Re: Ojulu Ochan Omot
ORB File No: 7613
Hearing held on: Tuesday, March 11, 2025
Place of hearing: Southwest Centre for Forensic Mental Health Care (Via Zoom Video Conference)
Pursuant to: Sections 672.48(1) and 672.81(2.1) of the Criminal Code
Before:
Alternate Chairperson: Ms. M. Labrosse
Members: Dr. R.D Chandrasena
Dr. M. Mamak
Mr. D. D’Intino
Ms. B. Little
Parties Appearing:
Accused: Ojulu O. Omot
Counsel: Mr. R. Cunningham
The person in charge of hospital: Counsel: Ms. J. Zamprogna
Attorney General of Ontario: Counsel: Ms. K. Dalrymple
REASONS FOR DECISION
(Dated March 24, 2025)
Introduction
On August 26, 2019, Mr. Ojulu Omot was found unfit to stand trial on charges of sexual assault (x3), criminal harassment (x4), indecent act, failing to comply with condition of undertaking, failure to comply with condition of judicial release and possession of marijuana, all contrary to the Criminal Code of Canada.
Mr. Omot is currently subject to a Disposition of the Ontario Review Board dated April 24, 2024, which detains him at the Southwest Centre for Forensic Mental Health Care, St. Joseph's Health Care London, hereinafter referred to as “the hospital”, on terms and conditions up to and including to live in the community of Elgin County in supervised accommodation approved by the person in charge.
By way of letter dated October 9, 2024, the hospital notified the Ontario Review Board, pursuant to s. 672.56(2)(b) of the Criminal Code, that Mr. Omot had been secluded for a period exceeding seven days, thereby triggering a restriction of liberty. Mr. Omot entered seclusion on that date and remained in seclusion until October 16, 2024.
On March 11, 2025, the Board convened a virtual hearing to address the significant increase in the restriction of Mr. Omot’s liberty, pursuant to s. 672.81(2.1) of the Criminal Code. Mr. Omot attended the virtual hearing and was represented by counsel, Mr. R. Cunningham.
The issues for this hearing are whether the hospital’s actions in secluding Mr. Omot between October 2, 2024, and October 16, 2024, constituted a significant increase in the restriction of his liberty, and if so, whether it was necessary and appropriate and represented the least onerous and least restrictive course of action available to the hospital at that time.
For the reasons set out below, the Board finds that the hospital’s decision to seclude Mr. Omot between October 2, 2024, and October 16, 2024, did indeed constitute a significant increase in the restriction of his liberty and that this course of action was reasonable and warranted given the increase in risk to other co-patients and staff of the hospital, and that this action by the hospital did represent the least onerous and least restrictive decision available to address the heightened risk.
As this hearing solely addresses the restriction of liberty, it is not necessary to repeat the recitation of the index offences and the background history which are set out in detail in the Reasons for Disposition dated May 6, 2024, emanating from Mr. Omot’s last annual review hearing which was held on April 15, 2024. Mr. Omot’s next annual review hearing is scheduled for April 7, 2025.
Evidence at the Hearing
The hospital’s evidence was presented through the Hospital Reports, including the ROL Report dated March 4, 2025, and through the oral evidence of Dr. N. Mokhber. This evidence is summarized below.
Dr. Mokhber adopted the contents of the Hospital Report and explained that Mr. Omot is not currently her patient but that she had attended to him as recently as late December of 2024. Dr. Mokhber was the attending psychiatrist at the time of Mr. Omot’s seclusion, and she has known him for approximately five years as she was also the physician who completed his fitness assessment in 2019. In September of 2021, Mr. Omot’s care was transferred to another psychiatrist until Dr. Mokhber became reinvolved at the time of the seclusion in October of 2024.
By way of background, Dr. Mokhber recounted that in 2023 Mr. Omot was deemed ready for transfer to the rehabilitation unit with the view of moving him into the community. Between September of 2023 and February of 2024, he was on the rehabilitation unit and the treatment team was working towards his discharge.
While on the rehabilitation unit Mr. Omot started experiencing side effects from his medication which led to a decision by the treatment team to change and adjust his medication. Unfortunately, this led to a decompensation of Mr. Omot’s mental condition. As a result of that decompensation, Mr. Omot was moved back to a treatment unit where the treatment team attempted to stabilize him and restart his previous medication.
Dr. Mokhber testified that she had viewed the video tape evidence of the October 2nd, 2024, incident which triggered the restriction of liberty. She explained that though Mr. Omot claimed that the other patient had started the altercation, the video evidence clearly shows that it was Mr. Omot who initiated the incident by starting to punch him. After the incident, Mr. Omot also claimed that he and this patient had been at Waypoint together, and that this was a revenge assault for a previous assault committed on him by this patient. Dr. Mokhber explained that though it is true that both Mr. Omot and this other patient were at Waypoint, they were never there at the same time as Mr. Omot was there in 2018 and the other patient was there in 2019, with no overlap.
The treatment team believes that the incident was the possible result of psychotic symptoms and/or behavioural dysregulation. It has also been speculated that Mr. Omot may have been confused by the fact that this patient had shaved and changed his look the day before such that there could have been some sort of misidentification.
Mr. Omot has not expressed any remorse or regret about this incident, at any time.
Following the assault, Mr. Omot had to be treated for a broken wrist that he sustained during the assault. The co-patient victim also sustained injuries, and according to Dr. Mokhber, was quite traumatized by the attack perpetrated on him by Mr. Omot.
Following the attack, Mr. Omot was immediately placed in seclusion. He was initially refusing to take medication and was very difficult with staff. He repeatedly expressed that he wanted to “finish the job” and kill the co-patient. He was seen responding to internal stimuli and punching walls with the cast that had been applied to his fractured wrist. After approximately a week, Mr. Omot started accepting medication and slowly began to stabilize and progress.
While in seclusion, Mr. Omot was transferred to a different treatment unit in order to ensure that there was no contact between him and the other co-patient.
Dr. Mokhber explained that while in seclusion, according to the hospital policy for patient seclusion, Mr. Omot was reassessed every 24 hours to see if seclusion continued to be needed to manage the risk. In addition, every third day, Mr. Omot was seen by a new doctor and again reassessed to determine if seclusion continued to be necessary.
On October 16, 2024, seclusion was discontinued, and Mr. Omot was put on constant observation on the unit, which continued for two days.
Dr. Mokhber indicated that she has not seen Mr. Omot since Christmas but that she has been given updates by his treatment team. Mr. Omot has continued to change his story as to why he attacked the co-patient. He has recently stated that the person had robbed him.
Dr. Mokhber confirmed that Mr. Omot is now back to the same medication regimen that he was on at the time that he was on the rehabilitation unit which includes long-acting injectable risperidone as well as lithium, and seroquel, which has been added to address agitation. A further medication, prazosin, has been added to address Mr. Omot’s nightmares, but does not appear to be working as hoped.
As of November 20, 2024, the team started seeing significant improvements with treatment. There were significant behavioural improvements as well as improvements in Mr. Omot’s mental status. By then Mr. Omot started rejoining programs and working with a social worker.
Dr. Mokhber stated that an application has been made for an external psychotherapist to come to the hospital to work with Mr. Omot on his past trauma. This psychotherapist is apparently experienced in working with the African Canadian population. This has not yet started.
The treatment team has also reported to Dr. Mokhber that Mr. Omot is more open to sharing his psychotic symptoms with the treatment team. He has also been engaging in activities such as listening to music and walking, both of which have been beneficial to him.
Mr. Omot is currently on Level 3 privileges, which permits him to leave the unit within the building without restriction. Dr. Mokhber was told by the treatment team that Mr. Omot recently had a conflict with another patient on the A-2 treatment unit but that rather than resorting to aggression, Mr. Omot approached the nursing staff for assistance. It was also reported that Mr. Omot and the victim co-patient from the October incident both attended the Christmas dinner at the same time but that they kept their distance from each other, such that there were no incidents.
In summary, Dr. Mokhber testified that Mr. Omot represented a heightened risk for himself and others as a result of his mental decompensation and aggressive behaviour and that he needed seclusion in order for that risk to be adequately managed.
Dr. Mokhber confirmed that the current Disposition continues to be necessary and appropriate until Mr. Omot’s upcoming annual hearing in four weeks, and that she continues to adopt the statements found at paragraphs 19 and 20 of the Reasons for Disposition of last year.
In response to questions posed to her by counsel for Mr. Omot, Mr. Cunningham, Dr. Mokhber responded as follows:
a) When reviewing the video-taped evidence of the incident, she had both a back view and a side view of Mr. Omot and the co-patient. They appeared to have been on the balcony for about 10 minutes together prior to the assault. There is no evidence in the video that they were conversing, and Dr. Mokhber added that the victim is someone who barely speaks. The victim was sitting on the balcony with his head down while Mr. Omot was pacing nearby, he approached him while the victim continued to have his head down and attacked him. Dr. Mokhber confirmed that there is no evidence that Mr. Omot was grabbed by the other patient as he claimed.
b) Dr. Mokhber confirmed that the treatment team has optimized his medication while he has remained on the A-2 treatment unit.
c) The rehabilitation unit aims to find accommodation for patients and testing patients in different settings. If there are any side effects or any problems during this process, the treatment team physician will work on the medication which is what happened last fall. The treatment team attempted to address his side effects by introducing olanzapine and clozapine, the latter of which Mr. Omot refused to take as he did not want to cooperate with the blood work. When it was judged that he was not responding to the medication changes, Mr. Omot was sent back to the treatment unit for optimization of medication.
d) Dr. Mokhber believes that Mr. Omot’s medications are currently optimized and confirmed that he is on a lower dose of the long-acting injectable risperidone but with an adjunct medication, such that this appears to have stabilized his symptoms. Dr. Mokhber added that stopping and restarting the same medications does not ensure that a patient will always respond the same way.
e) Dr. Mokhber confirmed that Mr. Omot’s current attending psychiatrist is Dr. Ashley Malka.
f) Dr. Mokhber stated that at the time of the incident on October 2, 2024, Mr. Omot was accessing privileges at Levels 0 to 2, which fluctuated on and off because of other behavioural issues such as smoking. He is now on Level 3 privileges which reflects that he has made progress in various ways since the incident.
g) Dr. Mokhber confirmed that Mr. Omot had started seeing a behavioural therapist in December of 2024. The hospital was still waiting for the external psychotherapy to start.
- In response to questions posed to her by members of the panel, Dr. Mokhber responded as follows:
a) She confirmed that Mr. Omot’s wrist has healed and that he is now out of a cast.
b) In the opinion of Dr. Mokhber, the seclusion of Mr. Omot was the only option available to the hospital to manage the risk posed by his heightened aggressive and violent behaviour.
c) Dr. Mokhber confirmed that the maximum privilege level on the treatment unit is Level 5, which includes three one-hour periods of hospital and grounds indirectly supervised passes. According to Mr. Omot’s current treatment team, he is not yet ready for transfer to the rehabilitation unit but is getting close.
d) Dr. Mokhber added that Mr. Omot has made great progress moving through the system; that he was initially very unwell and wanted nothing to do with female staff, including Dr. Mokhber who required two security guards when meeting with Mr. Omot, as he wanted to attack her. He has made significant progress since then.
e) Finally, Dr. Mokhber indicated that another hospital staff person from the transitional team was present with her at the hearing, as the transitional team wants to get to know Mr. Omot to prepare for his transfer to the rehabilitation unit and discharge planning.
- No other evidence was presented.
Submissions of the Parties
The hospital submits that the decision to seclude Mr. Omot between October 2 and October 16, 2024, was reasonable and warranted, following a serious and unprovoked assault which caused injury to both the victim and Mr. Omot. The assault appears to have taken place in the context of mental decompensation and/or behavioural dysregulation. At the time Mr. Omot was exercising privileges between Level 0 and Level 2. The behaviour required seclusion and transfer to another unit to prevent further attack on the peer. Mr. Omot was initially refusing medication and continuing to demonstrate positive violent symptoms. With medication and behavioural therapy, there have been significant improvements such that Mr. Omot is now at a Level 3 privilege on the same type of unit. Finally, the hospital submits that the current Disposition continues to be necessary and appropriate, and that Mr. Omot will have his annual review in approximately four weeks’ time.
Counsel for the Attorney General, Ms. Dalrymple, indicated her support of the hospital submissions. Counsel for Mr. Omot, Mr. Cunningham, made no submissions.
Analysis and Conclusion
Having considered all of the evidence tendered at the hearing and the submissions of the parties, the Board finds that the hospital’s decision to seclude Mr. Omot between October 2 and October 16, 2024, amounts to a significant increase in the restriction of his liberty, that was reasonable and warranted and represented the least onerous and least restrictive course of action available to the hospital at that time.
Regarding the law applicable to restriction of liberty hearings, the analytical framework established by Campbell (Re), 2018 ONCA 140, requires the Board to consider the liberty norm and the liberty status of an accused on a restriction. The liberty norm and liberty status for each restriction must be examined to determine the significance of the increase (if any) on the restriction of an accused’s liberty caused by the restriction. In determining the liberty norm of an accused at the outset of each period of restriction, the Board must “take a contextual approach – one that considers the individual’s pattern of liberty in the recent past.” ((Re) Campbell, para. 66). The liberty she/he was actually experiencing (rather than what she/he was entitled to) at the time of the increase is what the Board is to consider, and that “liberty must be of sufficient duration to have become, objectively speaking, the NCR accused’s norm” ((Re) Campbell, para 65).
The hospital submission presented to this Panel is appropriate on the evidence on each of the issues set out for consideration in Campbell. The necessity of the restriction arose from Mr. Omot’s violent assault on a co-patient. Mr. Omot was in a state of decompensation which appears to have been triggered by medication changes. The hospital had no other options than to seclude Mr. Omot and separate him from the other patients and staff given his level of aggression. Mr. Omot was initially refusing to take medication and vowing to re-attack the co-patient. There was, accordingly, a significant increase in the restriction of his liberties that was undertaken out of necessity, having regard to both the hospital’s obligation to ensure the safety of the public (as the primary objective) and its duty to ensure that Mr. Omot’s mental health and other needs are being met.
The restriction of Mr. Omot’s liberties was the least onerous and least restrictive course available to the hospital. The evidence was uncontradicted that as soon as Mr. Omot demonstrated sufficient improvement, the hospital ended the seclusion and returned him to a similar treatment unit and have increased and adjusted both privileges and programming in response to the progress that he is making. While, Mr. Omot was secluded, the hospital continued to follow its seclusion protocol which involves daily re-assessments, as well as 72-hour assessments by a different psychiatrist, to assess the need for ongoing seclusion. Once out of seclusion Mr. Omot was put on 1:1 observation for a further two days and has now gradually regained his privileges and more as he is now on a higher privilege level than he was at the time of the initiation of seclusion.
Taken as a whole, the ROL Report and Dr. Mokhber’s testimony clearly established that the hospital was aware of the principles of minimal intrusion on Mr. Omot’s liberties and was appropriately assessing and responding to his progress. Mr. Omot is now considered to be almost ready for transfer to a rehabilitation unit, where discharge planning would be commenced. The Board is hopeful that Mr. Omot will continue the forward progress he has made since in the past few months and we wish him the best.
DATED this 24th day of March 2025, at the City of Toronto, in the Region of Toronto.
Ms. M. Labrosse
Alternate Chairperson
Office of the Registrar
Ontario Review Board