Ontario Review Board
Re: Alexander G. Coaker
ORB File No: 7414
Hearing held on: Monday, January 13, 2025
Place of Hearing: Brockville Mental Health Centre
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. R. Bigelow
Members: Dr. Y. Alatishe
Dr. G. Kerry
Mr. K. McKenna
Ms. K. Brisson
Parties Appearing:
Accused: Alexander G. Coaker
Counsel: Ms. M. Munsterman
The Person in Charge Representative: Dr. A. Adiele
Attorney-General of Ontario: Counsel: Mr. K. Schultz
REASONS FOR DISPOSITION (Dated April 2, 2025)
Introduction
On August 31, 2018, Alexander Coaker was found not criminally responsible on account of mental disorder (NCR) on a charge of assault causing bodily harm contrary to the Criminal Code. Mr. Coaker is currently subject to a disposition of the Ontario Review Board dated January 12, 2024, ordering his detention at a Secure Forensic Unit of the Brockville Mental Health Centre with privileges up to and including residence in the community in supervised accommodation approved by the person in charge.
On Monday, January 13, 2025, the Board convened a hearing to review Mr. Coaker’s disposition pursuant to section 672.81(1) of the Criminal Code. Mr. Coaker was present at the hearing and represented by Counsel, Ms. Munsterman. The issues to be determined at the hearing were whether Mr. Coaker continued represent a significant threat to the safety of the public as defined in section 672.5401 of the Criminal Code and, if so, what was the necessary and appropriate disposition which was also the least onerous and least restrictive, taking into account the factors set out in section 672.54 of the Criminal Code.
Positions of the Parties
At the commencement of the hearing the parties were requested to provide their initial without prejudice positions with respect to the issues before the Board. The Hospital Representative advised that the position of the Hospital was that Mr. Coaker continued to represent a significant threat to the safety of the public and that the necessary and appropriate disposition was a continuation of the current detention order with the amendment to the current conditions 2(h), 2(i) and 2(j) to remove the restriction prohibiting more than four passes per year and further to amend condition 2(k) to read “to live in the community of Ontario in supervised accommodation approved by the person in charge”.
Both counsel for the Attorney General and Counsel for Mr. Coaker supported the hospital position.
Findings:
- For the Reasons that follow, the Board finds that Mr. Coaker 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 with the changes recommended by the Hospital.
Index Offence(s):
- The circumstances surrounding the index offences of May and September 2012 taken from last year’s reasons for disposition are as follows:
On Wednesday, August 1, 2018, the accused, and the victim got into an altercation for unknown reasons. At some point, the accused punched the victim causing a laceration to the left side of his head.
Background Information Regarding the Accused:
Mr. Coaker currently 39 years of age. He was born in Ottawa and raised in Carleton Place. He has an older brother who is also diagnosed with schizophrenia and a substance use disorder.
As a youth he was described as a “natural athlete” and an average student though he was reportedly quite bright. His parents separated in 1998, and they report that the years following the separation were quite chaotic as both as both Mr. Coaker and his brother were both heavily using substances.
Psychiatric History
- Mr. Coaker has a long-standing history of treatment resistant schizoaffective disorder and severe polysubstance abuse disorder. He has a history of mental health issues starting in his early teens. Prior to the index offences he had been admitted to hospital with respect to mental health related issues on nine separate occasions. His usual presentation involves auditory hallucinations, thought insertion, thought broadcasting, paranoid and referential delusions and believing he is being listened to much of the time. On a number of occasions, he acted aggressively towards family threatening them with weapons.
Current Diagnosis
- Mr. Coaker’s current diagnoses are
Schizoaffective Disorder, Bipolar Type
Amphetamine-type substance use disorder
Cocaine use disorder
Other or unspecified stimulant use disorder
Legal History:
- Mr. Coaker’s legal history is not entirely clear. Last year’s reasons for disposition summarized his legal history at that time as follows:
According to the CPIC provided, Mr. Coaker has no previous criminal record.
Interestingly, in his medical notes, there is a different legal history. More specifically, the notes mentioned that Mr. Coaker was charged with shoplifting in 2000 and 2002 and he pleaded guilty to both charges and received a one-year probation. In 2003, he was charged with possession of marijuana to which he pled guilty. In 2001, he was charged with assaulting a man who he believed was a child molester and he pleaded guilty. In September 2003, he was assessed by Dr. Fedoroff who did not believe the patient had pedophilic interests but did recommend that the patient not have unsupervised visits with children and that his preoccupation with pedophilia was obsessive in nature and egodystonic. He also has a history of stealing money and using other people’s bank cards on several occasions.
- In December 2024 Mr. Coaker was found guilty of a sexual assault that took place in September 2023. The circumstances surrounding the incident are summarized in the Hospital Report as follows:
On September 23, 2023, Mr. Coaker touched a female co-patient by grabbing her buttocks without her consent. This occurred in the common area of the rehab unit and was witnessed by staff. Initially when he was confronted by staff, he minimized the seriousness of this, though he later apologized to the co-patient.
- Mr. Coaker was granted a conditional discharge with six months non-reporting probation and minimal terms.
Evidence of Dr. Adiele
Dr. Adiele advised that Mr. Coaker arrived at the Hospital in February 2024 from the Royal Ottawa Hospital. He noted that Mr. Coaker’s family were extremely supportive and visited him often as well as spoke to him regularly on the phone. Dr. Adiele noted that upon his arrival at the Hospital, Mr. Coaker was receiving a “huge dose” of clozapine which had been reduced after his arrival and that the treatment team was continuing to optimize his medications. He noted that since Mr. Coaker’s arrival there had been no significant incidents of physical aggression and that and that the Hospital was waiting for responses to requests for community residential possibilities.
Dr. Adiele indicated that despite his compliance with medications Mr. Coaker continued to experience delusions and that a referral had been made to psychology for programming to assist him in dealing with his symptoms. Mr. Coaker would be commencing indirectly supervised community privileges as soon he completes the orientation program. The Hospital expected that he would likely be transferred to the least restrictive unit in the Hospital within the reasonably near future but that prior to the transfer he needed to exercise his community access privileges successfully over a period of time.
Since Mr. Coaker’s arrival at the Hospital, he has been participating appropriately in groups although having some issues with impulse control and social boundaries. He has been referred to their new psychologist for one-on-one counselling.
Dr. Adiele indicated that it was possible that Mr. Coaker could be discharged into the community in the latter part of the reporting year but noted that although Mr. Coaker has expressed a preference to be discharged to the Ottawa area, it would be likely easier and faster for him to be discharged to FITT (Forensic Intensive Treatment Team) residence on the property of the Hospital and subsequently request a transfer to the Ottawa area.
In response to questions from counsel for the Attorney General, Dr. Adiele indicated that although the Hospital Report mentioned three notable incidents of verbal aggression since Mr. Coaker’s arrival, two of those were unconfirmed and the third occurred approximately eight months prior to the hearing.
Dr. Adiele indicated although there was no evidence of substance use by Mr. Coaker since his arrival at the hospital, he continued to display limited insight into the impact of substance use on his mental health. He has been referred to the addictions counselling program at the Hospital but has indicated that he is not keen on the program because he does not think he needs it.
Dr. Adiele indicated that in his opinion Mr. Coaker required supportive housing on discharge but could work his way to independent housing.
In response to questions from panel members, Dr. Adiele indicated that Mr. Coaker had a good rapport with the treatment team and that his family also had a good rapport with the team. He also indicated that since Mr. Coaker’s arrival at the Hospital there had been no incidents of sexual touching although there had been some inappropriate comments which appeared to be more issues with respect to breaching appropriate boundaries.
Analysis and Conclusion, Significant Threat:
Although the issue of significant threat was not contested at the hearing, the Board nevertheless makes an independent finding that Mr. Coaker does represent a significant threat to the safety public. Mr. Coaker suffers from a treatment resistant major mental illness, and despite medication compliance continues to experience symptoms of his illness, demonstrates poor insight into his mental health and continues to experience violent ideation.
Mr. Coaker has recently been found guilty of a sexual assault committed while at his previous hospital and has a history of aggression, non-compliance with treatment and substance use exacerbating is mental health. Absent the supervision of the Board, he is likely to fall the away from treatment, return to the use of substances and act out aggressively as he has in the past resulting in significant physical and/or emotional harm to members of the public.
Analysis and Conclusion, Necessary and Appropriate Disposition:
- The Board finds that the evidence amply supports the joint submission that the necessary and appropriate disposition is a detention order on the terms as recommended by the Hospital. Given his history of the nonadherence to medication, substance use and aggression, any return to the community by Mr. Coaker must be gradual and carefully monitored. The treatment team needs to approve accommodation in order to ensure that appropriate supervision is in place and that any decompensation in community would be quickly noted and he could be returned to hospital before meeting the criteria under the Mental Health Act.
DATED this 2nd day of April, 2025, at the City of Toronto, in the Toronto Region.
Mr. R. Bigelow
Alternate Chairperson
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Office of the Registrar
Ontario Review Board