Mr Tougher was stabbed 55 times while on a break during a shift in Campbelltown, in southwest Sydney, in the early hours of April 14, 2023.
Jordan James Fineanganofo, 23, admitted stabbing the 29-year-old to death but pleaded not guilty to murder by way of mental health impairment, at the start of what was expected to be a six-week-trial in the NSW Supreme Court on Monday.
The court was told prosecutors had agreed to endorse a mental health verdict if Fineanganofo signed a statement of facts admitting the physical elements of the crime, which was captured on CCTV.
The family of Steven Tougher heard distressing details of his killing at a McDonald's. (Nikki Short/AAP PHOTOS)
Instead of proceeding with the trial, Justice David Davies adjourned the court until Friday to consider if the mental health defence was made out.
Pained cries rang out from family members as the court was told details including Fineanganofo didn't say a word as he approached and began stabbing Mr Tougher in a chilling attack lasting close to four minutes.
Fineanganofo hung his head and covered his face as the details of the killing were read to the court.
Crown prosecutor Ken McKay SC said Mr Tougher was unable to get away because he was trapped between the back of the ambulance and his attacker.
Mr Tougher tried to push Fineanganofo away but was unable to, saying, "What are you doing? Stop stabbing me mate".
Despite the efforts of several people to help, Fineanganofo continued to stab Mr Tougher, walking away several times before returning to deliver more wounds as the NSW Ambulance worker lay on the ground.
At one stage, Fineanganofo told Mr Tougher, "Say you're sorry to me".
Jordan Fineanganofo continued to stab Steven Tougher, even after he had fallen to the ground. (HANDOUT/NSW POLICE)
"I'm sorry, mate, whatever you think I've done," a badly injured but still conscious Mr Tougher replied.
Bystander James Arthur ran over in an attempt to help, kicking Fineanganofo and yelling at him to stop.
"You're going to kill him," Mr Arthur said, the court was told.
Responding to the appeals of another bystander, Fineanganofo was reported either to have said "I'm going to jail anyway, I may as well kill him" or "I got to kill him because I got to go to jail".
Fineanganofo has also pleaded not guilty on mental health grounds to a string of related charges over alleged incidents in nearby suburbs in the days leading up to killing Mr Tougher.
Those incidents included intimidating a woman who was pushing a stroller with a five-month-old child, threatening several men at a service station and swinging a knife at a man during a roadside incident, piercing his jacket but not his skin.
Fineanganofo's barrister AJ Karim said the position of the defence was largely identical to the prosecution, including that the physical acts of the offences had been committed.
Steven Tougher's killer looked like he was in a trance, the court was told. (Dean Lewins/AAP PHOTOS)
The prosecution and defence engaged psychiatrists who agreed it was available for Fineanganofo to argue he knew what he was doing but did not know it was wrong.
Forensic psychiatrist Kerri Eagle, who was engaged by the prosecution, determined Fineanganofo had a mental health impairment at the time of the offending and displayed signs and symptoms of a psychotic illness consistent with a relapse of schizophrenia.
Dr Eagle took note of witness evidence describing Fineanganofo as looking like "he was in a trance, calm, mumbling, grinning and odd", the court was told.
Mr McKay said Fineanganofo had previously been charged after assaulting a neighbour in 2021, but instead of being prosecuted was involuntarily entered into treatment for mental health issues.
Hospital records stated at that time Fineanganofo had been isolating within his family home for one year with minimal interactions with others, becoming increasingly paranoid of people, including his family.
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