Ontario Review Board
Re: Emmanuel A. Deflorimonte
ORB File No: 8169
Hearing held on: Monday, March 10, 2025
Place of hearing: Centre for Addiction and Mental Health 1001 Queen Street West, Toronto
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. S. Clapp Members: Dr. R. Sheppard Dr. S. Lessard Mr. D. Sandor Mr. J. Cyr
Parties Appearing:
Accused: Emmanuel A. Deflorimonte Counsel: Mr. D. Brodsky
The person in charge of hospital: Counsel: Ms. M. Warner
Attorney General of Ontario: Counsel: Mr. J. Rinaldi
REASONS FOR DISPOSITION
(Dated April 30, 2025)
Introduction:
On October 7, 2022, Emmanuel A. Deflorimonte was found not criminally responsible on account of mental disorder (“NCR”) on charges of indecent acts, exposure to person under fourteen years, failure to comply with probation order, assault with a weapon (x2), possession of weapon for dangerous purpose, and resisting or obstructing public or peace officer, all contrary to the Criminal Code.
Ms. Deflorimonte is a biological male who identifies as female and prefers to be referred to as Ms. Deflorimonte with she/her pronouns.
Ms. Deflorimonte is currently subject to a Disposition of the Ontario Review Board (“ORB” or the “Board”) dated March 19, 2024, whereby she is detained at the General Forensic Unit at the Centre for Addition and Mental Health (“CAMH” or the “hospital”) with privileges up to and including community living in accommodation approved by the person in charge.
On March 10, 2025, a panel of the Board convened at CAMH to conduct Ms. Deflorimonte’s annual review pursuant to section 672.81(1) of the Criminal Code. Ms. Deflorimonte attended the hearing and was represented by counsel.
The Hospital Report dated February 10, 2025, was marked as Exhibit 1 at the hearing. In addition to the documentary evidence, Ms. Deflorimonte’s attending psychiatrist, Dr. K. Valoo, gave evidence.
The issues to be decided at the hearing were whether Ms. Deflorimonte continues to meet the test of posing a significant threat to the safety of the public and if so, what is the necessary and appropriate Disposition, bearing in mind the four factors in section 672.54 of the Criminal Code.
Position of the Parties:
- At the outset of the hearing, the parties were asked for their initial without prejudice positions. On behalf of the hospital, Ms. Warner took the position that Ms. Deflorimonte remained a significant threat to the safety of the public and there should be no change to the Detention Order Disposition. Mr. Rinaldi supported the hospital’s position on behalf of the Attorney General. Mr. Brodsky stated that it was a joint submission.
Findings:
- For the reasons that follow, the panel found that Ms. Deflorimonte continues to pose a significant threat to public safety. The panel concluded that the necessary and appropriate Disposition, which is also the least onerous and least restrictive in the circumstances, is a continuation of the existing Detention Order.
Index Offences:
- The circumstances giving rise to the index offences are stated as follows in the Hospital Report (at page 10):
“Indecent Act, Indecent Exposure to Person under 16 years and Fail to Comply with Probation (August 20, 2020)
On August 20, 2020, officers were flagged down regarding an exposure that had just occurred. The complainant and her 2-year-old daughter were walking when the accused passed by and had his penis out of his pants. He turned and began to “twerk” his body up and down towards the complainants. Officers were able to locate the male a short distance away and placed him under arrest. They learned that he was on probation for a similar type of act.
Assault with a Weapon x2, Possession of a Weapon for a Dangerous Purpose (March 12, 2021)
On March 12, 2021, the victims were completing their night patrol at 55 Bloor Street West when they observed the accused loitering inside the premise. At approximately 1910h, the victims approached the accused, at which point they observed the male holding an Exacto knife. At approximately 1910hs, the accused presented the knife at the victims and began to charge at them. The victims managed to escape without injury and called police. Officers attended the area and the accused was placed under arrest.
Failure to Comply Probation (February 11, 2020 to March 5, 2020)
On January 23, 2020, Ms. Deflorimonte appeared in Court where she was convicted of Indecent Public Act, Fail to Comply Probation, Obstruct Peace Officer and Mischief under $5,000. She was adjudged a suspended sentence and placed on probation for 12 months. On February 11, 2020, Ms. Deflorimonte failed to abide by “condition #4” and failed to report to her probation officer as directed. A warrant was subsequently issued for her arrest.”
- At the time of the index offences, Ms. Deflorimonte was living in a shelter, not taking psychiatric medications, and using substances. She had a limited recollection of the events surrounding the index offences.
Background:
Ms. Deflorimonte’s personal background and history are set out in detail in the Hospital Report and will not be repeated here. Briefly summarized, Ms. Deflorimonte is a 34-year-old transgender woman. Her preferred name is Aaliyah. She is single with no children and is supported by the Ontario Disability Support Program. Her parents separated when she was approximately nine months old. She has two siblings and four half siblings. Ms. Deflorimonte has a grade nine education and left home at age 17. She lived in shelters and worked in the sex industry.
Ms. Deflorimonte maintains contact with both of her parents.
Criminal History:
- The Hospital Report included Ms. Deflorimonte’s criminal record which showed that she had incurred numerous charges and convictions between 2014 and 2020, including uttering threats, assault with a weapon, possession of a weapon, obstruct peace officer, mischief under $5000, indecent act, and failure to comply. She regularly received suspended sentences and probation.
Psychiatric History:
The Hospital Report outlines Ms. Deflorimonte’s extensive history of receiving mental health services for Schizoaffective Disorder, Bipolar Type which was complicated by polysubstance abuse and an underlying personality disorder. The Hospital Report included summaries of at least 18 psychiatric admissions between 2012 and 2021. Ms. Deflorimonte frequently presented with aggression, auditory hallucinations, delusions, religious preoccupation, sexually inappropriate behaviours, substance use, and noncompliance with psychiatric medications. Locked seclusion was often required in order to manage her behaviours. Ms. Deflorimonte lived a transient lifestyle and often left hospital against medical advice. There was also reference in the Hospital Report to failed community treatment orders and attempts to follow Ms. Deflorimonte in the community with little success.
Ms. Deflorimonte was found unfit to stand trial in relation to the index offences in October 2021 and was at CAMH until June 2022 on a Treatment Order. Following the NCR finding in October 2022, Ms. Deflorimonte was on a number of different forensic units at CAMH. Her mental status was described as cognitively disorganized, though she was fairly pleasant and cooperative with the treatment team. She was labile at times when her needs were not met. Ms. Deflorimonte was noted to have limited insight into her diagnosis and poor insight into substance use issues; however, she was compliant with psychiatric medications. Ms. Deflorimonte has been on a general forensic unit since December 14, 2023.
Ms. Deflorimonte’s current diagnoses are: Schizoaffective Disorder, Bipolar Type; Substance Use Disorder; and Borderline Personality Disorder. She has a significant history of substance use and reported that she smoked cannabis and used crack cocaine and crystal methamphetamine daily prior to her detention.
Ms. Deflorimonte is capable of consenting to treatment. She was found incapable of managing her property on May 9, 2024; therefore, the Public Guardian and Trustee manages her finances.
Evidence at the Hearing:
The Hospital Report stated that Ms. Deflorimonte had a “tenuous clinical course” this year with multiple incidents of concern rooted in behavioural issues and recreational substance use. Despite treatment with antipsychotic and mood stabilizing medications (and efforts to optimize that treatment), Ms. Deflorimonte continued to exhibit prominent symptoms including a labile mood, impulsivity, and disorganization of her thinking and speech. The Hospital Report stated that Ms. Deflorimonte’s illness is treatment resistant. Her symptoms were exacerbated by her comorbid borderline personality disorder which led to emotional instability and recurrent interpersonal conflicts with both staff and co-patients. She intermittently expressed conditional suicidal ideation when her needs were not met. Ms. Deflorimonte also struggled to retain information about the ORB system and CAMH’s pass ladder system. She only had sporadic engagement in structured programming.
A number of incidents of concern were listed in the Hospital Report, many of which involved Ms. Deflorimonte asking strangers for cigarettes during escorted passes into the community. In order to address these behaviours, and incentivize Ms. Deflorimonte to engage in therapeutic programming, the treatment team tried making an exception to the pass ladder in order to allow Ms. Deflorimonte to smoke cigarettes on a shadowed pass. Unfortunately, this was not successful and the usual pass ladder system was resumed.
There were also incidents of Ms. Deflorimonte being verbally abusive and threatening, and making insulting, racist or sexually inappropriate comments to staff and co-patients. Her passes were often suspended as a result of these behaviours. The Hospital Report stated that the majority of these incidents were perceived to be due to behavioural issues rooted in personality/characterological traits, as well as substance use disorders, as opposed to being related to her Schizoaffective Disorder.
Commencing in June 2024, Ms. Deflorimonte tested positive for cannabis on a number of occasions, and in September 2024, her urine sample tested positive for both cannabis and methamphetamines. In December 2024, she again tested positive for methamphetamines.
Ms. Deflorimonte’s father is an Approved Person but he did not follow through with completing a shadowed Approved Person pass; therefore, Ms. Deflorimonte had not been out on a pass with him yet.
The risk formulation in the Hospital Report concluded that Ms. Deflorimonte’s risk of future violence would be high in the context of a Conditional Discharge, but that a continuation of the current Detention Order would mitigate this risk by ensuring that she remained connected with an appropriate level of professional care and psychiatric treatment commensurate with her needs.
The Hospital Report included the following under “Team Review of Recommendation” (at page 30):
“The team is of the unanimous opinion that a continuation of the current disposition, that being a detention order at the Forensic Service of CAMH with the provision for community living, is necessary and appropriate to manage Ms. Deflorimonte’s risk to the public. She experiences ongoing symptoms of her mental illness such as emotional lability and disorganized thinking, and has fluctuating insight into her mental illness, the consequences of substance use, and her status within the forensic system. Her poor insight has led to repeated requests to be discharged from the hospital, and multiple instances of recreational substance use. Under the current disposition, ongoing admission to the forensic psychiatric inpatient environment has allowed Ms. Deflorimonte to received intensive support and oversight to ensure that her mental status has not deteriorated further. She has also made some meaningful clinical gains over the last reporting period, such as maintaining compliance with medications (with a few very brief exceptions), and cooperating with the clinical team’s attempts to further optimize her medication regime. She has exhibited some success regarding off-unit privileges and regular engagement with structured programming. The team is optimistic that a continuation of this disposition will facilitate ongoing intervention to further optimize her treatment regime, stability, and independence. Should she manage indirectly supervised passes more successfully over the upcoming year and show improved engagement in therapeutic programing, she may be suitable for commencement of discharge planning to supervised community housing.”
Dr. Valoo testified that Ms. Deflorimonte currently has Level 4 passes which are escorted passes. She does not yet have any indirectly supervised privileges. Dr. Valoo reported that there was another incident where Ms. Deflorimonte picked up a cigarette butt on an escorted community pass approximately a week and a half ago, but to Ms. Deflorimonte’s credit, she put it down when asked.
Dr. Valoo was hopeful that Ms. Deflorimonte will be able to progress through the pass ladder in the coming year. This will require Ms. Deflorimonte to exhibit an understanding of the expected behaviours, to go where she is told to go, to follow instructions, and to return on time. It will also require Ms. Deflorimonte to abstain from substance use and participate in her treatment by attending therapeutic programming. Dr. Valoo testified that staff have made a concerted effort to tell Ms. Deflorimonte which programs she needs to attend in order to progress.
In response to a question from Mr. Brodsky, Dr. Valoo clarified that Ms. Deflorimonte is currently not able to smoke. If she reaches Level 5, she will be able to use nicotine products. Dr. Valoo hoped that would occur by the end of March if everything went well.
In response to a question from the panel, Dr. Valoo stated that if Ms. Deflorimonte progresses through the pass levels successfully, there is a possibility that the treatment team could commence discharge planning. It was therefore helpful to have the community living provision in Ms. Deflorimonte’s Disposition.
Dr. Valoo was asked about Ms. Deflorimonte’s cognitive difficulties and apparent difficulties understanding the ORB system. Dr. Valoo stated that they continue to assess this, and continue to reiterate rules with her. It appeared that while Ms. Deflorimonte has some cognitive struggles, there was also a behavioural component in that she was seeing what was achievable. Dr. Valoo also stated that Ms. Deflorimonte continues to work very closely with a behavioural therapist.
Analysis and Conclusion:
Based on the Hospital Report and the evidence of Dr. Valoo, the panel found that Ms. Deflorimonte continues to represent a significant threat to the safety of the public. Ms. Deflorimonte continues to exhibit active symptoms of her major mental illness (despite treatment) which are compounded by her behavioural issues and substance use. She has a long history of criminal activity and noncompliance with psychiatric medication over many years. Her insight is underdeveloped and she used substances on a number of occasions this reporting year. The panel was satisfied that if Ms. Deflorimonte was not subject to the jurisdiction of the Board, she would have unstable housing, her mental status would become destabilized by psychosocial stressors, she would stop taking medications, and she would increase her substance use. This would result in an exacerbation of her manic and psychotic symptoms which would increase her risk of violence towards others, as has occurred many times in the past and at the time of the index offences.
The panel found that a continuation of the existing Detention Order is the necessary and appropriate Disposition, and accepted the joint submission of the parties. Ms. Deflorimonte had some challenges following the rules and engaging in her treatment this year. More time is needed for her to work on these things and progress through the pass ladder system. Ms. Deflorimonte requires the intensive support and oversight of the inpatient environment in order to progress in her recovery. A Detention Order is also required for the protection of the public.
The panel noted that Ms. Deflorimonte’s current Disposition provides her with a lot of room to advance, as it allows for indirectly supervised passes into the community as well as community living. The evidence demonstrated that if Ms. Deflorimonte progresses successfully this coming year, she may be eligible for discharge planning. In that case, the hospital requires the ability approve her housing and bring her back to hospital in the event of any decompensation.
Ms. Deflorimonte is encouraged to make efforts to work with the treatment team, follow the rules, abstain from substance use, and engage in her recovery so that she can progress towards discharge to the community and pursuing her life goals.
DATED this 30^th^ day of April 2025, at the City of Toronto, in the Toronto Region.
Ms. S. Clapp
Alternate Chairperson
__________________
Office of the Registrar
Ontario Review Board