Re: Maurice Ramjit
ORB File No: 1861
Hearing held on: Thursday, February 20, 2025
Place of hearing: Centre for Addiction and Mental Health, Toronto
Pursuant to: Section 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: Maurice Ramjit
Counsel: Mr. T. Whillier
The Person in charge of Hospital: Counsel: Ms. M. Warner
Attorney General of Ontario: Counsel: Mr. M. Feindel
REASONS FOR DISPOSITION
(Dated April 14, 2025)
Introduction
On June 22, 1994 Mr. Maurice Ramjit was found not criminally responsible by reason of mental disorder on a charge of assault contrary to the Criminal Code.
Under s. 672.81(1) of the Criminal Code, a panel of the Ontario Review Board (the Board) was convened on February 20, 2025 at the Centre for Addiction and Mental Health (CAMH or the Hospital) to review Mr. Ramjit's risk to public safety and the appropriate disposition under s. 672.54 of the Criminal Code.
Mr. Ramjit requested permission not to attend the hearing today. Mr. Whillier, attending remotely by telephone, indicated he received instructions from Mr. Ramjit to attend on his behalf. The Board granted permission under s. 672.5(10) of the Criminal Code for Mr. Ramjit to be absent.
Mr. Ramjit’s existing disposition dated March 18, 2024 orders that he remain subject to a conditional discharge with conditions among others that he reside at the LOFT accommodation on 3705 Bathurst St. in Toronto and report to the person in charge of the Hospital not less than once every four weeks.
At the start of the hearing the parties provided the Board with their respective positions on disposition and significant risk. The parties adopted a joint position that Mr. Ramjit should remain subject to a conditional discharge under the existing conditions absent the substance testing provision. The parties maintained their joint position at the close of the evidence.
Disposition
- For the reasons set out below the Board concludes, pursuant to s. 672.54 of the Criminal Code, that Mr. Ramjit 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 should remain subject to the existing conditional discharge with the removal of the substance testing provision.
Current Diagnoses
- Mr. Ramjit's current diagnoses are schizophrenia, undifferentiated type, residual, substance disorder in remission, unspecified personality disorder, paraphilias (exhibitionism and frotteurism) and borderline intellectual functioning.
The Evidence
- The Board has before it the Hospital Report dated January 26, 2025 which contains an account of Mr. Ramjit’s personal and psychiatric background which needs not be repeated in detail here. The Board also has the oral evidence of Dr. Deep Jaiswal, the author of the Hospital Report.
Index Offence
The circumstances of the index offence are described in the Hospital Report and are summarized as follows:
On April 29, 1994 at about 5:00 p.m. a young girl was walking with her mother northbound on George Street just north of Dundas Street East in Toronto. Mr. Ramjit was walking in the opposite direction and for no apparent reason he lunged at the girl. He grabbed her throat with one hand and her head with the other. He threw her to the ground then stood up and walked away. The victim called the police and Mr. Ramjit was arrested near the location of the assault. The victim suffered redness and soreness in the neck area.
Mr. Ramjit reported that on the day of the offence, he was intoxicated with alcohol and experiencing auditory hallucinations.
Criminal History
- Mr. Ramjit has a lengthy criminal record that spans from 1987 to 1993 and includes offences of sexual assault x 2, indecent exposure, attempted robbery, assault and possession of a narcotic.
Substance Use
- Mr. Ramjit began using alcohol and illicit substances including cocaine and cannabis at age 13. For two years Mr. Ramjit used one to four grams of cocaine four days a week and about two grams of cannabis at a time. He stated that he preferred psychoactive substances because they enhanced his sex drive. At the request of his parents he entered numerous drug treatment programs during his teens but he failed to keep appointments with the programs.
Mr. Ramjit’s Personal and Psychiatric History
Before the Current Reporting Year
Personal History
Mr. Ramjit is a 58-year-old male born in Georgetown, Guyana. His parents immigrated to Toronto in 1972. Their three children joined them two years later when Mr. Ramjit was seven years old. Mr. Ramjit has two older sisters. There is a history of family discord and domestic abuse noted in previous reports. His parents separated when he was age 10. Mr. Ramjit has not spoken to his father since 1999 but expressed affection for his mother who passed away in December 2018.
Until her death Mr. Ramjit's mother was the substitute decision-maker for his psychiatric medications whose role was later taken on by his sister. The Public Guardian and Trustee manages his finances. Mr. Ramjit has maintained ongoing contact with his sister. Before being hospitalized Mr. Ramjit mainly had sporadic intimate relationships with women.
Mr. Ramjit attended Yorkdale Adult Learning Centre. Psychological testing performed after the index offence revealed that Mr. Ramjit was functioning at the borderline range of intellectual functioning. Mr. Ramjit stated that he attended about five different high schools but never completed sufficient credits to progress past grade nine. His reading skills were found to be at a grade-four level.
Mr. Ramjit has a sporadic employment history doing menial jobs from which he was usually laid off or fired for poor performance. The longest he was employed at a job was four months when he was age 20. He is financially supported by ODSP.
Psychiatric History
Mr. Ramjit has a lengthy history of hospitalizations and emergency department attendances beginning in 1990 until he was conditionally discharged from CAMH to supervised housing on April 7, 2014. He has been admitted to North York General Hospital, York Finch Hospital, Clarke Institute of Psychiatry and CAMH. Many of his attendances were consequent upon criminal activity and violent encounters. From his early history of psychiatric assessments, he was found to abuse alcohol and other substances and to be suffering from anxiety, psychotic symptoms involving auditory hallucinations, persecutory delusions and a personality disorder. Mr. Ramjit was found to be sexually preoccupied and intimidating to female hospital staff.
After the not criminally responsible finding in 1994 he was admitted to Brockville Psychiatric Hospital, St. Thomas Psychiatric Hospital and CAMH.
From 1994 to 1996 the Board ordered him detained at a medium secure unit at Brockville where he was treated with anti-psychotic medication. He was found to stare at females inappropriately. He was transferred to CAMH to a medium secure unit from 1996 to 1998 where he was treated with anti-psychotic medications and he continued to stare inappropriately at females. He blamed staff for his auditory and visual hallucinations and reported that he had thoughts of retaliation against those individuals.
From 1998 to 2000 Mr. Ramjit was hospitalized in a medium secure unit at St. Thomas where he was treated with anti-psychotic medications for auditory hallucinations, thought disorder and persecutory delusions. He engaged in sexual impropriety involving masturbation in front of staff, exposing himself in front of patients and staff and calling out female staff’s names while masturbating. Mr. Ramjit threatened others and was physically aggressive.
From 2000 to 2014 Mr. Ramjit was hospitalized at CAMH.
In 2000 Mr. Ramjit was transferred to a medium secure unit at CAMH and in 2004 to a minimum secure unit. He continued to experience auditory hallucinations and persecutory and grandiose delusions. He was administered anti-psychotic and anti-depressant medications. He continued to behave inappropriately toward women following and staring at them and placing his hand on the back of a staff member. During an interview with a female psychologist Mr. Ramjit became sexually aroused and began to masturbate through his clothing. He was described in 2004 as high risk for sexual re-offence.
Mr. Ramjit's mental status improved from 2005 to 2008 and he did not present with behavioural or management difficulties. On May 5, 2008 Mr. Ramjit was discharged from the minimum secure unit at CAMH to an all-male facility with on-site 24-hour staffing at Holland Landing. Medications were administered and supervised by staff and his clinical care was transferred to the CAMH Forensic Out Patient Service (FOPS). Mr. Ramjit has not required re-hospitalization since his discharge into the community in 2008.
With his medication and treatment regimen, Mr. Ramjit's mental status and behaviour improved significantly in community housing although he continued to experience residual symptoms of psychosis. He became involved in social activities offered through his residence and affiliated mental health agencies.
Mr. Ramjit was pleasant but interacted superficially with staff and co-residents and otherwise remained socially isolated. He was not involved in an intimate interpersonal relationship. Mr. Ramjit continued to have telephone contact with family members. He travelled to Toronto to stay with family, including several days at his sister’s with her family, which outings occurred without incident. Urinalyses were negative for abuse of substances.
Mr. Ramjit was generally compliant and cooperative with the rules and expectations of his residence and did not exhibit aggression, violence or sexually inappropriate behaviours and, without resistance, he accepted his medications. However Mr. Ramjit showed no improvement in insight into his illness or the index offence and he disputed his diagnosis of schizophrenia. Mr. Ramjit initially declined participation in any formal therapeutic programs. Subsequently he entered an eight-week self-management and recovery program that incorporated wellness tools and strategies to help clients manage their symptoms. However Mr. Ramjit admitted he enrolled in the program to "look good for the ORB".
In satisfaction of Mr. Ramjit’s wish to live nearer to his family in Toronto, on April 7, 2014 the Board, among other conditions, discharged Mr. Ramjit to reside at Homes for Special Care – 50 Browns Line, Toronto (Brown’s Line). His circumstances did not appreciably change with the transition to his new residence.
Mr. Ramjit remained a resident at the Browns Line in Etobicoke, Ontario until he was transferred to a LOFT residence in February 2024. For his duration at Brown's Line Mr. Ramjit continued to present without behavioural or management difficulty and to be pleasant and cooperative with the rules and expectations of his residence. He did not require psychiatric assessments or re-hospitalization nor did he exhibit aggression, violence, sexually inappropriate behaviours or breach the conditions of his disposition. Urinalyses continued to be negative for substances. However Mr. Ramjit continued to show no improvement as to insight into his illness and the index offence.
For unknown reasons Mr. Ramji had numerous falls and possible seizures in 2021. He was transferred to the Hospital emergency department on several occasions following these incidents. Neurological findings suggested there was brain atrophy thought to be caused by his past substance abuse. Initially Mr. Ramjit declined recommendations for assistive devices.
Given Mr. Ramjit's declining physical health the clinical team concluded that Mr. Ramjit would likely require the increased support offered in a long-term care home and in August 2021 applications were made to several such facilities. He received two rejections both based on him being a smoker, being a high risk for falls, having a history of substance use and being under the jurisdiction of the Board.
There has been little change from 2021 in Mr. Ramjit’s mental status, his understanding of his illness, his compliance with the expectations of the residence or his behavioural patterns. He continued to experience residual auditory hallucinations and persecutory delusions which he said did not affect his functioning.
However in 2022 Mr. Ramjit continued to experience deteriorating physical health. In February 2022 he was taken to St. Joseph’s Hospital due to confusion, lethargy, weakness, blurry vision and falls. At this point Mr. Ramjit required prompting and support for all personal care and had a personal support worker (PSW) to support him with bathing and dressing. He required support to change and dispose of his incontinence products and soiled clothing. Mr. Ramjit was able to eat independently but meal preparation, housekeeping and medication were managed by housing staff.
The period 2023/2024 was replete with concerns about the increased frequency of Mr. Ramjit's falls and mobility difficulties. He required increased personal support help and nursing support with self-care and medication management. The increased frequency of falls was attributed to low blood pressure associated with the dose of his anti-psychotic medication. Over the year his anti-psychotic medication was reduced. Given his increased need for support, Mr. Ramjit was moved to the LOFT path home at 250 College St. in Toronto on July 23, 2023, which subsequently moved to 3705 Bathurst St. in Toronto in February 2024. That facility provides support and supervision more amenable to Mr. Ramjit's needs.
Mr. Ramjit continued to experience residual auditory hallucinations over the year which included for instance commands to engage in "sexual acts" with his sister, mother and father. Despite these residual symptoms Mr. Ramjit was thought not to be behaviourally driven or preoccupied by them. On the positive side while at LOFT the frequency of falls declined. It appears Mr. Ramjit last experienced a fall in October 2023. At this time he requested permission to move from his LOFT apartment to reside with his sister. His sister however indicated that due to her own health issues, she could not accommodate her brother.
During the 2023/2024 period Mr. Ramjit reported an absence of substance or alcohol use. There were no concerns about problematic behaviours during the year. The reporting year was absent of physical aggression, sexually inappropriate behaviours and absconding events.
The Current Reporting Period – 2024 -2025
During the current reporting year Mr. Ramjit continues to reside at LOFT at 3705 Bathurst Street. As noted, the residence offers 24-hour nursing and PSW services, three meals a day, snacks, and housekeeping and laundry services are provided. He also receives primary care and geriatric psychiatric support at the facility as well as recreational and social activities. Mr. Ramjit's unit contains a large private bedroom and washroom equipped with a shower fitted with safety equipment.
In terms of social engagement Mr. Ramjit has continued to have contact with his sister mainly by phone because of her own health issues. He has also attended house meetings and music and game groups.
Mr. Ramjit experienced hospitalizations in relation to his physical health related to chronic obstructive pulmonary disease, pneumonia and anemia. His mental health remained stable apart from some intermittent residual symptoms.
For most of the current review period Mr. Ramjit intermittently endorsed residual auditory hallucinations and delusionary thoughts but he was not behaviourally preoccupied by these experiences. The auditory command hallucinations continued to be sexual in nature but Mr. Ramjit denied an intent to engage in the commands. Mr. Ramjit showed limited insight into discussions about his mental illness and treatment. He acknowledged experiencing residual symptoms but was uncertain about having a mental illness and the rationale for his treatment. Mr. Ramjit again requested to leave the LOFT residence to reside with his sister.
Mr. Ramjit has required support in the area of instrumental activities of daily living including finance, transportation, medication administration and meal preparation. He also required a walker for mobility. He is on the waitlist for three long-term care facilities, Kipling Acres, Malton Village and Baycrest.
On the risk of re-offence with an absolute discharge, the Hospital Report states the following:
In the context of an absolute discharge, Mr. Ramjit would likely return to insufficient housing, receive an inadequate level of support for his physical health and mental health needs – finding the same to be stressful, fall away from treatment, and/or return to substances. These factors individually or in combination would likely result in a mental state decompensation. They may also impede his self-control. As has been the case in the past, in the context of a mental state decompensation or limited self-control, he is likely to engage in physical violence or sexually inappropriate behavior towards a member of the public. Thus, he meets the threshold for significant threat towards public safety. Continuing with the Conditional Discharge is likely to mitigate this risk. Thus, the same is a necessary and appropriate disposition at this juncture. [at page 38].
- The clinical team recommends a continuation of the existing conditional discharge disposition with the removal of the condition of substance testing but without the removal of the condition to abstain from substance use.
Oral Evidence of Dr. Deep Jaiswal
Dr. Jaiswal testified at the hearing. He provided material updates on Mr. Ramjit’s circumstances since the date of the Hospital Report.
Dr. Jaiswal testified that Mr. Ramjit’s current housing is transitional until he is placed for permanent residency in a long-term care facility. There are no updates at this time on Mr. Ramjit’s applications for long-term care. Dr. Jaiswal testified that the conditional discharge at LOFT housing at 3705 Bathurst Street is sufficient for Mr. Ramjit’s medical and psychiatric needs at this time until his placement in permanent housing.
Dr. Jaiswal explained that while the clinical team advocates the removal of the substance testing provision it wishes to retain the condition that Mr. Ramjit abstain from the use of substances. He testified that substance use is still a source of risk but the team is prepared to remove the testing requirement since in the controlled environment of his housing his urine samples have tested negative for substances.
In answer to queries about the effect of Mr. Ramjit's medication, Dr. Jaiswal testified that his medications attenuate his delusional and hallucinatory thoughts including his command hallucinations with sexual content.
The Parties’ Positions
- The parties maintain their joint position that Mr. Ramjit 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 the existing conditional discharge with the removal of the substance testing provision.
The Board’s Conclusion
While mindful of the parties’ joint position the Board is required to come to an independent determination.
Based on the evidence before us, the Board unanimously accepts the opinion, as stated in the Hospital Report, that Mr. Ramjit 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. Ramjit’s community re-integration, his mental condition and his other needs.
We accept, pursuant to s. 672.54 that the least onerous and least restrictive disposition, that is necessary and appropriate in the circumstances, is the existing conditional discharge absent the requirement for substance testing.
The Board arrives at that decision for the following reasons.
The Board finds from the evidence in the Hospital Report and the testimony of Dr. Jaiswal support for a conditional discharge to community housing that is responsive to both Mr. Ramjit's psychiatric and medical needs. From a psychiatric perspective Mr. Ramjit requires very basic support with medication compliance, personal care and hygiene, meals and assistive devices for his mobility and respiratory conditions. LOFT housing offers the support and supervision Mr. Ramjit requires at this time pending being accepted for admission to a long-term care facility.
In keeping with the Criminal Code’s s. 672.5401 criteria, the existing conditional discharge in the LOFT facility allows Mr. Ramjit to maintain his integration in the community and offers the services to address the growing demands of Mr. Ramjit’s failing physical health. The paramount criterion of public safety is provided for by the close supervision and monitoring of Mr. Ramjit’s medication compliance and mental status.
The Board appreciates the need for long-term care for Mr. Ramjit and hopes that sooner than later he will learn of his acceptance to a permanent place in a long-term facility.
Based on the evidence in the Hospital Report and the evidence added in Dr. Jaiswal’s testimony the Board finds, pursuant to s. 672.54 of the Criminal Code, that Mr. Ramjit remains a significant threat to public safety and that currently the necessary and appropriate disposition, which is the least onerous and the least restrictive to mitigate risk to public safety, is a conditional discharge on the existing terms absent the requirement for substance testing. We do note the team's efforts to transition Mr. Ramjit to long-term care and the Board is hopeful that this will materialize for him soon.
DATED this 14^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