Ontario Review Board
Re: Jacqueline Davies
ORB File No. 4832
Hearing Date: March 26, 2025
Hearing Location: St. Joseph’s Healthcare, Hamilton, West 5th Campus
Pursuant to: Section 672.81(1) of the Criminal Code of Canada;
Before:
Alternate Chairperson: Mr. M. Segal
Members: Dr. B. Sheppard Dr. G. Stones Ms. M. McKinnon Mr. K. McKenna
Parties Appearing:
Accused: Jacqueline Davies
Amicus: Ms. C. Francis
The Person in charge of Hospital: Counsel: Ms. L. Barney
Attorney General of Ontario: Counsel: Ms. K. Malkovich
REASONS FOR DISPOSITION
(Dated April 17, 2025)
Introduction
Ms. Davies was found not criminally responsible (NCR) on July 3, 2007, for the criminal code offences of assault with a weapon and aggravated assault.
She is currently subject to a detention order under a Disposition dated May 15, 2024, with privileges that extend to living in the community and 7-day passes to enter Southern Ontario indirectly supervised.
A panel of the Ontario Review Board (the panel) convened this annual hearing on March 26, 2025, at St. Joseph’s Healthcare, Hamilton, West 5th Campus (St. Joseph’s) to review the current Disposition pursuant to s. 672.81(1) of the Criminal Code of Canada.
At the commencement of the hearing, Ms. Davies advised the panel that she intended to represent herself. Ms. Francis participated in the hearing as Amicus.
The Hospital submitted that a continuation of the current detention order was appropriate. Ms. Davies and counsel for the Attorney-General agreed with the Hospital’s recommendation.
After considering the evidence, the panel concluded that Ms. Davies is a significant threat to public safety, and that a continuation of the existing detention order is necessary and appropriate. Paragraph 4(a) of last year’s Disposition prohibits Ms. Davies from consuming alcohol, drugs, or any other intoxicant save and except for the consumption of marijuana in accordance with Canada’s Lower-Risk Cannabis Use Guidelines. Dr. Duboff testified and suggested that the reference to the cannabis guideline be removed since Ms. Davies is incapable of following the guideline. The panel accepted this evidence, with the result that Ms. Davies will be permitted to use cannabis, and will not be restricted to the lower-use guidelines.
Index Offences
- The following is a synopsis of the index offences which occurred on February 16, 2007.
On February 16, 2007, at approximately 2130 hrs the accused had been standing alone in the front lobby at 85 1st Avenue holding a folding tree saw. Eleven year (11) old [N.P.] and [J.P.] walked past the accused on their way out to the parking lot through a rear door. The accused approached [N.P.] from behind and without provocation struck the girl in the back of the head with the blade of the saw. [N.P.]’s crying alerted her [J.P.] who then rushed to protect [N.P.] from further attack. [N.P.] sustained a superficial cut, measuring approximately six inches long, on the right side of her head, behind the ear, and cut with some swelling to her right thumb. [N.P.] attended the Welland County General Hospital Emergency for treatment of her injuries.
On Friday, February 16, 2007, at approximately 2130 hrs the victim, [J.P.], was walking in front of her daughter as they made their way out to the rear parking lot of the building when they passed the accused standing alone in the front lobby of their apartment. [J.P.] came to [N.P.]’s rescue after hearing her screams and seeing her being attacked with a tree saw by the accused. [J.P.] tackled the accused into a corner and yelled for [N.P.] to get away. The accused continued fighting and struck [J.P.]’s face with the saw. The accused was disarmed and fled on foot through the parking lot. [J.P.] attended the Welland County General Hospital with [N.P.] to have the large gash repaired and sore hand examined.
Hospital Report dated March 7, 2025
A Hospital Report dated March 7, 2025, was prepared for this hearing, and contains a detailed review of Ms. Davies’ personal and mental health history.
Ms. Davies has a long and extensive history of substance use, specifically, cannabis and cocaine.
Her behaviour began to deteriorate in high school. She became irritable and argumentative, started using substances, and stopped attending classes.
She has no criminal record, but was charged as a youth with assaulting her grandmother. This charge was eventually withdrawn.
Her psychiatric history is substantial and begins in 2003. She was experiencing agitation and paranoia, and behaviour that was difficult to control in school and at home. In 2005, she became increasingly psychotic. She was experiencing delusions and hallucinations. On one occasion in 2005, she punched her mother in the face while her mother was driving. Prior to the index offences, she was hospitalized on numerous occasions, and had extensive involvement with psychiatric professionals in the community.
The Hospital Report describes Ms. Davies as having difficulty controlling her impulsivity and behaviour. She loses control of her behaviour, screams, and uses profanity toward staff and co-patients. She also becomes physically aggressive to staff and co-patients and damages property when unwell.
In 2016, Ms. Davies was granted a conditional discharge. In July 2018, she did not return to her residence for the required curfew, and was located 6 days later in Toronto. The 2018 Disposition imposed a detention order, and she has remained in the hospital since that time.
Ms. Davies was transferred to Waterfall 3 from Harbor North 3 on May 28, 2024, after an attempted assault on staff and a recent history of threats against a doctor. Dr. Sutton prepared the following transfer summary.
“Ms. Davies is a 36-year-old woman who was found NCR in July of 2007 on charges of Assault and Assault with a Weapon. She is subject to a Detention Order with community living. She has been in the hospital since readmission in 2018 from Mathias Place.
Diagnostically, opinions have shifted somewhat over the years. What is clear from her history is that Ms. Davies has struggled from a young age with environmental sensitivities, emotional regulation problems, and interpersonal deficits that have hindered her functioning in multiple domains. She was diagnosed in the past with Pervasive Developmental Disorder (now Autism Spectrum Disorder), as well as ADHD, borderline personality disorder, cannabis/ETOH/stimulant use disorders, and more recently, schizophrenia. Although I have never seen Ms. Davies off of antipsychotic medication, in my opinion, the most appropriate diagnoses at this time would be ASD with severe borderline personality disorder, along with substance use disorders as noted above (in forced remission within a controlled setting). Although she has experienced symptoms of psychosis in the past, it is likely these were driven primarily by reaction to extreme stress in the context of her personality pathology and neurodevelopmental diagnosis, and substance use. It is important to note that when stable, she is able to meaningfully participate in academic pursuits, and vocational endeavors. She does not exhibit any negative symptomology characteristic of patients with schizophrenia.
Ms. Davies has fluctuated considerably over the course of her most recent admission. Of note, she was transferred to HN3 from R3 in early 2020 after assaulting her then MRP. While on HN3, she has consistently demonstrated difficulty in dealing with frustration and anger management, which has often led to emotional outbursts, and on occasion, violence directed towards staff and co-patients. She has required brief periods of seclusion during these times, most recently in the early part of this week for becoming aggressive and verbally threatening towards a specific staff member.
Currently, Ms. Davies does not have off ward passes, as all of her privileges were cancelled following her recent seclusion earlier this week. In general, she tends to do better when she has structured time off the unit, and she struggles when confined to the unit for long periods. That being said, she is prone to impulsive relapses re: substances when she has liberal, unstructured passes, which often leads to considerable deterioration in her mental status”.
Dr. Duboff became her most responsible physician on September 19, 2024. He indicates in the Hospital Report that there have been no appreciable changes in her presentation, and her mood can vary significantly on a daily basis. She has had periods of days to weeks of stability with her presenting as calm, having a euthymic affect, being cooperative with staff, following the rules, abstaining from substances, attending programs, and adhering to her prescribed medication. There were also episodes of significant instability. During times of distress, Ms. Davies had a labile affect, and intense irritability where she glared at staff and yelled profanity and threats towards them. This behaviour could last minutes or hours.
The Report indicates that she acts impulsively, and employs maladaptive coping strategies, including threatening harm to herself and others, writing vulgar messages about staff on the walls, and over the years has caused significant damage to property in the unit. The triggers for these events are often sleep deprivation, intoxication on cannabis and alcohol (consumption of hand sanitizer), interpersonal conflict with staff or co-patients, and difficulty following hospital or unit rules which she considers target her personally. She has also fasted for prolonged periods of time blaming the quality of the food in the hospital.
She has also been observed standing alone and appearing to have a conversation with someone, although she denies experiencing perceptual disturbances or auditory hallucinations.
Ms. Davies had numerous notable incidents this past year which were noted in the Hospital Report. They were typically being argumentative with a raised voice and threatening. The following incidents are examples to illustrate her behaviour.
On June 4, 2024, staff noticed cuts to her harm. She indicated that she had brought a small wooden piece from Harbor North 3 to Waterfall 3, and when she was upset, rather than throw chairs, she cut her arms to avoid seclusion. On one occasion she stated that she wanted to kill people and go to jail to get out of the hospital. In July, she approached staff and told them she wanted to go into seclusion or she would hurt someone. In October, she again asked for seclusion so she wouldn’t kill everyone.
After a visit with her father Ms. Davies became extremely agitated. Mr. Davies reported that she blamed him for being part of a conspiracy with the staff to keep her in hospital, and that she wants nothing more to do with the family.
In January 2025, Ms. Davies acknowledged to staff after a positive UDS test that she has been smoking marijuana butts she finds on the hospital grounds.
On February 10th, Ms. Davies appeared very agitated, talking to herself, and responding to internal stimuli. She appeared more labile than usual with an angry affect. The following day she acknowledged to staff smoking cannabis.
On February 13, Ms. Davies was observed by a staff member walking along the street off hospital grounds which was not permitted. She returned to the hospital and said she walked to a nearby mall to get something to eat. On February 20th, she was observed by a co-patient to drink hand sanitizer. Dr. Duboff referred to an incident a few days before this hearing when Ms. Davies required seclusion after becoming emotionally unstable.
Her current privileges are restricted to level 1.
She had been enrolled in courses at St. Charles Adult Education but withdrew in May 2024. She then talked to her vocational counsellor about registering for courses at Mohawk College but later decided to not pursue these courses.
Ms. Davies has had minimal involvement with behavioural therapy.
In October 2024, the Forensic Psychiatry Transitional Case Manager contacted Social Work to review Ms. Davies’ suitability for placement at the Good Shepherd, Emmaus Place, transitional housing. Ms. Davies had been on the wait-list since 2022. The transitional housing program requires that patients have a reasonable expectation of independent living within 2 years of entering the program. The clinical team did not believe Ms. Davies would be able to live independently within 2 years, and accordingly, her name was removed from the list. She is not currently on any housing wait-lists.
Social Work explored the suitability of Hummingbird Lodge in North Bay. This facility is a female forensic rehabilitation unit that provides specialized intensive treatment services to clinically complex women whose mental health conditions are impeding their progress. It was determined that this facility would be appropriate for Ms. Davies. She, however, declined to pursue this housing option. She has also in the past declined housing options with Christian sounding names.
Ms. Davies has been involved with individual counselling, but her attendance waned as she earned more privileges. Currently, she is seen at her request, which is sporadic.
A psychological test was conducted on January 27th and February 4, 2025. The assessor stated that Ms. Davies’ psychiatric symptoms and thought process appeared to interfere with her performance on the tests. The results, therefore, reflect her level of functioning in the context of ongoing symptoms. The conclusions from the testing indicate her risk to act out aggressively is in the high range, and her risk to act violently towards another person is in the moderate-high range. These scores represent her risk to public safety while under a detention order. The risk to act violently would increase if she did not have the support of the Forensic Psychiatry Program under a detention order.
Dr. Duboff Testimony
Dr. Duboff has been treating Ms. Davies since her transfer to Waterfall 3 in September 2024.
He referred to Ms. Davies’ condition as continually fluctuating. She has periods of time where she is stable, engaged in programming, and then decompensating, when her behaviour becomes very challenging. Often the decline follows substance use.
Dr. Duboff indicated that there are more notable incidents than those listed on pages 102-109 in the Hospital Report.
He referred to stress as often resulting in decompensation which happens very quickly. She then becomes quite hostile, and staff are unable to interact with her until she settles. Dr. Duboff does not believe that the incidents of self-harm reflect suicidal tendencies.
He referred to the relapses often following cannabis and alcohol use. She consumes alcohol by drinking hand sanitizer.
Dr. Duboff indicated to the Crown that there is no safe amount of cannabis for Ms. Davies. He referred to Canada’s Lower-Risk Cannabis Use Guidelines, which Ms. Davies provided to the hearing, where it states that “people with a history of psychosis or substance use disorders, should not use cannabis at all”.
Ms. Francis referred Dr. Duboff to Dr. Sutton’s comments in the Hospital Report where he indicated that schizophrenia may not be part of the diagnosis, but rather, autism spectrum disorder, borderline personality disorder, and the substance use disorders. Dr. Duboff stated that Dr. Sutton may be correct in his assessment, but at the current time, he believes that Ms. Davies does have schizophrenia. Dr. Duboff suggested that her reaction to cannabis use reflects a psychosis.
In answer to questions from the panel, Dr. Duboff stated that Ms. Davies does not respond to internal stimuli, but rather, responds very quickly to her perception of external events.
He indicated that Ms. Davies was recently in seclusion for 6 days after throwing chairs. A code white was initiated to take her into seclusion and avoid a physical altercation.
Testimony of Jacqueline Davies
Ms. Davies testified that she has created a self-help notebook which she will utilize over the next year. She indicated that in the next year she would like to use exercise for stress if granted 4-hour passes to the community.
Ms. Davies referred to the different strains of cannabis and the different potency of different cannabis products. She indicated her desire to smoke 1 marijuana cigarette in the morning. She explained that her recent incident of damaging property resulted from the “guy across the hall snoring”.
Ms. Davies also indicated that she would like to send a letter of apology to the victims of the index offence without having to direct the letter to the Crown Attorney’s office. The current Disposition prohibits any direct or indirect contact with the victims.
Submissions
- At the conclusion of the evidence, the parties continued to support a detention order. Ms. Davies indicated that the effects of the cannabis are gone after eating, so she will not eat immediately after using cannabis. The Hospital referred to Dr. Duboff’s evidence concerning the Lower-Risk Cannabis Use Guidelines, and suggested that reference to the guideline be removed from the Disposition.
Analysis
After considering the evidence, the panel accepts the ample evidence that establishes Ms. Davies is a significant threat to the safety of the public, and that a continuation of the detention order is necessary and appropriate.
She has been in the forensic system for 18 years. Her symptoms and behaviour have not improved to any significant extent. The compelling evidence is that Ms. Davies mood and behaviour are extremely volatile; she is calm, adherent to rules, and engages in programming for a period of time, only to become emotionally dysregulated, exhibit indicia of psychosis, and become extremely aggressive with co-patients and staff. Often, she has damaged unit property when angry and unwell. Staff are unable to engage with Ms. Davies when she is in this condition, and simply have to wait until she settles.
She will in all likelihood continue to smoke cannabis which, according to Dr. Duboff, results in a decline of her mental state.
Ms. Davies is not currently on any wait-list for community housing. The Hummingbird facility in North Bay may be an appropriate residence for her, but she declines to pursue accommodation in this facility.
The panel accepts the Hospital’s evidence concerning the lower-risk cannabis use guideline, and Ms. Davies’ inability to follow the directive. Reference to the guideline will be removed from the Disposition.
Concerning a letter of apology directed to the victims, it is appropriate that any such communication be sent to the Crown Attorney’s office, who can then decide if the correspondence should be forwarded to the victims. The index offences occurred in 2007, and they may have moved in the meantime. As well, the Crown Attorney’s office can determine if communication from Ms. Davies is welcomed by the victims.
It is necessary and appropriate for a detention order to be imposed with the same terms and conditions that currently exist, with the minor changes regarding the low-risk guideline, and the ability of Ms. Davies to send a letter of apology to the victims through the Crown Attorney’s office.
In coming to this conclusion, the panel has applied the principles provided in s. 672.5401 of the Criminal Code.
Dated this 17th day of April 2025, at the City of Toronto, in the Toronto Region.
Kevin McKenna
Legal Member
Office of the Registrar
Ontario Review Board