Ontario Review Board
Re: Noah D. Ferko
ORB File No. 8641
Hearing Date: March 6, 2025
Hearing Location: St. Joseph’s Healthcare, Hamilton, West 5^th^ Campus
Pursuant to: Section 672.47(1) of the Criminal Code of Canada
Before:
Alternate Chairperson: Mr. C. Flanagan
Members: Dr. K. Hand Dr. A. Kerry Ms. M. McKinnon Mr. K. McKenna
Parties Appearing:
Accused: Noah D. Ferko Amicus Mr. A. Confente
The Person in charge of Hospital: Counsel: Mr. S. O’Brien
Attorney General of Ontario: Counsel: Ms. C. Gzik
REASONS FOR DISPOSITION
(Dated April 9, 2025)
Introduction
Mr. Ferko was found not criminally responsible (NCR) on October 8, 2024, for the criminal code offences of break and enter, assault, forcible confinement, and fail to comply with probation (x2). Mr. Ferko was released on an undertaking and is living in the community.
This initial hearing was scheduled to be heard March 5, 2025. Mr. Ferko attended with his mother. Mr. Confente was in attendance, and had been appointed amicus by the Board the previous day.
At the outset of the hearing, Mr. Confente advised the panel that Mr. Ferko would like to represent himself, but had not yet had an opportunity to review the documents that would be relied on at this hearing. Mr. Ferko was, therefore, requesting an adjournment. This request was not opposed by either the Hospital or Counsel for the Attorney-General.
After a brief inquiry, it was determined that all parties, including Dr. Chaimowitz who would be testifying, and Mr. Confente as amicus, were available the following day, March 6, 2025. Accordingly, the hearing was adjourned, and the hearing proceeded on March 6, 2025.
At the commencement of the hearing, the Hospital advised the panel it was recommending a detention order with various terms that include reporting to the hospital monthly, approval by the person in charge of his accommodation, prohibition against substance use, and screening for substance use. Crown Counsel supported the position of the Hospital, and suggested that a no contact clause regarding the victim, Mr. Lee Griffin be imposed, and a term that Mr. Ferko stay away from the victim’s residence. Amicus submitted that Mr. Ferko was requesting a conditional discharge, and was not disputing the issue of significant threat.
A number of documents related to the finding of NCR by the court were filed. They included a victim impact statement, crown brief synopsis, information and transcripts, and the NCR Report. In addition, a Risk Assessment prepared for this hearing by Dr. Chaimowitz was filed as an exhibit.
The evidence at this hearing consisted of the documents filed, the testimony of Dr. Chaimowitz and the testimony of Mr. Ferko.
It should be noted that Mr. Ferko voluntarily agreed to attend the Hospital and meet with Dr. Chaimowitz for the purpose of preparing a Risk Assessment.
Index Offence
- On September 28, 2023, police received multiple calls from tenants at 2 Village Green in Stoney Creek, concerning at tenant in unit 303, Mr. Griffin, being assaulted by Mr. Ferko, a tenant in unit 203. The police learned that the previous night Mr. Ferko entered Mr. Griffin’s unit and damaged all of his property. Mr. Griffin advised the police that the previous evening his unit was entered by a person wearing a black balaclava and black cape. This person threw furniture and various personal items off the balcony. Mr. Griffin arranged for a new lock to be installed, and he spent the night at his mother’s home. Mr. Griffin and his mother returned to his unit on September 28, and discovered that the new lock was broken and there was fresh damage to his door. Mr. Ferko barged into the unit, grabbed a large wooden stick, and engaged in a brief struggle with Linda, Mr. Griffin’s mother. He then fled the residence. A short time later, Mr. Ferko returned to Mr. Griffin’s unit with personal items belonging to Mr. Griffin, which he said he found outside. Mr. Griffin told Mr. Ferko to leave, and Mr. Ferko responded by lunging at Mr. Griffin, and proceeded to punch and kick him for over 2 minutes. Mr. Ferko was apprehended under the Mental Health Act and taken to St. Joseph’s Hospital.
Evidence
Dr. Y. Naidoo prepared an NCR Assessment Report dated April 2, 2024. It contains detailed information pertaining to Mr. Ferko’s personal and psychiatric history. At the time of the assessment, Mr. Ferko was living with his parents and two sisters in Stoney Creek.
Mr. Ferko lived with his parents until approximately 24 years of age (2022.) At this time, he moved into his own apartment to have more freedom.
He completed high school, but was suspended for 1 month for selling cannabis. He then attended Mohawk College, but failed his program. He did not return to Mohawk. At age 23 he completed an eight-month certificate program in Urban Forestry at Humber College.
He worked for approximately one year with a Tree company, and quit to start his own company.
At 14 he began consuming alcohol. He was charged with impaired driving and attended an AA program, and then a drinking and driving program run by MADD, Mother’s Against Drunk Driving.
Mr. Ferko indicated that he smoked cannabis throughout high school, and sold cannabis to support his habit. He also used psilocybin and LSD, as well as cocaine from 2020 to 2022.
Mr. Ferko’s first mental health symptoms occurred in high school. He smoked cannabis regularly which made him anxious. This continued through grade 12.
Mr. Ferko advised that in 2021 he would “flip out” on people in his Arboriculture program. He was persistently irritable and would swear at them for no reason. A girl he was dating stopped seeing him as a result of his behaviour. He continually tried to contact her until the police became involved and warned him to stop any contact with this woman.
At this time, he believed that Korean people in cars were following him, and listening to his phone conversations. He saw a woman (Diana) at a bus stop he knew from Humber College, and started to believe they were soulmates. He believed that she would drive by him and tell him to eat less sugar.
In 2021 Mr. Ferko started feeling depressed.
In 2022, he was seeing signs telling him to run away. He believed he was going to be framed for a crime, which caused anxiety and panic attacks. In January 2023, he flew to New York and then to London. He saw a map of Egypt, which prompted him to travel to Egypt. When he arrived, he jumped a fence into an enclosure and climbed to the top of a pyramid where he slept the night. The following day he injured his leg climbing down the pyramid and was taken to the hospital. On his discharge, he lived on the streets of Cairo. He engaged in a fight with security guards at the Canadian Embassy when he attempted to enter. He ran from the police and swam across the Nile river. He was ultimately apprehended and returned to Canada.
Mr. Ferko advised Dr. Naidoo that he first started hearing voices in the three weeks prior to the index offence. The voices were his neighbours, the victim, and his ex-girlfriend, who were telling him that his apartment was being defiled and that they were raping him and assaulting women. He also experienced visual hallucinations in the form of God in the wall of his apartment, who told him to exact justice on his neighbour for the rapes he perpetrated. He also espoused bizarre beliefs that the voices were manifestations of dark matter which was embedded in his brain. This dark matter was able to take a human form and rape him at night. He was experiencing various delusional beliefs at this time.
Regarding his criminal record, Mr. Ferko was charged with impaired driving, but pled guilty to public nuisance.
Prior to the index offence, Mr. Ferko was being told by the voices that sex crimes were happening in Mr. Griffin’s apartment, and that Mr. Ferko was being watched by his neighbour. A voice told him to damage the victim’s home so he would not have a place to commit these crimes.
Following his arrest, he was taken to the St. Joseph’s. He continued to hear voices telling him to run away, and he continued to believe that he was being raped at night even in the hospital. He jumped a fence at the hospital and made his way to British Columbia. He purchased a bicycle and travelled to Seattle and then on to California. Mr. Ferko claimed asylum at the California/Mexico border to obtain safety from the rapes. He was detained for approximately 4 months and then returned to Canada.
Mr. Ferko’s mother confirmed his drug and alcohol use throughout high school. In or about 2021, his behaviour became bizarre and paranoid. He was extremely anxious and expressing a concern that Korean people were coming after him. He would cover the television with blankets to prevent people from watching him.
Mr. Ferko presented to the emergency department of St. Joseph’s Healthcare on October 21, 2020. He was experiencing substance-induced paranoia and hallucinations. He was preoccupied with internal stimuli and constantly looking at the vents. The day prior to attending the hospital he had consumed 2 beers and a half bottle of wine, and used .5 grams of cocaine. He was referred to the Concurrent Disorders outpatient program, and provided with resources to assist him with substance abuse.
On June 23, 2021 he was brought to the emergency department at Hamilton General Hospital having overdosed on fentanyl. He was treated and released to his mother.
Mr. Ferko was brought to St. Joseph’s emergency department on January 29, 2023, by his family. He had just been returned to Canada from Egypt. He expressed delusional thought concerning Egypt, the pyramids, and reincarnation. He did not believe he had any psychiatric issues, and declined any medication. He was placed on a Form 1 under the Mental Health Act, and transferred to the Mental Health inpatient unit. On March 4, 2023, he was transferred to the West 5^th^ Campus.
On March 3, 2023, he signed out of his unit for off-ward privileges and did not return at the agreed upon time. The police located Mr. Ferko at his apartment drinking alcohol, and returned him to St. Joseph’s. Prior to his discharge on March 27, 2023, he was connected to an addiction specialist through the Cleghorn clinic, and provided with olanzapine. The report comments that he did not accept that his trip to England and Egypt were indicative of a mental illness.
Following the index offence on September 28, 2023, Mr. Ferko was brought to St. Joseph’s emergency department by the police. He was aggressive at the time of admission, and placed in seclusion in physical restraints. He was placed on a Form 1. Mr. Ferko advised that he did not have any concerns about his mental health, and that he had stopped taking his medication because it was unnecessary. He appeared to have little insight into the circumstances that brought him to the hospital. He appeared to be responding to internal stimuli. On September 30, 2023, Mr. Ferko was transferred to the Acute Psychiatry Inpatient Unit at the West 5^th^ Campus.
The Risk Assessment prepared by Dr. Chaimowitz notes that Mr. Ferko was paranoid when he was first transferred, and attempted to block his door with his bed. On October 2^nd^, Mr. Ferko eloped and the police were contacted. He was found on the QEW highway stating that he was going to the beach. Two days later he eloped again, and given the length of time he was gone, the care team discharged him from hospital and initiated a Form 9, awaiting apprehension. His mother indicated that he may have gone to Winnipeg.
On April 22, 2024, Mr. Ferko attended St. Joseph’s emergency department with his father and sister. he had been hearing voices for a month, which were telling him to kill himself. A few days prior, the family found him on the roof of their house crying, and saying that, “if he had a gun, he would shoot himself.” He was aggressive with his family, and had not taken his antipsychotic medication for the past year.
He was transferred to the West 5^th^ Campus on April 22, 2024. After being prescribed aripiprazole, Mr. Ferko reported that he was no longer hearing voices. At the request of his family, the Office of the Public Guardian and Trustee assumed the role of substitute decision maker. The care team initiated a Community Treatment Order. During his first overnight visit with his family, Mr. Ferko informed the care team that he had stopped taking his oral medication. He was frustrated for not being discharged sooner since he believed that he was no longer unwell. Despite these comments, he advised staff that he heard voices 2 days earlier when he was feeling stressed. Following his next weekend pass, his parents indicated that Mr. Ferko had consumed a bottle of wine. Mr. Ferko informed the team that he experienced visual hallucinations after a panic attack. By mid-June, 2024, he had settled into his treatment plan, and the auditory hallucinations had mostly resolved. He was discharged to his parent’s home.
Outpatient care for Mr. Ferko was provided by the Cleghorn Early Intervention Program located at the West 5^th^ Campus. Mr. Ferko’s parents reported that their son stopped taking his oral medication following his discharge from the hospital, and they did not believe he would take any oral form of medication. Mr. Ferko informed his care team that he did not want to take any antipsychotic medication. On October 16, 2024, Mr. Ferko left his family home with a woman and consumed cocaine.
Mr. Ferko told his care team on November 11, 2024, that the voices were continuing and the medications were not helping. He felt that he had lost the ability to be free of the voices.
A Psychological Assessment dated January 6, 2025, was completed. It concludes that Mr. Ferko’s risk for violence falls in the high range without a detention order, and the ability to readmit him to the hospital rapidly if the need arises. This would allow the hospital to optimize his medication. He has achieved partial remission of his symptoms, but his insight is poor, and he is a high risk to abscond. The level of paranoid, bizarre, and grandiose ideation remains concerning. Decompensation of his symptoms, and escalation to violence was rapid after a discharge from hospital.
A mental health assessment was conducted on December 17, 2024, and January 8, 2025 by Dr. Chaimowitz. Mr. Ferko indicated to Dr. Chaimowitz during the December interview that he has ongoing hallucinations which occur daily. They are not command in nature, and have not changed substantially over time. He stated that he is haunted by a demon, and has been haunted by this demon since 2021. He continued to believe that at one point in time there was a microchip implanted in his body.
During the second interview on January 8, 2025, Mr. Ferko denied experiencing hallucinations or delusions. He acknowledged that if tired, he may experience a delusion for perhaps 30 minutes once per week. Later in the interview he denied experiencing them at all. He also denied experiencing any psychotic symptoms, even the ones he acknowledged in the first interview. He specifically denied hearing the demon or any other paranoid ideas.
Mr. Ferko is diagnosed with Schizophrenia and a Substance-Use Disorder. He has a significant history of substance use and eloping from hospital.
According to the Risk Assessment, it is necessary to further trial medications to clear the remaining psychotic symptoms. It is likely that the delusions and hallucinations that existed at the time of the index offence remain.
The Report supports a detention order. It relies on the fact that Mr. Ferko has a major mental illness, Schizophrenia, for which he is currently reluctantly taking treatment. He remains incapable to consent to treatment, and is on a Community Treatment Order. Mr. Ferko has absolutely no insight into his illness or the need for treatment. He does not believe that he needs medication, and has stated, that he will take the medication at this time only because it is an intramuscular injection, and he is worried about the consequences to his freedom should he stop. If given the opportunity, he will stop his medication immediately and become further unwell. In the opinion of the hospital, Mr. Ferko is a significant threat to the safety of the public.
He is currently managed on an injectable antipsychotic, being seen once per month by an outpatient Schizophrenia service. He remains managed in the community without difficulty.
In the opinion of Dr. Chaimowitz expressed in the Report, Mr. Ferko could be managed on a detention order, with monthly reporting. Dr. Chaimowitz suggests that a brief admission to the hospital initially may be required. References were also made to the need to have the hospital approve Mr. Ferko’s accommodation.
Dr. Chaimowitz testified at the hearing to supplement the comments in the Assessment Report. When questioned as to the need for a detention order rather than a conditional discharge, he indicated that Mr. Ferko has not been his patient. He stated that Mr. Ferko has a well-established mental disorder, and a lengthy history of substance abuse. In the past few years, Mr. Ferko has experienced significant difficulty, and he would no doubt discontinue his medication if not compelled by a detention order, which would make him increasingly unwell. Mr. Ferko needs a thorough assessment of his current condition, which may result in an adjustment to his medication and treatment. Dr. Chaimowitz also indicated that it would be appropriate for the hospital to approve his accommodation if he wanted to relocate.
Dr. Chaimowitz suggested that it would be important for the hospital to readmit Mr. Ferko rapidly if he became unwell.
Dr. Chaimowitz believes there is a manic component to Mr. Ferko’s condition, and a possible diagnosis of schizoaffective disorder which will require a separate form of treatment, including adjustments to his medication.
He also identified Mr. Ferko’s lack of insight as being problematic, which would likely contribute to his stopping his medication. Dr. Chaimowitz told the Crown that the lack of insight is part of the condition.
Dr. Chaimowitz responded to questions from the amicus by stating that, in addition to the Abilify, Mr. Ferko likely requires a mood stabilizer. The Abilify does not control manic symptoms.
He acknowledged that Mr. Ferko has been on a Community Treatment Order for the past year and living in a stable environment. Dr. Chaimowitz indicated that the Hospital was recommending a full range of privileges, including, living in the community. He would not object to Mr. Ferko travelling with an approved itinerary.
In answer to questions from the panel, Dr. Chaimowitz indicated that Mr. Ferko’s parents recognize the psychotic symptoms. He does not believe the Mental Health Act is sufficient to manage the risk to public safety. Mr. Ferko would not necessarily qualify under the Mental Health Act for involuntary readmission to hospital.
Mr. Ferko testified at this hearing. He stated that he has been on a Community Treatment Order for 8 months, and that he knows he needs help. He resides with his parents, he has not had any psychotic symptoms for 2 months, and he does not want to be hospitalized. He does not believe that the hospital is a good environment for him because of the behaviour of the other patients. Mr. Ferko expressed remorse for the index offence. He further stated that he recognizes the signs of delusions, and has a better understanding of what is occurring when he experiences psychotic symptoms.
Amicus asked Mr. Ferko what would happen if he stopped his medication. Mr. Ferko did not know. Mr. Ferko stated that he would voluntarily attend at the hospital for readmission if asked. When asked if he would agree to change his medication if suggested by his doctor, Mr. Ferko responded that he would listen, but stressed he is doing well on the current medication. He indicated that he is currently seeing a doctor monthly, and they discuss substance use.
Mr. Ferko indicated to Crown Counsel that he plans to stay at his parent’s home.
Submissions
The Hospital submitted that Mr. Ferko lacks insight into his illness and that he would most likely discontinue his medication if not compelled by a detention order. The diagnosis is either Schizophrenia, or perhaps, Schizoaffective Disorder, with the manic component. They require different forms of treatment.
The Crown supported the submissions of the Hospital.
Amicus submitted that Mr. Ferko has been doing well under a Community Treatment Order. He attends his appointments, and it appears the current medications are effective. He is also living in a secure and supportive environment.
Analysis
After considering the evidence, the panel concludes that a detention order is necessary and appropriate.
The index offence was extremely serious and violent. He was experiencing psychotic symptoms at the time which totally distorted his thought process.
Mr. Ferko was released on bail after the index offence, and apart from brief periods of hospitalization after attending at an emergency department, has not been hospitalized in the forensic system for a thorough assessment of his condition. Dr. Chaimowitz, the author of the Assessment Report, commented on the fact that he has never treated Mr. Ferko.
A thorough assessment is necessary to determine the appropriate diagnosis, and the appropriate treatment. This includes a determination of the appropriate medication.
Mr. Ferko lacks insight into his mental illness, and has consistently demonstrated his desire to stop taking his medication. He has indicated on various occasions that he does not believe he has a mental illness or any need for medication. It is very evident that he would discontinue his medication without the supervision available under a detention order.
Substance use has been a problem for Mr. Ferko, and needs to be closely monitored.
If Mr. Ferko wishes to change his residence, it is appropriate that the Hospital approves the residence. This is primarily in response to Mr. Ferko’s substance abuse history.
Mr. Ferko testified that he has not had any psychotic symptoms for 2 months. He has, however, been on medication for 8 months, which suggests that a modification of his medication regimen may be necessary.
If Mr. Ferko was to experience a deterioration in his condition, we could expect the reemergence of intense hallucinations, delusions, and paranoia. This would inevitably lead to violent behaviour which would put the public at risk.
The victim impact statement of Mr. Griffin was filed at this hearing. The index offence has had a profound effect on his emotional and mental health.
Mr. Ferko is a significant threat to the safety of the public. A detention order is necessary and appropriate with the terms suggested by the Hospital. The order should also include a prohibition from contacting the victim or the witnesses, and from attending at Mr. Griffin’s place of residence. It is also appropriate to include a weapons prohibition.
In coming to this conclusion, the panel has applied the principles provided in s, 672.5401 of the Criminal Code.
Dated this 9^th^ day of April 2025, at the City of Toronto, in the Toronto Region.
Kevin McKenna
Legal Member
Office of the Registrar
Ontario Review Board