Ontario Review Board
Re: L. (E.)
ORB File No: 6565
Hearing held on: Thursday, October 30, 2025
Place of Hearing: North Bay Regional Health Centre-North Bay Site
Pursuant to: Sections 672.81(2.1) of the Criminal Code
Before:
Alternate Chairperson: Mr. C. Flanagan
Members: Dr. K. Hand Dr. S. Wiseman Ms. N. Nathanson Ms. R. Chopra
Parties Appearing:
Accused: L. (E.) Counsel: Mr. D. Northcott
Person in charge of hospital: Counsel: Mr. T. Trenker
Attorney General of Ontario: Counsel: Ms. D. McCaig
REASONS FOR DECISION
(Dated November 17, 2025)
Introduction
On June 25, 2014, L. (E.) was found not criminally responsible on account of mental disorder (“NCR”) on a charge of second-degree murder, contrary to the Criminal Code of Canada (“Criminal Code”).
L. (E.) is currently subject to an Ontario Review Board (“the Board”) disposition dated July 4, 2025, which detains him at the Forensic Programs of the North Bay Regional Health Centre – North Bay Site (“NBRHC” or “the Hospital”), with the outer limit privilege to reside in the community of North Bay, in 24-hour supervised accommodation, approved by the person in charge.
On August 21, 2025, pursuant to section 672.56(b) of the Criminal Code, the Board received correspondence from NBRHC indicating that L. (E.)’s liberty had been restricted for a period exceeding seven days. L. (E.) was transferred from a Forensic Rehabilitation Unit to a Secure Forensic Unit, where he remained at the time of the hearing.
On October 30, 2025, a panel of the Board convened at NBRHC to review L. (E.)’s restriction of liberty (ROL), pursuant to s. 672.81(2.1) of the Criminal Code. L. (E.) did not attend the hearing. Mr. Northcott, counsel for L. (E.), attended the hearing by Zoom technology. He advised that L. (E.) did not wish to attend the hearing and that he had instructions to proceed in his absence. This Board made an order pursuant to s. 672.5(10)(a) of the Criminal Code, permitting the hearing to proceed in L. (E.)’s absence.
A Hospital Report dated May 20, 2025, and a Restriction of Liberty Report (ROL Report) dated October 5, 2025, were filed as Exhibits 1 and 2 respectively at the hearing.
The sole issue to be considered at the hearing is whether the restriction of L. (E.)’s liberty initiated on June 7, 2025, was necessary and appropriate at the time it was imposed and continued to be so until July 7, 2025.
Initial Position of the Parties
At the outset of the hearing, the parties were canvassed as to their initial recommendations to the Board.
Mr. Trenker, on behalf of the Hospital, submitted that L. (E.)’s restriction of liberty was necessary and appropriate and the least onerous and least restrictive, both at the time and through its duration.
Ms. McCaig, on behalf of the Attorney General of Ontario, supported the Hospital’s position.
Mr. Northcott, on behalf of L. (E.), indicated that he was likely to support the Hospital’s position.
All parties supported the Hospital’s position in closing submissions.
Index Offence
- The circumstances of the Index Offence are taken from the Reasons for Disposition, dated August 15, 2024, as follows:
On November 27, 2012, L. (E.) committed the Index Offence. (Note: he would have been 17 at the time.) It involved entering the residence of the Index victim in a state of intoxication from alcohol and beating him to death. L. (E.) acknowledged heavy drinking in the hours leading up to the Index Offence.
With regard to the Index Offence, based on the information available, there was no reason to believe that the victim or L. (E.) had any significant prior knowledge of each other and any history of negative interactions. The killing was reported as occurring in the context of heavy drinking and considerable substance misuse on his part. The killing occurred while L. (E.) was suffering with auditory hallucinations, which did not appear to provide L. (E.) with commands to complete the act, based on Dr. Krasnik's assessment. While L. (E.)'s account of the occurrence was inconsistent over the course of the assessment completed by Dr. Krasnik, there is no doubt that the killing was particularly brutal.
The NCR report contains the following information from an interview with Dr. A. McDonald on December 11, 2013, wherein L. (E.) indicated the following:
He indicated that he had been in custody Portage in Kenora between approximately April and October of 2012. Upon his discharge, he was released back to Grassy Narrows. While in his home community he reported that he was 'smoking weed' daily, doing cocaine as well as Tylenol 3 and oxycontin. He also admitted to "drinking a lot" estimating his use of alcohol as anywhere from 26-40oz of hard liquor and 4 extra-large bottles of beer every 2-3 days. He indicated that he was not taking his risperidone at the time and that his chronic auditory hallucinations did continue. He reported that they did not play a role in the incident. He did however state that the night of the incident, he was intoxicated on alcohol and indicated that he was 'scared of everyone on the reserve'. He did not wish to answer any further questions about this.
- The victim died several days after the Index Offence from “blunt force trauma to the head.”
Personal Background/Psychiatric History
- L. (E.)’s personal background and psychiatric history are extensively reviewed in the Hospital Report, filed as an exhibit, and need not be repeated in these Reasons for Decision.
Current Diagnosis
- L. (E.) diagnoses include Schizophrenia, Substance Use Disorder (Cannabis, Alcohol, Cocaine, Methamphetamine and Amphetamine) Alcohol Related Neurodevelopmental Disorder, Attention Deficit Hyperactive Disorder Intellectual Disability - Mild to Moderate, and History of Antisocial Personality Disorder.
Evidence at the Hearing
The Hospital’s evidence was presented through the oral testimony of Dr. G. Munro to supplement the evidence contained in the ROL Report filed as an exhibit at the hearing.
Dr. Munro advised that she has been L. (E.)’s treating psychiatrist since January 2025. L. (E.) has a mild to moderate intellectual disability. The ROL Report indicated that his verbal memory and comprehension are in the 1st percentile, indicating severe deficits that significantly impair his ability to process and interpret verbal information. While he may seem to understand spoken communication, he often lacks proper comprehension, which contributes to frustration, demoralization, anxiety, and episodes of reactive agitation. In this regard, Doctor Munro advised that L. (E.) has long-standing issues managing his anger and maintaining appropriate behaviour.
At the time of the restriction of liberty, L. (E.) resided on a rehabilitation unit (Owl Lodge) within the forensic program with restrictive privileges. These included supervised hospital, grounds, and community outings, as well as limited (30-minute) indirectly supervised hospital and grounds access.
On June 1, 2025, while utilizing supervised privileges with a personal support worker (PSW), L. (E.) was observed making sexually inappropriate gestures and staring at a female co-patient’s chest. The female co-patient appeared visibly uncomfortable, prompting staff intervention. L. (E.) apologized, and upon returning to the unit, his assigned nurse temporarily suspended his privileges pending review by Dr. Munro. Upon learning of the suspension, L. (E.) became angry and fixated on identifying the staff member who reported the incident. At this time, he demonstrated no insight into the inappropriateness of his actions or the connection between his behaviour and the resulting loss of privileges.
On June 7, 2025, L. (E.) was quite angry and agitated and approached nursing staff. The conversation escalated as L. (E.) began expressing hostility toward the PSW he believed reported his behaviour, saying, “He better not come here (Owl Lodge),” and implying that a physical altercation would happen if the PSW entered the unit. He refused an oral prn medication to help him settle and was escorted to his room.
Attempts to de-escalate L. (E.) were unsuccessful. He punched the walls and shoved the nurse causing her to fall to the ground. Several staff members attended the area in response to Code White. L. (E.) became physically aggressive and punched one nurse and two other staff members. As a result of the assault, the nurse required medical attention and time off work. L. (E.) was subsequently charged with two counts of assault, which remain outstanding before the court.
L. (E.) was moved from the Forensic Rehabilitation Unit (Owl Lodge) to a Secure Forensic Assessment Unit (Deer Lodge), where he was placed in seclusion. Dr. Munro advised that Deer Lodge offers a higher level of supervision and is a safer environment for people experiencing aggression, agitation, and emotional dysregulation. L. (E.) was extremely agitated, demanding and threatening and required four-point restraints for several hours. During his time in seclusion, L. (E.) had 1:1 staff with him and was assessed by Dr. Munro on a daily basis.
Over the next few days, L. (E.) remained quite irritable and did not engage with staff. This limited the treatment team’s ability to determine how safe L. (E.) would be once taken out of seclusion. L. (E.) eventually settled. On June 12, 2025, the seclusion was discontinued, and L. (E.) was escorted to a private room on the Deer Lodge Assessment Unit, where he was placed on segregation in his room to monitor risk, and supervised one-on-one by security staff. These enhanced supervision measures remained in place until June 19, 2025, during which time the treatment team developed a formal safety plan.
On June 25, 2025, the treatment team reviewed L. (E.)’s recovery progress and agreed that he would benefit from the reintroduction of supervised hospital, grounds, and community privileges. His behaviour remained stable, with no significant incidents. He showed engagement with his behavioural care plan and was open to redirection. Supervised Hospital and grounds privileges were formally reinstated on July 3, 2025.
L. (E.) expressed no intention of harming himself or others. On July 7, 2025, he was transferred to Heron Lodge. He regained supervised community privileges on July 22, 2025. L. (E.) remained cooperative with staff, adherent to medications, and responsive to redirection.
Dr. Munro advised that at the time of the hearing, L. (E.) was doing very well. He continues to work with a Behavioural Analyst and has made profound gains in his ability to follow direction, manage his interpersonal boundaries with appropriate behaviour. There have been no further incidents with staff or episodes of violence, and he has returned to his full privilege level.
L. (E.) has also returned to therapeutic programming and takes part in Dialectical Behaviour Therapy (“DBT”) with the Occupational Therapist. He is also actively involved in the cultural services offered by Mînowacihewin (“MINO”) – Regional Service for Indigenous People. His grandparents remain supportive.
When asked, Dr. Munro advised that there were two triggering events that led to the physical assaults. The first was his suspension of privileges on June 1, 2025, as a result of the incident with the PSW. The second related to a conversation L. (E.) had with his family wherein a trip was canceled.
The doctor advised that L. (E.) was remorseful for the incident and wrote letters of apology to staff. The plan going forward is to continue working with a behavioural analyst and appropriately exercising his privilege level. The doctor advised that she expects that a PTSD assessment will be completed in the upcoming year.
No further evidence was presented at the hearing.
Final Submissions of the Parties
Mr. Trenker, on behalf of the Hospital, maintained his initial position. When asked, he submitted that the restriction of liberty extended to July 3. 2025, at the time of reinstatement of hospital and grounds privileges.
Ms. McCaig, on behalf of the Attorney General of Ontario, maintained her initial position and supported the Hospital.
Mr. Northcott, on behalf of L. (E.), supported the position of the Hospital.
Conclusion and Decision
Pursuant to the decision of the Ontario Court of Appeal in Regina v. M.L.C. (2010) ONCA 843, the Board must consider not only the reason for the restriction and the initial decision to impose a restriction, but also the ongoing circumstances of the person for the period that the restriction remains in place including up to the time of review. The initial restriction of liberty and ongoing restriction of liberty must be the least onerous and least restrictive, necessary for public safety and the NCR accused.
Notwithstanding the joint submission of the parties, having considered all the evidence presented at the hearing, this Board finds that the restriction of L. (E.)’s liberty initiated on June 7, 2025, was necessary and warranted both initially and through its duration to July 7, 2025.
(a) The Initial Restriction on June 7, 2025
Prior to the initial restriction of L. (E.)’s liberty, he was residing on a Forensic Rehabilitation Unit (Owl Lodge) with restrictive privileges. These included supervised hospital, grounds, and community outings, as well as limited (30-minute) indirectly supervised hospital and grounds access.
As a result of certain events, including the suspension of his privileges (following inappropriate sexual gestures towards a female co-patient) and a cancellation of a family trip, L. (E.) became increasing agitated and angry with ongoing emotional dysregulation. On June 7, 2025, despite attempts to deescalate his behaviour, L. (E.) assaulted four staff including punching a nurse in the face. This necessitated his placement in seclusion and transfer to a Secure Forensic Unit (Deer Lodge) to stabilize his behaviour, prevent further escalation of violence, and protect the safety of persons on the unit. L. (E.)’s actions subsequently led to him being charges with two counts of assault, which remain outstanding before the court. Consequently, this Board finds the initial restriction of L. (E.)’s liberty, both warranted and necessary under all the circumstances.
(b) The Ongoing Restriction to July 7, 2025
Further, given his ongoing emotional dysregulation and untoward behaviour, it was necessary to have L. (E.) remain in seclusion and subsequently placed in segregation in a room on the Secure Forensic Unit. This allowed the treatment team to provide 1:1 supervision and daily assessments until a formal safety plan was developed. He was gradually permitted out of his room within several days. Over the next few weeks, L. (E.) became more open to redirection, showed engagement with his behavioural care plan, remained stable, and his supervised hospital and ground privileges were restored on July 3, 2025. As a result, he was transferred back to a rehabilitation unit (Heron Lodge) on July 7, 2025, and eventually his supervised community privileges were reinstated.
Although L. (E.)’s hospital and grounds privileges were reinstated on July 3, 2025, he was not returned to a rehabilitation unit until four days later. Consequently, This Board finds that the continued restriction of L. (E.)’s liberty, up until July 7, 2025, was both warranted and necessary. In this regard, the steps taken by the hospital since his initial restriction, allowed the stabilization L. (E.)’s mental state, prevented further violence and allowed his safe return to a rehabilitation unit.
In conclusion, this Board finds the restriction of liberty imposed on L. (E.) was warranted and necessary, and the least onerous and least restrictive intervention for the Hospital to take both initially and throughout its duration.
DATED this 17th day of November 2025 at the City of Toronto, in the Toronto Region.
Mr. C. Flanagan Alternate Chairperson
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Office of the Registrar Ontario Review Board