Ontario Review Board
Re: Sin Kim
ORB File No: 4554
Hearing held on: Wednesday, March 12, 2025
Place of hearing: Centre for Addiction & 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: Sin Kim Counsel: Ms. E. Gaudet
The Person in charge of Hospital: Representative: Mr. J. McIntyre
Attorney General of Ontario: Counsel: Mr. I. Sunderland
REASONS FOR DISPOSITION
(Dated May 12, 2025)
Introduction:
[1]. On September 8, 2006, Ms. Sin Kim was found not criminally responsible by way of mental disorder on a charge of failing to comply with probation, contrary to the Criminal Code of Canada. She is currently subject to a disposition of the Ontario Review Board, dated May 1, 2024, detaining her at the Forensic Service of the Centre for Addiction and Mental Health, Toronto (hereinafter referred to as “CAMH” or “the Hospital”) with privileges up to and including that of living in the community in accommodation approved by the person in charge of the Hospital. That disposition also subjects her to certain conditions, including that of refraining from contact or communication, direct or indirect, with the victim of the index offence and/or his family.
[2]. On March 12, 2025, a panel of the Ontario Review Board convened a hearing to review that disposition pursuant to section 672.81(1) of the Criminal Code. Ms. Kim was present for the hearing, represented by her lawyer Ms. Gaudet. A Korean English translator was provided for Ms. Kim.
[3]. The record for the hearing consisted of the Notice of Hearing dated January 30, 2025, the most recent Disposition (as mentioned, dated May 1, 2024) and the Reasons for that Disposition dated May 23, 2024. On the consent of all parties, a Hospital Report, dated February 19, 2025, was entered into evidence as an exhibit. A letter to the Board from CAMH dated March 10, 2025 re: Campbell Information, was marked as Exhibit 2.
[4]. The parties were canvassed for initial positions. The Hospital took the position that Ms. Kim continued to represent a significant risk to the safety of the public as that term is defined in section 672.5401 of the Criminal Code, and as it has been further explained by the Supreme Court of Canada in Winko v. British Columbia (Forensic Psychiatric Institute), 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625. It also took the position that it was necessary and appropriate, having regard to the objectives set out in section 672.54 of the Criminal Code, for Ms. Kim to continue to be subject to a detention order with privileges and conditions identical to those found in the detention disposition under review.
[5]. Both the representative of the Attorney General and counsel for Ms. Kim agreed with those positions, subject to questions they would have for Dr. Juliette Dupré, Ms. Kim’s treating psychiatrist, over the course of the hearing.
[6]. For the following reasons, the Board has agreed with that joint submission.
Evidence at the hearing
[7]. The evidence for the hearing came primarily from the Hospital Report mentioned and the live evidence offered by Dr. Dupré.
[8]. Turning first to the Hospital Report, it provides significant details regarding Ms. Kim’s family, education and employment history, as well as her medical and psychiatric history. It provides details associated with the index offence, as well as the predicate offence. These have been summarised in last year’s Reasons for Disposition as follows:
On May 20, 2004, Ms. Kim was convicted of criminal harassment. The sentence included an order placing her on probation. The victim was her previous physician, Dr. Im. On December 10, 2005, she breached a condition of the probation order by going to his home or place of business.
Dr. Im was a physician at St. Michael’s Hospital in Toronto. Ms. Kim entered his office in 1994 and informed him that in November 1994 a doctor had surgically removed a live fetus form her body. She claimed the child’s name was Johnny and insisted the victim was the father of the fetus. She began mailing him letters in 1998 and approached him at his church on two occasions in March 1998. Between March and July 1998, she attended the victim’s home on at least three occasions. Unwanted visits resumed in 2004 when she attended his office and church on three occasions between February and April of that year. On April 2, 2004, she attended the victim’s medical practice and advised him they were to be married on April 10, 2004, causing him to call the police and resulting in her arrests.
[9]. The Hospital Report further explains that Ms. Kim is now 78 years old and is a native of South Korea. She holds a nursing degree and has worked in Canada as a nurse’s aid. Following the birth of her first child, she stayed at home to raise that child and a second one.
[10]. The Hospital Report explains that Ms. Kim has struggled with major mental illness since the 1980’s when she began manifesting symptoms of psychosis and depression. She was followed for a period as an outpatient and received support from the Hong Fook Mental Health Association. She has a history of noncompliance with recommended medication in the community and became less functional over time. In 1999 she was assessed by Dr. I. Swayze at Old City Hall Court in Toronto following criminal charges of uttering threats. At that time her fitness to stand trial was considered marginal. While she has faced several charges in the past, only one of these led to a criminal conviction that appears on her criminal record – criminal harassment involving the victim of the index offence, dated May 20, 2004. Prior to this, she was charged with uttering threats in November 1998, but the outcome of that charge is unclear. She had contact with the police in 2000 as a result of harassing behaviours. According to her husband, she has a history of violence that has included damage to property and an assault on him with a kitchen knife.
[11]. Ms. Kim has no known history of alcohol or illicit drug misuse but reported using lorazepam on a regular basis for several years. When the clinical team tried to wean her off of this medication, she experienced psychological and physiological symptoms of withdrawal that were suggestive of a benzodiazepine dependence disorder.
[12]. The Hospital Report explains that Ms. Kim has historically struggled with insight regarding her major mental illness. She has continuously rejected the notion that she has a mental illness. Historically she has left her home to reside in shelters or with her brother for extended periods of time. She has maintained a consistent delusion that she has a relationship with Dr. Im. Her delusions have at times been religiously grandiose and she has endorsed hearing directions from God. She has been diagnosed with delusional disorder, erotomanic type.
[13]. In March 2009, Ms. Kim was discharged to the community to reside with her husband. She was eventually transferred to the North York General Hospital Assertive Community Treatment Team and attended every three weeks for her injection of antipsychotic medication but again became noncompliant with treatment. She believed that she was receiving direction from God who was telling her not to take the injections. She began expressing suicidal ideations. She had no insight into her mental illness or her need for ongoing medication. She was admitted to North York General Hospital on January 12, 2023, after being found unconscious in her basement following an intentional overdose of her medications. When transferred in April 2023 to Ontario Shores Centre for Mental Health Sciences (Ontario Shores), she harbored paranoid delusions, grandiose delusions with religious themes, and erotomanic delusions. She continued to believe that Dr. Im was her true husband.
[14]. As was noted in last year’s Reasons for Disposition, Ms. Kim began receiving electroconvulsive therapy on July 6, 2023, with the consent of her substitute decision maker (her husband). This resulted in significant improvement in her mood and psychotic symptoms. By September 2023, her erotomanic delusions regarding Dr. Im had completely resolved. She expressed regret that her behaviour had caused distress to her family. She continued, however, to deny having any mental illness and showed persistent lack of insight regarding her diagnosis or ongoing need for medication.
[15]. Her husband passed away from cancer on April 6, 2024. Since that time her sons, David Kim and William Kim, have been her main sources of family support. Their involvement has permitted her to spend time with family outside the hospital.
[16]. The Hospital Report’s update for this hearing begins at page 36. It notes that her mental status has fluctuated through this last review period. She has experienced periods of dysthymia, lability and irritability. These were usually experienced in relation to themes of grief and loneliness. She has expressed frustration over her ongoing treatment and hospitalization. She has endorsed some passive suicidal ideation when discussing having to continue to receive medication or undergo further electroconvulsive therapy. She continues to show poor insight into her diagnosis and lifelong need for treatment. She has frequently insisted that her long-acting injection be discontinued and has stated that she has either been cured of her schizophrenia, or that she was never ill. This lack of insight has persisted even when her psychotic symptoms have abated.
[17]. In summer of 2024, Ms. Kim began to again experience delusions with regard to Dr. Im. These began to include a belief that God had a plan for her and Dr. Im and progressed to the point where she was endorsing auditory hallucinations of God. She described herself as having experienced “beams” from God that made her feel dizzy and nauseous and that disrupted her sleep. Her medication was adjusted, and she began another acute course of electroconvulsive therapy on February 5, 2025. This led to some improvement in her preoccupation with Dr. Im and in some abatement of her delusions.
[18]. Ms. Kim, to her credit, has engaged with individual counselling that takes place once weekly. She has met periodically with spiritual care following her husband’s death. She is involved with on-unit recreational programs, including yoga, Tai-Chi and smile serenade. Other activities have been put on hold given her fixation on finding a husband and repeated struggles with erotomanic delusions. Ms. Kim uses accompanied passes to hospital grounds and the community. She enjoys the support of her family, including her two sons and daughters-in-law. In terms of physical health, she is monitored by the hospitalist for issues related to pain management, postural hypotension, increasing fall risks and osteoarthritis. She receives anti-inflammatory medication and has engaged successfully with physiotherapy for a shoulder injury.
[19]. Ms. Kim continues to be incapable of consenting to psychiatric treatment. The Public Guardian and Trustee is her substitute decision-maker. She is currently diagnosed with schizophrenia.
[20]. The Hospital Report includes a risk assessment that considers her key protective factors. These are the level of professional care she receives, her living circumstances, and the external control offered by the trusteeship of decisions involving psychiatric treatment and her continuing involvement with the Ontario Review Board. That risk assessment concludes that Ms. Kim’s risk of re-offending behaviour flows directly from the recurrence of psychotic phenomena which, when present, cause her to become preoccupied with fixed delusions that focus on Dr. Im and his son. Her re-offence scenario is described in the following terms:
If Ms. Kim were to re-offend, it will likely transpire in the following way: absent treatment and supports (both professional and personal), psychosocial destabilizers and/or a lack of insight will likely lead to non-compliance with medication, failure to cope, and increased guardedness which will result in inadequate psychiatric treatment, and worsening of her mental state, including an intensifying of psychotic symptoms which will then increase her risk of violence.
[21]. In her evidence, Dr. Juliette Dupré adopted the contents of the Hospital Report and provided further updates. She explained that Ms. Kim is two-thirds of the way through her electroconvulsive therapy. She said that the frequency of this therapy had been reduced owing to cognitive side-effects Ms. Kim was experiencing. She addressed further adjustments to Ms. Kim’s medications and explained that Ms. Kim’s indirectly supervised passes to hospital grounds had been reduced as a result of both the increased risk of falling and the deterioration of Ms. Kim’s mental status. Ms. Kim continues to access the community accompanied by her sons or staff.
[22]. Dr. Dupré explained that Ms. Kim suffers from a highly treatment resistant psychotic illness. She confirmed that Ms. Kim has returned to intense delusional beliefs about Dr. Im over the course of this review period and that she continued to lack insight into her illness. Ms. Kim still frequently asks to cease her injection. She expressed concern that Ms. Kim made active attempts to find Dr. Im this past review period through his pastor. Over the course of this review period, Ms. Kim believed a member of the public to be Dr. Im in disguise. Dr. Dupré explained that Ms. Kim continues to be unstable and her mental state is fragile. Her risk of harm is primarily psychological, however Dr. Dupré stated that there have been instances where Ms. Kim was physically aggressive. She said that a conditional discharge is not appropriate because Ms. Kim is at risk of rapid decompensation such that the provisions of the Mental Health Act would be inadequate to provide for the safety of the public, and the hospital requires the ability to approve her accommodation. Dr. Dupré did express hope that, following the completion of this round and a booster session of electroconvulsive therapy, Ms. Kim would be able to be discharged to the community. To this end, the treatment team is exploring retirement home options (Ms. Kim was declined for long-term care based on her high level of functionality). She was optimistic that a longer course of maintenance electroconvulsive therapy, optimization of Ms. Kim’s medications and some changes with her long-acting injectable antipsychotic medication would prevent similar decompensation to what Ms. Kim had experienced in the past.
[23]. In response to questions from Ms. Kim’s lawyer, Dr. Dupré explained that Ms. Kim and her family have all been involved in discussions involving a retirement home. Dr. Dupré expressed some concern that when Ms. Kim is unwell, she says that she wants to be in a home that will accommodate her and Dr. Im.
[24]. Dr. Dupré said that when Ms. Kim is unwell, her delusions are religiously grandiose. Meanwhile, when she is well, Ms. Kim’s religion provides her with a source of strength, particularly given the passing of her husband and her feelings of regret over the difficulties her family has experienced over the years of her struggles with her mental illness. She confirmed that, with regard to independent daily living, outside of Ms. Kim’s fall risk, she has high functional abilities that make retirement dwelling appropriate if the psychotic symptoms can be brought under sustained control.
Submissions
[25]. At the end of the hearing, the Hospital renewed its submission that Ms. Kim continued to represent a significant threat to the safety of the public. Its representative highlighted the resurgence of Ms. Kim’s delusions and her efforts to contact the victim of the index offence. While he acknowledged Ms. Kim’s progress with current treatments, he explained that these had not yet been completed, and that caution was needed as deterioration over this past review period following similar treatment was unexpected. He argued that there was no air of reality to any disposition other than that of a detention order at this time but said that community living privileges should remain in the disposition given the positive gains being seen. He suggested that the evidence supported the conclusion that Ms. Kim could stabilize sufficiently over this next reporting period such that a transition to a retirement home was a possibility.
[26]. The representative of the Attorney General and counsel for Ms. Kim both joined the Hospital in this submission. Counsel for Ms. Kim specifically argued that the disposition being recommended by the Hospital satisfied not just the primary objective set out in s. 672.54 of the Criminal Code (pertaining to assurance of the safety of the public) but also the other objectives of assuring that Ms. Kim’s mental health and other needs were met, including the ultimate objective of reintegration into the community.
Analysis and conclusion
[27]. While the Board benefitted from the joint submission, it nonetheless turned its attention carefully to the threshold issue of significant threat to the safety of the public. This attention arises from the serious nature of that issue in light of the provisions of section 672.5401 of the Criminal Code and the instruction given by the Supreme Court of Canada in Winko.
[28]. Section 672.5401 statutorily defines “significant threat” as follows:
For the purposes of section 672.54, a significant threat to the safety of the public means a risk of serious physical or psychological harm to members of the public — including any victim of or witness to the offence, or any person under the age of 18 years — resulting from conduct that is criminal in nature but not necessarily violent.
The Ontario Court of Appeal provided further insight as to the meaning of this term as it has also been explained in Winko. In Re Abeje, 2019 ONCA 734 at para. 19, the Court of Appeal says:
The meaning of the phrase “significant threat to the safety of the public” is well settled. It was summarized in R. v. Ferguson, 2010 ONCA 810, 264 C.C.C. (3d) 451, at para. 8:
The phrase refers to a foreseeable and substantial risk of physical or psychological harm to members of the public that is serious and beyond the trivial or annoying. A very small risk of even grave harm will not suffice. A high risk of relatively trivial harm will also not meet the substantial harm standard. While the conduct must be criminal in nature, not all criminal conduct will suffice to establish a substantial risk. There must be a risk that the NCR accused will commit a “serious criminal offence”.
[29]. In the case of Ms. Kim, the Board agrees with the joint submission. Ms. Kim suffers from a major mental illness that has persisted in its nature and character since the commission of the index offence many years ago. Her schizophrenia has been a contributing factor in previous assaultive, threatening, and harassing conduct. It is treatment resistant and Ms. Kim lacks insight into the fact that she has a major mental illness as much as she lacks insight into her lifelong need for medication. She has a history of noncompliance with treatment and continues to express a desire to cease her long-acting antipsychotic medication. She has manifested the primary symptoms of her psychosis over the course of this review period and has been unable to identify her delusions as such. Her delusions continue to be focused on the victim of the index offence but have, over the course of this review period, extended to another individual – a stranger that she thought was the victim of the index offence in disguise. Based on these factors, the Board is satisfied that Ms. Kim continues to represent a significant threat to the safety of the public, primarily in the form of psychological harm.
[30]. Turning to the issue of disposition, the Board is also satisfied that a continuation of the reigning detention order is necessary and appropriate having regard to the objectives set out in section 672.54 of the Criminal Code. Ms. Kim experienced a resurgence of primary psychotic symptoms following her first round of electroconvulsive therapy and is now in the midst of another round to be followed by a booster of the same treatment. There will be changes to her medications. All of this has been necessitated by virtue of a rapid return of delusions that fixated upon the victim of the index offence and extended, as mentioned, to a stranger that she believes was Dr. Im in disguise. There are currently no community options that are suitable to assure the safety of the public in the absence of a disposition, nor are there community supports that will address her mental health and other needs, including her falls risk and physical needs, absent the support of a detention disposition that permits the Hospital to respond quickly to signs of deterioration. Such an order will ensure that Ms. Kim completes the electroconvulsive therapy, its booster round, and then undergoes monitored changes to her antipsychotic medications. This in turn will help the Hospital identify and then transition Ms. Kim to an appropriate retirement home that will be suited to her personal circumstances. The Board is satisfied that no lesser disposition will either adequately ensure the safety of the public or ensure that Ms. Kim’s mental health and other needs (including the ultimate objective of reintegration into the public) are met. Accordingly, the Board agrees that a detention disposition is necessary and appropriate to manage the risk posed by Ms. Kim at this time.
[31]. The panel thanks all who have assisted in this hearing and joins the parties in hoping for the best of results for Ms. Kim over the course of the next review period.
[32]. An Order will issue accordingly.
DATED this 12th day of May, 2025, at the City of Toronto, in the Toronto Region.
Mr. D. Sandor Legal Member
Office of the Registrar Ontario Review Board