Joel Cauchi, a nurse in Queensland medical practice, was treated for schizophrenia, which made him remember him as a "compliant" and "hardworking" patient, told an investigation that she vomited when she learned that he had stabbed six people fatally in Sydney Mall.
Cauchi, 40, killed Ashlee Good, 38, Jade Young, 47, Yixuan Cheng, 27, Pikria Darchia, 55, Dawn Singleton, 25, and Faraz Tahir, 30, and was injured in Westfield Bondi Junction on April 13 last year and was shot and killed by police inspectors on April 13 last year.
Beginning in 2012, receiving treatment at a private clinic in Queensland, after being discharged from the public health system after 11 years of care. Mental health nurses are known only as RN2, she said she saw Cauchi monthly from 2015 to 2017 when she monitored his psychotropic drugs for schizophrenia and obsessive-compulsive disorder.
When she was sent, she learned the stabbing text, saying that the attacker at the Bundy junction was from Toowoomba.
"I looked at it and then saw it was his vomiting," she told the court.
"It's weird, it's not consistent with what I know about Joel. It really doesn't make any sense.
"I was very shocked. I never thought that he would do it. I had a very intrinsic response to it."
In the third week of investigating seven deaths in the five-week investigation, the Lidcombe Coroner Court is exploring why Cauchi was weaned from psychotropic drugs and how he exited the mental health system from 2020.
RN2 said Cauchi was “a very compliant guy…he never even came to date late and didn’t have to chase him, he was very compliant.
"I actually think he is relatively insightful and he is worried about his illness because he is very diligent in monitoring the signs of relapse. He doesn't want to be uncomfortable, he feels very serious about his mental health. I think it's evidenced by his punctuality and interaction with our service.
RN2 said: "There is anxiety around him.
Cauchi was prescribed (clozapine), indicating that he was resistant to drugs.
"It obviously means he's in a serious condition. But because he's so compliant, it's not difficult for him to manage and he's stable."
The court was informed that Kuch's treatment plan was to reduce chloropyridine to the most effective level relative to side effects such as cognitive "fuzzy" and sedation, rather than stopping the drug.
Cauchi's medical notes in early 2016 showed that he was "easier, easier" on lower doses of mountain planets. The nurse said she saw improvements in his energy levels and “higher quality of life” and was not concerned about lowering the drug.
The nurse left the practice and returned in 2019, when Cauchi completely stopped Clopine. She said she had never heard of the end of the mud without a replacement drug.
Asked Monday that on February 14, 2020, the nurse called Cauchi's mother and said she was concerned about the exercise and said she was worried about her inability to keep it clean.
He was preparing to move to Brisbane at the time. He becomes irritated when she brings up the topic with him. Notes on the phone have been read to the court.
The court heard: "He doesn't seem to take care of himself." He was told that he was isolated, irritated, and occasionally swore.
"That's out of place," the nurse said.
The court heard that shortly afterwards, Cauchi moved to Brisbane and fired his GP in the Toowoomba area from practice because he had no GP in Brisbane.
RN2 recalled conversations between the practitioners, suggesting that Cauchi was moving from the region and that its support network was "not ideal", but the team had no specific concerns.
She said that often highly confusing schizophrenia patients must self-manage themselves through GP self-transfer to new psychiatrists, which is not an “ideal system”.
Under cross-examination by Sue Chrysanthou SC, the attorney at RN2, who is a lawyer for Young, Singleton and Good, said Cauchi's mother "needs to be taken seriously" concerns because he could have mistakenly reported his symptoms to nurses and psychiatrists.
The nurse agrees that it is not appropriate to go from monthly monitoring to zero care.
When asked if Cauchi should follow up after March 2020 to check that he has a new psychiatrist, she replied: “Ideally.
“The best system is to ensure continuous care,” she said.
After the newsletter promotion
The court presented Cauchi's release letter from private practice in March 2020.
Chrysanthou asked RN2, whether Cauchi showed signs of violence, hallucinations, sounds, or the signs of collecting a knife while taking the medication. He didn't, the nurse replied.
Cauchi must be seen as a risk of harm to himself or others, and is detained under the Mental Health Act and forced to take antipsychotic drugs, the nurse said.
A year ago, Kuch's mental health had a loud wake-up call with his mother.
A second mental health nurse (known only as RN3) took over Cauchi's drug monitoring in 2018, and he agreed to Cauchi's health within a few months after stopping Clopine.
Notes from the exercises shown in court noted that in October 2018, Cauchi “had a great performance in function and could do it better than ever before.
In September 2019, these notes show that Cauchi is still “doing well” and completes TESOL certification but has poor sleep.
On October 17, 2019, Kuch's mother began to express concerns about possible relapse. The notes indicate that Coach showed no early warning signs of relapse, except for fatigue and less sleep.
They discussed Cauchi joining a peer support program to help him transition from home to independent living. Kuch's dates are transferred from monthly to weekly contact.
By next month, Cage's mother attracted significant attention to the practice of possible relapse.
His mother said he was writing “a lot of notes at home,” some of which imply that he was under Satan’s control. He had a desire for porn and said she observed "interesting walking" and "gait changes." He wore many clothes to prevent himself from getting sick.
He asked in an email from Cauchi to practice on November 12, 2019, that Cauchi admitted that he wanted to limit his porn exposure: "We can introduce some ideas for free porn phones...I want to have a completely free porn internet on my device."
She wrote in an email from Cauchi's mother to practice on November 20, 2019: "I feel like he is hearing sounds and so on now. He is very distracted, forgetful, obsessive-compulsive and obsessive-compulsive disorder with the soap in half of his shower...I don't want to see him having to take the stability of the medication after receiving medication!
RN3 said she took Cauchi's mother's concerns seriously, but at the time, she "sees no obvious signs of mental illness".
RN3 said she encouraged Cauchi to restart antipsychotic drugs, especially if there is a warning sign of early recurrence. But the court heard that Kuch's father's mental health history may have influenced Cage's treatment.
The exercise instructions show that Cauchi's father insisted that he didn't want his son to "kill him" to take the medicine. He said he was “traumatized by the demon” when he was awake and heard the sound.
Cauchi saw a sex worker in late 2019 and has since taken HIV medication for a month while focusing on exposure to sexually transmitted infections.
The court heard that Cauchi had not actually followed up after moving to Brisbane in March 2020. Because he has moved from the Toowoomba area, he is no longer eligible to appoint Medicare on Skype.
"I was surprised that he was discharged from the hospital," RN3 said.
The day after the attack, RN3 said RN2 called her to share news about Cauchi's involvement. "I was shocked. I had to... sit down," she said in a low mood.
"My thought is that everyone who knows Joel. The Joel we know is not what happened on April 13…we are all very shocked."
Cage "constantly performs well."