Ontario Review Board
Re: George Romani
ORB File No: 7779
Hearing held on: Monday, October 6, 2025
Place of hearing: St. Joseph's Healthcare Hamilton West 5th Campus, 100 West 5th Street
Pursuant to: Sections 672.48(1) and 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. S. Clapp Members: Dr. H. Bloom Dr. A. Kerry Mr. P. Capelle Mr. B. Apted
Parties Appearing:
Accused: George Romani Counsel: Ms. M. Addie
The Person in charge of Hospital: Counsel: Ms. L. Barney
Attorney General of Ontario: Counsel: Ms. K. Malkovich
REASONS FOR DISPOSITION
(Dated November 28, 2025)
Introduction
On September 17, 2020, Mr. George Romani was found unfit to stand trial on account of mental disorder on charges of utter threat to cause death or bodily harm and forcible confinement, contrary to the Criminal Code of Canada (the "Criminal Code"). Mr. Romani is currently subject to a Disposition of the Ontario Review Board (the "Board") dated October 21, 2024, detaining him at the Forensic Psychiatry Program of St. Joseph's Healthcare Hamilton, West 5th Campus (“St. Joseph's”), with privileges up to entering the community of Hamilton, accompanied by staff or a person approved by the person in charge.
On October 6, 2025, a panel of the Ontario Review Board (the "ORB" or the "Board") convened a hearing pursuant to ss. 672.48(1) and 672.81(1) of the Criminal Code. Mr. Romani was in attendance and was represented by his counsel, Ms. Addie.
The Hospital Report dated August 20, 2025 was marked as Exhibit 1. The Board also had a Prima Facie Order dated November 21, 2024 pursuant to section 672.33 of the Criminal Code as part of the record. The panel heard oral evidence from Dr. Lemmie Tan (a forensic psychiatry resident working under the supervision of Dr. J. Ferencz) and Mr. Romani.
Without Prejudice Position of the Parties
Ms. Barney, on behalf of the hospital, advised that as set out at pages 53 and 54 of the August 20, 2025, Hospital Report, Mr. Romani remains unfit and that a continuation of the current Detention Disposition, with the addition of the privilege to enter the community of Hamilton, indirectly supervised, be added.
Ms. Addie agreed with the hospital recommendations and conceded the ongoing presence of significant threat and unfitness.
Both Ms. Barney and Ms. Addie maintained their initial positions during closing submissions.
Ms. Malkovich, on behalf of the Attorney-General initially advised that she anticipates joining the Hospital’s recommendations but will have questions regarding the newly proposed term. After having heard the Hospital’s evidence, Ms. Malkovich stated that she did not take issue with the addition of the privilege enabling Mr. Romani to enter the community of Hamilton indirectly supervised because Dr. Tan stated it would be implemented gradually and subject to random urine testing.
Background and Index Offences
The Hospital Report outlines Mr. Romani’s history and background and need not be repeated here in detail. Briefly, Mr. Romani is now a 42-year-old single male financially supported by the Ontario Disability Support Program.
Mr. Romani has a long trajectory of mental health difficulties beginning in adolescence, with substance use starting at age 11 and escalating over time.
His psychiatric presentation includes psychotic symptoms with grandiose delusions (beliefs about wealth, property, and professional status).
Some 23 psychiatric hospitalizations preceded the index offenses with frequent police involvement and multiple instances of treatment non-compliance.
From 2010 Mr. Romani has been followed by an Assertive Community Treatment Team (“ACTT”) and since 2011 he was subject to a Community Treatment Order (“CTO”) when the index offences occurred.
Mr. Romani’s criminal record consists of a conviction for mischief in 2009 and a conviction for assault in 2016.
The circumstances of the index offences are taken from last year’s Reasons for Disposition as follows:
“The alleged index offence occurred on July 5, 2020. Mr. Romani attended a Tim Horton’s restaurant in Mississauga and was allegedly threatening to assault staff members and pull them over the counter. He is alleged to have forcibly confined himself and the staff members by locking the doors.”
Current Diagnoses
- Schizophrenia
- Substance Use Disorder (not otherwise specified)
Evidence at Hearing
Dr. Lemmie Tan, a PGY-6 Psychiatric Resident, was the hospital witness. Dr. Ferencz, Mr. Romani’s attending psychiatrist was also present as an observer.
Dr. Tan’s involvement with Mr. Romani began on July 2, 2025. Dr. Tan confirmed having read and adopted the contents of the Hospital Report. He last assessed Mr. Romani’s fitness in the hours preceding today's hearing which began at 10:30 a.m. Mr. Romani’s presentation was similar to what is noted in the Hospital Report at page 53. Mr. Romani presents as animated, and eager to discuss his perspectives. Mr. Romani continues to believe that there are no outstanding charges against him and that all his legal matters have been resolved.
Mr. Romani cannot demonstrate his understanding of plea options or potential outcomes as he believes he has already been found not guilty and any charges have been dealt with. Similarly, he cannot explain what an oath is. Mr. Romani can identify the lawyers and the judge but cannot elaborate their roles as he himself believes he is a lawyer and therefore entitled to speak directly to the judge as he has in the past.
Mr. Romani is aware who his counsel is and identified her this morning although a few weeks ago he could not recall her name. It is unlikely that he can meaningfully participate in his defence or instruct counsel as he insists the charges against him have been resolved and he has no need for a lawyer. At present, Dr. Tan’s opinion remains that Mr. Romani is unfit to stand trial. Dr. Tan added that if pressed on any of the fitness questions, Mr. Romani tends to become quite irritable as his position is that there are no longer any charges. He can be perseverative and difficult to redirect.
Dr. Tan noted that while Mr. Romani’s insight has fluctuated, at no time has he been found fit to stand trial. When asked about Mr. Romani’s understanding of the Board’s hearing today, Dr. Tan responded that Mr. Romani is unable to reconcile why he continues to have ORB hearings since he believes that all of his court matters have been resolved. However, Mr. Romani is pleased to have to opportunity to present his perspective and inform the Board that he has no charges and no symptoms of mental illness.
Mr. Romani’s clinical course this reporting year has been relatively static notwithstanding a switch from Amisulpride to Cariprazine. Unfortunately, he decompensated somewhat when this switch occurred and he was transitioned back to Amisulpride. He continues to demonstrate grandiose and delusional thought content, including beliefs that he graduated from many different colleges and universities, and that he is a surgeon, store owner, judge, engineer and doctor. He has no insight into his mental illness and the need for treatment. When Mr. Romani decompensates, he becomes increasingly disorganized and further entrenched in his delusions. This leads to behavioural changes and he is more difficult to manage. Nevertheless, there have been no incidents of aggression noted this reporting year.
There have been no discussions regarding the use of ECT since April 2025 when Mr. Romani’s father and SDM expressed his belief that previous sessions of ECT were at least partially attributable to his son’s current psychotic state. Dr. Tan does not believe this is a valid concern. Mr. Romani’s father has not wanted to become an approved person as the treatment team suspects that he does not want that level of responsibility because his son has previously incorporated the family in his delusions.
Addition of the privilege to enter the community of Hamilton, indirectly supervised to Mr. Romani’s Disposition will enable him to independently go to local stores.
Over the coming year the hope is to address Mr. Romani’s symptoms and render him fit to stand trial.
Ms. Malkovich inquired regarding Mr. Romani’s exercise of his level 3 privileges. Dr. Tan responded that generally Mr. Romani walks around the hospital grounds on his own and will have a cigarette. When exercising accompanied level 4 privileges, Mr. Romani is taken to the mall with a group of patients, subject to supervision. The potential concern surrounding Mr. Romani exercising indirect community privileges is that due to fluctuations in his mental state, he sometimes becomes irritable. Current presentation will therefore inform the suitability of each discretionary entry to the community. Dr. Tan agreed that Mr. Romani is currently at the ceiling of his privileges and there are no elopement concerns. Ms. Addie inquired of the status of her client on waitlists and housing searches. Dr. Tan responded that Mr. Romani is not currently on any list as the treatment team unanimously feel he is inappropriate for community living at this time.
A panelist inquired if the notable incidents described at pages 44 to 45 of the Hospital Report are attributable to disorganization (and not assaultive behaviours). Dr. Tan responded that they were and are also tied to delusions. He reiterated that there has been no violence or threats directed towards co-patients in the past reporting year.
In response to a question as to whether Mr. Romani is optimally treated, Dr. Tan stated that Mr. Romani remains very symptomatic despite trials of different medications. He believes that he is optimally treated based on the options available. As a result, there is no reason to believe that Mr. Romani will be deemed fit in the coming reporting year. A trial of ECT may help. A panelist inquired if Mr. Romani's father continues to act in his son's best interests in his role as SDM. Dr. Tan responded that his father believes that ECT contributed to his son’s psychotic state. Nevertheless, the treatment team will revisit ECT with Mr. Romani's father and any consideration of possibly removing him as SDM is dependent on the progress of those discussions.
There are no immediate concerns that substance use will occur if indirect community access is exercised by Mr. Romani. There has been no substance use since December 2023. When granted those passes, his mental state will nevertheless be closely monitored as it has been with indirectly supervised hospital grounds passes. Further, there will be regular drug screening.
Mr. Romani’s mental illness and treatment involved similar delusions to those seen at the time of the index offences when he was subject to a CTO. It was noted at page 11 of the Hospital Report that several Form 47s were required for Mr. Romani to have his intramuscular injections administered at that time.
Injectable medication will also be considered. As noted at page 11 of the Hospital Report, Mr. Romani was previously treated with clozapine in conjunction with injectable Clopixol in June of 2020 with the index offences occurring less than a week later. Dr. Tan confirmed that at that juncture reliance was placed on injections alone as there were no other means to return Mr. Romani to hospital and have him take other forms of psychotropic medication (i.e. he likely was not taking the oral Clozapine). Currently Mr. Romani is on Clozapine and Amisulpride (which requires special approval) and that is the gold standard for treatment refractory schizophrenia.
As compared to the time of the index offences, Mr. Romani has enjoyed a structured environment in the hospital for several years and has been stable on his prescribed medications for several months.
Mr. Romani was called to testify by his counsel. He stated that he has never broken the law, never hurt anyone, never stolen anything, never been violent, or addicted to drugs. Further, he has no mental health issues or drug addiction issues. He stated that he went to university and college and is trained as a doctor, lawyer, and teacher. He explained to his doctors that he himself is a doctor sent to work at this hospital.
Asked why the doctors want to treat him, Mr. Romani responded that they are uncertain if he is a patient or a doctor at St. Joseph’s.
Mr. Romani does not think there are any outstanding charges against him. Were he to go to court he would plead not guilty with an explanation.
Closing Observations
Ms. Barney submitted that Mr. Romani remains unfit and that if he is granted indirectly supervised community passes these will occur in a gradual fashion in conjunction with regular random drug screening.
Ms. Malkovich stated that she does not take issue with the addition of indirectly supervised passes as Dr. Tan stated they will be implemented gradually and subject to urine testing. Ms. Malkovich noted that all of Mr. Romani’s accompanied level 4 passes had gone well.
Ms. Addie noted that her client is currently at the ceiling of his passes within his Disposition and that he has accessed hospital grounds independently without incident. If there are concerns, he will not be given an indirectly supervised community pass. What Mr. Romani wants to do is to go to the shopping centre which is walking distance of the hospital. He promises to use this extra privilege appropriately. Ms. Addie submitted that this is appropriate expansion of Mr. Romani's current privileges.
Analysis and Decision
(a) Fitness to Stand Trial
Earlier this year the Supreme Court of Canada released its decision in R. Bharwani, 2025 SCC 26, which provides the decisive interpretation of the definition of “unfit to stand trial” within the Criminal Code as well as the application of the “fitness test”.
Before the Supreme Court of Canada, Counsel for Mr. Bharwani argued that the fitness test required an accused:
to have analytical capacity, meaning that the accused must possess the ability to make rational decisions in the conduct of their defence
The Supreme Court of Canada dismissed the above noted argument, stating the following at paragraph 6, vis-à-vis “fitness to stand trial”:
… an accused is fit to stand trial when they are able to make and communicate reality-based decisions in the conduct of their defence or instruct counsel to do so. Conducting a defence includes making decisions that an accused must always make personally and those which relate to the exercise of their right to full answer and defence, such as decisions about pleas, the mode of trial, selection of counsel, whether to testify, whether to call or cross-examine witnesses, and closing submissions, among others. The capacity required to make those decisions is a reality-based understanding of the nature or object of the proceedings and their possible consequences, an ability to understand the available options and their consequences, and an ability to select between those options when making decisions. Fitness to stand trial does not require an accused to make decisions in their best interests. Rather, it requires making decisions based on an understanding of reality that is not overwhelmed by delusions, hallucinations, or other symptoms of their mental disorder. Transient mental health symptoms do not necessarily compromise an accused’s ability to conduct a defence. The focus is always on assessing the extent to which an accused’s mental disorder impairs their understanding of reality when making and communicating decisions in their defence.
Whereas Mr. Romani’s fitness is said to fluctuate, at no time since the index offences, has he been assessed as fit to stand trial. When Mr. Romani’s fitness to stand trial was last assessed, in the hours prior to this hearing he was:
- unable to demonstrate his understanding of plea options,
- unable to explain what an oath is
- can identify lawyers and the judge but is unable to describe their roles as he believes he is a lawyer(which he is not) and therefore entitled to speak directly to the judge
- unlikely that he can meaningfully participate in his defence or instruct counsel as he insists the charges against him have been resolved.
Mr. Romani’s testimony at the hearing corroborated Dr. Tan’s evidence regarding Mr. Romani’s delusional beliefs. It was it clear that Mr. Romani does not believe that he is a patient at St. Jospeh’s or that he broke the law, and if there were any charges against him, they have all been resolved. As a result, he clearly lacks the requisite reality-based understanding of the nature or object of the proceedings and their possible consequences, an ability to understand the available options and their consequences, and an ability to select between those options when making decisions.
The panel took to heart Dr. Tan’s comment that Mr. Romani is unlikely to regain fitness in the coming year absent an exploration of ECT. This treatment consideration, which, together with clozapine is the gold standard if clozapine and Amisulpride have failed, can only proceed with the acquiescence of Mr. Romani’s father, who serves as his son’s substitute decision maker.
There is but one mention of ECT within the Hospital Report, contained at page 46, reproduced below for ease of reference
April 4, 2025: Mr. Romani’s MRP met with Mr. Romani’s father today to fill him in on Mr. Romani’s progress and provided him with some information regarding the use of ECT in schizophrenia. He seemed reluctant but is now aware that this modality is available should he elect to pursue it.
Therefore, this panel of the Board would encourage the treatment team to provide Mr. Romani’s father with psychoeducation regarding ECT given the comment attributable to him that ECT contributed to his son’s psychotic state.
(b) Significant Threat
Ongoing significant threat to the safety of the public cannot be speculative. It must entail a real risk of serious physical or psychological harm arising from conduct that is both serious and criminal in nature.
In determining whether Mr. Romani continues to represent a significant threat to the safety of the public the Board has carefully analyzed the evidence as it relates to the Supreme Court of Canada decision in Winko, 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625.
The Board unanimously finds that Mr. Romani continues to pose a significant threat to the safety of the public. In arriving at this determination, the Board considered the joint position of the parties in this regard and accepted the uncontroverted evidence of Dr. Tan that Mr. Romani continues to pose a significant threat. The Board also relies on the Hospital Report and the current Risk Assessment set out at pages 50-52 in independently determining that Mr. Romani continues to pose a significant threat to public safety. An excerpt from the conclusory paragraph is reproduced below:
If Mr. Romani were to engage in violence it would likely be the result of fluctuations in his mental status secondary to medication non-adherence, tobacco or substance use, or acute psychological stress. In such an event, Mr. Romani would likely experience increased disorganization, agitation, and reactivity secondary to his psychosis. He may engage in verbal and physical aggression toward patients, staff, strangers, or family members. Due to his poor insight into his illness and symptoms, limited amenability to treatment and professional care, and resistance to supervision or professional intervention, Mr. Romani is not considered a candidate for a conditional discharge based on his current risk profile and is best managed under a detention order.
Given the foregoing, the Board therefore accepts that absent an ORB Disposition, Mr. Romani would likely become non-compliant with prescribed medications which would lead to decompensation, use of tobacco/substances and acute psychological stress precipitating the re-emergence of behaviours similar to those seen at the time of the index offences. We are satisfied that absent an ORB Disposition, it is likely that Mr. Romani will cause serious physical or psychological harm to members of the public and such conduct will likely be criminal in nature.
(c) Disposition
Flowing from the Board’s finding that Mr. Romani continues to pose a significant threat to the safety of the public it must shape a Disposition for the year ahead. Its paramount consideration in doing so must be the safety of the public while also considering Mr. Romani’s needs pursuant to s. 672.54 of the Criminal Code.
The necessary and appropriate disposition for Mr. Romani provides him as much freedom as possible without subjecting the community to a real risk of dangerous behaviour.
Mr. Romani is not currently on any housing wait lists as the treatment team unanimously feel he is not yet appropriate for community living. After having heard the hospital evidence, the parties were ad idem that the extension of Mr. Romani’s privileges to include the privilege to enter the community of Hamilton, indirectly supervised was necessary and appropriate. The panel was encouraged to learn that Mr. Romani’s last use of substances occurred almost two years ago. Therefore, there are no immediate concerns that he will use substances when on indirectly supervised passes. Additionally, his mental state will be assessed prior to authorizing each pass in conjunction with ongoing random drug screens.
Conclusion
Therefore, the Board unanimously determines that the necessary and appropriate Disposition required to manage the threat Mr. Romani poses to the safety of the public while still meeting his needs remains a Detention Order with the agreed upon amendment.
In making this Disposition, the Board carefully considered the positions and submissions of the parties and the evidence of Dr. Tan and is satisfied that this determination is both necessary and appropriate. The Board reviewed the provisions of s. 672.54 of the Criminal Code and carefully considered the need to protect the public from dangerous persons, Mr. Romani’s mental condition, his reintegration into society and other needs.
DATED this 28th day of November 2025, at the City of Toronto, in the Toronto Region.
Mr. P. Capelle Legal Member Office of the Registrar Ontario Review Board