Ontario Review Board
Re: Mr. Manuel M. Pereira
ORB File No. 8525
Hearing Date: January 31, 2025
Hearing Location: St. Joseph’s Healthcare, Hamilton, West 5^th^ Campus
Pursuant to: ss. 672.47(1) Criminal Code of Canada;
Before:
Alternate Chairperson: Mr. J. Weinstein
Members: Dr. R. Buckingham
Dr. L. O. Lightfoot
Ms. B. Little
Mr. K. McKenna
Parties Appearing:
Accused: Mr. Pereira Counsel: Mr. A. Musitano
The Person in charge of Hospital: Counsel: Mr. S. O’Brien
Attorney General of Ontario: Counsel: Mr. S. Kim
REASONS FOR DISPOSITION
(Dated March 25, 2025)
Introduction
On April 29, 2023, Mr. Pereira set fire to his own house, and had to be removed from the burning house by the fire department. He was charged with Arson, contrary to s. 434.1 of the Criminal Code of Canada. He was released on bail in May 2023.
On February 14, 2024, Mr. Pereira was found not criminally responsible (NCR) for this offence.
This initial hearing has been the subject of 3 pre-hearing conferences and 2 prior adjournments. The issue was that the wording of the court information did not disclose an offence. This resulted in an adjournment of the 1^st^ scheduled hearing. The hearing was last scheduled for December 5, 2024, and was adjourned at the request of Mr. Pereira who was unwell that day.
A panel of the Ontario Review Board (the panel) convened this initial hearing on January 31, 2025, to make a Disposition pursuant to s.672.47(1) of the Criminal Code of Canada. Mr. Pereira attended this hearing with counsel and family members. There was also a Portuguese interpreter present for the hearing.
At the commencement of the hearing, the Hospital (St. Joseph’s) recommended a detention order with privileges that extend to living in the community in approved accommodation. Counsel for the Attorney-General supported this recommendation. Counsel for Mr. Pereira recommended a conditional discharge. He advised that Mr. Pereira would consent to treatment pursuant to s. 672.55 (1). He further advised that Mr. Pereira has been living at 17-25 Viking Drive, Binbrook since his release on bail in May 2023.
The panel was provided with various court documents related to Mr. Pereira’s NCR finding, including the NCR Report. A Risk Assessment Report dated July 12, 2024, was prepared at the direction of the Board for the hearing scheduled to be heard August 7, 2024, and which was adjourned to December 5, 2024. This was the most current assessment the panel had for this hearing.
Evidence
The evidence at this hearing consisted of the documents that were provided and the testimony of Dr. Chaimowitz.
Mr. Pereira is a 66-year-old gentleman with a diagnosis of Parkinsons Disease. Mr. James Thorpe (brother-in-law) said that Mr. Pereira began hallucinating, seeing bugs, chickens, and people in his home, in the summer of 2022. Mr. Pereira’s health records indicated that he had been admitted to St. Joseph’s Healthcare Hamilton, in March 2023 for hallucinations thought to be secondary to cellulitis. His family reported that this condition had worsened in April 2023 to include seeing demons.
Mr. Thorpe stated that on the day of the index offence Mr. Pereira had told him over the phone that he believed his home was “under invasion” from the bugs, animals, and people, despite assurance from family members that “there was no one else in the home.” Mr. Pereira was living in his own home independently at the time of the index offence, and his niece and nephew were visiting.
The following are the pertinent facts related to the index offence.
On April 29, 2023 Police were dispatched to assist the fire department at 810 Nebo Road in relation to an active fire. Manuel Pereira was located inside the residence and was subsequently transported to hospital with smoke inhalation.
While enroute to the hospital, Mr. Pereira made utterances indicating that he deliberately set the fire. Based on observations at the scene, the fire was determined to have been deliberately set. Mr. Pereira was the only occupant inside the home at the time.
Mr. Pereira advised that he and his family moved to Canada in 1975. He worked as a bricklayer his entire career.
Mr. Pereira advised the NCR assessment team that he was living independently with support from his family, and that he had moved in with his brother-in-law James Thorpe approximately 3 months ago. He required support with his daily needs, such as showering and dressing. Mr. Pereira indicated a desire to return to his home once the home was re-built.
Mr. Thorpe reported that he and the family believe that Mr. Pereira should reside in supportive housing because of his deteriorating condition. He and the family do not believe they are able to provide the significant amount of support he requires. Mr. Thorpe obtains Mr. Pereira’s prescriptions from his pharmacy, but Mr. Pereira takes his own medication and is medically compliant.
Mr. Pereira did not enroll in school in either Portugal or Canada, and is unable to read or write in either language.
Mr. Pereira was married for 5 years, but divorced as a result of his problem drinking. He has 2 adult daughters whom he does not see very often.
He has a criminal record during the years 1998-2003. There are 7 entries on his record and 4 are related to drinking and driving.
Mr. Thorpe advised that Mr. Pereira has been followed by his family physician, Dr. Dominic Rosario, since 2018. His previous family physician stopped seeing Mr. Pereira because of his ongoing substance use. Mr. Pereira’s niece, Ms. Jessica Cordell, is his substitute decision maker.
His health records indicate that he was diagnosed with Parkinson’s Disease in February 2022.
He is diagnosed with a Major Neurocognitive Disorder due to Parkinson’s Disease. He has no previous psychiatric diagnoses.
Mr. Pereira had admissions to the hospital on the following occasions.
(a) January 31, 2019; brought to emergency by EMS, after he was found in a parking lot behind a bar, having spent the evening at the bar drinking. He awoke in the snow outside of the bar having no memory of the evening.
(b) March 6, 2023: brought to emergency by family with a complaint of hallucinations and delusions. It was thought the hallucinations were due
to prescribed opioids and other psychoactives.
(c) March 27, 2023; brought to emergency with concerns of visual hallucinations. The diagnosis at the time of discharge was visual hallucination in the context of known Parkinson’s Disease; left leg cellulitis vs. Chronic Venous Insufficiency.
(d) April 29, 2023; brought to emergency by EMS, after being extricated from his home. When he was asked what started the fire, he responded, “I was trying to kill the son of a bitch.” Mr. Pereira expressed distress over the people who lived in his house, in his backyard, and kept moving items and furniture around in the house. His clear intent was to kill himself and the intruders. He was placed on a Form and admitted to the hospital. He continued to hallucinate in the hospital. He received a psychiatric consultation where it was opined that his hallucinations and delusions were most likely the product of delirium due to his cellulitis or to his Parkinson’s Disease.
Mr. Pereira has been heavily consuming alcohol all his adult life. He indicated at the time of the NCR assessment that he now drinks one to two glasses of wine nightly with dinner. He has a history of relapses with alcohol, which is a significant concern to the assessment team as it can lead to non-adherence with medication and a worsening of his physical as well as his mental health symptoms.
A mental status examination was conducted in May 2024. He was cooperative but was unable to provide detailed responses to questions being asked. It was difficult for him at times to express his thoughts.
Mr. Pereira expressed an intention to return to his home and live independently once the fire damage has been repaired. The Hospital sees this as demonstrative of his lack of insight into his ability to care for himself and to comply with his treatment regimen. This lack of insight, together with his cognitive decline, substance use, and his past risky behaviour, indicates that he is a significant risk to the public according to the Hospital. It is also noteworthy that he relies on his family for medications and groceries.
Dr. Chaimowitz testified that he has not met with Mr. Pereira since the risk assessment in July 2024. He does not believe the Hospital can manage Mr. Pereira’s risk at this time as long as Mr. Pereira is residing in the community. His major risk factors are his Parkinson’s Disease with a potential for auditory and visual hallucinations, and his response to what he hears or sees, and alcohol use, which can accelerate the symptoms. These factors were fundamental to him committing arson.
Under a detention order, Dr. Chaimowitz indicated that Mr. Pereira would be admitted to the Hospital. The team would update his medical, psychiatric, and substance abuse history, and assess Mr. Pereira and his family for appropriate housing. Dr. Chaimowitz would expect that Mr. Pereira would be hospitalized for a short period of time. In assessing an appropriate residence, he would be considering a place where the team could visit regularly.
Dr. Chaimowitz acknowledged the caring family support he receives, and part of the future plan is educating the family on Mr. Pereira’s illness and the role of the Review Board. He stated that a robust risk management plan will include ensuring that everything is in place to reduce the risk to public safety.
Counsel for the Attorney-General asked Dr. Chaimowitz if the passage of time since the risk assessment, without any further criminal behaviour or harmful behaviour, has affected his opinion regarding significant threat. He responded that the gravity of the circumstances surrounding the index offence, the fact that Mr. Pereira may have been drinking at the time and has a long history of severe alcohol use, and is suffering from this illness supports the opinion that Mr. Pereira is a significant threat.
In answer to questions from Mr. Musitano, Dr. Chaimowitz testified as follows:
(a) Mr. Periera’s last criminal conviction was 2003, and none of the convictions on his record are related to the index offence;
(b) Prior to 2022 there is no psychiatric diagnosis;
(c) His only hospitalization related to alcohol was in 2019;
(d) March 6 2023, was his only hospitalization for psychiatric symptoms, and the hospital record indicates that opioids or other psychoactive medications could have contributed to the hallucinations;
(e) He was prescribed Abilify to treat the hallucinations, although not certain if he has remained compliant with this medication;
(f) Mr. Pereira attended each scheduled appointment with the Hospital for the risk assessment to be conducted;
(g) Mr. Pereira advised Dr. Chaimowitz at the time of the risk assessment that he no longer experiences hallucinations, and has no thoughts of harming himself or others.
- In answering questions from the panel, Dr. Chaimowitz testified as follows:
(a) He is unaware of whether Mr. Pereira is compliant with his medication or is drinking alcohol;
(b) It is important to admit Mr. Pereira to hospital to fully understand his current condition and risk to the community;
(c) It is important for the Hospital to assess Mr. Pereira’ s ability to function, and determine the most appropriate residence that can provide the necessary care for him;
(d) It is difficult to conduct a thorough assessment on an outpatient basis;
(e) There is no current information concerning the ability of the family to care for Mr. Pereira;
(f) The Hospital does not want to keep Mr. Pereira in the hospital any longer than is required to assess his medical, psychiatric and functional needs;
(g) An in-hospital assessment would allow the treatment team to quickly ascertain if Mr. Pereira was still a significant threat, and if not, the hospital would arrange for an early hearing.
Submissions
The Hospital submitted that the risk assessment and the testimony of Dr. Chaimowitz provide a reasonable and sound basis for concluding that Mr. Pereira is a significant threat to the safety of the public.
Counsel for the Attorney-General submitted that it would be premature for Mr. Pereira to be placed on a conditional discharge at this time. There is information that Mr. Pereira has resumed consuming alcohol, and that increases his risk. Mr. Pereira has strong positive supports in the community, so hopefully, his hospitalization will be of very short duration.
Mr. Musitano submitted that the least onerous and least restrictive Disposition is a conditional discharge. He submitted that the criminal record is dated and unrelated. Mr. Pereira has no previous psychiatric history, notwithstanding, a long history of alcohol use. The hallucinations and delusions appear to have been eliminated by the introduction of Abilify. Mr. Musitano further submitted, that Mr. Pereira attended his appointments with Dr. Chaimowitz and was cooperative, and abided by the terms of his bail. He referred to the fact that the index offence was almost 2 years ago, and that there has been no problematic behaviour since then. Mr. Musitano concluded by stating that a conditional discharge can safely manage Mr. Pereira’s risk to public safety.
Analysis
Mr. Pereira committed a very serious index offence with the intention of killing himself and perceived intruders. He first started experiencing hallucinations and delusions approximately one year before the index offence, and he was hospitalized on March 6, 2023, and March 27, 2023 as a result of hallucinations.
He was diagnosed with Parkinson’s Disease in February 2022, and it is believed the hallucinations and delusions are a result of the Parkinson’s Disease, which causes neurocognitive impairment. It is an idiopathic disease with no known cure.
The panel appreciates the argument from Mr. Musitano. Mr. Pereira has no known psychiatric history prior to the onset of Parkinson’s Disease. He has been living in the community on bail since his arrest for the index offence without any breaches of his bail conditions, or re-admissions to the hospital. Mr. Pereira reported that his alcohol consumption is restricted to 2 glasses of wine with dinner. It also appears that Abilify has significantly reduced or eliminated the hallucinations and delusions.
From the Hospital’s perspective, it cannot properly manage Mr. Pereira’s risk to public safety while he is living in the community. Dr. Chaimowitz identified three areas as risk factors: the Parkinson’s Disease, Mr. Pereira’s alcohol use, and his response to things affecting his environment resulting from the symptoms of Parkinson’s Disease. Mr. Pereira has advised the Hospital that he now drinks approximately two glasses of wine with dinner. However, he has a history of relapsing into heavier alcohol use, that can lead to medication non-compliance. It also appears that Mr. Pereira has little insight into his illness and the support he requires.
Dr. Chaimowitz also indicated a need to assess his housing. The family members are very caring and supportive of Mr. Pereira, but Mr. Thorpe did indicate their belief that Mr. Pereira requires supportive housing, a residence that offers mores support than the family is capable of providing.
Dr. Chaimowitz also indicated that it is important for the treatment team to understand Mr. Pereira’s alcohol use and his compliance with medication. Both of these factors could directly cause a deterioration of his condition and elevate his risk to public safety.
After considering the evidence, the panel has concluded that Mr. Pereira is a significant threat to the safety of the public, and that a detention order is necessary and appropriate. Without Mr. Pereira being hospitalized, for hopefully a brief period of time, the Hospital is unable to assess all the circumstances in his life which may contribute to his risk to public safety, and address these risk factors with the appropriate treatment. It is important for the Hospital to know Mr. Pereira’s current level of alcohol use, and his compliance with medication. It is also important for the Hospital to assess his housing, and with the cooperation of Mr. Pereira’s family, determine the level of support Mr. Pereira requires.
The panel agrees that it will be much more efficient for the Hospital to determine the type of housing that would be appropriate for Mr. Pereira, and for the safety of the public, with Mr. Pereira in hospital. Hospitalization will also allow the Hospital to more quickly determine if a conditional discharge or absolute discharge is appropriate, in which case an early hearing would be arranged.
As indicated above, the latest risk assessment is from July 2024. Without a more current assessment of Mr. Periera’s risk to public safety, the panel has to rely on the evidence presented at this hearing.
In coming to this conclusion, the panel has applied the principles provided in s. 672.5401 of the Criminal Code.
Dated this 25^th^ day of March 2025, at the City of Toronto, in the Toronto Region.
Kevin McKenna
Legal Member
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Office of the Registrar
Ontario Review Board