Health Law - ONCA

The appellant appealed a dangerous offender designation and indeterminate sentence imposed on March 21, 2012.

The appellant, who suffered from brain damage from meningitis, borderline personality disorder, borderline intellectual functioning, and dysthymia, was self-represented during a complex dangerous offender hearing.

The Court of Appeal found that the proceeding was procedurally unfair due to multiple cumulative deficiencies: the failure to inquire whether the appellant wished to retain counsel despite facing severe jeopardy; the failure to conduct a fitness inquiry despite clear indicia that the appellant may not have been mentally present; the failure of amicus curiae to adequately protect the appellant's interests, including by conceding admissibility of psychiatric records and ultimately advocating in favour of the dangerous offender finding; and the failure to explore meaningful alternatives such as video linking to keep the appellant informed when she was absent from court.

The Court allowed the appeal and ordered a new hearing.

An appeal by an NCR (not criminally responsible) accused against the Ontario Review Board's disposition continuing his conditional discharge.

The appellant sought an absolute discharge, arguing the Board erred in finding he continued to pose a significant risk to public safety.

The appellant had been living unsupervised in the community for over a decade with stable mental health and medication compliance.

The Court of Appeal dismissed the appeal, finding the Board's decision was reasonable based on the appellant's lack of insight into his illness, his history of violence when unmedicated, and concerns that the civil mental health system could not adequately manage the risk of treatment non-compliance.

The appellant appealed the Ontario Review Board's disposition dated September 14, 2018, which ordered his detention at Ontario Shores Centre for Mental Health Sciences.

The sole issue on appeal was whether the Board erred in law or acted unreasonably in declining to impose a conditional discharge.

The appellant suffers from Schizoaffective Disorder with no insight into his condition, a pattern of medication noncompliance and substance abuse, and would not voluntarily return to hospital if requested.

The Court of Appeal found no error in the Board's decision and upheld the detention order, noting that the need to supervise housing and permit quick readmission if necessary are relevant considerations in determining whether a conditional discharge is appropriate.

The appellant appealed a disposition of the Ontario Review Board dated September 11, 2018, which found that the appellant continues to pose a risk of serious harm to the public and imposed a conditional discharge with reporting requirements and residence restrictions.

The appellant sought an absolute discharge.

The Court of Appeal upheld the Board's decision, finding no material change in the appellant's condition since the previous disposition and no basis to challenge the Board's conclusion that the evidence overwhelmingly demonstrated a risk of serious harm if the appellant were released without conditions.

The appellant appealed a disposition order from the Ontario Review Board that declined to provide a term allowing for community living at the hospital's discretion.

The Board instead included a generous daily pass provision at the hospital's discretion.

The Court of Appeal found the order reflected the evidence of the treating psychiatrist and hospital team, and that the daily pass provision adequately addressed concerns regarding the appellant's potential deterioration.

The appeal was dismissed.

The appellant, found not criminally responsible on account of mental disorder for sexual assault and other offences, appealed the Ontario Review Board's disposition ordering his detention pursuant to a hybrid order allowing transition from secure to general forensic unit with community living privileges.

The appellant had been on conditional discharge but was readmitted to hospital after missing his monthly antipsychotic medication injection.

Following rapid decompensation and aggressive behaviour requiring seclusion, the Board concluded a conditional discharge was inappropriate and ordered the hybrid detention.

The Court of Appeal upheld the Board's decision as reasonable, finding the appellant was not in a position to be in the community at the time of the hearing.

An appeal from the Ontario Review Board's disposition dated July 18, 2018, regarding the detention of an individual with a major mental illness.

The appellant challenged the Board's finding that he continued to pose a significant threat to public safety and that a detention order was necessary.

The Court of Appeal upheld the Board's decision, finding no error in the Board's application of the legal test for assessing ongoing risk or in its determination that detention was the appropriate disposition given the appellant's mental condition, history of non-compliance with medication, substance abuse, and prior violent conduct.

Crown appeal of an acquittal in an impaired driving causing death case.

The trial judge excluded evidence of the accused's blood alcohol concentration under s. 24(2) of the Canadian Charter of Rights and Freedoms, finding that the accused's s. 8 Charter rights were violated when police obtained urine ethanol results without legal authority by asking hospital staff for the information.

The police then used these illegally obtained results to obtain search warrants for the accused's medical records and blood samples.

The trial judge found the officer asked the nurse for the results rather than merely overhearing them, and that without these results the warrant could not have been issued.

The Court of Appeal upheld the exclusion of evidence, finding the trial judge's reasons were sufficient and conducting a fresh s. 24(2) analysis that confirmed exclusion was appropriate.

The appellant appealed a disposition of the Ontario Review Board ordering his continued detention at the General Forensic Unit of the Centre for Addiction and Mental Health.

The appellant had been found not criminally responsible for assault and robbery offences committed in 2013 near Sudbury.

He sought an absolute or conditional discharge, arguing he posed no significant risk of serious harm to the public.

The Court of Appeal dismissed the appeal, finding the Board's decision to be reasonable given concerns about the appellant's drug use triggering psychotic decompensation and his lack of community living experience.

However, the court expressed concern that the appellant's inability to abstain from drug use had become an insurmountable barrier to obtaining privileges and suggested the Board consider crafting a disposition to facilitate community living experience in future reviews.

Appellants sought a declaration that section 14 of the Health Insurance Act, which prohibits OHIP-eligible Ontario residents from purchasing private health insurance for OHIP-covered services, violated their Charter rights under section 7.

The appellants' OHIP coverage had been cancelled for failure to prove Ontario residency, and they claimed private insurers refused to sell them insurance citing section 14.

The application judge dismissed the application, finding the appellants were not affected by section 14 itself but rather by an alleged misinterpretation of it by private insurers.

The Court of Appeal upheld the dismissal, holding that the appellants failed to demonstrate that section 14 of the HIA, rather than a misinterpretation by non-parties, was affecting them.

The appellants, three physicians who practiced in the respondent hospital's urgent care centre, appealed the dismissal of their wrongful dismissal action.

The trial judge dismissed the claim on the ground that it was barred by section 44(5) of the Public Hospitals Act, which immunizes hospitals from liability for acts done in good faith when a hospital board decides to cease providing a service.

The appellants argued that section 44(5) should not apply based on legislative history and the characterization of their status as dependent contractors.

The Court of Appeal upheld the dismissal, finding that section 44(5) is clear and all-encompassing, barring all proceedings for damages arising from a hospital's decision to cease providing a service, regardless of the legal characterization of the terminated physicians' status.

An appeal of an Ontario Review Board disposition continuing a conditional discharge for an NCR accused.

The appellant argued that the Board's finding that he continued to pose a significant threat to public safety was unreasonable and sought an absolute discharge.

The Court of Appeal allowed the appeal, finding that the Board's risk assessment was unreasonable because it was based on speculative evidence regarding the likelihood of reoffending and failed to properly balance the seriousness of potential harm against the risk of that harm materializing.

The court emphasized that lack of insight alone is not a basis to deny an absolute discharge and that the contemplated harm fell towards the least serious end of the spectrum of serious criminal offences.

An appeal of an Ontario Review Board disposition concerning a Not Criminally Responsible (NCR) offender with a long history of serious psychiatric illness, including sexual sadism and pedophilia.

The appellant sought transfer from Waypoint Centre for Mental Health Care to a less secure all-male facility at either the Centre for Addiction and Mental Health (CAMH) or Brockville Mental Health Centre to access escorted community privileges.

The Review Board majority refused the transfer, citing concerns about diminished quality of life.

The Court of Appeal allowed the appeal, finding the Board erred in law by failing to meaningfully consider the appellant's reintegration into society and by failing to assign appropriate weight to the appellant's reasonable preferences and the objective benefits of transfer.

The appellant appealed a disposition order from the Ontario Review Board that imposed a hybrid detention order requiring detention at the Secure Forensic Unit of the Centre for Addiction and Mental Health with discretion to transfer to the General Forensic Unit or allow community residence in approved accommodation.

The appellant, found not criminally responsible for threatening others with a knife in 2011, had been living in the community under conditional discharge but experienced significant deterioration in 2017 due to medication non-compliance and substance use.

The Court of Appeal dismissed the appeal, finding the Board's findings of significant threat and the necessity of the detention order were amply supported by evidence.

An appeal from an Ontario Review Board disposition detaining a not criminally responsible on account of mental disorder (NCRMD) accused in a secure forensic unit.

The appellant challenged the Board's finding that she posed a significant threat to the safety of the public.

The Court of Appeal found that the Board failed to properly apply the legal test for "significant threat" under section 672.5401 of the Criminal Code, which requires a serious risk of serious physical or psychological harm from criminal conduct.

The Board's reasons did not adequately analyze either the risk or gravity of psychological harm.

The appeal was allowed and a new hearing was directed.

An appeal from a motion judge's decision certifying a class action and granting partial summary judgment against an anaesthesiologist in a bacterial infection outbreak case.

The motion judge certified the class proceeding and found the defendant breached his duty of care regarding infection prevention and control practices.

The appellate court allowed the appeal on procedural fairness grounds, finding that the motion judge reformulated the certified common issue without notice to or submissions from the parties, and then decided the summary judgment motion on the basis of this new formulation.

The court held that this violated procedural fairness and entitled the defendant to a new hearing.

The appellant appealed a disposition order from the Ontario Review Board dated January 5, 2017, which ordered his detention at Waypoint Centre for Mental Health Care – Provincial Forensic Division.

The appellant did not challenge the Board's finding that he posed a significant threat to public safety but argued that his transfer from CAMH to Waypoint was not necessary and appropriate for managing that risk.

He contended that the Board failed to consider the context of his behaviour and that the announcement of his transfer triggered his deterioration.

He also argued the Board did not give sufficient weight to the disruption of his therapeutic and familial relationships.

The Court of Appeal dismissed the appeal, finding the Board's decision was reasonable and amply supported by evidence.

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.

An appellant found not criminally responsible on account of mental disorder for criminal harassment appealed the Ontario Review Board's disposition that he constituted a significant threat to public safety and should be transferred between secure forensic units.

The appellant had been detained in the mental health system for over ten years.

Fresh evidence from the appellant's treating psychiatrist and a clinical forensic psychologist using a stalking-specific risk assessment tool concluded the appellant no longer posed a significant threat and was entitled to an absolute discharge.

The majority allowed the appeal and remitted the matter to the Board for fresh determination.

The dissenting judge would have granted an absolute discharge directly, finding the fresh evidence uncontradicted and unequivocal.

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.