Ontario Review Board
Re: Lula Daoud Ali
ORB File No: 8102/8441
Hearing held on: Wednesday, February 12, 2025
Place of Hearing: Royal Ottawa Mental Health Centre
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. P. Capelle
Members: Dr. G. Glancy
Dr. G. Boulais
Mr. P. Hageraats
Mr. A. Bernardo
Parties Appearing:
Accused: Lula Daoud Ali Counsel: Mr. M. Davies
Person in charge of hospital: Representative Dr. M. Strike
Attorney-General of Ontario: Counsel: Ms. M. Dufort
REASONS FOR DISPOSITION
(Dated April 10, 2025)
Introduction
On June 24, 2022, the accused, Lula Daoud Ali, was found not criminally responsible (NCR) on account of mental disorder on charges of assault (x3), cause disturbance in a public place (x2), and uttering threats, all contrary to the Criminal Code of Canada (the Criminal Code). On December 6, 2023, the accused, Lula Daoud Ali, was found not criminally responsible (NCR) on account of mischief – obstructs, interrupts or interferes with the awful use, enjoyment or operation of property, arson – damage to property, breaking and entering with intent, and conveying false information, all contrary to the Criminal Code;
Ms. Ali is currently subject to a Disposition of the Ontario Review Board dated February 28th 2024, which detains her at the secure forensic unit of the hospital with privileges up to and including to enter the community of Ontario, accompanied by staff.
On February 12th, 2025, a panel of the Ontario Review Board (“the ORB” or “the Board”) convened a hearing at the Royal Ottawa Mental Health Centre (“ROMHC”) pursuant to s. 672.81(1)of the Criminal Code of Canada. The annual review for Ms. Ali was held in person. The hospital was represented by Dr. Melanie Strike, Attorney-General by Ms. Marie Dufort and Ms. Ali’s counsel, Ms. Michael Davies.
Without Prejudice Position of the Parties:
- Dr. Strike, on behalf of the Hospital, recommended a transfer to CAMH together with removal of the privilege:
to live in the community in accommodation approved by the person in charge;
Ms. Dufort, on behalf of the Attorney General, joined the Hospital’s position.
Mr. Davies, on behalf of Ms. Ali, indicated he was in favour of the transfer recommendation but submitted that his client’s current disposition otherwise be left as is.
Index Offences
- The circumstances give rise to the charges in the index offences are set out in last year’s Reasons for Disposition as follows:
“On October 25, 2020, Ms. Ali attended at the Ottawa General Hospital in the early evening. Nurse Karen Beaupre was working her shift in the urgent care unit attending to another patient. While the nurse was preparing to take blood from the patient sitting in a lab chair, Ms. Ali stood at the threshold of the room. The nurse was facing away from Ms. Ali. Ms. Ali then passed other patients and staff, walked up to Ms. Beaupré and punched her in the rear of the head. She grabbed Ms. Beaupré’s hair and started to shake it from side to side. A clerk called an emergency code. Ms. Ali was arrested. Nurses who had witnessed the assault reported that while Ms. Ali was shaking the victim’s head, she was screaming “never talk like that to me again”. The attack was unprovoked.
On September 21, 2021, Ms. Ali was in the waiting room of the emergency department at the Queensway-Carleton Hospital. Approaching a patient unknown to her, she demanded a cigarette. She became belligerent when the cigarette was refused and yelled and swore at the male patient. Hospital staff asked her to stop yelling. Her behaviour escalated. Ms. Ali began to yell and swear more. She told staff she would retrieve an AK-47 gun and return to shoot them all. She stated she would strap a bomb to her chest and blow up the hospital. Staff and patients were fearful as a result of the disturbance. Parents in the lobby had to shield their children from Ms. Ali.
On September 23, 2021, police were called to the emergency room of the Ottawa General Hospital. They spoke to Ms. Ali’s cousin who reported that they had been at the hospital for about six hours. During that time, Ms. Ali assaulted two female nurses as follows: Ms. Ali spit directly in the eye of one nurse and spit on the left arm of the other. She uttered bomb threats to the hospital. She also threatened to spit in the face of attending police officers responding to the 911 call. She insulted hospital staff and police several times, swearing at them and threatening to spit on their faces.”
Current Diagnoses
Bipolar Disorder, Type 1
Alcohol Use Disorder, in a controlled environment
Borderline Personality Disorder
Background
The Board admitted into evidence the Hospital Report dated January 30th, 2025 as Exhibit 1. The document provides a great deal of information concerning Ms. Ali’s personal history, mental health history as well as her course in hospital and in the community both prior to and subsequence to the index offences. As the Hospital Report was made an Exhibit, it is unnecessary to reproduce the information contained therein in these Reasons. Briefly: Ms. Ali was born in Ottawa and is currently 32 years old. She is one of eight siblings, including four half-siblings on her father's side. Her childhood was unstable due to her mother's mental health issues. At age one, she was placed in the care of the Children's Aid Society and lived with various relatives until returning to her parents at age five when they temporarily reconciled.
Growing up, she witnessed arguments, domestic violence, and experienced physical discipline. Her home life stabilized around age ten when her parents reconciled again. At 18, she left high school before graduating and moved between Quebec and Ontario. During her young adult years, she experienced assault and sexual abuse from male acquaintances.
Ms. Ali held several short-term customer service jobs and briefly worked as a personal support worker. Between 2019-2020, she received Ontario Disability Support Program benefits when unemployed. She occasionally worked at a massage parlour.
Her relationship history includes living with an older man in Montreal when she was 18, which lasted about a year. In her mid-twenties, she was in a four-year relationship with another man in Gatineau and had a son who now lives with his father and paternal grandparents in the Ottawa area. She maintains contact with her son.
In 2018, Ms. Ali moved to France with family support but was arrested and spent about ten months in custody for an unspecified offence. In March 2019, she was deported to Canada and banned from re-entering France for ten years.
After returning to Canada, she experienced periods of mania, substance abuse, and homelessness. She voluntarily entered treatment at the Centre for Addiction and Mental Health in Toronto in December 2020, was transferred to Toronto General Hospital's Psychiatric Intensive Care Unit and was started on both oral and injectable medications. By January 2021, her condition improved sufficiently to enable her release from hospital and return to Ottawa, though she remained homeless and briefly entered a psychologically abusive relationship.
In September 2022, she faced criminal charges including assault, mischief, arson, and break and enter. She was found Not Criminally Responsible. Following her Ontario Review Board hearing in December 2022, she was detained at the Royal Ottawa Mental Health Centre with privileges up to and including the entitlement to reside in the community in approved accommodations.
Evidence at the Hearing
Dr. Strike gave evidence on behalf of the hospital. During 2023 Ms. Ali had been transferred back and forth between the hospital’s Forensic Assessment (FAU) Unit and Forensic Rehabilitation Unit (FRU) on several occasions. She was subsequently transferred to the all-female Hummingbird Unit at the North Bay Regional Health Centre (NBRHC) in August 2023. Ms. Ali remained at the NBRHC until March of 2024 when she was returned to the ROMHC.
Ms. Ali absconded from the ROMHC on January 22nd, 2025. Thereafter, on February 5th she returned on her own accord after reaching out to a hospital social worker and advising that she was staying with family in Toronto. . Ms. Ali was provided with a bus ticket to enable her to return to Ottawa. Dr. Strike testified that her Toronto family were unaware that she was absent without leave from the ROMHC. She had spent time in Ottawa and Montreal prior to traveling to Toronto.
Subsequent to Ms. Ali’s February 5th 2025, return to hospital, she has remained on 1:1 supervision. There have been several Code Whites due to incidents of aggression and agitation. Ms. Ali resisted being placed in restraints by flopping on the floor so she could not be returned to her bed. Nonetheless, Ms. Ali managed to extricate herself from five-point restraints on six occasions.
Ms. Ali became upset with and lunged at a female co-patient that she believed had made advances towards a male co-patient she(Ms. Ali) had been romantically involved with in recent months. This female co-patient now feels intimidated by Ms. Ali. Despite security measures in place, during the evening of February 9th Ms. Ali managed to spend 15 minutes in a bathroom with the aforementioned male co-patient.
With regard to community living, Dr. Strike noted that her patient was under a detention disposition which included that provision two years ago. At the time, when transferred to the FRU, Ms. Ali struggled with her treatment team’s decision to withhold her exercise of community living privileges. As a community living provision is included in her current disposition, she again feels an entitlement to be discharged to her family in Ottawa. This has prevented her ability to address risk factors while an inpatient. Dr. Strike added that in the event Ms. Ali makes significant progress over the next few months, that an early hearing could be called to consider reinstating a community living provision. Currently, every resource intensive intervention by team members have been perceived by the patient as unwarranted and an infringement of her liberties.
Throughout the past year it has been difficult for Ms. Ali to gain insight vis-à-vis her previous instances of violent behaviour. When asked, she only references having spit on a nurse in 2021.
Ms. Dufort referenced page 57 of the hospital report which indicates that one of Ms. Ali’s sisters threw an e-cigarette over the wall of the FAU for Ms. Ali. Dr. Strike responded that immediately after this occurrence the sister apologized for her actions during a case conference but stated that she was doing what Ms. Ali had asked of her. The sister was reminded of Ms. Ali’s history of fire-setting. Dr. Strike agreed with the suggestion that use of an E-cigarette may be a gateway to other smokable substances.
Dr. Strike opined, that in her opinion, it was both unfeasible and unsafe for Ms. Ali to live with her mother and sisters over the next 12 months. This past reporting year Ms. Ali has not acknowledged her previous difficulties with cannabis, substances or alcohol.
Questioned by Mr. Davies, Dr. Strike confirmed that the team was recommending a transfer to CAMH because she will be considered for admission to an all-female unit which specializes in personality issues together with fulsome behavioural programming.
Dr. Strike acknowledged that correspondence from CAMH contains no recommendations for changes to Ms. Ali’s current disposition, specifically, the removal of a community living provision. Mr. Davies expressed the concern that transferring a patient on a detention disposition with less privileges and flexibility, was overly restrictive. Dr. Strike responded that she has discussed Ms. Ali’s case with Dr. Darby at CAMH and that he would be recommending restricted access to the community. However, Dr. Strike did not advise Dr. Darby that she would be requesting removal of the entitlement of community living at this hearing.
Reference was made to page 54 of the hospital report. Dr. Strike acknowledged Ms. Ali’s previous ability to demonstrate rule adherence demonstrates that future community access is achievable. Ms. Ali acknowledges that she suffers from a bipolar illness for which she requires treatment. However, she attributes her impulsivity and aggressiveness to this illness rather than to a personality disorder. Responding to questions from the panel, Dr. Strike agreed that Ms. Ali currently rationalizes many of her inappropriate behaviours adding that the rigidity of her level of denial is more than just her conscious awareness, as she cannot acknowledge responsibility for her actions.
Ms. Ali had asked to discontinue her prescribed oral Abilify on January 6th 2025, as she asserted that it had brought on hyper-sexuality. Discontinuance of the Abilify, within the safety of a hospital setting, was trialled as a component of insight-building, to determine how her mental state would be impacted. Asked if she believes that Abilify destabilizes her patient, Dr. Strike responded that she did not, adding that in 2023 Ms. Ali showed a good response when her frequency of injectable Abilify was augmented from every four weeks to every three weeks. Dr. Strike now foresees that Ms. Ali should be treated by way of a long-acting antipsychotic. She remains on a mood stabilizer and Trazadone at bedtime.
It was noted that Ms. Ali’s mother and two sisters have not visited. Dr. Strike was unaware as to the rationale. Ms. Ali’s mother and sisters both reside in Ottawa and continue to support her return to live with them, which according to Dr. Strike “is not safe”. Dr. Strike noted that Ms. Ali has paternal family members in Toronto. The doctor described that in the fall of 2024 Ms. Ali was close to being placed on the transfer list to the FTU as at that time she felt supported by her paternal uncle who had agreed to strict limits and expectations surrounding his niece’s behaviour. Dr. Strike opined that Ms. Ali’s Toronto family have excellent insight to the challenges faced by Ms. Ali and do not support her defying hospital rules as has occurred at the ROMHC. The Toronto family had expressed an interest in being involved in Ms. Ali’s care where she to be transferred to CAMH. Dr. Strike observed, that to her patient’s credit, prior to her elopement, she had made significant progress in the areas of psychotherapy and behavioural therapy. It is anticipated that these efforts will continue both at the ROMHC and at CAMH if the transfer request is approved.
Recent drug and alcohol screenings have been negative for illicit substances but positive for hand sanitizer on four occasions. To her credit, Ms. Ali tested negative for alcohol or substances of any sort subsequent to her recent abscondment. Dr. Strike agreed that the abscondment was likely impulsive as Ms. Ali had neither money, nor a phone at that time.
Closing Observations
Dr. Strike highlighted Ms. Ali’s strengths specifically, the progress made in psychotherapy to address a difficult childhood, teamed with an adolescent diagnosis of mental health issues. The doctor also noted a period of excellent response to behavioural programming in the fall of 2024 and that Ms. Ali resisted the urge to abscond while attending a community medical appointment. Further, that Ms. Ali has prosocial goals and strengths.
Nonetheless, Dr. Strike opined that a detention disposition remains necessary and appropriate for the coming year, absent a community living provision.
Ms. Dufort was ad idem with the hospital position although she does not perceive the following sub-paragraphs as appropriate and necessary for the next 12 months: 2(c), only for the hospital not for the grounds; further subparagraphs 2(d), 2(g) and 2(h) should be omitted. Ms. Dufort added that it is inappropriate to include a community living privilege at this time. If the Board does include the privilege, then Ms. Dufort submitted that it should be restricted to 24-hour supervised accommodation, given the difficulties in managing Ms. Ali at the ROMHC in both the FAU and the FRU.
Mr. Davies submitted the disposition should be left as is noting that Dr. Darby from CAMH was prepared to accept Ms. Ali under those very conditions. He referenced page 54 of the hospital report wherein it is indicated that Ms. Ali responds better to positive reinforcement. He reiterated that the disposition should be left as is and reliance should be placed on the hospital to responsibly exercise any available privileges. He added that both psychotherapy and behavioural therapy were going well before Ms. Ali’s elopement which augers well for the future.
Analysis and Decision
(a) Significant Threat
Ongoing significant threat to the safety of the public cannot be speculative. It must entail a real risk of serious physical or psychological harm arising from conduct that is both serious and criminal in nature.
In determining whether Ms. Ali continues to represent a significant threat to the safety of the public the Board has carefully analyzed the evidence as it relates to the Supreme Court of Canada decision in Winko, 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625.
The Board unanimously finds that Ms. Ali continues to pose a significant threat to the safety of the public. In arriving at this determination, the Board considered the joint position of the parties and accepted the uncontroverted evidence of Dr. Strike that Ms. Ali continues to pose a significant threat. The Board also relies on the Hospital Report and the assertions contained therein in accepting the uncontroverted determination that Ms. Ali suffers from Bipolar Disorder, Type 1,; a major mental illness, complicated by Alcohol Use Disorder, in a controlled environment together with Borderline Personality Disorder.
Dr. Strike’s conclusory comments contained below the Opinions and Recommendations heading at pages 58-59 of the Hospital Report are reproduced below:
Ms. Ali repeatedly engaged in serious aggression and rule defiance during the reporting period, despite the external control of the forensic assessment unit, frequent use of enhanced therapeutic engagement (including one-to-one sitter), long-acting injectable antipsychotic medication, a firm behavioural care plan, and limited access to substances.
The forensic treating team cannot manage her risk to the public in the community at this time, nor were we in a position to do so at any point during the reporting period. However, she has not met criteria for an involuntary psychiatric admission under the mental health act of Ontario, thereby necessitating the form 49 to keep her admitted to hospital. It is clear that she would not agree to remain in hospital voluntarily, where she believes she is ready to live with her mother and sister in Ottawa and believes she will have no problem managing her sleep, mood, anger, impulsivity, or urges to use substances or otherwise breach her disposition, if she were discharged from hospital.
- Given the foregoing, the Board accepts that absent an ORB Disposition, Ms. Ali would likely become non-compliant with prescribed medications which would lead to decompensation, use of substances and the re-emergence of behaviours similar to those seen at the time of the index offences. We are satisfied that absent an ORB Disposition, it is likely that Ms. Ali will cause serious physical or psychological harm to members of the public and such conduct will likely be criminal in nature.
(b) Disposition
Flowing from the Board’s finding that Ms. Ali continues to pose a significant threat to the safety of the public it must shape a Disposition for the year ahead. Its paramount consideration in doing so must be the safety of the public while also considering Ms. Ali’s needs pursuant to s. 672.54 of the Criminal Code.
The necessary and appropriate disposition for Ms. Ali provides him as much freedom as possible without subjecting the community to a real risk of dangerous behaviour.
In considering Ms. Ali’s needs, the Board was attentive to her limited insight regarding previous instances of violent behaviour.
Specific instances are provided at page 56 of the Hospital Report, reproduced below for ease of reference:
Physical violence with her siblings and friends throughout her youth
Physical aggression (assaults, uttering threats and causing a disturbance) to hospital staff during psychiatric admissions, prior to being found NCR, including the index offences in 2020 and 2021
Fire-setting in France and Ottawa (most recently occurring in September 2022)
Break and enter, verbal aggression (including threats) and mischief/obstruct property, targeting various unknown individuals in the community (during the index offences of September 2022)
During her first forensic admission at the ROMHC (January to August 2023), she threw coffee at a co-patient and was involved in arguments that involve posturing and aggressive gesturing.
She assaulted a female co-patient during her admission to the NBRHC from August 2023 to March 2024
Ms. Ali recently eloped from the ROMHC for a two- week period during which she travelled between Ottawa, Montreal and Toronto. Ongoing aggression and agitation was documented following her return to hospital on February 5th precipitating several Code Whites and the necessity for 1:1 supervision.
Given Ms. Ali’s tumultuous history of late, this panel accepts Dr. Strike’s rationale for removing community living from this patient’s disposition for the 2025/2026 reporting year. Its inclusion is wrongly perceived by Ms. Ali as a right, rather than a discretionary privilege within a Detention Disposition to be accorded if and when deemed appropriate by the treatment team and ultimately the person in charge of the ROMHC or at CAMH if a transfer takes place within the next 12 months. This panel is therefore prepared to accept Dr. Strikes’ contention that the inclusion of a community living provision has precluded Ms. Ali’s ability to focus on, let alone address her risk factors, while a forensic in-patient. It remains unfeasible for Ms. Ali to return to live with her mother and sister or her paternal uncle’s family during the upcoming reporting year. A transfer to CAMH is necessary and appropriate so that Ms. Ali can access an all-female unit specifically intended for patient’s diagnosed with personality disorders. A transfer to CAMH also places Ms. Ali in closer proximity with her paternal uncle and his family who have shown a willingness to remain engaged with and supportive of Ms. Ali and her treatment needs. Additionally, it is important to note that although Ms. Ali remains on a mood stabilizer she has been sub-optimally treated subsequent to discontinuing oral Abilify in early January.
This panel of the Board certainly recognizes that Ms. Ali has the potential to again make significant strides in her rehabilitation through psychotherapy and behavioural therapy and encourages her to embrace those treatments in tandem with rigorous adherence to her psychotropic medications while avoiding the use of alcohol, marijuana and intoxicants of any kind.
Conclusion
Therefore, the Board unanimously determines that the necessary and appropriate Disposition required to manage the threat Ms. Ali poses to the safety of the public while still meeting her needs, is a Detention Disposition, limited to the specific privileges as set out in the Hospital Report.
In making this Disposition, the Board carefully considered the positions and submissions of the parties and the evidence of Dr. Strike and is satisfied that this determination is both necessary and appropriate. The Board reviewed the provisions of s. 672.54 of the Criminal Code and carefully considered the need to protect the public from dangerous persons, Ms. Ali’s mental condition, her reintegration into society and other needs.
DATED this 10th day of April 2025, at the City of Toronto, in the Toronto Region.
Mr. P. Capelle
Alternate Chairperson
Office of the Registrar
Ontario Review Board