Ontario Review Board
Re: Robert Pfaff
ORB File No: 4219
Hearing held on: Monday April 7, 2025
Place of Hearing: Southwest Centre for Forensic Mental Health Care
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. R. Bigelow
Members: Ms. S. Clapp Dr. S. Swaminath Dr. M. Green Ms. C. Plyley
Parties Appearing:
Accused: Robert Pfaff Counsel: Mr. W. Glover
The person in charge of hospital: Counsel: Ms. J. Zamprogna
Attorney General of Ontario: Counsel: Mr. D. Rows
REASONS FOR DISPOSITION (Dated May 7, 2025)
Introduction
On June 15, 2005, Robert Pfaff was found not criminally responsible on account of mental disorder on a charge of assault causing bodily harm contrary to the Criminal Code. Mr. Pfaff is subject to a disposition of the Ontario Review Board (the Board) dated April 29, 2024, ordering his discharge on conditions.
On Monday, April 7, 2025, the Board convened a hearing to review Mr. Pfaff`s disposition pursuant to section 672.81(1) of the Criminal Code. Mr. Pfaff was present and represented by counsel, Mr. Glover. The issues to be determined at the hearing were whether Mr. Pfaff continued to constitute a significant threat to the safety of the public as defined in section 672.5401 of the Criminal Code and, if so, what was the necessary and appropriate disposition that was also the least onerous and least restrictive taking into account the factors set out in 672.54 of the Criminal Code.
Initial Positions of the Parties
At the commencement of the hearing the parties were requested to provide their initial without prejudice positions with respect to the issues before the Board. Counsel for the Hospital indicated that it was the Hospital’s position that Mr. Pfaff continued to represent a significant threat to the public and that the necessary and appropriate disposition was a continuation of the current conditional discharge without change.
Both counsel for the Attorney General and Counsel for Mr. Pfaff supported the Hospital recommendation.
Evidence at the hearing
- The evidence at the hearing consisted of the Hospital Report dated March 13, 2025, and the oral evidence of Dr. Ajay Prakash, Mr. Pfaff’s treating psychiatrist.
Findings
- For the Reasons that follow, the Board finds that Mr. Pfaff continues to represent a significant threat to the safety of the public and that the necessary and appropriate disposition is a continuation of the current discharge under conditions without change to the terms.
Index Offence
- The circumstances surrounding the index offence as summarized in last year’s Reasons for Disposition are as follows:
On March 30, 2005 the accused and the victim were alone together in the dining room of the hospital ward. After the victim entered the room, the accused hung up the telephone he was using, walked over to her as she stood near the doorway, and punched her once in the face with a closed fist. The blow struck her in the nose and mouth, causing her to bleed heavily. Mr. Pfaff then walked out of the dining room to the nurses' station and stated to nursing staff "I hit her, I hit her". Upon being arrested later that evening Mr. Pfaff said, "I never hit her, it was an accident", and when told he punched the victim in the face he replied, "No. I shook my fist at her and she walked into it". The victim suffered swelling to her nose and lower lip, a cut to her lower lip, and bleeding from her nose.”
Background Information Regarding the Accused
- Mr. Pfaff is currently 63 years of age and second youngest in a sibline of seven children. He had difficulty in school, was required to repeat grade 8 and did not continue his education subsequently. He has no significant employment history.
Substance Use History
- Mr. Pfaff has no history of problems with respect to substance use.
Legal History
- Mr. Pfaff has one entry on his criminal record prior to the Index Offence for an assault committed while in hospital in December 2000 for which he received a suspended sentence and 12 months probation. However, he has a lengthy history of both verbal and physical aggression both in hospital and in the community.
Psychiatric History
Mr. Pfaff’s first hospitalization with respect to mental health related issues was in 1976 when he was 16 after he struck his father with a pipe rendering him unconscious and requiring him to receive sutures and a skull x-ray. He remained in the hospital until 1986 having been diagnosed with schizophrenia, catatonic type. In March 1986 he was placed in a supervised group home where he resided for a year and then in another group home for a further four months. Subsequently he was in and out of the hospital on both voluntary and involuntary admissions until he was discharged to a special care residence in April 1990. He remained at that residence with a few brief readmissions until January 2000 and subsequently continued the pattern of voluntary and involuntary admissions due to violent behaviour and psychotic symptoms until March 2005 when the index offence occurred.
Subsequent to the index offence Mr. Pfaff was subject to Detention Orders for many years due to ongoing symptoms, impulsive behaviours, and lack of insight. Attempts were made to place Mr. Pfaff in group homes or independent apartments, but he was repeatedly brought back to the hospital due to verbal and physical aggression, and unsafe living conditions. At times these admissions were voluntary. His last admission to hospital was from June to August, 2023.
Current Diagnosis
- Mr. Pfaff’s current diagnosis is schizophrenia.
Recent History
Mr. Pfaff was accepted into the Dearness Long-Term Care Home (Dearness), a locked facility, and was transitioned to that residence in February 2022. He completed an extended leave of absence from the Hospital at the residence and was discharged from the inpatient unit formally on April 28, 2022. While at the residence Mr. Pfaff continued to experience symptoms of his major mental illness such as paranoid ideation and delusional thinking.
Staff have noticed a general decline in Mr. Pfaff’s physical health and cognition in the last few years. He demonstrated significant difficulty with organizing, planning, following through, and problem-solving in any situation. He was highly forgetful and depended heavily on support staff. This resulted in increased frustration, irritability and anger. Any coping strategies that Mr. Pfaff employed tended to be maladaptive and often resulted in damage to his room (picking at the walls, punching walks, and creating a mess with food and feces).
Mr. Pfaff has no insight into his mental illness or violence risk. He is incapable to consent to treatment and the Public Guardian and Trustee is his substitute decision-maker.
On June 28, 2023, staff attended Dearness and Mr. Pfaff indicated to them that he was feeling unsafe in the residence and requested a readmission to Hospital. He was readmitted and a full medication review was completed resulting in a reduction of Ativan and an increase of Clozapine. Over time he returned to baseline although he continued to voice ideation of a paranoid nature however the intensity decreased to normative levels for him. He was discharged back to Dearness on August 9, 2023.
Although Mr. Pfaff continued to display symptoms of his illness the team felt that it was appropriate to refer him to Specialized Geriatric Services at St. Joseph’s Healthcare London to support a transition to the Discharge Liaison Team (DLT). He met with the DLT once and a transfer of care was anticipated for April 2025.
However, on the evening of March 9, 2025, Mr. Pfaff took an unwitnessed fall and the next day a further fall resulting in facial bruising and a nasal bone fracture. On March 11, 2025 Mr. Pfaff left the residence without permission and when he had not returned after a few hours he was reported missing. Police conducted a search of the local area and Mr. Pfaff was located at a Tim Hortons in the area and returned to Dearness. The treatment team and staff at Dearness noted that Mr. Pfaff displayed an increase in paranoia about harm being caused to him through his nose and it was determined that he should be readmitted to Hospital. He remained in the Hospital as of the date of the hearing.
Evidence of Dr. Ajay Prakash
Dr. Prakash indicated that he had been Mr. Pfaff’s psychiatrist for a number of years and had reviewed and adopted the contents of the Hospital Report. He confirmed that the Hospital was not recommending any changes to the current disposition and noted that the Mental Health Act had been successful in managing his risk at the time of his recent admission.
Dr. Prakash believed that Dearness would reaccept Mr. Pfaff. The treatment team also wish to hold discussions with staff at Dearness with respect to how Mr. Pfaff was able to leave the residence which they understood to be locked.
Dr. Prakash indicated that there would continue to be fluctuations in Mr. Pfaff’s mental state particularly given his long standing history of mental illness. The treatment team intended to continue working with the Geriatric Psychiatry Team and the DLT to move forward on a transition from the forensic to the civil mental health system, and see if they are able to manage Mr. Pfaff’s risk. In Dr. Prakash’s opinion Mr. Pfaff’s cooperation with readmission to hospital over the last several years supports a conclusion that the civil mental health system would be able to manage his risk.
In response to questions from counsel for the Attorney General, Dr. Prakash stated that the treatment team would be meeting with Dearness staff the following week and anticipated a discharge to that facility within a few weeks. He noted that Mr. Pfaff’s Clozapine dosage had been reduced and, although there had been no change in his mental state, the team might recommend a leave of absence to Dearness while monitoring for any changes resulting from the reduction in dosage.
Dr. Prakash added that Mr. Pfaff had a neurological examination and it was determined that the falls were not caused by epilepsy. The treatment team has ordered an MRI and EEG to further investigate the cause of the falls.
Analysis and Conclusion, Significant Threat
- Although the issue of significant threat was not contested at the hearing, the Board nevertheless makes an independent finding that Mr. Pfaff does represent a significant threat to the safety of the public. He suffers from a major mental illness, schizophrenia, and remains symptomatic with persecutorial delusional beliefs and hallucinations despite adherence to medication. He continues to require 24/7 monitoring to manage his behaviour as well as to ensure his well-being. He has poor insight into his mental illness, violence risk and need for treatment and has indicated that he would like to discontinue medication. Absent Board supervision there is a substantial likelihood Mr. Pfaff would cease treatment resulting in an increase in the symptoms of his mental illness and an increase in his risk to cause significant physical and/or psychological harm to members of the public.
Analysis and Conclusion, Necessary and Appropriate Disposition
- The Board finds that the evidence also amply supports the joint submission that the necessary and appropriate disposition is a continuation of the current discharge on conditions without change to the terms. Provisions of the Mental Health Act have been shown to be effective in managing risk and his current residence is supervised by staff who would quickly be able to respond to any signs of decompensation. A discharge on conditions is the least onerous and least restrictive disposition available to manage Mr. Pfaff’s risk.
DATED this 7^th^ day of May 2025, at the City of Toronto, in the Toronto Region.
Robert Bigelow Alternate Chairperson
____________________________
Office of the Registrar Ontario Review Board