Health Law - OCA

The appellant appealed a not criminally responsible on account of mental disorder (NCRMD) verdict entered on February 24, 2017, following a psychiatric assessment that concluded the appellant did not know his actions were wrong due to untreated schizophrenia.

The appeal was based on serious procedural defects at the hearing, including failure to arraign the appellant, failure to take a plea, failure to make elections on four of five charges, failure to read facts into the record, absence of viva voce evidence, and failure to address the appellant or allow him to speak.

The Crown conceded the procedural flaws warranted setting aside the verdict.

The court allowed the appeal, set aside the NCRMD verdict, and ordered a new trial.

This decision concerns an appeal by Iesha Mitchell from a detention order imposed by the Ontario Review Board.

The Board had found that, although Mitchell could live in the community with certain privileges, her housing required approval by the person in charge of the Centre for Addiction and Mental Health (CAMH), and that the Mental Health Act alone would not be sufficient to manage her risk to public safety.

The Court of Appeal found no error in the Board’s reasoning, holding that the evidence supported the need for approved housing and a detention order, given the subtlety of Mitchell’s decompensation and the need for prompt intervention.

The appeal was dismissed.

The appellant, A.B., appealed a disposition order from the Ontario Review Board that did not permit him to work unsupervised in the community.

The Court of Appeal found no error in the Board's decision, noting that the Board's conclusion was justified by the psychiatric evidence and the appellant's changed circumstances, including a subsequent criminal conviction while under a Board order.

The appeal was dismissed.

The appellant, found not criminally responsible for robbery in 2006, appealed a disposition of the Ontario Review Board.

The Board maintained his detention, removed indirectly supervised community privileges, and denied a transfer to another facility, following his conviction for child pornography.

The Court of Appeal upheld the Board's decision, finding its refusal to transfer and removal of community access reasonable given the appellant's lack of insight and ongoing risk, deferring to the Board's expertise.

This is an appeal from a medical negligence judgment.

The appellants, two doctors, challenged the trial judge's findings on standard of care and causation after Ms. Stevenhaagen suffered severe neurological injuries following an angioplasty procedure and subsequent aortic rupture.

The trial judge found the doctors liable for failing to consult a cardiovascular surgeon promptly and for transferring the patient to the Coronary Care Unit instead of directly to the operating room after temporary stabilization.

The Court of Appeal dismissed the appeal, upholding the trial judge's conclusions that the standard of care was breached and that this breach caused Ms. Stevenhaagen's injuries, applying the 'but for' test for causation.

The appellant, found not criminally responsible on account of mental disorder in 2003, appealed the Ontario Review Board's disposition that continued his detention at a forensic psychiatric hospital.

He sought an absolute or conditional discharge, arguing the Board failed to apply the "significant threat" test and consider all relevant factors for a necessary and appropriate disposition.

The Court of Appeal dismissed the appeal, finding the Board properly applied the "significant threat" test and reasonably concluded that a detention order was required given the appellant's ongoing mental illness, lack of insight, and risk of aggression, despite some progress.

The appellant, found not criminally responsible on account of mental disorder (NCRMD), appealed the Ontario Review Board's decision to continue his detention at a high secure unit.

He sought a transfer to a less restrictive medium secure facility.

The Court of Appeal upheld the Board's decision, finding it reasonable given the appellant's continued threat to public safety, the unsuitability of other facilities due to risk management concerns and long waitlists, and recent aggressive incidents.

The court affirmed that reweighing evidence is not its role in reviewing Board decisions.

Joseph Haddad appealed a disposition of the Ontario Review Board, which ordered his detention at a forensic mental health centre subject to conditions, specifically challenging a condition prohibiting him from attending within 250 metres of his mother's home.

Haddad was found not criminally responsible for an index offence involving discharging a shotgun.

The Board's decision to impose the condition was based on concerns for public safety, psychological harm to neighbours, and the appellant's transition to community living.

The Court of Appeal dismissed the appeal, deferring to the Board's reasonable decision, noting that the condition served to address victim safety and was not a significant restraint on the appellant's liberty, especially as his physician did not recommend visits to the family home.

A dual status offender appealed a decision of the Ontario Review Board refusing to schedule a placement hearing to determine whether his current place of custody (a penitentiary) was inappropriate to meet his mental health needs.

The appellant argued that the Review Board was obligated to review placement as part of every disposition review, or alternatively, that the Review Board should have exercised its discretion to order a placement hearing on its own motion.

The Court of Appeal upheld the Review Board's interpretation that a significant change in circumstances is a prerequisite to scheduling a placement hearing on an offender's application, and found no error in the Review Board's refusal to schedule a hearing on its own motion.

The appellant, found not criminally responsible on charges of dangerous operation of a motor vehicle, mischief, threatening death, and assault with a weapon, appealed the Ontario Review Board's disposition ordering her continued detention in a forensic psychiatric facility.

The appellant challenged the Board's application of the significant risk test and sought an absolute or conditional discharge.

The Court of Appeal upheld the Board's decision, finding no error in the legal test applied or its application to the evidence.

The Board properly considered the appellant's history of medication non-compliance, continued cannabis use in breach of conditions, and recent aggressive incidents with co-patients as active risk factors supporting a finding of significant risk to public safety.

An appeal from an Ontario Review Board disposition dated January 24, 2019, concerning a detention order for the appellant.

The appellant sought to include a term allowing community living at the Hospital's discretion, arguing it was a viable prospect within the year and would allow placement on a waiting list for community living.

The Board rejected these arguments after full consideration of the evidence.

The Court of Appeal upheld the Board's decision, noting that the Board had expanded the order to permit community access under indirect supervision, which the appellant was utilizing.

An appeal from an Ontario Review Board detention order with privileges up to the possibility of community accommodation.

The appellant challenged the Board's decision on three grounds: insufficient reasons, procedural error due to gaps in the record, and failure to adequately address why a conditional discharge was not the least restrictive disposition.

The Court of Appeal dismissed the appeal, finding no error in the Board's reasoning, no procedural defect, and that the detention order fell within a range of reasonable outcomes based on evidence of ongoing mental illness, delusional thinking, substance abuse, medication non-compliance, and lack of insight into symptoms.

The appellant appealed the Ontario Review Board's disposition ordering her detention on the secure forensic unit at Providence Care Hospital, Kingston.

The appellant, who suffers from schizoaffective disorder with persecutory delusions, sought an absolute discharge, or alternatively a conditional discharge or transfer to CAMH.

The Court of Appeal dismissed the appeal, finding the Board's determination that the appellant remained a significant threat to public safety was reasonable, and that a conditional discharge was premature given the ongoing nature of her delusions and the need for medication optimization.

The appellant appealed the Ontario Review Board's disposition dated February 21, 2018, seeking an absolute discharge or a new hearing.

The appellant argued that he no longer posed a significant danger to public safety due to improved insight into his mental illness, medication compliance, and stable employment and housing.

However, the court found the Board's concerns about recent cocaine use were reasonable given the appellant's history of manic episodes preceded by cocaine use and associated medication non-compliance.

The court allowed the appeal on the basis of transcription errors in the Board's reasons, which confused the appellant with another hospital patient and relied on irrelevant material.

A new hearing was ordered to take place as the appellant's annual review hearing in February 2019.

An appellant appealed the Ontario Review Board's disposition continuing his detention at Brockville Mental Health Centre following a finding of not criminally responsible on account of mental disorder.

The appellant sought an absolute discharge, arguing that the Board's conclusion that he posed a significant threat to public safety was unreasonable and unsupported by evidence, particularly regarding the change in his diagnosis from schizophrenia to antisocial personality disorder and the role of cannabis use.

The Court of Appeal rejected these arguments and dismissed the appeal, finding the Board's conclusion reasonable based on the revised diagnosis, evidence linking cannabis use to psychotic symptoms, a history of substance abuse, and a pattern of aggressive and violent behavior.

An appeal under Part XX.1 of the Criminal Code against a disposition of the Ontario Review Board dated April 6, 2017.

The appellant sought a conditional discharge and argued against residing in a group home, preferring to live with either his friend or stepfather.

The Court of Appeal found ample evidence supporting the Board's refusal to grant a conditional discharge and its requirement that the appellant continue residing in the group home.

The appeal was dismissed.

The appellant appealed a Consent and Capacity Board decision confirming her involuntary psychiatric admission.

She sought a declaration that a forced injection of anti-psychotic medication violated her Charter rights and requested rescission of her detention certificate as a remedy.

The central issue was whether the Board has jurisdiction to grant remedies under s. 24(1) of the Canadian Charter of Rights and Freedoms.

The Court of Appeal held that the Board does not have s. 24(1) Charter jurisdiction, despite having authority to decide questions of law.

The court found that the legislature clearly intended to exclude Charter remedies from the Board's jurisdiction based on the removal of s. 52(1) jurisdiction, strict statutory timelines, limited remedial powers, composition of the Board, and the availability of Superior Court appeals.

An appeal under Part XX.1 of the Criminal Code against a disposition of the Ontario Review Board dated November 29, 2016.

The appellant sought a hybrid order, but the Board imposed secure detention.

The Court of Appeal upheld the Board's decision, finding that the Board acted reasonably in rejecting the hybrid order request based on evidence from the treatment team and the hospital that secure detention was the necessary and appropriate disposition.

The Board retained discretion to determine when the appellant would be ready for transfer to a less secure setting.

The appellant appealed a disposition of the Ontario Review Board ordering his continued detention at Waypoint Centre for Mental Health Care.

The appellant, found not criminally responsible on account of mental disorder for assault, argued that he had reached a treatment impasse at Waypoint and sought an independent assessment and transfer to a less secure facility.

The Court of Appeal dismissed the appeal, finding that the evidence did not substantiate the existence of a treatment impasse and that the Board's decision to maintain detention at Waypoint was well-supported by evidence regarding the appellant's risk to public safety, including his history of water intoxication, threats to staff, and previous elopement from other facilities.

An appeal under Part XX.1 of the Criminal Code against a disposition of the Ontario Review Board dated July 12, 2016.

The appeal was dismissed as moot by the Court of Appeal for Ontario.