Ontario Review Board
Re: Thomas R. Hart
ORB File No: 3832
Hearing held on: Thursday, September 11, 2025
Place of hearing: St. Joseph's Healthcare Hamilton West 5th Campus, 100 West 5th Street
Pursuant to: Section 672.81(1) of the Criminal Code
Before: Alternate Chairperson: Mr. C. MacIntyre, KC Members: Dr. P. Prendergast Dr. G. Nexhipi Mr. K. McKenna Mr. A. Mete
Parties Appearing: Accused: Thomas R. Hart Counsel: Mr. L. Dimitry
The person in charge of hospital: Counsel: Mr. S. O’Brien
Attorney General of Ontario: Counsel: Ms. J. McKenzie
REASONS FOR DISPOSITION (Dated October 31, 2025)
Introduction
On September 16, 2003, Thomas R. Hart was found not criminally responsible on account of mental disorder on charges of assault, causing a disturbance, mischief under $5000 and breach of probation (x2), all contrary to the Criminal Code.
Mr. Hart is currently subject to a Decision and Disposition of the Ontario Review Board of September 19, 2024, which determined that restrictions of his liberty in April and May and June of 2024, were necessary and appropriate and that he be detained at the Forensic Psychiatry Program of St. Joseph's Healthcare Hamilton (“St. Joseph's”) with privileges up to and including to live in the community of Southern Ontario in accommodation approved by the person in charge.
On September 11, 2025, the Ontario Review Board convened at St. Joseph's to conduct Mr. Hart’s annual review and to make a disposition further to s. 672.81(1) of the Criminal Code. The parties were asked to present their preliminary positions prior to the hearing of the evidence. The hospital and Attorney General submitted that Mr. Hart continues to be a significant threat to the safety of the public and they agreed that Mr. Hart’s detention should continue with no change to the terms and conditions of his current Disposition.
On behalf of his client, Mr. Dimitry asks for an absolute discharge, but if the Board finds that his client is a significant threat to the safety of the public, then Mr. Hart agrees with the Disposition proposed by the hospital and Crown except he wishes the removal of the prohibition on cannabis contained at clause 4(a) of his Disposition.
Index Offences
- The index offences are described in last year's Reason for Disposition as follows:
“Briefly stated, they are that on May 27, 2003 Mr. Hart struck a woman in the back as he passed her on a street in Hamilton. Police approached Mr. Hart later that day after receiving a report of an individual causing a disturbance and trying to punch people he met on the street. He ran when police approached but was arrested for assault and causing a disturbance. In the interval between the assault and his arrest Mr. Hart kicked the bottom pane of the right door of the front entrance to a commercial building, causing approximately $500 in damage. Although not stated in the hospital report it is to be inferred that he was on probation at the time he committed the offences.”
Background
A Hospital Reported August 22, 2025, was filed as Exhibit 1 to this hearing. This contains information regarding Mr. Hart’s personal, criminal record and psychiatric background and the report should be referred to for detail. Mr. Hart is now 65 years old. His early childhood history was not a happy one. He was emotionally deserted by his birth father as a child and deserted by his mother as a teenager. It appears that the only way she could cope with her childrens’ acting out behaviour, was to withdraw emotionally from them.
Mr. Hart did not do particularly well in school. He appeared disinterested in elementary school and at the age of 15 he refused to attend classes. At the age of 16 he left his mother’s home in Hamilton and left to travel to Fort McMurray, where he secured a job in a pipe factory. After one year he returned home, and it is believed that since then he has never had any other gainful employment and has supported himself in the community on welfare and family benefits or by theft.
Mr. Hart's mother reports that by the age of 15 or 16 he was abusing solvents and that abuse increased significantly after he returned from Fort McMurray.
Records from Mr. Hart’s probation officers indicate that he had been using alcohol and drugs consistently. Mr. Hart’s criminal record is lengthy with convictions and charges running from 1978 through to 2001, numbering over 60. His record reflects 10 convictions for assault, numerous convictions for theft under, as well as fail to appear, mischief, possession of narcotic, fail to comply, threatening, and break and entering.
The hospital reports a psychiatric admission to the Hamilton Psychiatric Hospital in April of 1992. He had been held at the Hamilton Wentworth Detention Centre at the time. He had been hallucinating and picking fights with guards claiming that they were impostors. He endorsed paranoid persecutory delusions and olfactory, auditory and visual hallucinations with delusions of influence and reference. He constantly eloped from the hospital and finally on April 30, following an elopement, the Hamilton Wentworth Detention Centre staff returned him into custody.
In September of 1998, Mr. Hart was once again detained at the Hamilton Wentworth Detention Centre. His deteriorating mental state, including auditory hallucinations and persecutory delusions and bizarre behaviour, required him to be placed in segregation. He was eventually transferred to the Assessment Unit of the Hamilton Psychiatric Hospital on a Form 1. His admission diagnosis was schizophrenia - paranoid type, chronic with acute exacerbation.
Another admission in December 2000 to St. Joseph's Healthcare Hamilton was necessary due to chronic paranoid symptoms and recurrent aggressive behaviour. He was treated with antipsychotic medication on his own consent and the result was a gradual improvement. However, when given unaccompanied grounds privileges, he eloped and was once again taken into custody at the Hamilton Wentworth Detention Centre. His discharge diagnosis was schizophrenia - paranoid type.
Following Mr. Hart’s finding of NCR, he was ordered detained at St. Joseph's. In May 2006, after about two and a half years of treatment, he was discharged from the inpatient schizophrenia unit to a supervised residence in Hamilton.
In subsequent years, a number of readmissions to hospital were necessary due to breaches of his dispositions following consumption of marijuana or alcohol or both. Between October 2017 and July of 2019, Mr. Hart eloped from hospital or his community home on four occasions.
Mr. Hart has stayed in a number of different residences following his various discharges from hospital. The time period between November 16, 2023, and July 2024, was particularly chaotic as Mr. Hart was readmitted to hospital on six occasions. In that period of time his community residence was the Main East Rest Home. On his last readmission to hospital from there in June 2024, the Main East Rest Home terminated his residence as he had not stayed there for 47 consecutive nights, a rule of the home. Since then, he has been detained at the hospital. Since June 2024, three Restriction of Liberty hearings have been held, and the decisions of the hospital were found to be warranted on each occasion by the Review Board.
Mr. Hart is diagnosed with schizophrenia, substance use disorder (alcohol and marijuana) and borderline intelligence.
Evidence at Hearing
Dr. Sebastien Prat has been Mr. Hart’s most responsible physician since 2017. He advised the Board that for most of the past year Mr. Hart was an inpatient at St. Joseph's. No management issues were experienced at all while he was being highly monitored in hospital.
On July 16, 2025, Mr. Hart was discharged back to the community to the Main East Rest Home where he had earlier resided. This is a residential care facility and a 24-hour highly supervised home with all meals prepared for Mr. Hart and provision of his medications and some household tasks supported by the house staff.
In the circumstances of his back-and-forth living at that home in the past two years and finally losing his position there, the hospital has closely engaged with the staff who have agreed to monitor his whereabouts during the day and work closely with the hospital’s outpatient team.
Dr. Prat testified the while Mr. Hart was in hospital there had been no management issues and following a hernia operation which Mr. Hart initially resisted but eventually undertook, his attitude appeared to change a bit. Whereas in the past he used to elope or tried to elope, this year there were no difficulties. He began to ask to be engaged in programs and seemed to be doing more than he used to. In so far as risk to members of the public is concerned, Dr. Prat testified that undoubtedly public safety would be compromised if Mr. Hart obtained an absolute discharge. He has no insight and still presents residual psychotic symptoms. Mr. Hart sees little to no benefit to treatment and would stop it if he had the chance.
Mr. Hart’s lack of insight includes no appreciation that he can become violent nor can he recognize when psychotic symptoms arise. His level of risk and instability is such that a Community Treatment Order would be insufficient to monitor and supervise him according to Dr.Prat.
Importantly, Mr. Hart has always rejected the diagnosis of schizophrenia and has denied experiencing any related symptoms. He further asserts that alcohol and cannabis have no negative effects on his mental state or his behaviour. He can not associate his illness or substance use to his previous criminal behaviour.
The hospital has tried to consider Mr. Hart’s request to be able to use cannabis and if it can be done without risk. Dr. Prat submits that neither his access to substances nor the quantity that he takes can be controlled. His mental state changes when he uses cannabis, with early signs of this being disorganization and lack of personal care.
Dr. Prat was referred to psychologist Dr. Moulden’s description of Mr. Hart’s views contained in the Hospital Report with which Dr. Prat agreed.
Dr. Moulden stated:
“Mr. Hart acknowledged that his psychiatrists have consistently diagnosed him with Schizophrenia over the years, but he rejects the diagnosis and denied experiencing any related symptoms. This in spite of recorded clinical observations of him pacing the halls, laughing and talking to himself (i.e., responding to internal stimuli). He stated that he does not take medications. At that juncture, he was reminded of the prescribed long-acting injectable medication, which he stated he is “forced to take”. Mr. Hart added that, if his medication was voluntary, he would not be compliant. He went on to state that he derives no benefit from treatment and he would prefer not to take treatment so that he could be “normal”. Furthermore, Mr. Hart denied any problematic substance use currently or in the past. He asserted that alcohol and cannabis have no deleterious effects on his mental state, psychiatric symptoms, or behaviour. Mr. Hart did not associate his mental illness or substance abuse with his previous criminal behaviour. When asked about the index offence he stated that the victim was in his way, and denied inflicting any harm on the victim. He attributed the index offence and subsequent NCR finding to being young and angry combined with the judge’s frustration with his pattern of repeated offending. When asked how he manages his risk and refrains from criminal behaviour currently, Mr. Hart stated that he tells himself to “smarten up...behave yourself”. Upon further queries about his patterns of escape and breaches of disposition, Mr. Hart described a “sudden urge” to use. He added that it makes him happy, and went on to rationalize his substance use on the basis that alcohol and cannabis are legal. Mr. Hart described his physical health as good, and his medical record confirms that there are no significant medical conditions. He acknowledged smoking cigarettes (10/day in hospital).”
Dr. Moulden also stated: “Mr. Hart expressed his desire for Absolute Discharge, and explained that in this case he would disengage from any form of mental health support and treatment, reside alone, and use cannabis and alcohol. Despite identifying many forensic program staff as sources of professional supports whom he described as “good to work with” he was adamant that he would not seek out any such supports if granted an Absolute Discharge.”
With respect to Mr. Hart’s request to remove cannabis as a prohibition, Dr. Prat and the hospital team oppose any use of cannabis. This has been a consistent, and almost uninterrupted disorder for Mr. Hart. There is a direct link between cannabis use and his mental state.
Mr. Dimitry asked Dr. Prat if there was any way that the hospital could permit some limited use of cannabis by Mr. Hart. Dr. Prat answered that they do have some patients with controlled use of cannabis but with Mr. Hart that is not realistic. He has limited cognition and despite years of encouragement there is no confidence that he would adhere to any limit.
Mr. Hart is incapable of making his own treatment decisions and his sister is his Substitute Decision Maker.
Decision
All counsel have submitted that Mr. Hart is demonstrating some small signs of improvement, however all jointly agree that he is still considered a significant threat to public safety.
The Board also finds that the test for significant threat has been made out. The Board accepts the evidence of Dr. Prat and as contained in the Hospital Report which in considerable detail explains that Mr. Hart needs the monitoring and supervision of the hospital to function safely in society. He is unable to live on his own. He lacks insight into his illness and the need for medication and the effects of substances, particularly cannabis, on his mental health.
Mr. Hart rejects that he has an illness, and it is not speculative that if discharged from hospital he would stop his treatment and his medication and quickly abuse alcohol and cannabis and the symptoms of schizophrenia would return. His behaviour will then return to that which brought about the index offences.
As asserted by Dr. Prat and the hospital, Mr. Hart’s cannabis use has been a factor in his offences, a factor in his other criminal behaviour and other behaviour over the years, and it is clear that he is incapable of and not wanting to stop using. There is no justification whatsoever for the removal of the prohibition on cannabis from his Disposition.
Accordingly, Mr. Hart will continue on his Detention Order with the same terms and conditions as his current Order. This is considered not only necessary and appropriate for the safety interests of the public and Mr. Hart’s own mental health well-being but is the least onerous and least restrictive Disposition in the circumstances.
DATED this 31^st^ day of October 2025, at the City of Toronto, in the Region of Toronto.
Mr. C. MacIntyre, KC Alternate Chairperson
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Office of the Registrar Ontario Review Board