Re: Juan Carlos Bran Martinez, 2025 CanLII 13618

Ontario Review Board

Re: Juan Carlos Bran Martinez

ORB File No: 6158

Hearing held on: Tuesday, January 14, 2025

Place of hearing: Centre for Addiction and Mental Health Via Zoom Video-conference

Pursuant to: Section 672.81(2.1) of the Criminal Code

Before:

Alternate Chairperson: Ms. L. Banks

Members: Dr. R. Chandrasena Dr. R. W. Hill Ms. K. Tomaszewski Mr. A. Mete

Parties Appearing:

Accused: Juan Carlos Bran Martinez

Counsel: Mr. J. Wilton

Person in charge of the Hospital: Representative: Dr. P. Darby

Attorney General of Ontario: Counsel: Ms. V. Culp

REASONS FOR DECISION AND DISPOSITION

(Dated February 18, 2025)

Introduction:

1. On July 6, 2012, Juan Carlos Bran Martinez was found not criminally responsible (“NCR”) on account of mental disorder on charges of criminal harassment and fail to comply with condition of undertaking or recognizance, contrary to the Criminal Code of Canada (“Criminal Code”).

2. Mr. Bran Martinez is currently subject to a Disposition of the Ontario Review Board (“ORB” or the “Board”) dated November 26, 2024 pursuant to which he is ordered detained at the General Forensic Unit at the Centre for Addiction and Mental Health (“CAMH” or the “hospital”) with privileges up to and including residing in the community in accommodation approved by the person in charge of the hospital.

3. By letter dated November 28, 2024, the hospital gave notice to the ORB that on November 20, 2024, Mr. Bran Martinez was admitted to the hospital from his community residence. Mr. Bran Martinez remained in the hospital for a period in excess of seven days, from November 20, 2024 until December 12, 2024 (“ROL #1), and the hospital’s letter was considered notice pursuant to s. 672.56(2)(b) of the Criminal Code.

4. By letter dated December 24, 2024, the hospital gave notice to the ORB that on December 16, 2024, Mr. Bran Martinez was again re-admitted to the hospital from his community residence. Mr. Bran Martinez remained in the hospital for a period in excess of seven days, from December 16, 2024 to the hearing date (“ROL #2”) and the hospital’s letter was considered notice pursuant to s. 672.56(2)(b) of the Criminal Code.

5. On January 14, 2024, the Board convened a hearing by Zoom videoconference to review the increased restrictions on Mr. Bran Martinez’s liberties during ROL #1 and ROL #2 pursuant to s. 672.81(2.1) of the Criminal Code. Mr. Bran Martinez was present at the hearing and was represented by his counsel, Mr. Wilton.

6. The issues at the hearing included a determination of whether the hospital’s decision to significantly increase the restrictions on Mr. Bran Martinez’s liberty during ROL #1 and ROL #2 was the least onerous and least restrictive intervention in the circumstances, both initially at the time of his readmission to the hospital, and throughout the duration of the respective admissions.

7. At the hearing, Mr. Bran Martinez was also assisted by a Spanish interpreter. Mr. Bran Martinez advised the Board that he did not require simultaneous verbatim translation but that he would request assistance when needed and the hearing proceeded on that basis.

8. For the reasons set out below, the Board finds that the hospital’s decisions to significantly increase the restrictions on Mr. Bran Martinez’s liberty throughout ROL #1 and ROL #2 by virtue of his readmissions to the hospital were each the least onerous and least restrictive intervention in the circumstances, both initially at the time of his readmission to the hospital, and throughout the duration of his detention in hospital.

Index Offences:

9. The circumstances giving rise to the index offence are set out in the Hospital Report dated October 7, 2024 (the “Hospital Report”), and are summarized as follows:

“On September 30, 2011, Mr. Bran Martinez approached a 16-year-old woman after

recognizing her from his church. He requested her telephone number in order to set up a

youth group. Over the next month he made a number of calls to her which concerned her

family who contacted the police. The police cautioned Mr. Bran Martinez. At the time of

these contacts, Mr. Bran Martinez was an involuntary patient at CAMH.

On October 31, 2011, Mr. Bran Martinez left CAMH and tried to locate the victim at her

apartment building. Security contacted police and Mr. Bran Martinez was returned to

CAMH. In November 2011, Mr. Bran Martinez was discharged from CAMH. That same month, he attended at the victim’s apartment building and place of work trying to

locate and speak to her. On January 30, 2012, Mr. Bran Martinez was found outside the

victim’s apartment building where he was arrested on two outstanding warrants. Mr.

Bran Martinez subsequently advised that he had been noncompliant to medication

through much of the previous few months.”

Personal Background:

10. The Hospital Report details Mr. Bran Martinez’s background, criminal history and course in hospital and in the community subsequent to the index offences and need not be repeated in detail. Briefly stated, he is a 39-year-old divorced man who was born in El Salvador. He has one son.

11. Mr. Bran Martinez finished high school at eighteen and attended the police academy for one year to train to become a police officer. He worked as a police officer for about three years from the age of twenty to twenty-three. He reported that while still in El Salvador, he worked for a year as a taxi driver like his father.

12. Mr. Bran Martinez immigrated to Canada from El Salvador in 2007. He arrived in Toronto in October 2009, claimed refugee status. He was granted permanent status and has since obtained his Canadian citizenship. When he arrived in Canada, he first worked as a painter with his brothers in Edmonton, Alberta for about one year. He then returned to Toronto in early 2011 and worked in construction for a brick and paving company for about six months. He has family members who reside in Edmonton with whom he has close contact and support.

13. Mr. Bran Martinez has a significant history of alcohol use and reportedly first began drinking at age 16. He has also used marijuana and cocaine.

Psychiatric History:

14. Mr. Bran Martinez’s first contact with the mental health system occurred in 2010 when he was living in Edmonton and working with his brothers. He was involuntarily admitted to a hospital there as he began expressing thoughts that he had been chosen by God and was preaching to others. His involuntary admission lasted for approximately two months until his discharge. Within months of his discharge, he discontinued his prescribed medications.

15. In September 2011, Mr. Bran Martinez was admitted to hospital having been brought there by police. At that time, he presented as disorganized and psychotic and reported that he had been non-compliant with his prescribed medications. The Hospital Report indicates that he agreed to a voluntary admission at CAMH. He was restarted on Lithium but was unwilling to accept treatment with Risperidone. He left the hospital against medical advice on September 21, 2011. He once again was involuntarily hospitalized on September 26 to October 25, 2011. Details of this admission and a subsequent admission from October 28 to November 18, 2011 are all detailed in the Hospital Report. Of note, during the latter admission, Mr. Bran Martinez revealed more of his delusional system, including, that he had a microchip in his arm.

16. Mr. Bran Martinez had an additional involuntary admission at CAMH from January 3-13, 2012. At that time, he advised that he had been fighting with the devil for several months. He was once again restarted on Lithium and his antipsychotic medication was increased. He was discharged to Seaton House with a diagnosis of Bipolar 1 Disorder with psychotic features and alcohol abuse. He was arrested and taken into custody several days later on January 30, 2012.

17. Mr. Bran Martinez was detained at CAMH until June 2014 when he was discharged to the community.

18. Mr. Bran Martinez has had a number of admissions to hospital since that time, usually in the context of decompensation triggered by either non-compliance with medication or alcohol use. He was admitted from September 2016 to February 2017, from December 2017 to April 2018, from November 2021 to December 21, and from May 2022 until June 2023.

Current Diagnosis:

19. Mr. Bran Martinez 's current diagnoses are:

Schizoaffective Disorder; and

Substance Use Disorder.

Legal History:

20. Mr. Bran Martinez denied having any legal history when living in El Salvador. The Hospital Report references charges for assaulting a peace officer, disarming a peace officer (2011), unlawfully in dwelling, mischief under $5000, criminal harassment (2011), and a charge of failure to attend court (2012) but the report does not identify the outcome of these various charges.

Positions of the Parties:

21. At the outset of the hearing, all parties were canvassed as to their initial positions. Dr. Darby, on behalf of the hospital, recommended that the restrictions of Mr. Bran Martinez’s liberty imposed during ROL #1 and ROL #2 were the least restrictive and least onerous interventions in the circumstances, both initial and throughout their respective durations.

22. In terms of Disposition recommendations, Dr. Darby recommended that Mr. Bran Martinez’s Disposition remained necessary and appropriate but that paragraph 5 thereof should be deleted as Mr. Bran Martinez was no longer requesting a transfer of his care to Alberta.

23. Counsel for the Attorney General expected to support the hospital’s position in all respects but wished to hear the evidence first.

24. Counsel for Mr. Bran Martinez also supported the hospital’s recommendation with respect to ROL #1 and ROL #2 but commented that his client was anxious to be discharged to the community. With regard to Mr. Bran Martinez’s existing Disposition, counsel endorsed the hospital’s recommendation that it remained necessary and appropriate and reiterated that his client no longer wished to have his care transferred to the Province of Alberta.

25. All parties re-affirmed their joint recommendation to the Board at the conclusion of the evidence.

Evidence at the Hearing:

26. The following documents were marked as Exhibits: #1- Hospital Report; #2 - Restriction of Liberty Report of January 10, 2025; and #3 - replacement Restriction of Liberty Report, also dated January 10, 2025. The Board also had the benefit of the viva voce evidence of Dr. P. Darby, who advised that he has been Mr. Bran Martinez’s out-patient psychiatrist. Dr. Darby advised that during Mr. Bran Martinez’s admission in ROL #1, Dr. Ng and Dr. Durani acted as his attending psychiatrists and that throughout ROL #2, Dr. Ginsberg has been Mr. Bran Martinez’s attending psychiatrist. Dr. Darby indicated that he had consulted with each of these individuals in order to prepare for his testimony at today’s ORB hearing.

27. Dr. Darby advised that when living in the community, Mr. Bran Martinez received case management services from the hospital’s Forensic Outpatient Service (“FOPS) team.

28. The Board’s recent Reasons for Disposition dated December 9, 2024, indicate that during the reporting year 2022/2023, Mr. Bran Martinez demonstrated an increasingly unstable mental status over several months. He was presenting with increasingly agitation and hostility and, on April 4, 2022, he was apprehended and taken to the hospital. He remained detained in hospital on a General Forensic unit until June 27, 2023 when he was discharged to high support accommodation in the community. Of note, his hospital stay was extended due to a lack of available housing.

29. Dr. Darby testified that until his recent return to the hospital on November 20, 2024, Mr. Bran Martinez’s reporting year had been quite a positive one. The recent ORB Reasons for Disposition attribute that progress to the following:

“…his mental status has been consistently stable; he has been self-administering his medication independently for the past year with no issues; he acknowledges the benefit of his medication to his mental health; he has been compliant with his anti-psychotic medication; he is co-operative with the collection of urine samples for drug testing; there have been no behavioural concerns observed or reported at the residence; he has a part-time job; he is polite and cooperative with the clinical team; and he has close support from his family.”

30. Dr. Darby advised that Mr. Bran Martinez is currently assessed as capable of consenting to treatment and he currently receives daily oral doses of Clozapine, an antipsychotic medication, and Epival, a mood-stabilizing medication.

31. With regard to ROL #1, Dr. Darby testified that Mr. Bran Martinez’s admission on November 20, 2024 was prompted due to a deterioration in his mental status. This had occurred in the context of transitioning his antipsychotic medication from Clozapine to Risperidone. Mr. Bran Martinez had expressed his longstanding concerns related to the sedating effects of Clozapine and, in consultation with Dr. Darby, the plan was to slowly transition his medication from Clozapine to Risperidone. According to Dr. Darby, this cross-titration process began in late August or early September 2024. Dr. Darby testified that on or around November 15, 2024, Mr. Bran Martinez began to present with signs of a decompensation in his mental state.

32. Mr. Bran Martinez suddenly indicated that he had changed his mind and no longer wanted

to move to Edmonton. This was out of character for him as he been consistent in his desire

to move to be closer to his family. He refused to engage with Dr. Darby, believing that

he was forcing Mr. Bran Martinez to move to Edmonton. In the past, Mr. Bran Martinez

and Dr. Darby had enjoyed a positive therapeutic relationship.

33. Dr. Darby commented that it was clear to the FOP team that Mr. Bran Martinez was “way off his baseline presentation” and he needed to be admitted for closer assessment and stabilization. Mr. Bran Martinez was admitted to hospital on November 20, 2024.

34. On admission, Mr. Bran Martinez was disorganized with elevated mood. He disrobed in the emergency department, requested kisses from staff, and was quite disinhibited. He did not exhibit psychotic symptoms.

35. He was initially quite resistant to the clinical’s team’s recommendation that he transition back to Clozapine but eventually, he agreed to do so. Over time, his hypomanic symptoms resolved, he was much less irritable, and no longer expressed anger towards Dr. Darby. By December 10, 2024, he was utilizing extensive liberal passes appropriately and was anxious to be discharged back to his community residence, particularly so that he could enjoy greater liberties with both his mother and his son who had an upcoming visit to Toronto planned for mid-December 2024.

36. On December 12, 2024, Mr. Bran Martinez was discharged back to his community residence.

37. Mr. Bran Martinez had advised his housing staff that he was planning a weekend visit to Niagara Falls with his mother and his son. Housing staff advised the FOP that Mr. Martinez did not in fact travel to Niagara Falls with family members on his approved itinerary but instead, had refused to accept his Clozapine medication from housing staff and had reported he consumed between 4-6 beers over the weekend. When questioned about this, Mr. Bran Martinez stated that his Clozapine medication had not been available at his residence.

38. Within a few days, Mr. Bran Martinez presented with pressured speech, disorganized thinking, significant irritability, paranoid thinking, and he was refusing to engage with his FOP team members. He expressed hostility and paranoia with regard to Dr. Darby. Further, Mr. Bran Martinez was not responsive to staff direction at his residence and he also refused to engage with his case manager, with whom he had enjoyed a positive rapport. Given his affective instability, level of heightened irritability, his refusal of Clozapine and his alcohol consumption, the FOP team felt that Mr. Bran Martinez required closer observation, monitoring and re-stabilization in the hospital and he was readmitted on December 16, 2024. Dr. Darby testified that Mr. Bran Martinez remains in hospital.

39. Since his most recent readmission, his current attending in-patient psychiatrist has noted that Mr. Bran Martinez has engaged in verbal altercations with his co-patients and has generally presented with pressured speech and heightened irritation. He presented as hypomanic and he has continued to be difficult to direct. At times, he is intrusive and demanding with nursing staff.

40. On December 23, 2024, Mr. Bran Martinez refused his medications and was awake all night. He was using his phone to make a video on the unit. When he was told to stop, he pointed gestured his hand as a gun at a nurse, pointing it at her. He was challenging and intrusive to nursing staff’s personal space. He continued to be agitated, accusatory and hostile. He insisted he should not be in hospital, should have passes, and should be able to go home.

41. Throughout December and January, Dr. Ginsberg and Dr. Darby continued to consult about the best strategy to address Mr. Bran Martinez's presentation. Medical records indicate that he has experienced significant side effects on Lithium and that Epival is the best mood stabilizer for Mr. Bran Martinez. To date, his blood levels indicate a therapeutic level of Epival. Dr. Darby testified that Mr. Bran Martinez is now back at his pre-November 20, 2024 Clozapine dose of 250 mg/day but that he has not yet returned to his best baseline presentation. The doctor commented that it may take a few months for Mr. Bran Martinez to get there.

42. At the present time, the plan may be to introduce another antipsychotic medication to augment Mr. Bran Martinez’s current treatment regimen. Mr. Bran Martinez currently receives Clozapine and Epival but, Dr. Darby testified that “his affect is unstable”. Aripiprazole is being considered as this antipsychotic medication is known to have mood-stabilizing effects. Mr. Bran Martinez has not been receptive to this suggestion but it will continue to be canvassed with him. The treatment team believes it is necessary to optimize Mr. Bran Martinez’s medications in order to enable him to. return to his community residence as soon as possible. Dr. Darby advised that his community home continues to be available to him.

43. Of note, Dr. Darby commented that more recently, Mr. Bran Martinez has demonstrated some affective improvement but he continues to present with special pressured speech and is often difficult to direct. On a positive note, he is somewhat less irritable and is no longer expressing paranoid ideation or thoughts about Dr. Darby.

44. In terms of insight, Dr. Darby stated that Mr. Bran Martinez does not express any appreciation with regard to his affective instability, hypomania, or his challenging interactions with nursing staff.

45. In terms of his privileges, Mr. Bran Martinez has gradually progressed to level 5 indirectly supervised hospital and grounds passes which he has used without incident.

46. At Mr. Bran Martinez’s recent annual ORB hearing in November 2024, the Board recommended, as per his request, that he be transferred to the jurisdiction of the Province of Alberta for the purpose of recovery and treatment there. In evidence before that panel was the fact that Mr. Bran Martinez had family supports in Edmonton, namely his mother and his brothers.

47. Dr. Darby stated that over the past several months, Mr. Bran Martinez has consistently expressed that he no longer wants to be transferred to Edmonton, Alberta and that he has strong social supports in Toronto. He also comments that he enjoys his residence and his part-time work in Toronto. He also has the support of his ex-wife and his son who often spend time visiting with him in Toronto.

48. Dr. Darby advised that Mr. Bran Martinez’s current Disposition indicates that he is recommended for transfer to the jurisdiction of the Alberta Review Board. However, given that Mr. Bran Martinez no longer wishes to move to Edmonton, Dr. Darby testified that the hospital recommends that his existing Disposition be amended to remove paragraph 5 thereof which is the term recommending his transfer to Alberta.

49. No further evidence was called by the parties.

Analysis and Conclusion:

50. Pursuant to the decision of the Ontario Court of Appeal in Regina vs. 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 accused for the period of time 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 for the accused.

51. The Board finds that the initial restriction of Mr. Bran Martinez’s liberty on November 20, 2024 was warranted and that the actions taken by the hospital at that time were the least restrictive and least intrusive in the circumstances. His re-admission was prompted by a deterioration in his mental state, likely a result of a medication change.

52. The Board finds that the restriction of Mr. Bran Martinez’s liberty throughout ROL #1 until December 12, 2024 was the least restrictive and least onerous intervention in the circumstances. He required hospital admittance for assessment and stabilization. In hospital, he was re-established on Clozapine medication and his mental state settled.

53. The Board also finds that the initial restriction of Mr. Bran Martinez’s liberty on December 16, 2024 was warranted and that the actions taken by the hospital at that time were the least restrictive and least intrusive in the circumstances. His re-admission was prompted by his medication non-compliance, alcohol use and affective dysregulation.

54. The Board finds that the restriction of Mr. Bran Martinez’s liberty throughout ROL #2 which was ongoing as at the hearing remains the least restrictive and least onerous intervention in the circumstances. Mr. Bran Martinez continues to require ongoing detention in hospital as the team attempts to optimize his medications to achieve better symptom management.

55. The Board also orders that Mr. Bran Martinez’s existing Disposition be amended to remove paragraph 5 thereof which is the term recommending his transfer to Alberta. This was the joint recommendation of the parties.

56. In reaching our Disposition, the Board has taken into account the need to protect the public from dangerous persons, Mr. Bran Martinez’s mental condition, his other needs, and his reintegration into society.

DATED this 18^th^ day of February, 2025, at the City of Toronto, in the Toronto Region.

Ms. L. Banks

Alternate Chairperson

__________________

Office of the Registrar

Ontario Review Board