Re: Isaac D. Bedolfe, 2025 CanLII 15872

Re: Isaac D. Bedolfe

ORB File No: 8382

Hearing held on: Thursday, January 30, 2025

Place of hearing: St. Joseph's Healthcare Hamilton

Pursuant to: Sections 672.48(1) and 672.81(1) of the Criminal Code

Before:

Alternate Chairperson: Mr. J. Weinstein

Members: Dr. R. Buckingham

Dr. L.O. Lightfoot

Mr. K. McKenna

Ms. B. Little

Parties Appearing:

Accused: Isaac D. Bedolfe

Counsel: Mr. L. Dimitry

The person in charge of hospital: Counsel: Mr. S. O’Brien

Attorney General of Ontario: Counsel: Ms. J. McKenzie

REASONS FOR DISPOSITION

(Dated February 26, 2025)

Introduction:

On September 1, 2023, Mr. Isaac D. Bedolfe was found unfit to stand trial, on a charge of aggravated assault, contrary to the Criminal Code of Canada (“Criminal Code”).
Mr. Bedolfe is subject to a Disposition of the Ontario Review Board (the “Board”), dated November 24, 2023, finding him unfit to stand trial and detaining him at the Forensic Psychiatry Program of St. Joseph's Healthcare Hamilton - West 5th Campus (“St. Joseph's”).
On January 30, 2025, the Board convened a hearing at St. Joseph's to conduct the annual review of the current Disposition.
Mr. Bedolfe was represented by his counsel, Mr. L. Dimitry, as he was at last year’s hearing. Counsel advised that his client did not wish to attend this hearing and that he was able to proceed in Mr. Bedolfe’s absence. An order was made to allow Mr. Bedolfe to be absent from this hearing, pursuant to s. 672.5(10)(a).
A Hospital Report, dated January 3, 2025 (the "Hospital Report"), was entered as Exhibit 1.
In accordance with s. 672.48(1) of the Criminal Code, the Board must decide whether Mr. Bedolfe is fit to stand trial on the day of the hearing, within the meaning of s. 2 of the Criminal Code. Specifically, is Mr. Bedolfe unable, on account of mental disorder, to understand the nature of a trial and the possible consequences of the proceedings and to communicate with counsel? The other issues before the Board are whether Mr. Bedolfe is permanently unfit, and if so, whether he remains a significant threat to the safety of the public.
If Mr. Bedolfe is found fit, he must be sent back to court. If he is found unfit, but not permanently so, the Board must make a Disposition that is necessary and appropriate, considering the criteria set forth in s. 672.54 of the Criminal Code. Similarly, if he is found to be both permanently unfit and a significant threat, the Board must determine the appropriate Disposition. If he is not found to pose a significant threat to public safety, he must be returned to the court.
For the reasons set out below, and based on the evidence before it, this Board has concluded that Mr. Bedolfe is unfit to stand trial. The Board further concluded that Mr. Bedolfe is not permanently unfit. The Board also found that the necessary and appropriate Disposition required to manage the threat posed to the public by Mr. Bedolfe is a continuation of the existing Detention Order.

Outstanding Charge:

The circumstances of the allegations against Mr. Bedolfe are extracted from last year's Board Reasons, as follows:

“On March 16, 2023, at Victoria Manor, Mr. Bedolfe allegedly pushed the victim who hit a wall in his fall, causing damage to the wall and a broken finger, wrist and hip in the victim, necessitating a hip replacement surgery.”

Current Psychiatric Diagnoses:

Mr. Bedolfe’s current diagnoses are:

Schizoaffective Disorder

Other Substance Use Disorder

Unspecified Personality Disorder

Mr. Bedolfe’s history and background are outlined in the Hospital Report, and they are accurately summarized in last year’s Reasons:

“Mr. Bedolfe had an unusual and difficult childhood. He was raised as a member of the cult Children of God in India and Texas from his birth until age 14 when he was expelled from the cult after having been found with the cult leader’s daughter. The cult had a distinct culture that included the sexual and physical abuse of children and promotion of promiscuity. Mr. Bedolfe was sexually abused from age three or four.

Mr. Bedolfe and his mother left the cult. He started school for the first time in high school with a lot of difficulty. He left school in grade 11. The Children’s Aid Society became involved with the family and he was made a crown ward when he was 15 to 16 years old.

Mr. Bedolfe was 18 years old when the symptoms of his mental illness emerged. His relationship with his mother was further complicated and ended due to the intensification of his Capgras delusions about her in 2004. He received the services of an assertive treatment team (ACTT) from 2003.

From the period spanning 2005 to 2014 Mr. Bedolfe was either in hospital or homeless / underhoused. He was found unfit to stand trial and was under the jurisdiction of the ORB in 2005 and 2006. He then remained as an involuntary patient at Waypoint Centre for Mental Health Sciences (Waypoint) until 2011. He was transferred to St. Joseph’s Healthcare Hamilton (SJHH) where he remained as an involuntary patient until 2014. He came to live at Emerald Lodge in 2020 and was doing very well there until it closed down in 2021. He then went to live in homeless shelters, was admitted to hospital and then came to live at Victoria Manor, where the alleged index offence took place.

Mr. Bedolfe’s history shows a pattern of being non-adherent with medications after hospital discharges, leading to housing breakdown and homelessness.

For the five and a half years he was detained at Waypoint under the Mental Health Act Mr. Bedolfe was on clozapine which reduced his aggression, but he continued to have auditory and visual hallucinations. His clozapine was restarted July 17, 2023 with minimal change in his presentation. He was taken off of it with no change in presentation.

Mr. Bedolfe was on a community treatment order (CTO) in the early 2000s and again after his long involuntary hospitalisation (2005 to 2014) prior to his discharge. He remained on a CTO at the time of the alleged index offence. His CTO was last renewed May 8, 2023 and expired November 7, 2023.

Mr. Bedolfe receives Ontario Disability Support Plan payments and his only work history is two seasons of construction work.

Mr. Bedolfe has a history of using cannabis, alcohol, LSD, ecstasy and cocaine.

Mr. Bedolfe does have a criminal record. It spans 1994 as a youth to 2018 and includes a variety of offences including assaults, harassment, forcible entry, indecent act (x2) and breaches of court orders. His convictions for indecent act arose from exposing himself to children.”

Course Since Last Disposition:

Mr. Bedolfe’s course since his last Disposition is set out in detail in the Hospital Report. The following extracted paragraphs are relevant to this hearing:

“Mr. Bedolfe is incapable to consent to treatment with psychiatric medications. He is also incapable to manage his finances. The Public Guardian and Trustee acts as his Substitute Decision Maker in both domains.

Mr. Bedolfe was transferred to Harbour North 3 (HN3) on November 28, 2023, following his initial Ontario Review Board (ORB) hearing and being found Unfit to Stand Trial. Due to his extensive history of numerous admissions to this hospital, Mr. Bedolfe has quickly adapted to the unit’s logistics; however, he has struggled to understand the restrictions and limitations associated within the Forensic Psychiatry Program.

Since his transition to the unit, Mr. Bedolfe has generally presented as pleasant and cooperative during generalized interactions. However, his demeanor can quickly change to irritable, agitated and aggressive if his needs are not met immediately or he receives news which he feels is dissatisfying.

The rapid changes in Mr. Bedolfe’s presentation are most often related to his various hallucinations and/or his sensitivity to misinterpret others’ intentions. In addition, excessive caffeine intake and sleep dysregulations have also significantly impacted Mr. Bedolfe’ dysregulation.

Mr. Bedolfe experiences a variety of hallucinations which can be commanding and distressing in nature.

Although Mr. Bedolfe has not been physically aggressive with others while on this unit, he has become reactive, loud and verbally aggressive when responding to his perceptual disturbances. This has made others on the unit feel threatened and unsafe frequently leading to conflicts with peers and/or staff.”

Pages 29 to 31 of the Hospital Report set out many notable instances, which include verbal threats, yelling, argumentative behaviour, and responding threateningly to internal stimuli.

Position of the Parties:

Counsel for the hospital recommended no change to his current Disposition and asserted that Mr. Bedolfe was unfit to stand trial. Counsel took no position with respect to whether Mr. Bedolfe is permanently unfit.
Counsel for the Attorney General joined the hospital in their recommendation and position. She advised that Mr. Bedolfe’s next prima facie hearing is scheduled for April 30, 2025.
At the conclusion of the hearing, counsel for Mr. Bedolfe advised that, while he could not take a formal position, the evidence before the Board quite clearly demonstrated that his client is unfit to stand trial. He agreed that the appropriate Disposition is the continuation of the existing Detention Order.

Evidence at the Hearing:

The Board had available to it the evidence and documents forming the Record, Exhibits, and oral evidence from Dr. Sutton.
Dr. Sutton co-authored the Hospital Report, and he testified as follows:

a) He has been Mr. Bedolfe’s treating psychiatrist since his admission to St. Joseph's in July 2023.

b) He has read, and adopted, the contents of the Hospital Report.

c) He agreed that the following paragraphs from the Clinical Risk Summary in the Hospital Report are still true today:

“Mr. Bedolfe’s mental status has not changed appreciably over the past reporting year. Despite further adjustments to his antipsychotic regimen, he continues to experience residual psychotic symptoms, with marked disorganization of thought and behaviour, delusional ideation, perceptual disturbance, and periodic agitation. His symptoms continue to be sufficiently impairing to the extent that his ability to understand and meaningfully participate in addressing his legal matters remains deficient. As such, he continues to be unfit to stand trial.

The clinical team is unanimously of the opinion that Mr. Bedolfe continues to pose a significant threat to the safety of the public. Mr. Bedolfe has a longstanding history of treatment refractory psychosis dating back to the late 90s. When unwell, Mr. Bedolfe is easily agitated and has exhibited threatening behaviour as well as overt acts of violence, as was evident at the time of the index offence. When unwell Mr. Bedolfe becomes behaviourally disinhibited, which has led on a number of occasions to sexually explicit behaviours that have resulted in criminal charges. Symptoms of psychosis have likely intensified over the years in the context of repeated relapses due to treatment non-compliance. Even with the assistance of a community ACTT team and conditions of a Community Treatment Order, Mr. Bedolfe has unfortunately decompensated numerous times in the community, at times warranting rather lengthy admissions to hospital in order to stabilize his mental state.

Currently, Mr. Bedolfe’s insight into his illness and need for treatment is very limited. He requires considerable support and supervision to adhere to his medication regimen, as periods of noncompliance and resistance to antipsychotic treatment continue to be of concern. Even with reasonable medication compliance, Mr. Bedolfe continues to exhibit residual symptoms of psychosis, which at times have led to agitated, disorganized, and disinhibited behaviour that others have perceived as threatening. Perhaps the most beneficial aspect of clozapine treatment has been the associated reduction in aggression observed. Absent the close clinical supervision and oversight, Mr. Bedolfe would almost certainly discontinue his clozapine treatment, which would invariably lead to a rapid deterioration in his mental status, with intensification of his psychotic symptoms, and the resurfacing of aggression and violence towards others.

He requires frequent prompting and encouragement to maintain personal hygiene and other activities of daily living. While utilizing indirectly supervised hospital/grounds passes, he requires frequent prompting and reminders to return on time. This degree of support and supervision would preclude any consideration of a community placement at this time. In fact, the team is of the opinion that risk cannot be sufficiently managed even with supervised passes in the community; Mr. Bedolfe is often difficult to redirect and can be quite intrusive with panhandling activities which would pose an obvious elevated risk should he engage in this behaviour in the community.”

d) Despite minor changes to Mr. Bedolfe’s medication regimen, there have been no real improvements in Mr. Bedolfe’s symptoms. Mr. Bedolfe remains quite disorganized and delusional and is internally distracted by his delusions.

e) Mr. Bedolfe is often seen responding to his delusions, by aggressively swatting his hands in front of him. It is very difficult to engage him in conversation, as he has difficulty focusing and often has to be redirected.

f) Mr. Bedolfe continues to believe that the charges against him have been dropped. He describes a variety of delusional beliefs as reasons for his exoneration.

g) Mr. Bedolfe often presents as quite agitated and angry, which can be quite unsettling for people around him. Mr. Bedolfe’s disturbing effect upon others has been evident both on the inpatient unit and when he exercises his level 3 passes on the hospital and grounds.

h) Because of Mr. Bedolfe’s intrusive behaviours, his privileges have been put on hold frequently, in the past reporting year.

i) Mr. Bedolfe cannot appreciate how his behaviour affects others.

j) The treatment team does not feel that Mr. Bedolfe can use indirectly supervised passes into the community. Therefore, it has not been included in his current Disposition.

k) Mr. Bedolfe can, at times, understand the basic Taylor test questions, when he is able to stay on topic. However, he often becomes so tangential and disorganized that he is unable to meaningfully engage in a discussion of the outstanding charges or to continue with this conversation.

l) Because of Mr. Bedolfe’s heavy symptom burden, he would not likely be able to carry on any consequential conversation with his counsel nor to participate meaningfully in his legal proceedings.

m) A Conditional Discharge has no air of reality. Mr. Bedolfe has a long-standing history of medication noncompliance and lack of follow-up with professional supports, despite having had fairly intensive supports in the community. He was on a Community Treatment Order for quite some time and had an ACT team in place. Despite all this support, he still required multiple readmissions to the hospital to stabilize him.

n) If Mr. Bedolfe were to become medication non-adherent, he would become quite agitated, disinhibited and physically aggressive, as he did at the time of the Outstanding Charges. Mr. Bedolfe could also become quite sexually disinhibited, as his history demonstrates.

o) Mr. Bedolfe was recently switched to a liquid form of clozapine, as the treatment team noticed that his therapeutic levels had dipped periodically. They have seen some improvement since this change.

p) In the past, Mr. Bedolfe has been found unfit and then regained fitness. While he is not optimistic that Mr. Bedolfe will become fit in the future, he cannot currently diagnose Mr. Bedolfe as permanently unfit.

In response to questions from counsel for Mr. Bedolfe, Dr. Sutton testified:

a) He does not believe Mr. Bedolfe has asked for, or used, any escorted, or accompanied, passes into the community of Hamilton. If he were to request them, he would only be granted passes into the community escorted with two staff members. Mr. Bedolfe does use his level 3 passes, which allow him to smoke on hospital grounds.

In response to questions from the panel, Dr. Sutton testified as follows:

a) As set out in the Hospital Report, Mr. Bedolfe’s risk cannot be sufficiently managed with supervised passes into the community.

b) He does strongly feel that Mr. Bedolfe has significant cognitive deficits, which also would represent a challenge to Mr. Bedolfe becoming fit.

c) In the past, the team has seen modest improvements in Mr. Bedolfe’s ability to become fit, as his agitation diminishes and his behaviour improves, but he will always be left with some residual cognitive issues. These cognitive issues have likely worsened over the past five years.

d) Paragraph 46 from last year’s Reasons for Disposition is still true today:

“A conditional discharge would not be adequate in the circumstances. Mr. Bedolfe is actively psychotic with delusions and hallucinations that he acts on and requires the support and structure of a detention order. His presentation has only changed a little from that at the time of the alleged index offence before the court, (where it is alleged he pushed a co-resident resulting in multiple broken bones and the need for a hip replacement surgery). He has a history of treatment non-adherence upon leaving hospital resulting in further decompensation of his mental state. He is paranoid and while his aggression had decreased in hospital with treatment there was no suggestion he would remain in hospital as a voluntary patient and it is not likely that the Mental Health Act provisions would be adequate to ensure he remained in hospital long enough to stabilize his mental state given that in the past he has required intensive hospitalization. Mr. Bedolfe has a long history of severe and difficult to treat mental illness and at best his response to treatment to date has been partial, even when treated with clozapine which is used for treatment resistant psychotic disorders. His aggression is mitigated with treatment but still very present and if he were not consistently receiving treatment his aggression would increase. Not only is he not yet clinically ready to leave hospital there is no adequate housing available to him if he does. His history shows a clear connection between housing stability, and treatment adherence.”

e) While Mr. Bedolfe may be able to answer the basic Taylor test questions at times, he could not be expected to focus throughout a trial. Mr. Bedolfe does not meet the test as set out in Bharwani, as he could not meaningfully participate in a trial, understand its consequences, nor discuss his options with his counsel.

No other evidence was called.

Analysis and Conclusions:

Having heard and considered all the evidence and submissions from the parties, this Board finds that Mr. Bedolfe is currently unfit to stand trial, based on the test to be applied in R v Taylor, as well as set out in R v Bharwani, 2023 ONCA 203. The uncontroverted evidence of Dr. Sutton was that Mr. Bedolfe could not remain focused in any trial, nor would he be able to participate meaningfully in one. Mr. Bedolfe becomes quite agitated and distracted, even when having normal, everyday conversations. He also does not believe that he has any outstanding charges.
The Court of Appeal addressed the fitness tests most recently in R. v. Bharwani. The five-member Court emphasized the need for meaningful participation in proceedings to be fit for trial.
Applying the test set out in Bharwani, nothing in the evidence before this Board allows us to conclude, on a balance of probabilities, that Mr. Bedolfe meets the test for fitness. In particular, the Board believes Mr. Bedolfe would not be meaningfully present, and he would not be able to participate appropriately, nor to instruct counsel, in criminal proceedings.
Having found that Mr. Bedolfe is unfit, but not permanently so, the Board must make a Disposition that is necessary and appropriate, considering the criteria set forth in s. 672.54 of the Criminal Code. In particular, the Board relies on the following extracted paragraphs from the Hospital Report:

“The clinical team is unanimously of the opinion that Mr. Bedolfe continues to pose a significant threat to the safety of the public. Mr. Bedolfe has a longstanding history of treatment refractory psychosis dating back to the late 90s. When unwell, Mr. Bedolfe is easily agitated and has exhibited threatening behaviour as well as overt acts of violence, as was evident at the time of the index offence. When unwell Mr. Bedolfe becomes behaviourally disinhibited, which has led on a number of occasions to sexually explicit behaviours that have resulted in criminal charges. Symptoms of psychosis have likely intensified over the years in the context of repeated relapses due to treatment non-compliance. Even with the assistance of a community ACTT team and conditions of a Community Treatment Order, Mr. Bedolfe has unfortunately decompensated numerous times in the community, at times warranting rather lengthy admissions to hospital in order to stabilize his mental state.

For the reasons set out in last year’s Reasons for Disposition, and agreed to by the doctor, a Conditional Discharge is not appropriate. It should be noted that Mr. Bedolfe’s current Disposition does not even include the privilege of living in the community, in accommodation approved by the person in charge.
In consideration of all the evidence, submissions of the parties and taking into consideration the criteria set forth in s. 672.54, namely the paramount consideration being the safety of the public, in addition to the mental condition of Mr. Bedolfe, his reintegration into society and his other needs, the necessary and appropriate Disposition is a continuation of the existing Detention Order.

DATED this 26th day of February, 2025, at the City of Toronto, in the Region of Toronto.

Mr. J. Weinstein

Alternate Chairperson

Office of the Registrar

Ontario Review Board