IN THE MATTER OF PART XX.1 (Mental Disorder) of the Criminal Code R.S.C c. C-46, as amended 1991, c. 43 AND THE BRITISH COLUMBIA REVIEW BOARD

Transcription

1 IN THE MATTER OF PART XX. (Mental Disorder) of the Criminal Code R.S.C. c. C-, as amended, c. AND THE BRITISH COLUMBIA REVIEW BOARD IN THE MATTER OF THE DISPOSITION HEARING OF TAYLOR CHRISTIAN BICKERT RECORD OF PROCEEDINGS AND DECISION HELD AT: BC Review Board Offices Vancouver, BC November, 0 BEFORE: CHAIRPERSON: B. Walter MEMBERS: Dr. L. Grasswick, psychiatrist B. Long APPEARANCES: ACCUSED/PATIENT: Taylor Christian Bickert ACCUSED/PATIENT COUNSEL: J. Deuling HOSPITAL/CLINIC: B. Lohmann/Dr. N. Hodelet A. Churko DIRECTOR'S COUNSEL: D. Lovett, Q.C. ATTORNEY GENERAL: L. Hillaby VERBATIM WORDS WEST LTD. #0 nd Avenue, Surrey, B.C. VW P Phone (0) - Fax (0) -

2 Proceedings (RECORD OF PROCEEDINGS OF TELECONFERENCE) CHAIRPERSON: We are on the record. For the record, this is a special hearing or proceeding of the British Columbia Review Board in the matter of Taylor Christian Bickert. The issue before us this morning is somewhat focused, and that is the sole issue before us, is whether or not the Review Board will see fit to approve Mr. Bickert for out of country travel to Mexico later in this winter. For the record, the Review Board is represented by myself chairing, Walter, Dr. Grasswick is the psychiatric member, and Mr. Long is with us, sitting today as the third member. I am also advised that counsel for Mr. Bickert, Mr. Joseph Deuling is in attendance, along with Mr. Bickert, the accused; Paul Bickert, the accused's father, and Ms. Bickert, the accused's mother. Mr. Hillaby is present for the Crown. On behalf of the Director of Adult Forensic Psychiatric Services, we have Ms. Lovett as counsel; Ms. Lohmann representing the Director's office; Dr. Hodelet, the local Forensic psychiatrist in the Kelowna area; as well as case manager, Churko. CHAIRPERSON: As no one is speaking, I will assume that I've named everybody. And when you're called upon to speak, if you are called upon to speak or ask any questions, for the benefit of others, just introduce yourself and say who is speaking.. I'd like to preface the hearing with some preambular or introductory remarks and to set the tone here. Mr. Bickert is, of course, under the Review Board's jurisdiction as a result of a March, 0 verdict of NCRMD, secondary to charges of B & E and possession of a weapon, when he was arrested in a home that he had broken into and therein found in possession of a knife. By way of background and in support of the verdict, Mr. Bickert is diagnosed with schizophrenia. There is an, apparently somewhat now distant, history of substance abuse as well as inconsistent adherence to treatment. A complicating factor in Mr. Bickert's clinical progress has been his, and I believe his family's belief in alternate treatment modalities

3 Proceedings to wit: orthomolecular treatment. This alternative has apparently been accommodated by the forensic system and he has also had a positive response to more traditional treatment with antipsychotics. Another feature of Mr. Bickert's presentation, and I suspect relevant to risk assessment, is that he has consistently either denied, or alternatively claimed no memory of the index offence, or offences, which we've learned through Victim Impact Statements filed from time to time were quite traumatizing for the victim and her son and, indeed, she claims PTSD. Nevertheless, Mr. Bickert has been compliant, abstinent and at one point, from my review of the file, was termed a model patient. After, I think it was two years in custody at FPH, he was conditionally discharged and he now resides with his very supportive family in Kelowna. Somewhere at or after his July 0 hearing, Mr. Bickert's father raised the question of the accused's accompanying his parents to either Europe or the USA. However, that issue was not further explored until his last hearing which I believe was on July st, 0. At that point, the Board, apparently not aware of the Director of Forensic Services policy regarding international travel, and the Board's own 00 internal policy in this respect, included in its disposition what is currently Clause. That clause purports to delegate to the Director the discretion to authorize the accused's travel to Mexico for days' subject to arrangements satisfactory to the Director. Now, this is, of course, contrary to the -- both the Director's and the Board's policies and procedures. So, as a result of communication between myself, on behalf of the Board, and the Director's counsel, the Director took steps to clarify its -- and perhaps a better word would be to reiterate its policy regarding international travel which I, in looking at other Review Board files, have noted fell into disuse, or perhaps was forgotten over the years. In any event, a new policy directive was issued on October th,. Similarly, the

4 Proceedings Board reissued and revised its procedural memorandum which had first been issued in 00, which includes the criteria that it applies in considering whether or not to undertake the responsibility of approving an accused for international travel. That memorandum was reissued to Board members and parties on October, 0. So, as a result of the steps and the, I suppose, unworkable Clause in the accused's disposition, the Director, through Ms. Lohmann, requested an amendment to that clause in the July 0 disposition. It is for that reason that the Board has convened this somewhat unusual or special hearing by teleconference to receive evidence of the details and the arrangements of Mr. Bickert's proposed travel to Mexico. Then the Board will determine whether, subject to these or other safeguards, it will approve such travel out of Canada. I just want to set the record straight. This is an unusual process. Before proceeding, I want to get the approbation or consent of the parties that they agree that this is not a full review of the accused's disposition. I do not intend to entertain evidence or argument on the issue of the accused's significant threat which is, of course, the threshold for our jurisdiction over Mr. Bickert. This proceeding, having been convened as a courtesy to Mr. Bickert, will focus solely on the issue of international travel. Mr. Deuling, and Mr. Hillaby, and Ms. Lovett, are the parties agreed to having this hearing focus on that issue solely? MR. HILLABY: Lyle Hillaby here. Yeah, for the Attorney General, I'm content to have you deliberate on that isolated issue. MS. LOVETT: I'm Deborah Lovett for the Director. I am also content to have it proceed in the fashion you've described. CHAIRPERSON: And Mr. Deuling? MR. DEULING: Yes. Thank you. Thank you. Mr. Bickert agrees as well, and we're thankful that the -- that the Review Board is actually doing this for us. CHAIRPERSON: Very well. We can proceed then. Now, we'll perhaps change up the process a little bit.

5 Proceedings Usually we tend to hear from the Director first but in this -- in this case, because it is to Mr. Bickert's benefit to have this approval and because Mr. Bickert, Sr. has provided the Director and through her us, a letter of October th, 0 outlining the family's travel plan to Mexico, I will turn to Mr. Deuling and ask you whether you wish to add any submissions or any evidence to what is outlined in Dr. Paul Bickert's letter of October th? MR. DEULING: Yes. Thank you. The letter -- the letter is a little bit not specific with respect to address and telephone number of where he's going to be staying specifically, but those details can be provided. What I would ask the Board to consider more specifically is, I did contact Dr. Roger Morgan, the psychiatrist named in the letter and his -- and his cell phone number is there. He does answer that phone. Mr. -- Dr. Morgan, rather, sorry, asked me -- I told him that I was Mr. Bickert's counsel and that there was a Review Board hearing and that Tyler -- Taylor was under the jurisdiction of the Review Board -- CHAIRPERSON: Yes. MR. DEULING: -- and he was found criminally responsible -- or, not criminally responsible. He told me -- he asked me to stress to the Board that he is not Taylor's doctor -- CHAIRPERSON: Yes. MR. DEULING: -- but he is a -- he is a licensed psychiatrist in both Arkansas and Mexico. He has a clinic and partners in Mazatlan. He's aware of Taylor and can assist him if needed. He's aware of the diagnosis. CHAIRPERSON: Yes. MR. DEULING: And -- and he told me, for what it's worth, that they have a great medical system down in Mazatlan so that's -- from my perspective, that's what I was concerned about when I considered the jurisdictional matter and Mr. Bickert -- CHAIRPERSON: Yes. Well, I appreciate that addition. Can I just ask you, I -- I fully acknowledge that Dr. Morgan is not Mr. Bickert's treating psychiatrist and therefore his role would obviously be somewhat limited, but you say that

6 Proceedings he has a clinic and he's willing to, I guess, see Mr. Bickert if necessary? MR. DEULING: He -- he is -- he's willing to see him, and if he's --he can't guarantee that he'll be there. CHAIRPERSON: Yes. MR. DEULING: But he is -- either he or one of his partners will see him and if not in a clinic, then in a hospital. CHAIRPERSON: Okay. And, of course, we hope that doesn't become necessary. Have you shared, or has Mr. Bickert shared with this Dr. Morgan his forensic background. MR. DEULING: I have not, other than telling him that he was under a -- the Board's jurisdiction -- CHAIRPERSON: Okay. MR. DEULING: And that -- and that he was found not criminally responsible. I didn't go into any other details with him. I'm not certain if -- if his dad had -- CHAIRPERSON: Okay. MR. DEULING: -- added anything. MR. PAUL BICKERT: This is Paul Bickert. I did explain to the doctor that there was -- there was an index offence, okay. I didn't get into a lot of detail about the index offence. I gave him the dates, the time that he spent at FPH in Vancouver, and his questions were more of his medication and just wanting to know that background. Wanting the contact information for his doctor in Kelowna. CHAIRPERSON: Okay. MR. PAUL BICKERT: Dr. Hodelet. And this man is -- his primary associate in the clinic is the Chief of Forensic Psychiatry at the hospital but he's affiliated with -- CHAIRPERSON: This is the hospital in Mazatlan? MR. PAUL BICKERT: Yes. CHAIRPERSON: Yes. Okay. Thank you. Mr. Deuling, is there anything else you'd like to add subject to questions from other parties and the Board? MR. DEULING: Nothing springs into my mind right now. CHAIRPERSON: Okay. Well, you'll be able to summarize any submissions or any information that you rely upon at the end. So if we can leave it at that for the

7 Proceedings moment, may I ask you, Mr. Hillaby, whether you have any questions of the accused, his family, or counsel, I guess, under these circumstances. MR. HILLABY: No. My questions would be for Dr. Hodelet. CHAIRPERSON: All right. Thank you. Ms. Lovett, do you have any questions of the accused? MS. LOVETT: No, I do not. CHAIRPERSON: Thank you. Dr. Grasswick, do you have any questions? DR. GRASSWICK: No, thank you, I do not. CHAIRPERSON: Mr. Long? MR. LONG: No, thank you, I don't either. CHAIRPERSON: Okay. Thank you. Well, then, Ms. Lovett, why don't we turn to you and your witnesses if you wish to introduce any evidence of their position and perhaps Mr. Bickert's current clinical status. MS. LOVETT: Yes. Well, of course, our position is just -- just simply that we wish to have the -- an appropriate disposition condition placed in a conditional discharge order rather than in a placement of -- for the one right now that delegates to the Director. CHAIRPERSON: Right. MS. LOVETT: And in terms of his current -- Mr. Bickert's current clinical status, I would just ask his treating psychiatrist to comment on that. CHAIRPERSON: All right. Dr. Hodelet. DR. HODELET: Yes. So Mr. Bickert continues to see me approximately every month. His mental state remains very stable with really no evidence of any deterioration -- MR. HILLABY: Mr. Walter, the doctor's voice is very faint. CHAIRPERSON: Yes. Dr. Hodelet, could you speak up a bit. I found your voice kind of faint when you signed on as well. DR. HODELET: Okay. I'll do my best. CHAIRPERSON: Thank you. DR. HODELET: I -- I'm calling you from the hospital so, again, we have noises going on in the background that might interrupt me. CHAIRPERSON: Yes. DR. HODELET: Is that better now? CHAIRPERSON: How's that for you, Mr. Hillaby? MR. HILLABY: I'll listen keenly.

8 Proceedings CHAIRPERSON: Yeah, I have my phone turned up to the maximum and I'm having a bit of trouble. There also seems to be a bit of screechy background noise from time to time. DR. HODELET: There's a lot of interference on the line unfortunately. CHAIRPERSON: All right, do your best, Dr. Hodelet. DR. HODELET: So -- yes, Mr. Bickert continues to attend his appointments, he continues to take his depot antipsychotic medications. He connects with his case manager and [indiscernible] to occur as directed. We've noticed no deterioration in his mental state since the discussions we had at his last Review Board hearing. CHAIRPERSON: Mm-hm. DR. HODELET: And -- yeah, we're -- we're -- you know, our position essentially is unchanged [indiscernible] presenting to us at present. CHAIRPERSON: I see. And under those circumstances, I take it -- sorry, Ms. Lovett, I'll defer to you. MS. LOVETT: That's fine. Please go ahead, ask the question. CHAIRPERSON: Well, I was going to just get Dr. Hodelet's position that under those somewhat stable circumstances she would be in a position to not stand in the way of Mr. Bickert's travel for three and a half weeks? DR. HODELET: Yes. So I understand the memo from the Director indicates that I would have to assess Mr. Bickert, I think around about a week before the travel was to -- to take place. CHAIRPERSON: Yes. DR. HODELET: And, certainly, you know, if at that point he remains stable with no evidence of deteriorating and the Board had agreed it was appropriate, then I would -- I would quite agree that he was able to travel. CHAIRPERSON: Yes. Okay. And are you willing to see Mr. Bickert a week or so -- within a week of his planned travel? DR. HODELET: Absolutely. CHAIRPERSON: All right. And I guess I should point out that since this is somewhat unusual, the expectation on our part would be that if he is seen as unsuitable for such travel, you would notify the Review Board through your counsel or

9 Hodelet, Dr. N. Exam by Dr. Grasswick through yourself? DR. HODELET: Yes, I would do that. CHAIRPERSON: Thank you. Ms. Lovett? MS. LOVETT: I don't have any other questions. CHAIRPERSON: Okay. Mr. Deuling, do you have any questions of Dr. Hodelet? MR. DUELING: No, thank you. CHAIRPERSON: Dr. Grasswick? DR. GRASSWICK: Yes, I do. EXAMINATION BY DR. GRASSWICK: Q Dr. Hodelet, regardless of the stability of any patient, forensic or otherwise, prior to travel, travel really to anywhere but particularly to -- with a long flight and to a different country, different stimulation, you know, in the airport, regardless of his stability, that travel can -- has the potential to destabilize a patient. So my question -- my questions are more about can you comment on how the travel might affect Mr. Bickert and whether the psychiatric resources in Mazatlan, but also during travel, are sufficient in your mind to prevent a risk to the public? A Okay, so there's several parts to that question. The first part with regard to how he might respond to travel, really the only thing I have to go on is that Mr. Bickert did undertake, I think a three or four week trip with his family out of the B.C. jurisdiction to Alberta, and I'm sorry I can't give you the exact dates but I think that was around about two years ago. That went without any difficulty. He ensured that he received his depot medication before he went and he returned before his next injection was due and the travel there didn't lead to -- result in any problems. Now, of course, that's a slightly different situation to travel abroad. We know that sometimes changes in time zones can be particularly problematic for patients. That won't be the case if the travel is to Mexico. It's hard to predict how Mr. Bickert would respond. For example, if there were significant delays or there were weather problems that meant the area had to be evacuated. Of course, all these kinds of things can happen. However, from what I notice is that Mr. Bickert doesn't particularly seem to be terribly troubled by much

10 Hodelet, Dr. N. Exam by Dr. Grasswick that goes on in his environment. He tends to lead a fairly solitary existence within his parental and family group and he's going to continue to be risk[indiscernible] during this trip. I do believe that they would not be slow to be in touch with us if they did have any concerns about his mental health. Certainly we would be available by phone to provide them with support or advice should Mr. Bickert encounter any difficulties. I think the last part of the question was with regards to the services available in Mazatlan. I simply cannot comment on those services and I have not, at this stage, contacted Dr. Morgan. I felt that that would be premature to do so as I wished to find out what the Board's decision would be before I made any further investigations. CHAIRPERSON: Dr. Grasswick. DR. GRASSWICK: Q Do you have any -- any knowledge or any understanding of the -- okay, I'll back up. If Mr. Bickert deteriorated while in -- in Mazatlan and he wasn't willing to take medication or follow any medical direction, do you have any knowledge of how a psychiatrist could intervene to turn things around and reduce the risk of any harm to the public? CHAIRPERSON: Well, with all due respect, Dr. Grasswick, I think Dr. Hodelet has responded that she can't speak to services in Mazatlan. She's not an expert on Mexican psychiatry. DR. GRASSWICK: Okay. Okay, thank you, then that's all my questions. CHAIRPERSON: Mr. Long? MR. LONG: Thank you, I don't have any questions. CHAIRPERSON: Mr. Hillaby? EXAMINATION BY MR. HILLABY: Q Yes. Just a few remaining, Dr. Hodelet. I'm not well acquainted with your patient. I've read the materials, but I have a few simple questions remaining. Are you of the view that the diagnosis is clear in this case? A Yes. Q And I gather his schizophrenic illness is amenable to the treatment that it's providing. It -- it -- he's responding to the treatment?

11 Hodelet, Dr. N. Exam by Mr. Hillaby A Yes. He is stabilizing and -- but he is not -- he's not currently psychotic, or developing any new delusional beliefs. Q Right. But looking at the report as to how he spends his time, would you agree that the illness does affect the fullness of his life? He has a somewhat [indiscernible] life even while stable? A Yes, I would agree with that. I think he does lead a somewhat restrictive existence and relies quite heavily, I think, on family and support staff. Q Right. And it appears from what I've read that he enjoys a very comfortable and supportive home environment with a lot of -- of a worry addressed by others? A Yes. Q So my question is along the lines of Dr. Grasswick, I guess, of how resilient a person your patient is with ordinary frustrations and challenges in his environment. A Yeah, I -- it's not as straightforward a simple facing answer I suppose because he really doesn't, at this stage, face very many challenges in his environment, and he is quite a stubborn individual who -- who, at times, seem a little bit [indiscernible]. For example, we discussed recently that I felt that his outreach worker and he shouldn't simply be doing the same thing every two weeks when they meet [indiscernible] outreach worker took him to the gym and that they worked out and I felt that really the outreach worker should be utilized [inaudible/pa system announcement]. That led to Mr. Bickert saying well, I won't do anything with him then, and so, you know, we -- we do see this sometimes, we see quite a stubborn streak. The other thing about Mr. Bickert though, which I think probably is relevant, is that I think that his affect and his emotional responses have been affected by his illness in that he does display a number of negative symptoms of schizophrenia, and I think that this would actually [indiscernible] perhaps not being so emotionally affected as others might be by environmental difficulties or changes, going from one area to another. But, of course, I -- you cannot predict exactly how he will react when he

12 Hodelet, Dr. N. Exam by Mr. Hillaby goes -- if he goes to Mexico. All I can say is that he has had a three to four-week vacation with his family to Alberta and that that seemed to go without any difficulty. Q All right. My impression from reading the materials is that your patient's quality of life, which is a fairly high quality of life, can be to a significant extent marked to the credit of his parents who seem to provide him with assistance and good judgment and -- and just feeling with general quality of life issues, am I right? A Yes, I would agree with that. Q And would you agree that probably travel on his own would be ill-advised? A I would definitely agree with that. Q So is it your impression, Doctor, that the parents are an effective and useful support for the travel and, in particular, that they will help him contend with the stresses of travel? A Yes, I agree with that. Q And you consider that that's been shown by the domestic travel, I gather? A Yes. Q Adult children aren't always happy to be guided by their parents. What is the dynamic in this family? A I -- I mean I get the sense that Mr. Bickert is very content in his current situation with his parents. I think that they -- they provide a lot for him materially and I think that he -- he can appreciate that, and I don't get the sense that there is ever particularly a lot of conflict between the parents and Mr. Bickert. It doesn't seem to me like the kind of relationship where an adult child is living with parents because it's really their only option. It seems to me like at this stage, it's an arrangement that all the parties seem to enjoy and are content to continue with. Q Okay. So is there more harmony in the guidance he gets from his parents than from the outreach worker, for example? A I think he [indiscernible] so I think that any -- any situation where [indiscernible] proposed that is not something that he is the driver of would be difficult for him to consider. Q Right. And, finally, apart from the -- the

13 Hodelet, Dr. N. Exam by Chairperson aspect of your team not having ready access [indiscernible], when we're looking at the risk here, does the length of the travel have much to do with the heightening of risk here, or is it the challenges of international travel and airports, and other country's officials and so forth? What are the factors that raise clinical concern to any extent? A Well, if -- if the travel was for a longer period of time than the interval between his depot injection, then that would be my concern. My view is that the greatest risk for Mr. Bickert is non-compliance with his medication and as he receives by intramuscular injection every days, travel which is less than that period of time I think is much less of a problem than any longer term travel. I do believe that Mr. Bickert is -- you know, travel to Mexico, it's not a hop, skip, and a jump from Vancouver, but neither is it in this day and age, you know, an expedition that requires numerous changes of airports. I -- I haven't been to Mazatlan, but I'm guessing that the airport there, given the number of North Americans who go through it, will be of fairly high standards with fairly efficient processes in place. So, you know, the -- the biggest concern I would have would be if he were for some reason not complying with his medication, but I don't think that there's any possibility of that happening. MR. HILLABY: Very good. Thank you, those are my questions, Mr. Walter. CHAIRPERSON: Thank you. EXAMINATION BY THE CHAIRPERSON: Q Just a couple of added things, Dr. Hodelet. Have you met Mr. Bickert's parents? A Yes, I have. Q And on more than one occasion? A Yes, I have. Q And have you, beyond just meeting them in a clinical setting, have you actually had conversation with them? A Outside of a clinical setting, no? Q No. But within a clinical setting. A Yes, within a clinical setting. Q So do they attend interviews when Mr. Bickert

14 Hodelet, Dr. N. Exam by Chairperson sees you? A They don't attend every -- every meeting. Q Yes. A But from time to time, especially if there's a specific issue -- Q Okay. A -- that they want to discuss then, yes, they do attend. Q So you have had a chance to interact with them? A Yes, I have. Q And have you been able to form an impression of the extent to which they understand Mr. Bickert's illness and its management? A Yes, I think I do. Q And what is your assessment of that? A I think that his family have had some unusual beliefs about what has caused his symptoms and treatments that are helpful for it. Q Mm-hm. A To that end, they ensure that their son is provided with a very long list of vitamins and supplements which Mr. Bickert takes every day. Q Yes. A However, they also have been cooperative with the treatment team. They support Mr. Bickert getting to his appointments. They all support him at his Review Board hearings. I don't get the sense that either of his parents are irresponsible or impulsive or unreliable -- Q Okay. A -- in any sense. We do have an area that we've had -- disagree on in terms of what may be the cause of his illness -- Q Okay. A -- however, I think that we do have a fairly good relationship in the sense that they are always welcoming to the treatment team when they visit Taylor at home. We don't get any sense of hostility or rejection of our team or our -- or our recommendations for his treatment. Q Okay. So even though they espouse beliefs in -- in a treatment modality that the Review Board has been exposed to over the years, do I hear you saying that you don't get the sense, or you're not leaving me with the sense that they, despite these beliefs, are actively discouraging Mr. Bickert from complying with the treatment that

15 Hodelet, Dr. N. Exam by Chairperson A Q A Q A Q A Q A Q A Q A Q A Q you prescribe? No. Okay. Secondarily, having met them and interacted with the parents, do you believe that they are sufficiently knowledgeable and informed that they could, if Mr. Bickert were showing signs or symptoms of decompensation, that they would be in a position to recognize or identify such signs or symptoms that are relatively timely or early stage? Yes. I think they would. But I would also -- I would want to ensure that prior to any travel -- Yes. -- that we went over with the family a kind of early warning signs, and then we worked out, you know, what would be the course of action to take-- Yes. -- in a situation, so I would -- I would hope that we would have that all, you know, fairly clearly in black and white so that there would not be any room for doubt with the family -- Okay. -- if they did have to take any action. And you would do that? Yes. Myself and Mr. Cole [phonetic] would do that with the family. Okay. You'd review that. The other question that I had with -- in respect of Mr. Hillaby's questions regarding Mr. Bickert's resilience to perhaps environmental stressors, you're saying that because his affect is somewhat, I suppose, flat or negative that unless he's less overtly emotional that perhaps this would render him somewhat more resilient to environment change? Yes. I think what I -- I think what I'm seeing is the kinds of things I get -- regular parents who are helping in terms of travelling, or delays that kind of thing -- Yes. -- but I -- I can imagine Mr. Bickert actually not being terribly phased by it. Okay. Thank you for that. And, finally, in addition to the plan that has been put forward by Mr. Bickert and his family in terms of contacts, where they are staying, the names of doctors and so on, would you be looking for in any approval,

16 Hodelet, Dr. N. Exam by Chairperson an additional perhaps condition or requirement that in the course of the three and a half weeks, Mr. Bickert and/or his family call into your clinic? A I think that would be a very useful addition, and I'm -- you know, I think if we were able to check in with him, his case manager, at some point during the trip, if you get -- and it could be done by telephone -- Q Yes. A -- or it could even be regular contact by , then I think that that could all be very helpful. Q Good. Well -- so, in other words, if perhaps -- well, we're talking about days, so at day or, or if you or the case manager were to call the Bickert family's cell phone or they were to call the clinic, you would find that of some assistance? A Yes, that would definitely be of assistance. CHAIRPERPERSON: Okay. Thank you. And perhaps they can consider doing that. I think those are all my questions. Thank you, Dr. Hodelet. A Thank you. CHAIRPERSON: Ms. Lovett, do you want to bring forward anything else? MS. LOVETT: No, I do not, thank you. CHAIRPERSON: Okay. Mr. Hillaby, are you presenting any evidence on the matter? MR. HILLABY: No, thank you. CHAIRPERSON: Mr. Deuling, is there anything else you would like to bring forward? Mr. Deuling? MR. DEULING: Sorry, I'm just waiting for that -- yes -- no, I don't have anything further to add. CHAIRPERSON: Okay. And let me ask the Board members, has anything arisen that you would like to pursue from any questions by any other parties? Dr. Grasswick? DR. GRASSWICK: No, thank you. CHAIRPERSON: Mr. Long? MR. LONG: No, thank you. CHAIRPERSON: Okay. So, just out of an excess of formality here, perhaps I'll entertain any closing submissions only if parties want to make them. So, Mr. Deuling, based on what you've heard, is there any closing submission you'd like to make at this point? MR. DEULING: The only thing is that the -- the

17 Proceedings Bickerts would certainly be agreeable and want to meet up with -- with the team before leaving, and -- and they'd certainly be -- they're inclined, certainly, to stay in contact with the team of the clinic over the length of travel if it's -- if it's permitted. CHAIRPERSON: Sure. And I would think that would be an arrangement they could enter into with Dr. Hodelet then. MR. DEULING: Yes. CHAIRPERSON: All right. So you're -- you're arguing for and you're submitting that the Review Board ought to approve Mr. Bickert's travel under the circumstances that we've heard about this morning? MR. DEULING: Yes, that's correct, and I'd also agree that the -- that condition in the July st, 0 order be -- be amended as suggested by counsel for the FPH. CHAIRPERSON: Okay. Thank you. Ms. Lovett? MS. LOVETT: I have nothing further to add. CHAIRPERSON: Thank you. So you're in support? MS. LOVETT: Yes. CHAIRPERSON: Mr. Hillaby? MR. HILLABY: Yeah, I'd like to say that evidently at the proceeding in which the Panel made, the Panel did not have the benefit of any contribution from the Attorney General and I apologize for that. Now that I have the opportunity to correct that, I would say that you should replace term with -- in conformity with the policies of both FPS and the Review Board and that I do not, on this evidence, oppose Mr. Bickert's travel out of your jurisdiction -- CHAIRPERSON: Okay. MR. HILLABY: -- fashion contemplated by the evidence. CHAIRPERSON: Thank you. Unless there are any other issues to be brought forward, I would excuse the parties and ask the members of the Review Board to stay on the line so that we could deliberate and discuss the proposal before us and whether or not to shoulder the amendment to Clause. Is that all right? Anything -- DR. HODELET: Thank you. CHAIRPERSON: Thank you to the team. Thank you, Mr. Hillaby, Mr. Deuling, and the Bickerts. MR. DEULING: Yes, thank you. Do you know -- do you

18 Proceedings 0 0 know when we'll be -- will we be advised by letter? CHAIRPERSON: You'll no doubt be provided, if it goes ahead, with an amended disposition and then I will undertake to obtain a transcript as a record of this proceeding which will also go into the accused's evidentiary record. MR. DEULING: Thank you. MR. HILLABY: Do you have a timeline in mind, Mr. Walter? CHAIRPERSON: Well, I think we could certainly amend the disposition if we're going to do that within the day. MR. HILLABY: Thank you. MR. DEULING: Thank you. CHAIRPERSON: Thank you all. DR. HODELET: Goodbye. Thank you very much. CHAIRPERSON: Bye bye. (EXCERPT CONCLUDED)

19 DECISION [ ] The Review Board s process in respect of its approval of an accused s international travel, in response to the Director s internal policy in that regard, was set out in a directive in April 00, and reiterated October, 0 (attached). [ ] Mr. Bickert, the accused in this case, seeks approval to travel to Mexico for days, between February, 0 and March, 0, accompanied by his parents, with whom he resides. Mr. Bickert s father has submitted a Travel Plan which identifies a US psychiatrist who is licensed and operates a clinic in Mazatlan, Mexico, and where other psychiatrists are employed. That physician (Dr. Morgan) is willing to see the accused in Mexico, should it prove necessary, in order to assess Mr. Bickert s mental state. Mr. Bickert s verdict and legal status, as well as his diagnosis and medication regime, have been disclosed to Dr. Morgan. He has also been provided with Mr. Bickert s FPS treatment team s contact information in Kelowna. Dr. Morgan s contact information will also be shared with the team. [ ] Mr. Bickert s mental has been stable for some time. He has been abstinent since his verdict. He accepts his depot antipsychotic medication. He has responded well to treatment, though he displays some negative symptoms e.g. flat affect. There is no evidence of any deterioration in his mental state since his last hearing. [ ] In keeping with policy expectations, Dr. Hodelet is willing to assess Mr. Bickert within a week prior to the proposed departure date to determine his stability, risk level and suitability to travel. If Mr. Bickert is deemed unsuitable to travel, clinically or from a risk perspective, the Director will notify the Review Board. [ ] Regarding the possible destabilising impact of travel exigencies, Mr. Bickert has previously undertaken a three or four-week trip to Alberta with his parents, two years ago, without difficulty. He received his medication before departure and returned in time for his next injection. For the current proposal, the period of travel accords with his medication administration schedule. [ ] Travel to the vacation destination involves no time zone changes that might affect Mr. Bickert. Moreover, he seems unperturbed by matters in his environment, such as delay or weather, perhaps due to his negative symptoms.

20 [ ] The Bickerts are cooperative, responsible and informed. They are seen as an effective and useful source of support and monitoring. They are aware of the warning signs of decompensation, which will be reviewed with them prior to departure. Mr. Bickert s parents can be relied upon to contact Dr. Morgan and/or the Kelowna Treatment Team during their absence and as may be required. Dr. Hodelet is open to direct conversation with Dr. Morgan as well. [ ] Mr. Bickert s application and proposal satisfies the Board s informational criteria, as set out at paragraphs and of the attached policy memorandum. [ ] Accordingly the Review Board has amended Mr. Bickert s July 0 Disposition to approve his travel to Mexico during the proposed period and subject to any issues that might arise from his further assessment within a week of his proposed departure. It is our expectation that if Mr. Bickert is, on the basis of that assessment, deemed clinically or from a risk perspective, unsuitable to travel to Mexico, the Director will forthwith notify the Board and parties. The Board reserves the right, without further process, to withdraw its conditional approval to travel, though it will extend every effort to provide a speedy opportunity for the parties to make further submissions on the issue. The parties are welcome to approach the Board with further information or for further direction, on notice to the Board and other affected parties.

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