Re: Dr. Alf Breitwieser
ORB File No: 3912
Hearing held on: Thursday, January 30, 2025
Place of hearing: Southwest Centre for Forensic Mental Health Care
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. T. Mann Members: Dr. A.D. Jones Dr. H. Moulden Ms. K. Tomaszewski Ms. C. Plyley
Parties Appearing:
Accused: Dr. Alf Breitwieser Counsel: Mr. R. Cunningham
The person in charge of hospital: Counsel: Ms. J. Zamprogna
Attorney General of Ontario: Counsel: Mr. D. Rows
REASONS FOR DISPOSITION
(Dated February 4, 2025)
Introduction
[1]. On January 28, 2004, Dr. Alf Breitwieser was found not criminally responsible on account of mental disorder, on charges of utter threat to cause bodily harm and fail to comply with probation order, both contrary to the Criminal Code of Canada (“Criminal Code”).
[2]. Dr. Breitwieser is currently subject to the terms and conditions of a Disposition of the Ontario Review Board (the “Board”), dated February 8, 2024. Pursuant to this Disposition, he is detained at the Southwest Centre for Forensic Mental Health Care, St. Joseph's Health Care London (“Southwest” or the “hospital”). This Disposition provides him with various privileges, including to live in the communities of Elgin County and Middlesex County, in accommodation approved by the person in charge.
[3]. The Board convened a hearing at Southwest on January 30, 2025, to conduct the annual review of the current Disposition. Dr. Breitwieser was present at the hearing and was represented by his counsel, Mr. R. Cunningham.
[4]. At the outset of the hearing the Alternate Chair raised a preliminary issue about a possible conflict, as she had professional contact with Dr. Breitwieser’s file in 2009. All parties indicated they had no objection to Ms. Mann continuing as Alternate Chair for this hearing.
[5]. A Hospital Report (“Hospital Report”), dated November 19, 2024, was entered as Exhibit 1.
[6]. The issue at this hearing is whether Dr. Breitwieser is a significant threat to public safety, as defined in s. 672.5401 of the Criminal Code. If so, the necessary, and appropriate, Disposition in the circumstances must be determined, bearing in mind the factors enunciated in s. 672.54 of the Criminal Code.
[7]. At the outset of the hearing the parties were canvassed for their initial positions. Ms. Zamprogna indicated that the hospital took the position that Dr. Breitwieser continues to pose a significant threat to the safety of the public, and that the necessary and appropriate disposition is a continuation of the current Detention Disposition with four changes, as set out on page 262 of the Hospital Report.
[8]. Mr. Cuningham agreed with the hospital’s position. Mr. Rows, acting for the Attorney General, supported the hospital’s position, but with some questions. The Board had before it a joint submission subject to some questions by Mr. Rows. In final submissions, Mr. Rows supported the hospital’s position with the exception of the removal of the weapons prohibition.
[9]. For the reasons set out below and based on the expert evidence and opinions before us, the Board concluded that Dr. Breitwieser continues to represent a significant threat to the safety of the public. The Board ordered that the continuation of the existing Detention Order with the changes recommended by the hospital, with the exception of the removal of the weapons prohibition, is the necessary, and appropriate, Disposition in the circumstances.
Current Psychiatric Diagnosis
[10]. Schizoaffective Disorder, Bipolar Type
Index Offences
- The circumstances giving rise to the Index Offences are extracted from last year’s Board Reasons, as follows:
“On June 26, 2003, Dr. Breitwieser entered into a probation order, a condition of which was to keep the peace and be of good behaviour. On July 31, 2003, there was an incident at Dr. Breitwieser's apartment where the victim was concerned for Dr. Breitwieser's safety and police were let into his apartment. Dr. Breitwieser was very upset that police were allowed into his apartment. On August 1, 2003, Dr. Breitwieser called the victim (his case manager) at home and also called him twice at work between the hours of 10:30 and 11:30 am. He was accusing the victim of breaking and entering and letting the police into his apartment. At approximately 11:15, Dr. Breitwieser entered the office of the victim, Walter Friesen, and threatened him by stating "I'll bite your fucking cocksucking head off" and left the building. Mr. Friesen, who had been Dr. Breitwieser's caseworker for approximately twelve years, was fearful for his safety because of Dr. Breitwieser's history of violent behaviour. On August 4, 2003, police were called to a restaurant in Waterloo to ask Dr. Breitwieser for the third time to leave the property. Police discovered an outstanding charge and arrested Dr. Breitwieser.”
Course since Last Disposition
[11]. The following excerpts from the Hospital Report, adopted by his attending psychiatrist, Dr. Arun Prakash, summarize Dr. Breitwieser's course since the last Disposition:
“Dr. Breitwieser’s year in review is captured in two parts. First, when he was an inpatient on the Forensic Rehabilitation Unit (B1) and then when he transitioned to a Group Home in the community. He moved to the Group Home, located on 16 Aldborough Avenue in St. Thomas, on August 13, 2024, while being placed on a Leave of Absence (LOA). This residence has both private and publicly funded beds (subsidized through the Community Housing Opportunities program with the local Canadian Mental Health Association). There are 24/7 staff that support meals and medication supervision. Tenants share living and dining areas in addition to having some private space for meetings or quiet time offered within the home. He currently resides in a privately funded bed within the home. After a successful transition and LOA, his care was transferred to Dr. Arun Prakash, forensic psychiatrist, and the outreach team on September 24, 2024.”
“While residing on the Forensic Rehabilitation Unit (B1), Dr. Breitwieser remained mostly stable with some reported management concerns. In April 2024, he demonstrated signs of mental deterioration and decompensation (e.g., paranoia and hypersexuality) … He had a tendency to sleep in his chair when decompensating.”
“Dr. Breitwieser also demonstrated behavioural instability. He scored on the Aggressive Incidents Scale after becoming angry with staff for monitoring his blood pressure, which was a normal routine pertaining to the medication he is on. … He can be described as someone who keeps to himself (e.g., spends much of his day in his room reading the paper or in the dining room and visitor room sitting in silence), and did not typically engage in programming or group activities while in the hospital, this generally describes his baseline. During periods of decompensation, he can be described as more elevated and euphoric in presentation (e.g., hysterically laughing, using inappropriate language, presenting as passive aggressive and making derogatory remarks).”
“Dr. Breitwieser’s stressors included periods of mental health instability. He is generally unable to cope with stressors when decompensating and demonstrated this by showing signs of affective and behavioural instability (e.g., quick to anger, irritability, and irrational behaviours).”
“Shortly after Dr. Breitwieser’s transition to the community (during the 30-day LOA), he had an unwitnessed fall (August 24, 2024). There were also two reported near misses (falls) following this incident. The near misses occurred in the group home when Dr. Breitwieser almost missed sitting on the seat of his chair at mealtime and almost fell off his desk chair in his room. …Since these incidents, he only leaves the residence with Forensic Outreach and Transition staff for clinical appointments.”
It was reported that Dr. Breitwieser has happily transitioned to living in the community. He denied any symptoms of his major mental illness, including hallucinations, paranoia, elevated mood, since his transition. Staff have also reported there has been no evidence of decompensation, except for a brief period when he contracted covid-19 (November 1 to 25, 2024). He reported that he would like to continue to reside in the group home, likely even after discharge from Forensics. He continued to remain pleasant and cooperative with Forensic outreach and group home staff. His room was considered neat and organized, suggesting that he is taking pride in his environment and maintaining a sense of personal order, all positive indicators of emotional well-being. Overall, he has become more integrated into the group home living environment, is reasonably independent, and appears to be making efforts to increase his engagement with staff and peers.”
Evidence at the Hearing
[12]. The Board had available to it the evidence and documents forming the Record, the Exhibit, and oral evidence from Dr. Arun Prakash.
[13]. Dr. Prakash testified that Dr. Breitwieser is happy with his new residence. He likes his private room, the group home, the people in the home, and his books. He is compliant with his medications and has not experienced any decompensation since moving to the group home, unlike his time on the rehabilitation unit during the early part of the reporting period.
[14]. He is getting along well with the staff and other residents of the home, and there have been no reported issues with respect to his mental state or his residence.
[15]. When he decompensates, Dr. Breitwieser experiences paranoia, hypersexuality, and changed feelings towards his substitute decision maker. Pharmacologically, the mood stabilizer seems to have kept him stable, and he has not had any manic episodes, delusions, or pressured speech. Dr. Prakash noted that the mood stabilizer is taken orally.
[16]. When he is well, he has good insight into his illness, but when he decompensates, Dr. Breitwieser does not want his medications; is paranoid others will harm him; and becomes irritable over minor issues. He has a history of non-compliance with medications and decompensation and has had many failed attempts at community living in the past. When he is unwell, Dr. Breitwieser exhibits similar symptoms to those surrounding the index offences.
[17]. Dr. Prakash identified the following as signs of decompensation: isolative behaviour; sleeping in his chair; anger; paranoia. The team and staff of the group home have not seen any of these signs since Dr. Breitwieser moved into the group home.
[18]. Dr. Prakash attributes this stability to one external factor: Dr. Breitwieser’s current living conditions. Dr. Breitwieser really likes this home. It is a new building where every resident has their own room. The home provides 24/7 supervision and has a CHO worker and recreation programming onsite.
[19]. In Dr. Prakash’s opinion, Dr. Breitwieser remains a significant threat to the safety of the public. It is early days in his tenure in the community, especially considering the failed attempts at community living in the past. It is too soon to consider a conditional discharge. Dr. Prakash adopted the reasoning set out in paragraph 25 of last year’s Reasons for Disposition.
[20]. The hospital requires a Warrant of Committal to bring Dr. Breitwieser to the hospital quickly if he starts to decompensate. Decompensation occurs within days, and historically he has a pattern of 1 to 2 decompensations per year. The hospital also needs to be able to approve the accommodation.
[21]. Dr. Prakash explained that the purpose of the changes to the Disposition requested by the hospital is to make the Disposition the least restrictive in the circumstances.
[22]. The following changes to the Disposition are intended to make it possible for Dr. Breitwieser to move to a long-term care facility (“LTC”) in the future: change living in “Elgin and Middlesex Counties” to living in “Southwestern Ontario;” and reduce reporting to 2 times per month.
[23]. Dr. Prakash explained that a move to an LTC would be for physical health reasons, and Dr. Breitwieser is capable to make this decision. There is no immediate need to look for an LTC placement, but because the waitlist can be up to 5 years, the hospital wishes to make placement on a waitlist.
[24]. The hospital recommends removing the no-contact clause because the victim was Dr. Breitwieser’s landlord in 2003. Dr. Breitwieser has no desire to contact him. Dr. Prakash was not aware of any attempts to contact the victim in the last 22 years despite Dr. Breitwieser having access to the internet.
[25]. The team unanimously recommended the removal of the weapon prohibition. It was Dr. Prakash’s evidence that this decision had been based on the team’s understanding that weapons had not been an issue for the last 20 years. Dr. Prakash was not concerned about Dr. Breitwieser’s ability to access a firearm because he resides in a group home which is supervised 24/7.
[26]. Dr. Prakash told the board that Dr. Breitwieser had no history of firearms charges. He has been irritable, angry, and has made threats of violence, but these are mostly verbal and have not involved weapons. The risk of use of a weapon may be reduced by decreasing mobility.
[27]. In response to a question from Mr. Rows, Dr. Prakash confirmed that the hospital was not suggesting that Dr. Breitwieser would be a suitable candidate for owning a firearm.
[28]. In response to a question from the Board, Dr. Prakash agreed that it might be appropriate to revisit the removal of the restriction on weapons in the future once Dr. Breitwieser has continued to live successfully in the community for a longer period of time.
[29]. There was no further evidence.
Analysis and Conclusion
[30]. Having heard and considered the entirety of the evidence as well as the submissions from the parties, the Board agrees that Dr. Breitwieser remains a significant threat to the safety of the public.
[31]. In Winko, the Supreme Court outlined that, in coming to the conclusion on the issue of significant risk, 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 medical condition; the NCR accused’s own plans for the future; the support existing for the NCR accused in the community; and most importantly, the recommendations provided by experts who examined the NCR accused. In coming to our conclusion in this matter, the Board relies on the uncontroverted expert evidence of Dr. Prakash, in addition to the documentary evidence before us.
[32]. Dr. Breitwieser suffers from a major mental illness, Schizoaffective Disorder, bipolar type. In the first part of the reporting period, Dr. Breitwieser experienced bouts of decompensation. He decompensates rapidly. When he experiences decompensation, he loses his insight and does not understand his need for medication. When he does decompensate, he engages in threatening behaviours similar to the index offences.
[33]. The Board relies on the Reoffence Scenario set out on page 259 of the Hospital Report:
Absent forensic supervision, Dr. Breitwieser would likely experience decompensation either spontaneously or due to noncompliance with prescribed medications. As a result, he would quickly deteriorate, becoming manic and increasingly paranoid and delusional which would result in the re-emergence of aggressive and threatening behaviours towards innocent stimuli in his environment, similar to those seen at the time of the index offences and as evidenced in this reporting period.
[34]. The Board also relies on the Current Clinical Assessment of Significant Risk, set out on page 260 of the Hospital Report:
Current Clinical Assessment of Significant Risk
It is the opinion of the treatment team that Dr. Breitwieser continues to pose a risk of serious physical or psychological harm to members of the public. The following evidence supports this opinion:
Dr. Breitwieser is diagnosed with Schizoaffective Disorder, Bipolar type. He remained somewhat impacted by symptoms of his illness during the beginning of the reporting year. When unwell, he becomes elevated in mood, irritable, and actively delusional as well as having decreased insight into his mental health and violence risk. He also presents with inappropriate racist and sexual comments, and aggressive and violent behaviour. His mental state remains quite fragile, especially when considering his recent transition to the community;
Historically, Dr. Breitwieser has a lengthy psychiatric history with many relapses and re-hospitalizations, secondary to noncompliance with medication and absconding. He also has a significant criminal history involving threats and assaultive behaviours. This is an area of future risk management concern;
Dr. Breitwieser’s insight into the index offence, his illness, and his need for treatment are not fully developed. He would likely not take his medications if left to his own devices, in particular when decompensated;
Dr. Breitwieser currently receives both oral and long-acting antipsychotic medications as well as an oral mood stabilizer to manage his symptoms but despite medication over the year, his symptom control is treatment refractory. His mental disorder is relapsing in nature. Given his risk for non-compliance with his oral medications, and the nature of his mental disorder, he requires ongoing monitoring and supervision to remain treatment-compliant and stable while living the community; and
Dr. Breitwieser has no risk-reducing personal supports or professional mental health supports outside of the forensic system.
[35]. The Board agrees with Dr. Prakash’s opinion that a conditional discharge is unrealistic to mitigate the risk to the safety of the public, and adopts paragraph 25 of last year’s Reasons for Disposition:
Dr. Breitwieser continues to lack insight into the Index Offence, his mental illness, the need for treatment and his risk of violence. He has a pattern of non-adherence when he begins to decompensate. His decompensations are rapid and spontaneous. The treatment team clearly needs to approve his accommodation, so a Detention Order is the necessary, and appropriate, Disposition to ensure the safety of the public.
[36]. The Board adds that the hospital needs to be able to return Dr. Breitwieser to hospital quickly if he begins to deteriorate, since his deteriorations are rapid and spontaneous.
[37]. The Board finds that the appropriate and necessary disposition is a continuation of the current Detention Disposition, with some of the changes recommended by the hospital, including the change to geographic area for community living, the reduction in reporting requirements, and the removal of the no-contact provision.
[38]. The Board agrees with Mr. Rows’ submission that the no-contact concerns “have been resolved with the passage of time.” There is no evidence before the Board that Dr. Breitwieser has made any effort to contact the victim in the past 20 years, or that he would be willing or able to do so.
[39]. After an extensive discussion, the Board declined to accept the hospital’s recommendation that the weapons prohibition be removed from the Disposition. The Board is cognizant that ‘weapons’ in this context are not limited to firearms and includes the use of environmental objects.
[40]. The Board carefully considered Dr. Breitwieser’s history as set out in the hospital report, and noted that pages 3, 5, 131, 182, and 240 contain references to Dr. Breitwieser threatening the use of weapons or using weapons (e.g. described as an excellent shooter or marksman; threatened to shoot someone with a gun in 2001; threatened to put a bullet in the head of staff; 1987 – tried to get into a person’s car with a knife; spat on someone; threw a cup of tea; threw food at a peer; flipped over a table, threw papers and poured soap all over the floor).
[41]. The Board noted that Dr. Prakash’s recommendation was based on the understanding that the team had no knowledge of weapons use, and no knowledge of incidents or threats involving weapons.
[42]. The Board notes that the current period of stability is encouraging in the context of Dr. Breitwieser’s previous history but is objectively a relatively short period of time. Dr. Breitwieser decompensates quickly and becomes aggressive abruptly. While he does not tend to go out of the group home unescorted, he is free to do so.
[43]. Dr. Prakash agreed that most of Dr. Breitwieser’s aggression is focused on the staff around him, and that further evaluation of his stability and his actions this year before removing the weapons prohibition would be appropriate to protect the public safety.
[44]. The Board adopts the submissions of Mr. Rows that while the risk of acquiring a firearm is low, Dr. Breitwieser decompensates rapidly, and it is not in the interest of the safety of the public to “test” whether Dr. Breitwieser will refrain from the use of weapons. Mr. Rows submitted that there would be no benefit to Dr. Breitwieser to remove the clause, and that the clause is important to protect the safety of the public.
[45]. In consideration of all the evidence, submissions of the parties and taking into consideration the criteria set forth in s. 672.54 of the Code, the paramount consideration being the safety of the public, in addition to the mental condition of Dr. Breitwieser, his reintegration into society and his other needs, the necessary, and appropriate, Disposition is a continuation of the existing Detention Order with the modifications discussed above.
DATED this 4th day of February 2025, at the City of Toronto, in the Region of Toronto.
Ms. K. Tomaszewski Legal Member