An external review was conducted on treatment given to a mental health patient who, just days after being released from hospital, killed an Auckland pensioner, but the findings weren't disclosed to a court hearing his murder trial, shocking the lawyers involved.
The Auckland District Health Board's (ADHB) treatment and diagnoses of Gabriel Hikari Yad-Elohim - a man with a history of schizophrenia - in the days before he brutally killed Michael David Mulholland has come under fire during Yad-Elohim's High Court murder trial.
Today, Dr Peter (William) McColl, the service clinical director at ADHB's mental health unit Te Whetu Tawera, was questioned under cross-examination by defence lawyer Matthew Goodwin.
The doctor said an external review has already been completed on Yad-Elohim's treatment, surprising Goodwin and others in the courtroom unaware of the report.
The review, McColl said, showed the medical notes kept on Yad-Elohim were "misleading" but added he did not think he or his staff "dropped the ball".
The Herald earlier revealed Yad-Elohim, a 30-year-old Japanese man, was a patient at Te Whetu Tawera.
Herald sources said the Tokyo-born man was released from its care just three days before killing Mulholland, 69, whose body was found in the stairwell at the Western Springs flats where he lived on September 26 last year.
The defence team, led by Annabel Cresswell, is seeking a verdict of not guilty by reason of insanity for Yad-Elohim, who changed his name from Yuuki Watanabe to his Hebrew name, which translated means "hand or messenger of God".
Earlier today, McColl spoke of when Yad-Elohim self-presented at Auckland City Hospital's emergency room on September 17 before later being admitted to his mental health ward.
Medical notes show Yad-Elohim was agitated and disorganised when first assessed by the on-call psychiatrist.
"He may have also been hearing the voice of God, but that wasn't that clear," McColl said.
During McColl's cross-examination, the court also heard of medical notes stating Yad-Elohim had thoughts of harming others.
He was hearing "two chronic voices", one was of Satan, the second was a voice telling him to avoid Africans and Koreans, the court heard.
However, the notes also said Yad-Elohim wished to kill Africans and Koreans.
"This voice has increased and he is now overwhelmed by it," the notes show.
"He presents in a disorganised manner and he may act on such thoughts," the on-call psychiatrist wrote.
Yad-Elohim also asked for a Bible and grew upset when he did not immediately get one
"Te Whetu Tawera is a pretty acute place, everyone there is pretty ill," McColl said.
Yad-Elohim's condition, however, appeared to improve after he was given anti-psychotic medication, according to the doctor, and, by September 20, Yad-Elohim had stopped hearing voices.
A drug test had also showed traces of methamphetamine and cannabis in Yad-Elohim's system.
Under cross-examination, however, McColl conceded it is difficult to conclude if a person's psychosis is caused by substance abuse or other health issues.
Despite this, with Yad-Elohim's condition seemingly improving, McColl decided to discharge his patient and scheduled community treatment. But Yad-Elohim was kept in the unit because he had no accommodation.
Then, on September 23, there were 56 patients at Te Whetu Tawera, leaving just two empty beds.
McColl said that day two more people at Auckland City Hospital had been sectioned under the Mental Health Act.
"The hospital [Te Whetu Tawera] had become full," the doctor said.
"If it becomes full [we] look for people to discharge to respite," he said, explaining respite is the process of finding a halfway house for the patient.
Yad-Elohim was released and just three days later Mulholland was killed.
"I'm very aware of the [alleged] murder," McColl said.
"I regret to say the deceased did not fit the demographic [of Yad-Elohim's death threats] ... I am bitterly sorry for the victim's family in the back of the court."
However, before Yad-Elohim's release a doctor had noted he was "still" having hallucinations to kill people.
"I think she's mistaken," McColl told the court, questioning his own doctor's notes.
Goodwin said: "You're trying to throw her under the bus because you've got a medical record indicating that only a few days before the killing that he's still suffering from hallucinations to kill."
McColl denied the accusation.
"It was a good discharge, it was well thought through," McColl said. "This is what we do."
Goodwin asked: "Where are the safeguards, doctor, where are the safeguards for the community with this patient being released?"
McColl replied: "All the pieces were in place to follow up ... he was well, his symptoms had resolved.
"He no longer needed hospital-level care," McColl, who admitted some of his notes were also inaccurate, said.
"You say that but three days after release he killed someone," Goodwin retorted.
Dr Anton Wiles also told the court of Yad-Elohim's medical assessment while the accused was in custody after the bloody assault.
Wiles said he was alerted to Yad-Elohim's schizophrenic condition by arresting officer Detective Ray Fa'aofo.
The doctor made notes which described Yad-Elohim sitting in a chair "making jerky movements" with his limbs and sweating from his brow.
Wiles also made a comment to Fa'aofo that given Yad-Elohim's mental health history he assumed his legal counsel would seek an insanity defence.
CCTV recorded the entirety of Yad-Elohim's attack on Mulholland.
It shows Yad-Elohim pulling Mulholland out of his apartment and viciously beating him to death in the stairwell.
The footage has been suppressed by Justice van Bohemen but lasts several minutes and has been seen by the Herald.
Yad-Elohim was arrested in central Auckland the day after the attack.
During his recorded police interview with Fa'aofo, conducted without a lawyer, Yad-Elohim talks to himself in Japanese of nirvana and Jesus several times.
He also appears to start "maniacally laughing", Cresswell described to the court yesterday.
Fa'aofo told the court when police searched Yad-Elohim on its database a mental health alert appeared underneath his name,
However, under the orders of Detective Phil Cox, no further action was taken for a mental health assessment of the defendant.
Crown prosecutor Kirsten Lummis told the jury the killing was a "drug deal gone wrong".