Re: Chieu Lac Tang
ORB File No: 7605
Hearing held on: Wednesday, February 19, 2025
Place of hearing: Centre for Addiction and Mental Health, Toronto
Pursuant to: Sections 672.48(1) and 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. M. Segal
Members: The Hon. B. Allen
Dr. B. Bordoff
Dr. J. Kis
Mr. J. Cyr
Parties Appearing:
Accused: Chieu Lac Tang
Counsel: Mr. A. Rai
The Person in charge of Hospital: Counsel: Ms. M. Warner
Attorney General of Ontario: Counsel: Ms. V. Culp
REASONS FOR DISPOSITION
(Dated April 10, 2025)
Introduction
1On September 20, 2019 Mr. Chieu Lac Tang was found unfit to stand trial on charges of possession of a weapon for a dangerous purpose and assault with a weapon (x 2) contrary to the Criminal Code on account of mental disorder.
2Under s. 672.81(1) of the Criminal Code, a panel of the Ontario Review Board (the Board) was convened on February 19, 2025 at (CAMH or the Hospital) to review Mr. Tang's risk to public safety and the appropriate disposition under s. 672.54 of the Criminal Code.
3There is also an issue of Mr. Tang's fitness to stand trial. Under s. 672.48(1) of the Criminal Code, the Board is required to address the issue of whether, on the day of this hearing, Mr. Tang remains unfit to stand trial within the meaning of s. 2 of the Criminal Code.
4Mr. Tang’s existing disposition dated March 19, 2024 orders that he be subject to detention at a secure forensic unit at CAMH with discretion given to the person in charge to transfer Mr. Tang to a general forensic unit should Mr. Tang’s condition and progress justify such a transfer. The Board’s existing disposition also determined that Mr. Tang remained unfit to stand trial.
5There is an error on page 1 of the Hospital Report which, regarding his existing disposition, states that Mr. Tang has privileges up to residing in approved accommodation whereas the disposition does not provide such a privilege.
6At the time of the current hearing Mr. Tang resides in a general forensic unit and the Hospital recommends a continuation of the same during the upcoming year.
7At the start of the hearing, the parties provided the Board with their respective positions on disposition, significant risk and fitness to stand trial. The defence and Crown adopted the Hospital's opinion that Mr. Tang remains a risk to the public and should be detained at a general forensic unit at CAMH and further asked for an approved community living housing provision. The parties also agreed that Mr. Tang remains unfit to stand trial. The parties maintained their joint position at the close of the evidence.
Disposition
8For the reasons set out below the Board concludes, according to s. 672.54 of the Criminal Code, that Mr. Tang continues to pose a significant risk to public safety and that the necessary and appropriate disposition, that is the least onerous and the least restrictive to mitigate risk to public safety, is that he remain detained at CAMH on a general forensic unit under the existing conditions.
Issues Before the Board
Significant Risk
9Under s. 672.54 of the Criminal Code the Board must determine whether Mr. Tang continues to be a significant threat to public safety and whether he should remain detained at CAMH on the same terms and conditions as his existing disposition. This requires looking at whether the existing disposition is necessary, appropriate and reasonable, commensurate with the requirement that detention is the least onerous and least restrictive measure and in keeping with the paramount criterion of the safety of the public and Mr. Tang’s community re-integration, his mental condition and his other needs.
10As noted above the Board concludes that the existing disposition should continue.
Fitness to Stand Trial
11Section 2 of the Criminal Code provides that unfit to stand trial means unable on account of mental disorder to conduct a defence at any stage of the proceedings before a verdict is rendered or to instruct counsel to do so. The Board must decide, under s. 672.48(1) of the Criminal Code, whether, on the day of the hearing, Mr. Tang is unfit to stand trial within the meaning of s. 2 of the Criminal Code.
12The Board finds, based on the evidence set out below, that Mr. Tang does not satisfy the requirements set down under s. 2 and in the tests prescribed by case law. The Board finds the evidence presented in the Hospital Report and by its author, Dr. Maryana Kravtsenyuk, leaves no doubt that Mr. Tang is not fit to stand trial as of the date of this hearing.
THE ANNUAL REVIEW
The Evidence
13The Board has before it the Hospital Report dated January 31, 2025, which contains an account of Mr. Tang's personal and psychiatric backgrounds which needs not be repeated in detail here. The Board also has the oral evidence of Dr. Maryana Kravtsenyuk, the author of the hospital Report. Mr. Tang received simultaneous interpretation by a Vietnamese interpreter.
Current Diagnoses
14Mr. Tang's current diagnoses are unspecified schizophrenia spectrum and other psychotic disorders and a remote diagnosis of a learning disability.
Index Offences
15The circumstances of the index offence are described in the Hospital Report and are summarized as follows:
16On July 19, 2019 the accused attended the CIBC bank branch located at 247 Spadina Ave. in Toronto. Mr. Tang walked into the branch behind another customer and became angry when the staff acknowledged that customer first. Mr. Tang suddenly brandished a large serrated kitchen knife and began pointing first at the customer service representative who was closest to him (victim #1) and then at the manager who had come over to help (victim #2). Mr. Tang walked toward the manager causing him to walk backwards and retreat behind the counter where he called the police.
17Officers arrived and were alerted to Mr. Tang by the victims. After a brief chase Mr. Tang was placed under arrest and read his rights to counsel. Mr. Tang was then transported to 52 Division where he was held for a show cause hearing. Neither victim sustained injuries as a result of the assault.
Criminal History
18In 2006 Mr. Tang was charged but not convicted of aggravated assault, assault with a weapon and assault causing bodily harm. On December 2, 2008 Mr. Tang was charged with assault and was found unfit to stand trial. He was subsequently hospitalized at CAMH under the authority of the Board. He was returned to court on April 8, 2009 and was found fit to stand trial and was subsequently discharged from the Hospital.
Substance Use
19There is no evidence of current or historical alcohol or illicit drug use.
Mr. Tang’s Personal and Psychiatric History
Before the Current Reporting Year
Personal History
20Mr. Tang is a 54-year-old male of Vietnamese descent who immigrated to Canada in 1993. The information available at the time of his arrest in 2008 was that Mr. Tang had never been involved in an intimate relationship and had no children. It is unclear if this situation has changed in the years since. He is supported by ODSP and is capable of managing his finances. He resided in a rooming house and an apartment before his 2008 arrest.
21The records reveal that Mr. Tang has done factory work from which he was fired for strange behaviour and worked for brief periods at a restaurant and a job doing "loading."
Psychiatric History
22Mr. Tang’s psychiatric history is scant as he has been reluctant to provide information in interviews and there is little collateral information. His delusional or hallucinatory symptoms appeared to be managed on an anti-psychotic medication regime although his mental status was difficult to discern since Mr. Tang did not report these types of experiences.
23The Board's disposition dated March 20, 2009 indicates that Mr. Tang lacked short-term memory and the capacity to engage in abstract reasoning. A tentative diagnosis of psychotic disorder not otherwise specified was assigned. Clinical notes from CAMH suggested that Mr. Tang was followed as an outpatient from 2015 to 2019. These notes stated that Mr. Tang remained delusion-free and medication-compliant with the anti-psychotic medications he was prescribed.
24Mr. Tang had early hospitalizations in 2003 at William Osler Health Care Centre and Toronto Western Hospital. He was also hospitalized at CAMH from April 2008 to December 2008. As noted, he was found unfit on December 12, 2008 and was re-admitted to CAMH under the authority of the Board on December 19, 2008. Following a period of treatment Mr. Tang was deemed fit to stand trial and was discharged to court on April 8, 2009.
25Mr. Tang was admitted to North Bay Regional Health Centre (North Bay) from July 23, 2019 – October 8, 2020 and was diagnosed with “unspecified schizophrenia spectrum and other psychotic disorder”. He presented with disorganized and avoidant behaviour. Nursing staff noted that he tried to hide under blankets and in the washroom, drink excessive water, frequently change his clothes and seemed to respond to internal stimuli. Mr. Tang typically got only one or two hours of sleep at night and napped during the day. He was prescribed medication to assist with the disorganized behaviour attributed to psychosis and his disrupted sleep.
26At North Bay Mr. Tang did not openly communicate with others. It was initially thought that the difficulties communicating with Mr. Tang were due to a language barrier. However during the first interview with an interpreter, the interpreter concluded that Mr. Tang was capable in multiple languages, English included. Mr. Tang made his needs known in English using only a few words and incomplete sentences usually only to ask for food or to answer staff questions. Mr. Tang seemed to mumble in a mixture of English and Cantonese.
27Mr. Tang kept to himself avoiding co-patients and staff. Staff had difficulty engaging him. For instance he would attempt to hide from staff, refuse all interactions and lack interest in any purposeful activity. Mr. Tang continued to respond to internal stimuli laughing without any discernible cause and speaking and interacting with unseen entities. He would cease this behaviour when he knew the staff was observing him. He however presented with no problematic behavioural concerns during the admission.
28That Mr. Tang lacked insight into his mental illness and treatment plan and did not fully appreciate his legal jeopardy presented further barriers. For instance, although Mr. Tang was on a waitlist to be transferred to CAMH at the end of 2020, even with the use of a translator and with daily reminders of his upcoming transfer, Mr. Tang continued to inquire as to when he would be going home.
29Mr. Tang was admitted to secure forensic units at CAMH from March 2021 to the end of the 2023/2024 reporting period. His presentation remained relatively unchanged throughout his admission.
CAMH - Current Reporting Period February 2024 – January 2025
30Mr. Tang was successfully transitioned to a general forensic unit at CAMH on December 18, 2024. He made some progress during the current reporting year. There were no incidents of seclusion or non-compliance with his medication. He gradually progressed to level 4 on the pass ladder. There has been no evidence of substance use during this reporting period although there is no record of a history of this at all.
31Mr. Tang maintained a calm and cooperative demeanour during assessments but continued many of his earlier behavioural presentations. He had irregular sleeping habits going to bed late, awaking intermittently during the night and napping during the day. Mr. Tang remained compliant with prescribed medications but continued to refuse bloodwork deemed necessary to optimize his anti-psychotic medications. He frequently over-hydrated himself at the water fountain. And he continued to engage in behaviours indicative of responding to internal stimuli. He was often observed laughing and giggling to himself.
32There were no significant concerning behaviours. But there were a few isolated incidents, for instance: an unwillingness to follow directions on May 4, 2024; on August 13, 2024, displaying a negative attitude and impulsivity during a community outing; and on November 16, 2024, inappropriately grabbing a co-client's genitals and when queried about this he denied doing it. Mr. Tang's overall behaviour however remained stable following his transfer to the general forensic unit. There were no ongoing aggressive tendencies observed and staff interventions were effective in addressing behavioural concerns.
33Mr. Tang's social engagement improved substantially in the general forensic unit during the current reporting year. He actively participated in various structured programs and therapeutic activities. For example he was involved in music therapy sessions, including drumming and mindful meditation and participated in social and recreational activities such as movie nights, smoothie groups and art sessions. He attended quality-of-life interventions and support meetings to enhance his social skills and well-being.
34The increase to pass level 4 privileges permitted Mr. Tang greater access to rehabilitation and recreational activities where he for example engaged in conversation in Vietnamese with staff at a Vietnamese restaurant. He also attended group activities at a gymnasium and attended the Toronto Art Crawl and Diwali events. There were no problematic incidents reported during his outings and he remained compliant with pass rules.
35Mr. Tang continued to lack social support outside the Hospital. He had no established contact with his family including a sister living in Toronto despite the Hospital indicating they would attempt to locate her.
Oral Evidence of Dr. Maryana Kravtsenyuk
36Dr. Kravtsenyuk testified at the hearing. She indicated that Mr. Tang was in her care from August 2023 to December 2024 at which time Dr. Scott Woodside took over his care. Mr. Tang’s clinical status has remained basically unchanged since the last reporting year. He has been able to enter the community escorted by staff and needs support due to the language barrier. Overall he demonstrates an ability to listen to staff and obey the rules.
37Dr. Kravtsenyuk indicated that she and Dr. Woodside recently discussed a plan to optimize Mr. Tang's anti-psychotic medication to clozapine and Mr. Tang has refused the bloodwork deemed necessary to optimize his treatment with a clozapine trial. Thus far it has been difficult to gain his acceptance of clozapine.
38Dr. Kravtsenyuk is of the view that Mr. Tang remains unfit to stand trial. She explained that in her experience with Mr. Tang, despite him receiving three years of coaching on the Taylor questions which seek to assist in deciding fitness, Mr. Tang has consistently demonstrated a lack of understanding of the questions and the fundamentals of the court process.
39Dr. Kravtsenyuk pointed out an interesting and maybe perplexing occurrence. When Dr. Woodside recently administered the Taylor questions Mr. Tang was able to answer all of the questions on that one occasion. A translator has been used on each occasion that the Taylor test was administered. Dr. Kravtsenyuk indicated that Dr. Woodside is hopeful that if Mr. Tang’s medication is optimized to clozapine he will be able to reach a point of fitness.
40In answer to questions about future goals for Mr. Tang, Dr. Kravtsenyuk referred to the possibility that optimization to clozapine will lead to fitness and eventual entry into the community. She testified she believes Mr. Tang will be suitable for community living with support and supervision of his medications, mental status and activities of daily living once his treatment is optimized and the medication begins to improve his mental status. Mr. Tang has reached level 4 passes and Dr. Kravtsenyuk believes that it may take several months to a year for him to move through the pass levels to reach the point of being suitable for community living.
41The Hospital Report indicates that Mr. Tang’s mental state may decline and he may present a risk to causing physical harm to others. The concern is that if Mr. Tang were to engage in harmful acts this would “likely be impulsive and unpredictable, in the context of situational factors and his limited adaptive ability coping”. [at page 24].
42The Board proposed that non-pharmaceutical options such as therapeutic and educational sessions might be introduced to assist in advancing Mr. Tang to community living with which suggestion Dr. Kravtsenyuk agreed. The Board also proposed that if Mr. Tang's clinical status improves sufficiently before his next annual review, it might be possible to hold an early Board hearing. Dr. Kravtsenyuk also agreed that this is possible.
43Based on its assessment of Mr. Tang’s psychiatric status to date the clinical team recommends that the appropriate and necessary disposition to manage his risk remains a detention order at the forensic service at CAMH.
The Parties’ Positions
44At the completion of evidence, the parties maintained their joint position that Mr. Tang continues to be a significant risk to the safety of the public and that the least onerous and least restrictive disposition, that is necessary and appropriate in the circumstances, is an order detaining Mr. Tang in a forensic unit at CAMH on the same terms as the existing disposition. The defence requested that the disposition include an additional provision for approved community housing.
The Board’s Conclusion
45While mindful of the parties’ joint position the Board is required to come to an independent determination.
46Based on the evidence before us, the Board unanimously accepts the opinion, as stated in the Hospital Report, that Mr. Tang remains a significant threat to public safety within the criteria outlined in Winko and as defined in s. 672.5401 of the Criminal Code. The Board considered the criteria, as set out in s. 672.54, namely, the paramount criterion of the safety of the public and Mr. Tang’s community re-integration, his mental condition and his other needs.
47We accept, under s. 672.54, that the least onerous and least restrictive disposition, that is necessary and appropriate in the circumstances is continued detention on a general forensic unit at CAMH under the existing conditions.
48The Board arrives at that decision for the following reasons.
49The Board finds from the evidence in the Hospital Report and the testimony of Dr. Kravtsenyuk that a detention order is necessary and appropriate to manage Mr. Tang’s risk.
50The Hospital Report describes Mr. Tang’s presentation on the general forensic unit during the current review period as follows:
When he spoke, his responses were often incoherent or fragmented, and he primarily relied on gestures and nodding to communicate his needs. He typically reported his mood as "okay" or "good," though his affect remained constricted, blunted, or flat. His interactions were subdued and minimally responsive. His thought process was difficult to assess due to the language barrier and limited verbal output, though he frequently perseverated on wanting to go home. He denied suicidal or homicidal ideation or self-harm thoughts. While he denied perceptual disturbances, he was observed smiling, laughing, and mumbling to himself, suggesting he may have been responding to internal stimuli. [at page 21].
51The Board finds it evident from Mr. Tang's behaviour that his condition has remained substantially unchanged from the time of his assessments at the North York Regional Health Care Centre and throughout his stay at CAMH. Despite improvements in his engagement in social activities in the unit and on community outings under his level 4 privileges, Mr. Tang generally remains uncommunicative.
52Mr. Tang prefers to be by himself and continues not to disclose or admit his delusionary and hallucinatory inner life although his mumbling and indecipherable speech, apparently directed at unseen entities, raises concerns about Mr. Tang’s risk of dangerous conduct if released at this time from the highly structured and supervised environment of the Hospital. Of considerable concern is Mr. Tang’s persistent poor judgment and poor insight into his mental illness and his risk factors.
53While Mr. Tang's behaviour on community outings has generally presented without incident the Board notes the incidents of inappropriate and aggressive behaviour toward the end of the current reporting year exemplified by incidents of impulsivity and grabbing a co-patient’s genitals on outings. There was also on one occasion unwillingness to follow directions.
54The Board is hopeful that with the optimization of his medication and further non-pharmaceutical interventions, Mr. Tang can progress more easily through community pass levels to reach a point of being acceptable for community living and, depending on his level of success, even possibly be ready for a Board hearing before his next annual review.
55In keeping with the Criminal Code’s s. 672.5401 criteria, the existing detention order allows Mr. Tang to maintain a level of integration in the community during outings and provides for public safety given the Hospital’s authority over monitoring his medication and mental status and the Hospital’s authority to increase and decrease Mr. Tang’s community privileges when appropriate.
56Based on the evidence before us the Board finds, according to s. 672.54 of the Criminal Code, that Mr. Tang remains a significant threat to public safety and that currently the necessary and appropriate disposition, that is the least onerous and the least restrictive to mitigate risk to public safety, is to detain him at CAMH in a general forensic unit.
FITNESS TO STAND TRIAL
57Section 2 of the Criminal Code provides that unfit to stand trial means unable on account of mental disorder to conduct a defence at any stage of the proceedings before a verdict is rendered or to instruct counsel to do so. The Board must decide, under s. 672.48(1) of the Criminal Code, whether, on the day of the hearing, Mr. Tang is unfit to stand trial within the meaning of s. 2 of the Criminal Code.
58The Ontario Court of Appeal in R. v. Bharwani, 2023, ONCA 203, considering their earlier case in R. v. Taylor, 1992 CanLII 7412 (ON CA), [1992] O. J. No. 2394, further refines the idea of an accused’s “ability” as referenced in the definition of “fit to stand trial” in s. 2 of the Criminal Code.
59R. v. Bharwani held that the accused must: (a) have a reality-based understanding of the nature, object and possible consequences of the proceedings; (b) understand the possible consequences of the proceedings; and (c) have the ability to make decisions, although are not required to have the capacity to engage in analytic thinking in that the accused need not be able to act in their own best interests.
60The Board finds Mr. Tang does not approximate the “ability requirement” stipulated in R. v. Bharwani.
61The Board finds the evidence presented in the Hospital Report and provided by Dr. Kravtsenyuk in testimony leave no doubt that Mr. Tang does not have the capacity at the time of this hearing to satisfy the Bharwani test.
62The Hospital Report makes it clear that despite progress in some areas, Mr. Tang's overall mental status remains unchanged. He continues to be guarded and avoids prolonged interactions. His interactions are limited due to a language barrier and his reluctance to communicate with others. He displays fleeting eye contact occasionally staring blankly at staff when spoken to before disengaging from communication. Mr. Tang exhibits a short attention span, poor insight into his mental illness and treatment needs and consistently displays poor judgment.
63The clinical team concluded that Mr. Tang remains unfit to stand trial as he has continued to show an inadequate level of knowledge and understanding of criminal proceedings to meet a legal standard of fitness to stand trial. The Hospital Report sums up the clinical team’s assessment as follows:
The magnitude of his impairments has been unchanged since the initial assessment. His fitness has not been successfully restored through psychiatric treatment or education over the last reporting year despite ongoing meetings to practice Taylor Test Questions with assistance from the interpreter. This mental disorder impacts Mr. Tang's ability to understand the nature and object of the court proceedings, the consequences of the proceedings, communicate with counsel and affect his ability to be meaningfully present and participate in his proceedings. In summary, Mr. Tang was unable to engage in a meaningful conversation including about existing legal obligations and proceedings. Therefore, from a psychiatric perspective, Mr. Tang remains unfit to stand trial. [at page 24].
64To satisfy the R. v. Bharwani test Mr. Tang must have a reality-based understanding of the nature, object, and possible consequences of the proceedings, understand the possible consequences of the proceedings and have the ability to make decisions.
65The Board carefully considered the clinical team's assessment of Mr. Tang's fitness to stand trial. We find that the evidence overwhelmingly establishes that Mr. Tang cannot decidedly appreciate the nature, purpose and consequence of the court proceedings. And with his language barrier, even with an interpreter, he expresses often undecipherable speech patterns. His ability to communicate with and instruct counsel and to purposefully be present and participate in the proceedings would be gravely hampered by his deficits.
66In the result the Board finds as of the date of this hearing, pursuant to s. 2 of the Criminal Code, that Mr. Tang remains unfit to stand trial.
DATED this 10^th^ day of April, 2025, at the City of Toronto, in the Toronto Region.
The Hon. B. Allen
Legal Member
__________________
Office of the Registrar
Ontario Review Board