Re: Joseph Pampano
ORB File No: 4083
Hearing held on: Monday, October 6, 2025
Place of hearing: St. Joseph’s Healthcare Hamilton, West 5th Campus Hamilton, Ontario
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. P. Capelle
Members: Dr. H. Bloom Dr. A. Kerry Ms. S. Clapp Mr. W. Apted
Parties Appearing:
Accused: Joseph Pampano Counsel: Mr. S. Bernstein
The person in charge of hospital: Counsel: Ms. L. Barney
Attorney General of Ontario: Counsel: Ms. K. Malkovich
REASONS FOR DISPOSITION
(Dated November 25, 2025)
Introduction:
On November 16, 2004, Joseph Pampano was found not criminally responsible on account of mental disorder (“NCR”) on one charge of possession of incendiary device and three charges of arson, contrary to the Criminal Code. He is currently subject to a Disposition of the Ontario Review Board (“ORB” or the “Board”) dated October 18, 2024, whereby he is detained at the Forensic Psychiatry Program at St. Joseph’s Healthcare Hamilton, West 5th Campus (“SJHCH” or the “hospital”) with privileges up to and including community living in approved accommodation. He is also required to abstain from substance use, and refrain from possessing weapons and incendiary devices (with the exception of a lighter for smoking).
On October 6, 2025, a panel of the Board convened at SJHCH to conduct Mr. Pampano’s annual review pursuant to section 672.81(1) of the Criminal Code. Mr. Pampano attended the hearing and was represented by counsel, Mr. Bernstein.
The Hospital Report dated September 18, 2025, was marked as Exhibit 1. In addition to the documentary evidence, Mr. Pampano’s most responsible physician, Dr. Khashayar Shariati, gave evidence.
The issues to be decided at the hearing were whether Mr. Pampano continues to meet the test of posing a significant threat to the safety of the public as set out in section 672.5401 of the Criminal Code, and if so, what is the necessary and appropriate Disposition, taking into account the four factors set out in section 672.54 of the Criminal Code.
Position of the Parties:
At the outset of the hearing, the parties were asked for their initial without prejudice positions. On behalf of the hospital, Ms. Barney took the position that Mr. Pampano continues to represent a significant threat to the safety of the public, and that a continuation of the existing Detention Order remained necessary and appropriate.
Ms. Malkovich supported the position of the hospital on behalf of the Attorney General.
Mr. Bernstein stated that Mr. Pampano was requesting an Absolute Discharge.
Findings:
- For the reasons that follow, the panel found that Mr. Pampano continues to pose a significant threat to public safety. The panel concluded that the necessary and appropriate Disposition, which is also the least onerous and least restrictive in the circumstances, is a continuation of the Detention Order with no changes.
Index Offences:
The specific circumstances of the index offences are included in the Hospital Report at pages 6-7, and can be summarized as follows. On July 31, 2004, Mr. Pampano put an advertisement in The Hamilton Spectator that said, "Joe P. Timothy McVeigh -J. F. K. Federal building blown away. What else do I have to say." Concerned citizens brought this to the attention of Hamilton Police Services, who did an investigation and interviewed Mr. Pampano at his home. On Monday, August 16, 2004, Mr. Pampano made Molotov cocktails at his home by putting gas in empty wine bottles. He put white cloths in the top of each bottle. Mr. Pampano took four of the Molotov cocktails and went to the centre area of Hamilton. He threw lit Molotov cocktails through the windows of a government building, City Hall, and the Family Court building. Police later found more Molotov cocktails in Mr. Pampano’s kitchen. A list was seen beside the phone mentioning several of the places where he lit off the Molotov cocktails.
Mr. Pampano admitted to the offences at all of the buildings, and said that if he were released, he would continue this behaviour.
Background:
Mr. Pampano’s personal history is outlined in the Hospital Report in detail and will not be repeated here. In summary, Mr. Pampano is a 49 year single man. He has one sister. He attended high school until grade 10, when he became involved with drugs and preferred to be with friends than continue with his schooling. Mr. Pampano’s parents separated when he was 14 years old, and his father was a habitual marijuana user. Records indicated that Mr. Pampano worked as a full-time labourer from February 1999 to June 2000, and then had a few short-term jobs.
Mr. Pampano has a son born in 1994 who resided with his mother. He has not had any contact with his son for many years.
The Hospital Report stated that Mr. Pampano began drinking alcohol and using cannabis at age 15. He regularly used alcohol and cannabis throughout his 20s. He also reported experimenting with cocaine, ecstasy and acid. Mr. Pampano denied cannabis or alcohol use prior to the index offences.
The Hospital Report stated that Mr. Pampano’s family were “shaken” by his mental illness in the two to three years prior to the index offences. They initiated a hospitalization in 2002 and then supported him in obtaining individual living accommodations. Mr. Pampano’s family noticed a deterioration in his mental condition in the months leading up to the index offences. On the day of the index offences, Mr. Pampano attended at his mother’s house and asked for some glass bottles. Mr. Pampano’s mother had no idea that Mr. Pampano would use them the way he did, and she actually worked in one of the government buildings that Mr. Pampano targeted.
Criminal History:
- Mr. Pampano did not have any prior criminal convictions. However, clinical records indicated that charges of theft and driving without insurance had been resolved. Mr. Pampano also admitted to selling cannabis.
Psychiatric History:
The Hospital Report included a summary of Mr. Pampano’s lengthy hospital admission from September 17, 2002 to January 13, 2003 at McMaster University Hospital and then St. Joseph’s Centre for Mountain Health Services. His family had completed a Form 2 under the Mental Health Act (“MHA”) due to paranoia and reclusiveness. He had ongoing delusional thinking and there were concerns about risk to his family. Mr. Pampano was diagnosed with Schizophrenia and he was discharged to live at the family home with outpatient follow-up at the McMaster Psychotic Disorders Clinic.
Mr. Pampano has had a long and variable course at SJHCH under the jurisdiction of the Board, and the details are outlined in the Hospital Report. Briefly summarized, Mr. Pampano did relatively well in his early years and efforts were made to discharge him into the community on two occasions in 2005. However, he was readmitted on both occasions after a short period of time in the community due to cannabis use. Mr. Pampano was discharged to the community again in February 2006, and received a Conditional Discharge in November 2006. The Conditional Discharge was continued in December 2007 with a decrease in reporting; however, an early Board hearing was held in March 2008 because Mr. Pampano was refusing to provide urine samples for testing. A Detention Order with community living was reinstated and Mr. Pampano was readmitted to the hospital.
Mr. Pampano was next discharged to the community in December 2008; however, he tested positive for cannabis in February 2009 and was readmitted. During that admission, Mr. Pampano assaulted a co-patient and was placed in seclusion. He also required a transfer to a different unit after developing strong delusions about a female occupational therapy assistant. Mr. Pampano remained in the hospital until November 2012, when he was discharged to a boarding home in the community. He did well in the community and moved to an independent living setting in December 2013.
Mr. Pampano continued to do well in the community and the Board granted a Conditional Discharge in March 2015. Mr. Pampano agreed to a voluntary admission in June 2015 following numerous positive tests for cannabis. He was then picked up by an Assertive Community Treatment Team (“ACTT”), and the Conditional Discharge was continued.
Mr. Pampano began refusing all medications after his Board hearing and was assessed as incapable to consent to treatment in June 2016 (which was confirmed by the Consent and Capacity Board in 2016 and 2021). An early Board hearing was held in November 2016 and a Detention Order was reinstated. Mr. Pampano continued to refuse medications and exhibited persecutory delusions. He was difficult to engage and threatened violence if he was forced to take medications. He developed the belief that the medications were harming him and he was “deformed” because of them.
In 2022, Mr. Pampano became more settled and cooperative and began accepting medications. He was discharged to community living at Emmaus Place in February 2023. He remained guarded and reclusive, but was abstinent from substance use and did not exhibit any aggression or threatening behaviour. He reluctantly accepted psychotropic medications. Mr. Pampano was evicted from Emmaus Place and readmitted to hospital in August 2024 after failing to pay his rent (even after the hospital negotiated a three month extension) and declining supports to secure permanent housing (the unit was transitional). Mr. Pampano was solely focused on maximizing an RDSP at the time.
The Hospital Report lists Mr. Pampano’s current diagnoses as: Schizophrenia; Alcohol Use Disorder, in sustained remission; and Cannabis Use Disorder, in sustained remission. He is incapable to consent to treatment and the Public Guardian and Trustee is his substitute decision-maker. He is capable to manage his property.
Evidence at the Hearing:
- The Hospital Report stated that Mr. Pampano keeps to himself on and off the unit. He continues to endorse delusions regarding co-patients and staff. He has no insight into his mental illness and does not believe he needs treatment. He can be seen openly responding to internal stimuli and is observed to have full conversations with himself and/or laughing to himself. The following excerpt from the Hospital Report describes Mr. Pampano’s presentation (at page 100):
“Mr. Pampano’s symptoms of major mental illness include delusions, visual, and auditory hallucinations. These symptoms can be intense at times and attempts to reorient him or challenging him on these have not provided relief. Mr. Pampano’s delusional beliefs involve nursing staff and co-patients. This has resulted in several verbal altercations, intimidations, and threats toward co-patients on the unit this reporting period. He believes that co-patients are “out to get him”. He believes they are going in to his bedroom, and/or knocking on his bedroom door. This has resulted in several bedroom changes for Mr. Pampano and co-patients on the unit to mitigate risks of conflict between him and co-patients. He has been accepting of redirections to remove himself from the area when he is having confrontations with co-patients. This has resulted in close monitoring of Mr. Pampano when he is in the general unit milieu. It has also resulted in several co-patients being concerned for their safety following verbal confrontations from Mr. Pampano.
Mr. Pampano believes that the long acting medication is “harming him”, “altering his abdomen”, and that he doesn’t need the medications as he “does not have a mental illness.” Mr. Pampano has refused taking any oral medications to help treat his mental health symptoms.”
The Hospital Report also stated that Mr. Pampano’s long-acting injectable medication was changed from every 12 weeks to every 10 weeks, and eventually every nine weeks. This decision was made due to his worsening clinical presentation including impaired functioning, withdrawal from nearly all activities, increased anxiety, persecutory ideation, and multiple verbal altercations with co-patients. There are multiple notable incidents in the Hospital Report outlining these incidents.
The Hospital Report referenced an incident on May 7, 2025, when Mr. Pampano refused the long-acting injection and stated, “I'm not going to let you do this to me this time. I am taking a stance and I am going to fight.” Staff were required to go “hands on” to escort him to seclusion for safety. The injection was eventually administered and Mr. Pampano was kept in seclusion for four hours until he calmed down.
The Hospital Report also stated that Mr. Pampano declined a Clozapine trial after hearing about the requirement for routine blood work.
Mr. Pampano has no Approved Persons or visitors. He has no contact with family (including his adult son), and is not interested in contacting them. In response to a question from the panel, Dr. Shariati agreed that connecting Mr. Pampano with the Peer Support Program could be explored.
The Hospital Report stated that Mr. Pampano is not currently on any housing waitlists “due to disinterest in available options.” It was noted that Mr. Pampano has demonstrated little progress in his recovery and has had increased negative interactions with co-patients. He has not cooperated with applying for housing options, and he continues to be fixated on finances. He has also not engaged in therapeutic programming and spends most of his day by himself.
The Hospital Report stated that the psychological risk assessment completed by Dr. Heather Moulden in 2024 which concluded that Mr. Pampano’s risk for violent reoffending fell in the low to moderate range under a Detention Order remained valid.
The Clinical Risk Summary in the Hospital Report included the following statement about the issue of significant threat (at page 107):
“Given fixed persecutory beliefs, absent insight, repeated confrontation pattern, and predictable medication agitation, he poses a foreseeable, significant risk of serious interpersonal harm outside structured care. Risk is contained on the unit but would rise materially in less-structured settings. Mr. Pampano continues to meet the threshold for significant risk to the safety of the public.”
Dr. Shariati testified that he has been Mr. Pampano’s attending psychiatrist since February 2023. He described Mr. Pampano as having an “eventful” year, and referred to verbal agitation and confrontations with co-patients. He stated that these behaviours stem from Mr. Pampano’s Schizophrenia which is not optimally treated. Dr. Shariati testified that the change in the administration of the long-acting injection to nine weeks seems to be having a positive effect because there had been no verbal outbursts in the last two months. However, Dr. Shariati was clear that he is still assessing Mr. Pampano and there is need for caution.
Dr. Shariati testified that if Mr. Pampano were granted an Absolute Discharge, he would immediately fall away from psychiatric services, discontinue medication, and his mental state would return to what it was at the time of the index offences. This would include delusions with potential grandiose and gang-based themes, as well as emotional dysregulation. Dr. Shariati noted that even in the hospital setting, Mr. Pompano has exhibited verbal aggression and agitation, which would have likely escalated to fights resulting in physical harm if staff had not intervened and de-escalated the situations. Dr. Shariati stated that Mr. Pampano’s privileges had been restricted many times because the treatment team did not feel safe interacting with him due to the intensity of his aggression.
Dr. Shariati reiterated that Mr. Pampano does not believe that he has a mental illness or that the index offences were a mistake or a result of a mental illness. He therefore does not believe that he poses a risk to anyone. Dr. Shariati stated that Mr. Pampano feels that he is unwell because of something that the hospital is doing to him.
Dr. Shariati testified that Mr. Pampano’s risk factors include that he has a major mental illness, he has no insight into his mental illness or the need for treatment, he has no supports in the community, he has a lack of structured activities, he continues to be symptomatic, and he has a recent history of aggressive and inappropriate interactions with staff and co-patients.
When asked about what steps had been taken to assist Mr. Pampano with his finances and potential housing options, Dr. Shariati stated that the social workers and recreational therapists had worked with Mr. Pampano extensively without success. Mr. Pampano will not accept the requirements of a number of the housing options including the need to take oral medications, share a bathroom, or live in a group home. Dr. Shariati agreed that the barrier to discharging Mr. Pampano to suitable housing was not due to lack of availability of housing, but rather to Mr. Pampano’s preferences and inability to engage in a meaningful discussion. The treatment team asked Mr. Pampano to tell them where he wants to live, but that had not happened. There are also some concerns about Mr. Pampano’s management of his finances, but Dr. Shariati stated that it was not that Mr. Pampano does not have enough money, but that he prioritizes other factors. Dr. Shariati also testified that it had been very challenging to assess Mr. Pampano’s capacity to manage property.
In response to questions from Mr. Bernstein, Dr. Shariati agreed that all of Mr. Pampano’s altercations had been verbal, but Dr. Shariati stated that they were indicators of Mr. Pampano’s mental status and could lead to a “very real risk” of physical harm similar to the index offences. Dr. Shariati also agreed that the index offences were many years ago, but he noted that Mr. Pampano had threatened physical violence recently when refusing his injection in December 2024 and May 2025. Dr. Shariati specifically described the May 2025 incident as a “big event” that required more than 12 staff members, and was a “very serious physical confrontation.”
Dr. Shariati testified that Mr. Pampano would “probably” be ready for community living if they could agree upon appropriate accommodation. From the treatment team’s perspective, this would include significant oversight, Forensic Outpatient services, monitoring, and medication administration. Dr. Shariati did not think that a community treatment order (CTO) would work for Mr. Pampano in light of the intensive resources that would be required and because he is resistant to all intervention. Dr. Shariati explained that Mr. Pampano is so against the forensic system that he has told the treatment team that, if ever required, he does not want to receive CPR from them. He said that Mr. Pampano does not trust anyone at the hospital, and this extends to the entire treatment team.
Dr. Shariati also explained that Mr. Pampano’s verbal confrontations are likely the result of frustration, delusions, and misattributions or misinterpretations of stimuli or interactions as being threatening.
Dr. Shariati did not think that a Conditional Discharge was appropriate for Mr. Pampano given the need for the hospital to approve housing and intervene quickly. He testified that the plan going forward is to continue to canvass and assess accommodations, and encourage Mr. Pampano to work with the team towards discharge. Dr. Shariati did not think that there was a treatment impasse, and stated that he believed he has a “fair” working relationship with Mr. Pampano. However, Dr. Shariati is considering whether Dr. Duboff could take over Mr. Pampano’s care again given that Mr. Pampano seemed to do better during the time that Dr. Duboff was his psychiatrist.
Dr. Shariati was asked about the apparent contradiction between Mr. Pampano not wanting to be in the hospital (and not trusting the treatment team), and not working with the team towards discharge. Dr. Shariati responded that Mr. Pampano has had difficulty working with various treatment team members, and has always prioritized something else over housing for the last two years.
In response to a question from Ms. Barney, Dr. Shariati agreed that Mr. Pampano assaulted a co-patient in March 2009 by punching him in the face (outlined at page 28 of the Hospital Report).
No further evidence was called by the parties.
Submissions:
Ms. Barney maintained the hospital’s position that Mr. Pampano remains a significant threat to the safety of the public and pointed to the Clinical Risk Summary and Psychological Risk Assessment in the Hospital Report. She submitted that if Mr. Pampano was not subject to the jurisdiction of the Board, he would not accept treatment because he does not believe that he has a mental illness that requires treatment. To the contrary, Mr. Pampano believes that the medications are harming him. Ms. Barney referred to the two occasions over the past year where “hands on” efforts by staff and seclusion were required in order to give Mr. Pampano his injection. She also referenced Mr. Pampano’s violent attitudes in March 2009 when he assaulted a co-patient, and incidents in 2020 where Mr. Pampano threatened to “take things into his own hands” in relation to incidents he had with a co-patient (at pages 67-68 of the Hospital Report). Ms. Barney further submitted that the hospital requires the ability to approve Mr. Pampano’s housing because he needs a specialized level of support. This will be more challenging in light of the fact that Mr. Pampano refuses to engage with housing options.
Ms. Malkovich submitted that the structure of the Detention Order is what manages Mr. Pampano’s risk to the public. He has a major mental illness that is refractory to treatment and his insight is non-existent. Although the index offences were 20 years ago, the severity of violence was significant. Ms. Malkovich submitted that an Absolute Discharge was not supported by the evidence, and took the position that a Conditional Discharge was premature because the hospital needs to be able to approve housing and readmit Mr. Pampano quickly if required. Ms. Malkovich stated that the “ball is in Mr. Pampano’s court” to get his name on waitlists so he can get back into the community.
Mr. Bernstein submitted that Mr. Pampano’s verbal altercations all appear to have occurred in the context of the hospital, as there had been no reports of difficulties in the community. He stated that this was because Mr. Pampano is “somewhere that he does not want to be.” Mr. Bernstein noted that Mr. Pampano has no other criminal record, has been compliant with the long-acting injectable medication recently, and the index offences were over 20 years ago. The last time he was physically aggressive was in 2009, and there had been nothing other than verbal aggression since then. Mr. Bernstein submitted that this did not rise to the level of significant threat. Mr. Bernstein also submitted that the reasons that Mr. Pampano gave for rejecting certain housing options were reasonable, and stated that it “falls on the hospital to get him into the community.”
Analysis and Conclusions:
The panel found that the Hospital Report and the evidence of Dr. Shariati clearly demonstrated that Mr. Pampano continues to represent a significant threat to the safety of the public. The panel accepted the evidence of Dr. Shariati and agreed with the submissions of Ms. Barney and Ms. Malkovich. In coming to this conclusion, the panel carefully considered the decision of the Supreme Court of Canada in Winko v. British Columbia (Forensic Psychiatric Institute), 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625 (“Winko”). In that case, the Court stated that a significant threat to the safety of the public must be: more than speculative in nature and supported by the evidence; significant, in the sense of there being a “real risk of physical or psychological harm to members of the public that is serious in the sense of going beyond the merely trivial or annoying”; and the conduct giving rise to the harm must be criminal in nature. Further, the Court stated that there must be a positive finding of a significant threat to the safety of the public in order to support restrictions on an NCR accused’s liberty. Anything else, for example uncertainty, cannot suffice.
In the Winko case, the Supreme Court of Canada also stated that in coming to a conclusion on the issue of significant threat, a Review Board should closely examine a range of evidence including the circumstances of the original offence, the past and expected course of the accused’s treatment, the present state of the NCR accused’s mental condition, and the NCR accused’s own plans for the future, the support services existing for the NCR accused in the community, and the recommendations provided by experts who have examined the NCR accused.
Although the index offences were 20 years ago, they were very serious and could have resulted in much more harm than they did. Mr. Pampano does not acknowledge that he was unwell at the time of the index offences, or at the current time. He adamantly denies that he suffers from a mental illness or that he needs treatment. In fact, he views the medications as harmful, and has refused them on at least two occasions during the past reporting year, with significant verbal aggression and physical agitation. Further, Mr. Pampano’s Schizophrenia is not optimally treated, and he continues to display overt psychotic symptoms, which increase his risk to act out. The panel accepted the evidence that but for the closely supervised environment of the hospital and the staff’s quick interventions, Mr. Pampano’s confrontations with staff and co-patients likely would have escalated to the point where physical injury would have occurred.
The panel concluded that absent the supervision or the forensic system, Mr. Pampano is very likely to fall away from psychiatric services and discontinue medications. This is because Mr. Pampano does not believe that he has a mental illness that requires treatment and he has no supports in the community. He would then become increasingly symptomatic and may use substances as he did in the past. This would lead to a rapid increase in his psychotic symptoms which would likely result in him acting out in a violent way and causing harm to members of the public.
The panel found that a continuation of the existing Detention Order is the necessary and appropriate, and least onerous and least restrictive, Disposition for Mr. Pampano at this time. It is clear from Mr. Pampano’s history and his current mental state that the hospital requires the ability to approve Mr. Pampano’s housing and bring him back to the hospital in the event that a transition to the community does not go well. A Conditional Discharge was not effective in the past, and is also not appropriate at the current time for these same reasons.
Finally, the panel noted the internal inconsistencies in some of Mr. Pampano’s views and actions. Specifically, although Mr. Pampano says that he does not want to be in the hospital and does not trust anyone at the hospital, he is unable or unwilling to engage with the treatment team in working towards discharge to housing that is acceptable to both him and the treatment team. Mr. Pampano is encouraged to work with the treatment team on these issues so that he can move forward with his reintegration into the community.
DATED this 25th day of November 2025, at the City of Toronto, in the Toronto Region.
Suzanne Clapp
Legal Member
Office of the Registrar
Ontario Review Board