Re: Ronald Nicholson
ORB File No: 8797
Hearing held on: Tuesday, October 21, 2025
Place of hearing: Southwest Centre for Forensic Mental Health Care 401 Sunset Drive, St. Thomas
Pursuant to: Section 672.47(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. C. Finley
Members: Dr. L.O. Lightfoot Dr. S. Swaminath Ms. C. Murray Mr. A. Mete
Parties Appearing:
Accused: Ronald Nicholson Counsel: Mr. S. Gehl
The person in charge of hospital: Counsel: Ms. J. Zamprogna
Attorney General of Ontario: Counsel: Mr. D. Rows
REASONS FOR DISPOSITION
(Dated November 7, 2025)
Introduction
On June 2, 2025, Ronald Nicholson was found not criminally responsible on account of mental disorder on a charge of attempted murder, contrary to the Criminal Code of Canada. The Honourable Court declined to make a disposition, and remanded Mr. Nicholson to the Southwest Centre for Forensic Mental Health Care, (Southwest/the hospital) by way of a Warrant of Committal dated June 2, 2025.
On October 21, 2025, the Board convened a hearing at Southwest to make an initial disposition pursuant to s. 672.47(1) of the Criminal Code. Mr. Nicholson was present and represented by his counsel, Mr. Gehl.
The issues to be determined were whether Mr. Nicholson is a significant threat to the safety of the public, and if so, the necessary and appropriate disposition to manage that threat having regard to the criteria set out in s. 672.54 of the Criminal Code.
Ms. Zamprogna, on behalf of the hospital, submitted that Mr. Nicholson represents a significant threat to the safety of the public and that the necessary and appropriate disposition was a detention order with discretionary privileges up to and including the ability to reside in the community of Southwestern Ontario in accommodation approved by the person in charge of the hospital. Mr. Rows, on behalf of the Ministry of the Attorney General, and Mr. Gehl concurred in the hospital’s positions. Mr. Gehl specifically conceded the issue of significant threat. Thus, a joint submission was put before the Board.
Findings
- For the reasons that follow, the panel found that Mr. Nicholson currently represents a significant threat to the safety of the public and the necessary and appropriate disposition is a detention order with the terms and conditions as recommended by the parties.
The Evidence
- The evidence at the hearing consisted of the Hospital Report, dated July 25, 2025 (ex. 1), the Update to the Hospital Report, dated October 10, 2025 (ex. 2), and the viva voce evidence of Dr. Ardani, Mr. Nicholson’s current treating psychiatrist.
The Index Offence
- The following is a summary of the facts as taken from the Hospital Report. In the early morning of May 8, 2024, Mr. Nicholson was being cared for by his daughter-in-law. He suddenly and without warning cut her throat with a box cutter knife, leaving a ten-inch laceration from ear to ear. The victim fled the home and called 911. Mr. Nicholson also called 911 and reported that he had just cut his daughter-in-law's throat. He did this because she had taken over his bank accounts.
Background Information
The Hospital Report contains a significant amount of background information relating to Mr. Nicholson’s personal history and need not be reviewed in these Reasons beyond the following material facts. Mr. Nicholson is an 81-year-old man who grew up in Rockwood Ontario. He left school after completing grade eight and started working. He married at the of 21 and had a son. In 2006, Mr. Nicholson stopped working in order to care for his wife who ultimately died of breast cancer. He is currently receiving Old Age Security and retirement pensions.
At the time of the index offence, Mr. Nicholson was residing in his home in Elmira. Since his wife’s death, Mr. Nicholson has relied on family supports and neighbours to continue to live independently in the community.
Mr. Nicholson has no history of problematic substance use and no criminal record or history of violence.
In 2022, Mr. Nicholson had surgery for a left hip replacement. Unfortunately, the surgery failed due to an infection at the site, caused by a microorganism resistant to conventional antibiotic treatment. After twelve weeks of intravenous antibiotic treatment, he underwent revision surgery on the same hip on May 30, 2022. Mr. Nicholson remained relatively stable until December 2023, when he began experiencing increased pain and difficulty ambulating. A two-stage revision surgery was recommended. The first stage was performed on February 2, 2024, but, once again, complications arose due to infection from the same resistant microorganism.
While in the hospital and awaiting the second stage of surgery, Mr. Nicholson fell on March 16, 2024, fracturing his left femur. As a result, the second stage of surgery was expedited and performed on March 25, 2024. Unfortunately, the surgical wound did not heal properly. On April 30, 2024, Mr. Nicholson was discharged back to his home with a plan for nursing care and rehabilitation to be delivered in his home.
Following his hip surgeries, Mr. Nicholson experienced significant cognitive decline. He also reported abnormal mental features, including confusion, paranoia and hallucinations, closely associated with the underlying physical/medical conditions. On May 4, 2024, Mr. Nicholson attended the Grand River Hospital emergency department in the company of his son. He reported having memory problems and paranoid ideation, including beliefs that his daughter-in-law was after his money. He requested a psychiatric consultation. During the consultation, cognitive deficits were noted. A Long-Term Care facility was recommended and Mr. Nicholson was discharged home with his son. He was also given a prescription for lorazepam.
Mr. Nicholson’s current diagnosis is Delirium with perceptual disturbance resolved by history, due to multiple etiologies (etiologies are unresolved). Since the NCR finding, his mental status has remained stable. He experiences short term memory issues and has appeared confused. Mr. Nicholson has reported seeing shadows and numbers on the wall in the dark although he has not experienced any pseudo-hallucinations since his medications were optimized. He has not experienced any more instances of delirium, paranoia, or visual or auditory hallucinations.
Mr. Nicholson has good insight into his mental condition and the symptoms that he experiences. He has good insight into the need for medication and acknowledges that he would not be able to administer his own medication independently. He appreciates that his delirium has resulted from a number of factors including complications from his hip surgery. He has expressed remorse for the index offence and is grateful that his daughter-in-law bears him no animosity and has forgiven him.
The following passage found at page 33 of the Hospital Report outlines the current risk that Mr. Nicholson represents:
“Given that Mr. Nicholson's hip continues to have an ongoing infection which in the past has been associated with spells of delirium (since 2014) in which he has acted violently towards others (the index offence), considering his concurrent cognitive decline, it is unlikely that he will be able to be discharged absolutely. For now, it seems that Mr. Nicholson is a low-risk individual as long as his delirium is monitored closely and his infection is managed appropriately. He will require fairly close medical monitoring, such as a LTC facility, to maintain a low risk of violence. With appropriate safeguards, such as infection monitoring, medication adherence, and prompt response to early signs of change in his sensorium, his risk can be significantly mitigated. His risk of reoffending increases significantly in the context of untreated or unrecognized delirium. The team considered a conditional discharge, but historical information suggests that he has not been agreeable with treatment plans and recommendations i.e., for a voluntary admission when he was unwell. Although he is cooperative now, he doesn’t fully understand his support needs and at times has indicated his preference to return to his home.”
Dr. Ardani testified before the Board. He reported that Mr. Nicholson continues to experience a decline in his general cognitive function. In the doctor’s opinion, there is an interplay of factors resulting in the brain not being able to function properly. Since the index offence, Mr. Nicholson has been under continuous monitoring. The treatment team has been able to manage the various factors at play.
In Dr. Ardani’s opinion, Mr. Nicholson’s current level of cognitive functioning would decline if he were not in a supportive environment such as a hospital. His cognitive functioning declines with the intensification of his infection, which continues to be present. Currently, Mr. Nicholson’s medical treatment involves six doctors. With suboptimal treatment, his risk to the safety of the public would increase.
Mr. Nicholson has undergone two Montreal Cognitive Assessments over the past year. In January 2025, he had a score of 24/30. In August his score was 19/30. Dr. Ardani indicated that the unpredictable fluctuations in Mr. Nicholson’s cognitive abilities is expected to continue and requires continuous monitoring.
Dr. Ardani testified that the hospital needs to be able to approve Mr. Nicholson’s accommodation to ensure that he receives the necessary and appropriate level of care. Critical components of that support will be wound care and the administration of medication. The team is currently in discussions with Ontario Health at Home. Unfortunately, the agency has declined their request for a transfer to a Long-Term Care facility, on the basis that Mr. Nicholson is too independent with his Activities of Daily Living (ADL’s). Dr. Ardani is planning to meet with representatives from the agency and advocate on behalf of Mr. Nicholson.
In Dr. Ardani’s opinion, a plan that would have Mr. Nicholson return to his home with nursing care would not be practical and would be costly. That was the case at the time of the index offence. The care was not sufficient to manage the risk posed by Mr. Nicholson’s delirium.
All parties maintained the joint submission.
Analysis and Conclusion
- The panel carefully considered the Hospital Report, the Update and the evidence of Dr. Ardani and unanimously concluded that Mr. Nicholson represents a significant threat to the safety of the public. Mr. Nicholson’s mental status is inextricably bound to his physical health. The following reoffence scenario found at p. 34 of the Hospital Report is apposite:
“Mr. Nicholson has a documented history of acute confusion and behavioural dysregulation during episodes of infection-induced delirium. The infection has not responded to any treatments. Without an active medical treatment, taking into account his age and respective cognitive decline, he is highly at risk for physical health decompensation, and re-emergence of delirium. Without proper medical monitoring, early signs of delirium (e.g. confusion, agitation, and disorientation) could go unrecognized. Without timely medical intervention, his condition would likely deteriorate into full-blown delirium. During this state, he would experience disturbing visual hallucinations and would become increasingly paranoid, as evident historically, misperceiving others as threats, likely responding with sudden and unprovoked physical aggression, resulting in injury, similar to his index offence.”
Having found that the threshold for significant threat has been met, the panel also had to determine the necessary and appropriate disposition taking into consideration the criteria set out in s. 672.54 of the Criminal Code. It is clear from the evidence that Mr. Nicholson requires a significant amount of support. The ongoing management of his infection continues and currently is being monitored by multiple doctors and wound management specialists. This is critical in ensuring that Mr. Nicholson does not experience a reemergence of the symptoms of delirium. Further, Mr. Nicholson’s cognitive decline and increasing memory issues require that his medication be administered by others.
The panel accepted and agreed with the joint submission that the necessary and appropriate disposition is a detention order with the ability for Mr. Nicholson to reside in accommodation approved by the hospital.
DATED this 7th day of November 2025, at the City of Toronto, in the Region of Toronto.
Ms. C. Finley Alternate Chairperson
____________________________ Office of the Registrar Ontario Review Board