfied on the evidence of Dr M S Carter (general practitioner) and Dr Peter Fama (psychiatrist) that the defendant was suffering from a transient acute delirium as a side effect of the cogentin she had taken. Such a delirium is recognised as a mental illness in ISD-10, (classification F15.03- Mental and behavioural disorders due to use of other stimulants, including caffeine – acute intoxication with delirium) and in DSM-IV-TR (substance intoxication delirium).
Both of the assisting psychiatrists considered it to be a mental illness from the clinical perspective. Dr Wood described the defendant as having an idiosyncratic reaction to cogentin, rather than classic intoxication within hallucinations. Dr Grant advised the Court that a number of factors may have contributed to the delirium – the effects of the anti-depressant and anti-nausea medication, that she may have been dehydrated from the infectious disease, and that she may have been particularly sensitive to cogentin. Cogentin is a drug where the upper end of the clinical dosage range is close to the toxic level. The prescribed dosage was within the clinical range, but at its upper end. A particularly sensitive patient might become delirious on such a dosage.
I have taken account of those passages in ISD-10 and DSM-IV-TR to which I was referred and the advice of the assisting psychiatrists in reaching my conclusion that the delirium from which the defendant suffered was a mental disease within the meaning of the definition of “unsound mind” in Schedule 2 of the Mental Health Act2000.
Further, I am satisfied that the delirium itself was of sufficient intensity to deprive the defendant of the capacity to control her actions and of the capacity to know that what she was doing was wrong. It is unnecessary to consider whether unintentional intoxication comes within the scope of unsoundness of mind for the purposes of the Mental Health Act2000. I note the submission of Mr Devereaux for the defendant that the extensions to section 27 of the Criminal Code effected by section 28 of the Code are incorporated into the definition of “unsound mind” in Schedule 2 of the Mental Health Act. Whether this is so remains an open question.
I find that at the time of the alleged offence the defendant was suffering from unsoundness of mind as described in Schedule 2 of the Mental Health Act2000. A forensic order is not called for in the circumstances of this case and I expressly decline to make one.
0
0
2