Re: Ana Bertila Arana-Sanchez, 2025 CanLII 28965

Re: Ana Bertila Arana-Sanchez

ORB File No: 4212

Hearing held on: Thursday, February 6, 2025

Place of hearing: Centre for Addiction and Mental Health 1001 Queen Street West, Toronto

Pursuant to: Section 672.81(1) of the Criminal Code

Before:

Alternate Chairperson: Mr. P. Capelle Members: Dr. S. Lessard Dr. L. Leong Ms. C. Finley Mr. A. Bouvier

Parties Appearing:

Accused: Ana Bertila Arana-Sanchez Counsel: Ms. M. Perez

The person in charge of hospital: Counsel: Ms. A. Feldstein

Attorney General of Ontario: Counsel: Mr. C. Coughlan

REASONS FOR DISPOSITION

(Dated April 4, 2025)

Introduction

1. On June 3, 2005, Ana Bertila Arana-Sanchez was found not criminally responsible on account of a mental disorder on one count of arson – disregard for human life and one count of arson – damage to property, contrary to the Criminal Code of Canada. She is currently subject to a disposition of the Ontario Review Board (ORB/the Board), dated February 8, 2024, detaining her at the Forensic Service at the Centre for Addiction and Mental Health (CAMH/the hospital) with discretionary privileges up to and including the ability to reside in approved accommodations.

2. On February 6, 2025, the Board convened a panel to conduct the annual review of Ms. Arana-Sanchez’s disposition pursuant to s. 672.81(1) of the Criminal Code. Ms. Arana-Sanchez was present and represented by her counsel, Mr. Perez. Ms. Arana-Sanchez was assisted by simultaneous translation by a Spanish interpreter.

3. At the outset of the proceedings, all parties were canvased as to their positions on the issues to be determined by the Board: whether Ms. Arana-Sanchez continues to represent a significant threat to the safety of the pubic, and if so, the necessary and appropriate disposition having regard to the criteria set out in s. 672.54 of the Criminal Code.

4. Ms. Feldstein, on behalf of the hospital, submitted that Ms. Arana-Sanchez continues to represent a significant threat to the safety of the public and that the necessary and appropriate disposition is a continuation of the current detention order. Mr. Coughlan, on behalf of the Ministry of the Attorney General, and Ms. Perez concurred in the hospital’s positions. Ms. Perez indicated that she was not contesting the issue of significant threat.

Findings

5. For the reasons that follow, the panel finds that Ms. Arana-Sanchez remains a significant threat to the safety of the public and that the necessary and appropriate disposition is a continuation of the current detention order.

The Evidence

6. The evidence at the hearing consisted of the Hospital Report, dated January 3, 2025 (ex. 1), and the viva voce evidence of Ms. Arana-Sanchez’s treating psychiatrist, Dr. Pearce.

The Index Offences

7. On December 18, 2002, Ms. Arana-Sanchez was residing with her husband in a basement apartment of a triplex in Toronto. On that day she placed a blanket in the electrical oven, turned the oven on to its highest setting and left the building. Shortly thereafter, another person in the building smelled smoke and notified the fire department. They found the apartment filled with smoke. When questioned about the incident, Ms. Arana-Sanchez stated that she put the blanket into the oven to set the house on fire.

Background Information

8. The Hospital Report contains limited information relating to Ms. Arana-Sanchez’s background and psychiatric history and need not be reviewed in these reasons. Ms. Arana-Sanchez is a 62-year-old-woman who came to Canada from El Salvador in 1986. She and her husband initially settled in Kitchener, Ontario.

9. Ms. Arana-Sanchez has a lengthy psychiatric history that includes the diagnoses schizophrenia, substance (i.e., alcohol, marijuana, solvent) abuse, and mental disability. Records indicate that she has experienced severe auditory and visual hallucinations, as well as paranoid and persecutory delusions with resultant violence.

10. Due to a fall out of a truck, Ms. Arana-Sanchez suffered a head injury when she was 15. This head injury affected her cognitive abilities.

11. Ms. Arana-Sanchez has a history of non-compliance with medication use, which has resulted in significant deterioration and increase in her psychotic symptoms. Ms. Arana-Sanchez also has a history of alcohol, marijuana and solvent abuse as well as abuse of over-the-counter (“OTC”) medications available without a prescription.

12. In November 2004, Ms. Arana-Sanchez was referred for neuropsychological consultation. The following passage was included in the findings as found on pp. 5-6 of the Hospital Report:

Significant deficits in the moderate to severely impaired range were noted for several cognitive domains including verbal memory, executive functioning and conceptualization and reasoning. The magnitude of this deficit is considered significant and very likely to significantly impact her ability to function independently.

…It is expected that Ms. Arana-Sanchez' current cognitive deficits will have a negative and substantial impact on her activities of daily living and independent functioning. In this regard, she is likely to require 24-hour supervision and custodial care.

13. During her course under the ORB, Ms. Arana-Sanchez has been discharged to supportive housing in the community and then required a number of readmissions to hospital. She continued to misuse OTC medications, and in August 2016, engaged in minor fire-related behaviour. Once she was stabilized, Ms. Arana-Sanchez was discharged back to her residence with additional supports.

14. On May 13, 2023, Ms. Arana-Sanchez was readmitted to hospital due to her problematic behaviour while at the residence. She was advised that the residence was not willing to have her return. Ultimately, LOFT Transitional Housing at 30 White Squirrel Way, which is on the hospital grounds, accepted Ms. Arana-Sanchez into their housing program. She was formally discharged on October 10, 2023. LOFT housing provides on-site staff on a 24/7 basis as well as intensive case management including medication administration and assistance with ADLs.

Course Since the Last Disposition

15. Ms. Arana-Sanchez’s current diagnoses are Schizophrenia, Substance Use Disorder and Cognitive Disorder NOS. She is considered marginally capable of making treatment decisions.

16. Since her discharge to LOFT housing, Ms. Arana-Sanchez has remained psychiatrically stable. She has remained compliant with medication. Of concern, she has provided a number of urine samples all of which have been positive for Gravol.

17. Ms. Arana-Sanchez continues to receive support from her husband who visits with her on a regular basis. Ms. Arana-Sanchez also was in receipt of DSO funding, but the only service and program she agreed to partake in was to receive the support of a Spanish-speaking worker. To date one has not be located for her.

18. Dr. Pearce testified before the Board. He reported that Ms. Arana-Sanchez has had a very good year and the team is looking forward to finding her suitable long-term housing. The team is actively looking for appropriate housing. No time line could be provided.

19. Dr. Pearce indicated that the treatment team was taking a harm reduction approach to Ms. Arana-Sanchez use of OTCs. Although Ms. Arana-Sanchez has continued to use substances, they do not seem to cause any serious problems with her mental health. The team has been monitoring her mental status closely.

20. In response to questions from the panel, Dr. Pearce indicated that Ms. Arana-Sanchez is able to articulate some benefits from the medication that she receives to treat her schizophrenia. This ability has been constant over the last 15 years and Dr. Pearce does not expect it to change. He testified that he meets with Ms. Arana-Sanchez every couple of months and during those meetings they discuss her medications and whether they are helping her. When asked when he last had a probing discussion on this issue, Dr. Pearce indicated that on occasion he would ask what would happen if she stopped taking her medications but not every time. Dr. Pearce indicated that he has been working with Ms. Arana-Sanchez for the last 15 years and he doesn’t recall her status changing when other doctors looked after with her. He stated that it is not his practice to treat patients as capable if they are not capable.

21. In response to another question from the panel, Dr. Pearce indicated that there was no update in terms of finding a Spanish-speaking worker who could provide support to Ms. Arana-Sanchez. The team received this information 6 months ago. Dr. Pearce testified that “he imagined that the team might ask again sometime during the next clinical year”.

22. All parties maintained the joint submission.

Analysis and Conclusion

23. The panel carefully considered the Hospital Report and the evidence of Dr. Pearce and unanimously concludes that Ms. Arana-Sanchez continues to represent a significant threat to the safety of the public. Ms. Arana-Sanchez suffers from schizophrenia. She has a history of medication non-compliance and substance use, which exacerbates her psychotic symptoms. When ill, she becomes floridly psychotic, with hallucinations, delusions and aggressive behaviour. As at the time of the index offences, when Ms. Arana-Sanchez experiences such a deterioration she is a threat to the safety of the public.

24. Having found that Ms. Arana-Sanchez continues to represent a significant threat to the safety of the public, the panel must consider the necessary and appropriate disposition taking into consideration the criteria set out in s. 672.54 of the Criminal Code, which includes the need to protect the public from dangerous persons, the mental condition of the accused, the integration of the accused into society and the other needs of the accused.

25. The Hospital Report includes the following observations under Clinical Risk Factors/Re-offence Scenario, at p. 34:

Ms. Arana-Sanchez is intellectually limited and lacks insight into the role her major mental illness played in the index offence. She has difficulty articulating symptoms of her condition and is unsure whether such symptoms may return should she go untreated. She lacks coping skills and requires a great deal of support when in the community.

Ms. Arana-Sanchez is most likely to re-offend in the context of a mental decompensation due to discontinuation of her medication treatment and/or heavy substance use. Limited support and supervision as well as unsuitable housing would be important factors in that regard.

26. The panel finds that the necessary and appropriate disposition is a continuation of the current detention order. It is clear that a residence that provides supervision and support is critical to managing Ms. Arana-Sanchez’s risk in the community. As such, the hospital requires the ability to approve her accommodation. Ms. Arana-Sanchez’s current LOFT residence is transitional in nature and efforts are currently underway to find permanent housing. Given her history, that process may take some time.

27. On a final note, the panel encourages the treatment team to strongly advocate for DSO support for Ms. Arana-Sanchez that would allow her greater opportunities in the community. Greater advocacy is required.

DATED this 4th day of April, 2025, at the City of Toronto, in the Toronto Region.

Ms. C. Finley Legal Member

__________________ Office of the Registrar Ontario Review Board