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| Nurse who treated Joel Cauchi for schizophrenia threw up when told about Bondi Junction stabbings, inquest hears | Nurse who treated Joel Cauchi for schizophrenia threw up when told about Bondi Junction stabbings, inquest hears |
| (32 minutes later) | |
| Health worker describes 40-year-old as ‘compliant’ and ‘diligent’ patient but recalls 2020 phone call and a possible ‘warning sign’ of mental health relapse | Health worker describes 40-year-old as ‘compliant’ and ‘diligent’ patient but recalls 2020 phone call and a possible ‘warning sign’ of mental health relapse |
| A nurse at the Queensland medical practice where Joel Cauchi was treated for schizophrenia remembers him as a “compliant” and “diligent” patient and told an inquest that she vomited when she learned he had fatally stabbed six people at a Sydney shopping centre. | A nurse at the Queensland medical practice where Joel Cauchi was treated for schizophrenia remembers him as a “compliant” and “diligent” patient and told an inquest that she vomited when she learned he had fatally stabbed six people at a Sydney shopping centre. |
| Cauchi, 40, killed Ashlee Good, 38, Jade Young, 47, Yixuan Cheng, 27, Pikria Darchia, 55, Dawn Singleton, 25, and Faraz Tahir, 30, and injured 10 others at Westfield Bondi Junction on 13 April last year before he was shot and killed by police inspector Amy Scott. | Cauchi, 40, killed Ashlee Good, 38, Jade Young, 47, Yixuan Cheng, 27, Pikria Darchia, 55, Dawn Singleton, 25, and Faraz Tahir, 30, and injured 10 others at Westfield Bondi Junction on 13 April last year before he was shot and killed by police inspector Amy Scott. |
| Cauchi was treated at a private Queensland clinic from 2012, when he was discharged from the public health system after 11 years in its care. Known only as RN2, the mental health nurse said that she saw Cauchi on a monthly basis from 2015 to 2017, when she monitored his psychotropic medication for his schizophrenia and OCD. | |
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| When she learned of the stabbings, she was sent a text saying the Bondi Junction attacker was from Toowoomba. | When she learned of the stabbings, she was sent a text saying the Bondi Junction attacker was from Toowoomba. |
| “I looked it up and then I vomited when I saw it was him,” she told the court. “It’s odd, it’s incongruent with what I know of Joel. It really doesn’t make any sense. | “I looked it up and then I vomited when I saw it was him,” she told the court. “It’s odd, it’s incongruent with what I know of Joel. It really doesn’t make any sense. |
| “I was incredibly shocked. I wouldn’t have ever thought that was something that he would have done. I had a very visceral response to that,” she said. | “I was incredibly shocked. I wouldn’t have ever thought that was something that he would have done. I had a very visceral response to that,” she said. |
| In the third week of the five-week inquest into the seven deaths, the court was exploring why Cauchi was weaned off psychotropic medication and how he dropped out of the mental health system from 2020. | In the third week of the five-week inquest into the seven deaths, the court was exploring why Cauchi was weaned off psychotropic medication and how he dropped out of the mental health system from 2020. |
| RN2 said Cauchi was “someone who was very compliant … he was never even late for appointments and there was no having to chase him up, he was very compliant”. | RN2 said Cauchi was “someone who was very compliant … he was never even late for appointments and there was no having to chase him up, he was very compliant”. |
| “I actually thought he was relatively insightful and he was also concerned about his illness in that he was quite diligent in monitoring for signs of relapse. He didn’t want to get unwell and he was very conscientious with regard to his mental health. I think that was evidenced by his punctuality and engagement with our service,” the New South Wales coroner, Teresa O’Sullivan, heard. | “I actually thought he was relatively insightful and he was also concerned about his illness in that he was quite diligent in monitoring for signs of relapse. He didn’t want to get unwell and he was very conscientious with regard to his mental health. I think that was evidenced by his punctuality and engagement with our service,” the New South Wales coroner, Teresa O’Sullivan, heard. |
| “He had anxiety around it,” RN2 said, adding that he “wanted to get the support and do the right thing”. | “He had anxiety around it,” RN2 said, adding that he “wanted to get the support and do the right thing”. |
| Cauchi had been prescribed Clopine [clozapine], indicating that he had treatment-resistant schizophrenia, she said. | Cauchi had been prescribed Clopine [clozapine], indicating that he had treatment-resistant schizophrenia, she said. |
| “That obviously meant that his condition was quite severe … However, because he was so compliant, he wasn’t difficult to manage and he was stable as well.” | “That obviously meant that his condition was quite severe … However, because he was so compliant, he wasn’t difficult to manage and he was stable as well.” |
| Cauchi’s treatment plan was to reduce the Clopine to the most effective level relative to the side effects as opposed to ceasing the medication, the court heard. | Cauchi’s treatment plan was to reduce the Clopine to the most effective level relative to the side effects as opposed to ceasing the medication, the court heard. |
| Cauchi’s medical notes from early 2016 showed he was “easier and more relaxed” on a lower dose of Clopine. The nurse said she saw an improvement in his energy levels and “more quality of life” and did not have any concerns about his medication being lowered. | Cauchi’s medical notes from early 2016 showed he was “easier and more relaxed” on a lower dose of Clopine. The nurse said she saw an improvement in his energy levels and “more quality of life” and did not have any concerns about his medication being lowered. |
| The nurse left the practice and returned in 2019, by which time Cauchi had stopped taking Clopine altogether. She said she had never heard of a patient ending Clopine without moving to other alternative drugs. | |
| On 14 February 2020, the nurse spoke with Cauchi’s mother after she called the practice expressing her concern about his inability to keep his unit tidy. He was preparing to move to Brisbane at the time. When she broached the subject with him, he would become irritable, the court heard. | On 14 February 2020, the nurse spoke with Cauchi’s mother after she called the practice expressing her concern about his inability to keep his unit tidy. He was preparing to move to Brisbane at the time. When she broached the subject with him, he would become irritable, the court heard. |
| Notes from that call were read to the court. | Notes from that call were read to the court. |
| “He can’t seem to look after himself”, the court heard, with dishes in his sink and “mess everywhere”. He was isolated, irritable and occasionally swearing, the practice was told. | “He can’t seem to look after himself”, the court heard, with dishes in his sink and “mess everywhere”. He was isolated, irritable and occasionally swearing, the practice was told. |
| “That was out of character,” the nurse said, adding that the concerns may have been due to Cauchi’s developmental delay because of his illness – or early warning signs of relapse. | “That was out of character,” the nurse said, adding that the concerns may have been due to Cauchi’s developmental delay because of his illness – or early warning signs of relapse. |
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| Cauchi’s transfer of care ‘less than ideal’ | |
| Shortly afterwards, Cauchi moved to Brisbane and was discharged from the practice into the care of his GP in the Toowoomba area because he did not have a GP in Brisbane, the court heard. | |
| RN2 recalled a conversation between practice staff suggesting Cauchi’s move from the area and its support network was “less than ideal” but that the team did not have specific concerns. | |
| She said schizophrenia patients – who were often highly disorganised – having to self-manage their transfer to a new psychiatrist via a GP was “not an ideal system”. | |
| Under cross-examination by Sue Chrysanthou SC, the barrister for the families of Young, Singleton and Good, RN2 said the concerns of Cauchi’s mother “needed to be taken seriously” given he could have been falsely reporting his symptoms to the nurse and his psychiatrist. | |
| The nurse agreed that it was inappropriate to go from monthly monitoring to zero care. | |
| When asked whether the practice should have followed up with Cauchi after March 2020 to check he had a new psychiatrist, she replied: “Ideally.” | |
| “The best system would be to ensure there was continuity of care,” she said. | |
| The court was shown Cauchi’s discharge letter from the private practice to his GP in March 2020. There was no recommendation for monthly monitoring by his treating psychiatrist. | |
| Chrysanthou asked RN2 if, when on medication, did Cauchi show signs of violence, hallucination, hearing voices or discuss having a knife collection. | |
| He did not, the nurse replied. | |
| The nurse said that Cauchi would have had to have been deemed at risk of harm to himself or others to be detained under the mental health act and forced to take antipsychotic medication. | |
| In her opening remarks last month, the senior counsel assisting Peggy Dwyer SC said that Cauchi had successfully been treated for schizophrenia for more than 18 years. He “was effectively lost to follow-up from early 2020”, Dwyer told the court. | |
| In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978. In the UK, the charity Mind is available on 0300 123 3393 and Childline on 0800 1111. In the US, call or text Mental Health America at 988 or chat 988lifeline.org. | In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978. In the UK, the charity Mind is available on 0300 123 3393 and Childline on 0800 1111. In the US, call or text Mental Health America at 988 or chat 988lifeline.org. |