Re: Diana L. Kireto, 2025 CanLII 23550

Ontario Review Board

Re: Diana L. Kireto

ORB File No: 8389

Hearing held on: February 19, 2025

Place of hearing: Thunder Bay Regional Health Science Centre (Via Zoom Audio-Visual Technology)

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

Before:

Alternate Chairperson: Mr. J. Goldenberg Members: Dr. H. Bloom Dr. P. Wright Mr. D. Sandor Mr. S. Duffy

Parties Appearing:

Accused: Diana Kireto Counsel: Mr. D. Shannon

The Person in charge of Hospital: Representative: Ms. M. Davidson

Attorney General of Ontario: Counsel: Mr. T. Jukes

REASONS FOR DECISION

(Dated March 21, 2025)

Introduction:

1On September 20, 2023, Diana L. Kireto was found not criminally responsible on account of mental disorder on a charge of criminal harassment (repeated communication), contrary to section 264(2)(b) of the Criminal Code of Canada. She is currently subject to a disposition of the Ontario Review Board, dated January 31, 2025, detaining her at the Forensic Unit of the Thunder Bay Regional Health Sciences Centre (hereinafter referred to as “the Hospital”).

2That disposition includes privileges up to and including that of living in the community in Northwest Ontario in accommodation approved by the person in charge. It also imposes certain terms and conditions, including that of abstaining absolutely from the non-medical use of alcohol or drugs or any other intoxicant, and that of submitting samples for the purpose of monitoring compliance with the abstain condition.

3On February 7, 2025, the Hospital sent correspondence to the Ontario Review Board pursuant to section 672.56(2) of the Criminal Code. It advised that Ms. Kireto had been admitted to the Hospital whereas she had been living in the community of Longlac. She had remained in the Hospital for a period exceeding 7 days, necessitating a hearing pursuant to the provisions of section 672.81(2.1) of the Criminal Code.

4On February 19, 2025, the Board convened a hearing at the Hospital via Zoom Audio-Visual Technology to review the restriction of Ms. Kireto’s liberties. Ms. Kireto attended the hearing and was represented by counsel. At the outset of that hearing, all parties agreed that no changes to the most recent disposition were being sought. The only issue before the Board was whether the Hospital’s restriction of Ms. Kireto’s liberties was justified at the time undertaken, whether it represented the least onerous and least restrictive option available to the Hospital at that time, and whether it remained so.

5The record for the hearing included the Notice of Hearing and the last Disposition dated January 31, 2025. On the consent of all parties, the letter from the Hospital advising of the subject restriction of liberties was marked as exhibit 1. A Restriction of Liberties Report, dated February 11, 2025, was entered into evidence as exhibit 2.

6At the outset of the hearing, the Hospital’s representative, Ms. Davidson, advised that Ms. Kireto remained in the Hospital. She expressed the Hospital’s position that the restriction of Ms. Kireto’s liberties was justified and necessary at the time undertaken and represented the least onerous and least restrictive option available to the Hospital at that time. She further took the position that the restriction of liberties continues to be justified and the least onerous and restrictive option available. She was joined in her initial position by both the representative of the Attorney General and counsel for Ms. Kireto.

7For the reasons that follow, the Board has accepted that joint submission.

Evidence at the hearing

8The evidence for the hearing came in the form of the Restriction of Liberties Report mentioned and from the oral evidence offered by Dr. P. Schubert, Ms. Kireto’s treating psychiatrist. The Restriction of Liberties Report explains that Ms. Kireto was admitted to the Forensic Inpatient Unit at the Hospital ten days following her last annual review hearing with the Ontario Review Board. It incorporates an excerpt from Dr Schubert’s February 3, 2025, progress note, saying that Ms. Kireto and her partner had attended an appointment at the Complex Centre for Diabetic Care on January 31, 2025. The Centre’s notes indicated that Ms. Kireto’s speech was pressured, rapid and repetitive. She stated that she did not want to continue with her current living situation with her partner. A decision was made to take her to the Emergency Room for an assessment of her mental status.

9Once in the Emergency Room, information was received from Ms. Kireto’s daughter, Sarah, who is her Substitute Decision Maker. Sarah advised that she was concerned about her mother’s well-being. Ms. Kireto had herself declared that she was having a “mental breakdown” associated with her partner’s control over her. Her blister pack of medications suggested non-compliance which Ms. Kireto confirmed by saying she felt that she “did not need them.” Throughout her period in the Emergency Room, Ms. Kireto rambled and showed disorganized and tangential though. She denied suicidal or homicidal ideations. Her behaviours became increasingly concerning as she sought to elope from the Emergency Room, requiring the intervention of security. Her level of physical agitation and sexual impropriety obliged chemical and physical restraints.

10The following day, Ms. Kireto was seen by Dr. Wadhwa for a psychiatric consultation. The Restriction of Liberties Report summarizes Dr. Wadhwa’s observations. Ms. Kireto was agitated and extremely difficult to redirect. Her speech was pressured, and she endorsed not taking her medications.. She was intrusive, argumentative, and threatening.

11Ultimately Ms. Kireto was admitted to the Forensic Inpatient Unit where she continued to be verbally and physically aggressive, banging on walls, screaming, arguing, confronting others, and disrobing and defecating on the floor. Her symptoms required PRN antipsychotic medication at that time.

12Once Ms. Kireto was restarted on her medication, she began to settle but continued to display manic symptoms. She expressed ongoing discontent at living with her partner Larry and said that she wanted to have her own housing away from him.

13The Restriction of Liberties Report explains that Ms. Kireto continued to display manic behaviours compounded by lack of insight and cognitive limitations associated with her major mental illness. It provides details of her aggressivity and inappropriate sexual comments and gestures directed to co-patients and staff. As a result, on February 7, 2025, Dr Schubert and the Hospital’s program social worker, Ms. Forget, met with Ms. Kireto’s daughter/Substitute Decision Maker to review medications with the intention of switching to a depot formulation of Ms. Kireto’s antipsychotics and to discuss community living options once she stabilized. Near its conclusion, the Restriction of Liberties Report expresses hope regarding Ms. Kireto’s progress. It notes hat over the course of her hospitalization, she has become compliant with prescribed medication and is now exercising supervised hospital grounds privileges appropriately.

14Dr Schubert updated the panel further during his viva voce evidence. He explained that Ms. Kireto has a diagnosis of bipolar disorder and mild intellectual disability. He described circumstances that suggested Ms. Kireto was undergoing rapid decompensation in a context of relationship stressors and noncompliance with her treatment regime. At the time of the last hearing on January 21, 2025, Ms. Kireto was doing well living in the community 300 kilometers northeast of Thunder Bay. She was supported by her partner Larry, with the two of them living in his mother’s home. But by January 31, 2025, Ms. Kireto was showing manic symptoms that led to her being admitted, as described above, pursuant to the provisions of the Mental Health Act. The following Monday she continued to display manic symptoms. She was easily frustrated and intrusive. Dr Schubert said that Ms. Kireto had been following other co-patients around the unit, displaying pressured, and harassing speech that put her at risk of aggressive reactions from those she was following. He explained that she needs support to live in the community, but that attempts to place her at group homes in the past had failed. He explained that, even at the date of the hearing, it was difficult to predict Ms. Kireto’s trajectory, though the Hospital remained hopeful for a discharge in the next couple of weeks. He expressed hope in the efficacy of adjustments that had been made to Ms. Kireto’s medications but indicated that the Hospital was still in the process of assessing that efficacy. He confirmed that Ms. Kireto’s partner, Larry, continued to be willing to have her back once she was a bit more stable. It was unclear whether Ms. Kireto would continue to express dissatisfaction or concerns with that living arrangement, which would be a further complication. In whole, his evidence led to the clear conclusion that the situation at the date of the hearing was still fluid and subject to several uncertain contingencies..

Submissions

15At the end of the hearing, the parties renewed their submissions as stated at the hearing’s outset. All agreed that the restriction of Ms. Kireto’s liberties was justified and necessary. All agreed that it represented the least onerous and least restrictive option available to the Hospital at the time undertaken. All agreed that it continued to be so.

Analysis and conclusion

16As stated, the Board agrees with that joint submission. The evidence supported the conclusion that Ms. Kireto’s liberties had been significantly restricted. As a result of her decompensated state, she was admitted to the Hospital from where she had been living in accommodations approved with her partner in the community. Her privileges have been restricted as she has been placed back on a treatment regime for her major mental illness. Her mental state at the time of her initial presentation to the emergency room was one of rapid decline. She was aggressive and manic and admitted to noncompliance with prescribed medication. She showed little to no insight into her need for medications. She was living 300 kilometers away from Thunder Bay in a dwelling shared with her partner, Larry. Her manic symptoms continued, and the symptoms of her major mental illness have persisted in spite of compliance with medications that have been adjusted while in the Hospital. It is clear on such facts that the initial restriction was justified and necessary and that the ongoing restriction continues to also be justified and necessary.

17It is also clear on the evidence that the parameters of Ms. Kireto’s restrictions were and continue to be the least onerous and least restrictive options available to the Hospital. Ms. Kireto is being stabilized and supported. Her daughter and partner are working with the Hospital with regard to discharge planning. Ms. Kireto has been receiving increased privileges in accordance with her progress. While her situation is still difficult, the evidence supports the conclusion that the Hospital is mindful of the importance of her liberty interest and is seeking to increase privileges in accordance with her progress. The Board joins with Dr Schubert and all who participated in this hearing in our expression of hope that Ms. Kireto will continue to progress and will ultimately be able to transition back into approved accommodations in the community.