Ontario Review Board
Re: Joe Puthenkulam
ORB File No: 8325
Hearing held on: Thursday, March 27, 2025
Place of hearing: St. Joseph's Healthcare Hamilton West 5th Campus, 100 West 5th Street
Pursuant to: Section 672.81(2) of the Criminal Code
Before:
Alternate Chairperson: Mr. M.D. Segal
Members: Dr. B. Sheppard Dr. G. Stones Mr. K. McKenna Ms. M. McKinnon
Parties Appearing:
Accused: Joe Puthenkulam Counsel: 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 28, 2025)
Introduction
Joe Puthenkulam, age 29, was on June 21, 2023, found not criminally responsible on a charge of assault with a weapon and forcible confinement, contrary to the Criminal Code. Mr. Puthenkulam is on a Detention Order dated June 25, 2024, with privileges up to and including living in the community of Southern Ontario in accommodation approved by the person in charge.
On March 27, 2025, Mr. Puthenkulam appeared before the Ontario Review Board (the “Board”) from St. Joseph's Healthcare Hamilton (the “hospital”) for an early hearing under s. 672.81(2). All parties jointly requested that a Conditional Discharge on conditions replace the current Disposition. Significant threat was conceded.
The Board had before it as Exhibit 1, a Hospital Report dated March 3, 2025. Mr. Puthenkulam’s family was in attendance.
By the end of the hearing the panel agreed that the joint position was necessary and appropriate.
The hospital proposed conditions at page 37 of the Hospital Report. They include a residence at the family home, and various other conditions. The hospital was not proposing a ban on substances, but continued urine screens are required.
Current Diagnoses
Bipolar 1 Disorder Cannabis Use Disorder – in sustained remission
Mr. Puthenkulam is treatment capable.
Index Offence
- The circumstances of the index offences are excerpted from last year’s Board Reasons, as follows:
“On February 28, 2023, the accused and his mother were inside their family residence. He was extremely agitated and forced his mother into a bedroom, locking the door. He pinned her to the floor, face down, and repeatedly smashed her face off the ground. He then attempted to wrap a guitar chord around her neck. He then proceeded to stab her in the back approximately 50 times with nail cutting scissors. When Mr. Puthenkulam left the room, the victim messaged her husband saying, “call 9-1-1, he’s trying to kill me.” The police were called and while en route to the home, they received a call from a neighbour who described seeing the accused outside of his house, holding a knife, rocking back and forth, and yelling about someone hiding in the attic. The police arrived at the house and arrested Mr. Puthenkulam. The victim was transported to hospital for treatment of her injuries. He provided a statement to the police in which he explained that he was stolen from his biological parents at birth and that the victim was an imposter. He stabbed her to force a confession. After the assault, he ran downstairs and grabbed two butcher knives to protect himself from her. He also advised the police that he had used cannabis that day and had not been taking his medication.”
Background
- This is set out in detail in the Hospital Report. The panel also adopts the summary from last year's Reasons for Disposition:
Mr. Puthenkulam is 28 years of age. He has current diagnoses of bipolar 1 disorder and cannabis use disorder- moderate (in early remission). He is treatment capable for psychiatric decisions and capable for managing his financial matters. His initial Board disposition was in 2023.
Mr. Puthenkulam is the son of George Puthenkulam and Deepthi Alex, and he has twin sisters who are 21 years of age. The parents are originally from India, but they have also lived in Saudi Arabia, and Dubai, and in 2013 the family came to Canada. The hospital report refers to an incident in Dubai, when Mr. Puthenkulam was 8 years of age. He apparently attempted to hang himself by tying a towel around his neck.
Mr. Puthenkulam is an intelligent and educated young man. His time at university and being away from home were precipitating events for his drug use and mental health decline. In 2013 he started the Mechatronics program, which is part of the Engineering program at the University of British Columbia (UBC). It was at this time he started using cannabis and by 2017, he was consuming cannabis daily.
In November 2016, he was brought to the emergency unit of St. Paul’s Hospital in Vancouver by his friends. His behaviour was bizarre and disorganized. He was agitated and experiencing hallucinations and Mr. Puthenkulam advised hospital staff that he had consumed mushrooms earlier in the day.
In June 2017, Mr. Puthenkulam was admitted to Vancouver General Hospital for five days. He was disorganized and fixated on having been sexually assaulted by his friends and family. He displayed anxiety and paranoia and admitted to daily use of cannabis and recent experimentation with MDMA. Mr. Puthenkulam was responding to internal stimuli and pre-occupied with recurring thoughts of rape. He returned home to Burlington, Ontario following his discharge from hospital, and was referred to the Phoenix Outpatient Program for Early Intervention in Psychosis.
He returned to UBC in 2018 and was followed by the Kitsilano-Fairview Mental Health Clinic. Shortly after the pandemic emerged in March 2020, he resumed his use of cannabis. After being notified by his friends that Mr. Puthenkulam was unwell, his father travelled to Vancouver to see his son. Mr. Puthenkulam returned to Burlington with his father and reconnected with the Phoenix Outpatient Program. From June 2020 to September 2021, he attended school on-line. He had insight into the harmful effects of cannabis use on his mental health and abstained from cannabis during this time.
Mr. Puthenkulam returned to Vancouver in September 2021, and very quickly started using cannabis and stopped taking his prescribed medication. He was again admitted to Vancouver General Hospital in November 2021. He was running through traffic and behaving aggressively toward his female cousin, who sought police assistance. He was taken by the police to the hospital under the Mental Health Act. Mr. Puthenkulam was observed to be animated and responding to strangers on the street. The hospital noted that he presented as grandiose with blunted affect and with odd speech. He admitted to consuming alcohol and cannabis earlier in the day, and not adhering to his medication for several weeks. Mr. Puthenkulam returned to Burlington after his discharge from hospital.
He began working for his father’s company as a software programmer and lived with his parents. His cannabis use continued which created significant tension within the family.
In June 2022, he booked a last-minute flight to Calgary without notifying any family members or his employer. He stayed with friends as much as possible, until he was asked to leave, and then stayed in hotels in Vancouver. He spent over $10,000.00 in a two-week period. His parents requested the police check on his wellbeing, and the police found him to be very distraught, psychotic and with a substantial amount of cannabis in his hotel room. He was admitted to Vancouver General Hospital for three weeks and then returned to Burlington with his father. The hospital described his presentation as bizarre with symptoms of psychosis and mania. Mr. Puthenkulam acknowledged to the hospital staff that he was using cannabis daily.
Mr. Puthenkulam’s parents noted that their son’s demeanor had changed significantly since returning to Burlington. He was verbally abusive and hostile; he was not attending work regularly and was ultimately terminated from his employment in October 2022. As a result of this behaviour, he was asked to leave his parent’s house and he lived temporarily with his cousin. It was during this time that Mr. Puthenkulam began suggesting that his parents were not his biological parents. The serious and violent index offence against his mother occurred in the family home in February 2023.
Mr. Puthenkulam was admitted to St. Joseph’s on May 1, 2023. His thought process was disorganized, and he expressed his belief that his parents were imposters. He had poor insight into his illness and was insistent that he should not be prescribed medication. He became increasingly suspicious and irritated and suspected that some of the staff had a sexual interest in him.
His sleep was poor, and he spent most nights awake. He became more disorganized and endorsed bizarre beliefs, such as referring to himself by various names and informing staff he was the king of Britain. Staff observed Mr. Puthenkulam respond to internal stimuli, and he was placed in seclusion after he became verbally aggressive to staff. He continued to refuse medication and became highly disorganized and delusional.
Mr. Puthenkulam was deemed incapable to consent to treatment and his father became his substitute decision maker. His father consented to long-acting antipsychotic medication being administered. With treatment, his symptoms improved significantly.
As his admission progressed, he became less resistant to his scheduled antipsychotic medication, and he became more engaged in recreational programming. Initially, he was distracted in group settings, responding to internal stimuli and experiencing auditory hallucinations. These symptoms subsided with treatment.
Mr. Puthenkulam has been an inpatient on Harbour North 3 since early September of last year. He has consistently maintained a positive attitude and respectful behaviours which have helped him adapt quickly to the unit and gain privileges. His mental status has been mostly stable. He regularly describes his mood as positive. Occasionally he voices anxiety or low mood relating to being hospitalized and remorse for his index offence against his mother. He also expresses a longing to return home to live. To manage these periods of anxiety and low mood he occupies himself with activities and receives support from staff.
Mr. Puthenkulam attends his parents’ residence in Burlington every week on 72-hour passes. He otherwise has regular contact with both of his parents and continues to receive strong family support.
Mr. Puthenkulam has been actively engaged in therapeutic programming. Although he has expressed a desire to work, at this stage in his recovery it is not being recommended or actively pursued. As noted, Mr. Puthenkulam is educated, and this will be a goal in the future to further his university education.
Evidence at Hearing
Dr. W. Sutton, the patient’s psychiatrist since September 2023, reported on a very positive year. In August 2024, Mr. Puthenkulam was discharged to live in his family home in Burlington. He continued to be followed by the forensic team. Mr. Puthenkulam has been co-operative, reachable and attends all appointments. His urine screens have all been negative. Substances have not been an issue. Mr. Puthenkulam's time is spent working out, playing guitar, family activities and working at his father's place of business. He receives injections of Abilify.
Mr. Puthenkulam enjoys strong family support. He has traveled with his family in Ontario. In the past reporting period, he has traveled with family to India for three weeks to visit with relatives. That trip was co-ordinated with his injection schedule. The trip went smoothly with Mr. Puthenkulam checking in by video and by phone. There are other travel plans being contemplated to visit family in the United Kingdom, Europe and the United States.
Mr. Puthenkulam still requires monitoring as these are relatively early days.
Significant threat is grounded in a serious mental health disorder, the number of repeat incidents attached to his illness, the relative freshness of his entry into the forensic system. Mr. Puthenkulam is an intelligent man. His insight has greatly improved. Mr. Puthenkulam appreciates that he has a life-long condition that needs to be properly managed.
He continues to attend a virtual peer support group.
The family is knowledgeable of what to look for in relation to potential decompensation. Such signs include a decline in sleep health, mood changes and consumption of substances. Mr. Puthenkulam's mother continues to be a strong support, notwithstanding she was the victim of the index offences.
At his last annual hearing, Mr. Puthenkulam was treatment incapable, but he is now capable.
Mr. Puthenkulam has been referred for help with sleep and 1:1 CBT. The panel observed that a psychological assessment should be prepared.
Once on a Conditional Discharge, the hospital would look for professional mental health supports in the community. That could include St. Joseph's Mood Disorder Clinic.
The doctor is confident that Mr. Puthenkulam will abide with the conditions of his Disposition.
Analysis
The hospital's decision to call an early Board was sensible. Mr. Puthenkulam has been doing extremely well. There have been no incidents. Mr. Puthenkulam is doing prosocial things. He is working at his father's business. A three-week trip to India went very smoothly. Insight has improved to a noticeable degree. While risk remains, especially given the type of illness and the early stages in the forensic system, the progress is admirable.
While significant risk to the community was conceded, the panel finds that it is present arising from the Hospital Report and Dr. Sutton’s testimony, including a history of non-adherence to medication and the consumption of substances. Things are quite different now. Mr. Puthenkulam is behaving in a pro-social way. He is working. There have been no incidents. He is fully cooperative with his forensic team. He has strong family support. He continues to progress. In all circumstances, the panel is of the view that a Conditional Discharge on the conditions recommended in the Hospital Report is the appropriate Disposition balancing the safety of the public and the patient’s rehabilitation. We wish Mr. Puthenkulam well in the upcoming year.
DATED this 28th day of April 2025, at the City of Toronto, in the Region of Toronto.
Mr. M.D. Segal Alternate Chairperson
Office of the Registrar Ontario Review Board