Re: Andy A. Ramlall
ORB File No: 6290
Hearing held on: Tuesday, April 29, 2025
Place of hearing: Ontario Shores Centre for Mental Health Sciences 700 Gordon Street, Whitby
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. G. Beasley Members: Dr. B. Sheppard (via Zoom) Dr. W. Loza Ms. C. Murray Mr. A. Bouvier
Parties Appearing:
Accused: Andy A. Ramlall Counsel: Mr. T. Whillier
The person in charge of hospital: Counsel: Ms. J. Szabo
Attorney General of Ontario: Counsel: Ms. N. MacDonald
REASONS FOR DISPOSITION
(Dated May 27, 2025)
Introduction
On February 22, 2013, Mr. Andy A. Ramlall was found not criminally responsible on account of mental disorder (“NCR”) on one charge each of utter threat to cause death or bodily harm and assaulting a police officer and two charges of assault, all contrary to the Criminal Code of Canada (the “Criminal Code”).
On April 29, 2025, a panel of the Ontario Review Board (“Board” or “panel”) convened to review Mr. Ramlall’s current Disposition pursuant to s. 672.81(1) of the Criminal Code. At the time of the hearing, Mr. Ramlall was ordered detained within the Forensic Program at Ontario Shores Centre for Mental Health Sciences (“Ontario Shores” or “the hospital”), with privileges up to and including living in the community in accommodation approved by the person in charge.
Mr. Ramlall was present at the hearing and represented throughout by his counsel, Mr. Thomas Whillier.
A Hospital Report dated April 17, 2025, was entered as Exhibit 1.
The issues to be determined are whether Mr. Ramlall continues to represent a significant threat to the safety of the public, and if so, the necessary and appropriate Disposition to manage that risk having regard to the criteria set out in s. 672.54 of the Criminal Code.
For the reasons set out below and based on the evidence and opinions before us, the Board found that Mr. Ramlall continues to represent a significant threat to the safety of the public. The Board finds that a Detention Disposition within a General Forensic Unit at Ontario Shores is the necessary and appropriate Order having regard to the safety of the public, which is the paramount concern, and also having regard to Mr. Ramlall’s mental health, reintegration into society, and his other needs.
Current Psychiatric Diagnoses
- Schizophrenia; Unspecified Anxiety Disorder; Cocaine Use Disorder, in sustained remission in a controlled environment; Cannabis Use Disorder, in sustained remission in a controlled environment; Alcohol Use Disorder, in sustained remission in a controlled environment; and Antisocial Personality Disorder Traits
Position of the Parties
At the commencement of the hearing, the parties were canvassed for their without prejudice positions. The hospital, represented by Ms. Jessica Szabo, supported by counsel for the Attorney General, Ms. MacDonald, took the position that Mr. Ramlall continues to represent a significant threat to the public and the necessary and appropriate Disposition is a continuation of the current Detention Order on the same terms as last year.
Counsel for Mr. Ramlall, Mr. Whillier, conceded significant threat and agreed with the hospital’s recommendations. However, Mr. Whillier requested an exclusion for cannabis and alcohol in clause 4(a) of the Disposition.
Index Offence
- The details of the index offences are found in the Hospital Report. They are summarized herein as follows:
On October 8, 2010, Toronto police received a call to attend an Esso Station. Upon their arrival, Mr. Ramlall ran from the scene and, as the officers gave chase, he shouted a threat to kill the police. He was charged with uttering a threat to cause death and assault police.
On April 11, 2012, without warning or provocation, Mr. Ramlall punched the victim who had exited a building in Toronto, striking the victim twice on the right side of the face and causing the victim to fall to the ground. An unidentified person drew the attention of Mr. Ramlall away from the victim. Mr. Ramlall moved toward the unidentified person saying, “I’m going to fuck you. I’m going to take my pain out on you,” causing this person to flee. Police arrived and Mr. Ramlall approached the officer stating, “I will fuck you up. I will make you feel my pain.” He moved toward the officer with clenched fists and arms waving. The officer placed Mr. Ramlall under arrest.
Background and History
The Hospital Report contains extensive information regarding Mr. Ramlall’s background and history, the entirety of which need not be repeated here in detail. However, the following particulars are noteworthy.
Mr. Ramlall is a 40-year-old male who immigrated to Canada at the age of nine from St. Lucia. He has a high school education.
Mr. Ramlall has prior criminal charges for assault and utter threats in 2005, and theft under in 2008 and 2009. The Hospital Report outlines further convictions for use of imitation firearms, threaten death, theft, mischief, possession of marijuana, assault, assault police officer, and failure to comply with probation.
Mr. Ramlall reported that he had approximately five prior psychiatric admissions for psychosis exacerbated by drug use. He admitted to having been non-compliant with psychotropic medication and psychiatric care.
Mr. Ramlall historically used cannabis daily and abused crack cocaine. He also admitted to having consumed alcohol and had been arrested after being involved in incidents while intoxicated.
Mr. Ramlall worked in restaurants primarily as a line cook. However, he has not worked in a number of years.
Historically, Mr. Ramlall regularly stayed at shelters. He acknowledged that he struggled to maintain housing given his mental illness and non-compliance with medication.
Mr. Ramlall is supported by the Ontario Disability Support Program (“ODSP”).
For the entirety of at least the past two reporting years, Mr. Ramlall remained an inpatient on the general Forensic Transitional Unit (FTU).
Evidence at the Hearing
The Board had available to it the evidence and documents forming the Record, the Hospital Report, and oral evidence of Dr. Alioglu Karayilan (“Dr. Alioglu”), Mr. Ramlall’s psychiatrist and clinical fellow in psychiatry. She co-signed the Hospital Report along with Dr. Hartfeil who was also present at the hearing and provided oral evidence for clarification of some issues. In addition, Mr. Ramlall gave oral evidence.
There were no incidents of violence, relapse to substance use, or elopements in the past reporting year.
In the past year, Mr. Ramlall was observed to have mood lability and mild disorganization of thought processes.
Mr. Ramlall remained capable of consenting to psychiatric treatment, although capacity is continually reassessed because his capacity is considered by the doctor to be marginal. He continued to express resistance to recommended medication adjustments related to mood stabilization and social anxiety.
In July 2024, Mr. Ramlall had a brief episode of deterioration during which time he exhibited significant affective lability, psychomotor agitation, disorganized and tangential speech, and paranoid ideation. He also engaged in unusual behaviours.
Mr. Ramlall continues to display frequent inconsistencies in thought organization and vague, scattered, or disjointed communication.
Mr. Ramlall remained compliant with medication, although he was primarily motivated by a desire to follow rules rather than internal motivation or treatment engagement. At times he remained fixated on reducing his medication dosage without any apparent reason.
Mr. Ramlall’s insight remained limited. His insight into his illness, risk, and need for treatment are underdeveloped. However, he is able to identify symptoms of his psychotic illness.
Mr. Ramlall enjoys unlimited indirectly supervised hospital grounds privileges up to four hours with a two-hour check-in, as well as one six-hour indirectly supervised community privilege with a three-hour check in. He is required to carry a hospital cell phone with him at all times while exercising indirectly supervised privileges.
Mr. Ramlall does not have and Approved Person.
According to the Hospital Report, in the past year Mr. Ramlall remained ambivalent about his eventual transition to the community. He accepts that he will be placed in whatever type of housing the hospital approves. He was referred to housing through the Canadian Mental Health Association (CMHA). However, CMHA declined his referral until he demonstrates improved mental health consistency and decreased ambivalence. He is adamantly opposed to housing through Durham Mental Health Services (DMHS) because of a previous negative experience. However, he has agreed to a referral to the DMHS complex care program.
Dr. Alioglu testified that she would like the alcohol and cannabis prohibition to remain in the Disposition because these substances are one of the biggest risk factors for Mr. Ramlall. The Hospital must be able to intervene quickly when needed when there are psychotic symptoms related to substance use. Around the time of the offence Mr. Ramlall was using cannabis and alcohol on a daily basis. He currently has residual symptoms of his mental illness. If he used cannabis or alcohol his mental state would deteriorate even further including hallucinations and delusions, which would result in violent behavior and significant risk to the safety of the public.
Dr. Alioglu testified that if Mr. Ramlall used substances, it would impact his ability to be discharged to housing in the community. His daily functions are already impaired. The use of substances would cause an increase in disorganization. He would disengage from professional services and personal support systems. Mr. Ramlall is considered marginally capable to consent to treatment at this time. However, the use of alcohol and cannabis would likely affect his capacity.
Mr. Ramlall does not have specific life goals and has difficulty setting clear objectives. Dr. Alioglu testified that the treatment team is trying to deal with this issue but Mr. Ramlall is declining group treatment. The occupational therapist, recreational therapist, and psychotherapist are all working on helping him to engage in treatment.
Dr. Alioglu testified that Mr. Ramlall has reluctantly agreed to group home referrals. He was declined from Canadian Mental Health Association (CMHA) housing. The referral to MacKay House is still in the review process. MacKay House is a 24-hour supervised complex care program.
Dr. Alioglu testified that Mr. Ramlall agrees to take his medications but there are still times that he asks for a decrease in his medications and times he asks to be able to use cannabis and alcohol. He is unable understand how substance use affects his risk to the public and does not appreciate medication in the control of his mental disorder.
In response to questions of Mr. Whillier, Dr. Alioglu testified that in 2017 Mr. Ramlall was involved in an altercation in a group home when he was using alcohol. She states that this altercation was a direct result of the use of alcohol. She further pointed out that Mr. Ramlall was readmitted to hospital from the community in 2016 due to cocaine and marijuana use, with the risk of substances increasing his violent behaviour. If he were allowed to use cannabis or alcohol, he would abuse these substances. She highlighted Mr. Ramlall’s clear substance use disorder history.
Dr. Hartfeil provided oral evidence. She stated that Mr. Ramlall engaged in significant alcohol and cannabis use during the period of time that covered both index offences. He has a history of non-responsible use of substances around the time of the index offences and she expects this would be true if he were allowed to use alcohol and cannabis at this time.
Dr. Alioglu testified that before Mr. Ramlall receives community living, the treatment team will need to see that Mr. Ramlall is less disorganized. She believes that community living is possible in the coming year.
Mr. Ramlall has been on a General Forensic Unit for at least three or four years. In response to a question of a panel member, she conceded that the least onerous and least restrictive Disposition would be detention on a General Forensic Unit.
Mr. Ramlall has undergone random weekly urine drug screens (UDS) in the past year, which seem to follow a pattern of more or less every twelve days.
At the completion of Dr. Alioglu’s evidence, Mr. Ramlall gave oral evidence. He testified that he wants the alcohol and cannabis provision removed from his Disposition so that he has a choice. He says he wants to have some enjoyment during social gatherings. He stated that he does plan to use alcohol and cannabis if he has a choice, though he stated he does not intend to use it daily. When asked by Ms. MacDonald if marijuana had ever affected his mental state, he stated “I don’t know. No, not really.”
Mr. Ramlall testified that alcohol motivated him in the past to work and to get up in the morning. He was unable to answer what would be the maximum amount he would consume if he was allowed.
Analysis and Conclusions
Having heard and considered the entirety of the evidence as well as the submissions from the parties, the Board independently finds that Mr. Ramlall remains a significant threat to the safety of the public.
Mr. Ramlall’s risk to the public stems from his schizophrenia. He also has substance use disorders and an anxiety disorder that contributes to the risk. Although Mr. Ramlall has had a good year, he continues to have residual symptoms.
Mr. Ramlall is adherent to his medication regimen because he has a desire to follow rules, rather than having any internal motivation to comply with his medication regimen. His insight into his illness, risk, and need for treatment is underdeveloped.
The Board accepts and relies on the clinical risk assessment that Mr. Ramlall’s risk to the public safety would be considered moderate-low with a continuation of his current disposition but would elevate to moderate-high if granted a Conditional Discharge at this time.
Mr. Ramlall remains ambivalent about engaging with supports, medication, psychotherapeutic treatment, and supervised housing. He agreed to group home referrals, but he has also expressed a desire to live in an independent apartment or even in a homeless shelter.
Mr. Ramlall does not appreciate the risks associated with using cannabis and alcohol.
The Board accepts the hospital’s evidence that were Mr. Ramlall to have inadequate supervision and support, or if he did not have conditions prohibiting alcohol and cannabis use, he would likely relapse with respect to substance use, further withdraw from psychiatric supports, and reduce or discontinue medication. He would then likely experience a re-emergence of his psychotic symptoms. In this context, given the preponderance of evidence, he would then be at high risk of causing serious physical and/or psychological harm to the public.
In light of the Board’s finding of significant threat, it is charged with shaping a Disposition for the coming year.
A continuation of the Detention Order is necessary to ensure that the hospital is able to approve Mr. Ramlall’s housing should he become appropriate to live in the community in the coming year.
Mr. Ramlall has been managed on a General Forensic Unit for at least three or four years without incident. The Board feels that the Disposition should reflect his progress in this regard.
The Board finds that the necessary and appropriate, least onerous and least restrictive Disposition is a Detention Order on a General Forensic Unit at Ontario Shores, on the same terms as last year.
It was clear from the evidence presented that alcohol and cannabis must remain prohibited for Mr. Ramlall. The Board accepts Dr. Hartfeil’s evidence that Mr. Ramlall engaged in significant alcohol and cannabis use during the period of time that covered both index offences and she expects he would engage in irresponsible alcohol and cannabis use if his Disposition did not restrict such use at this time. As stated earlier, if Mr. Ramlall’s Disposition did not have conditions prohibiting alcohol and cannabis use, he would likely relapse with respect to substance use, further withdraw from psychiatric supports, and reduce or discontinue medication. He would then likely experience a re-emergence of his psychotic symptoms, which the Board finds would create a high risk of physical or psychological harm to the public.
The panel would like to thank Mr. Ramlall for giving his evidence at this hearing. We know that it was extremely difficult for him to do so, but we sincerely appreciate his efforts to be actively engaged in the hearing process. We wish him all the best on his road to wellness.
DATED this 27th day of May 2025, at the City of Toronto, in the Toronto Region.
Ms. Christine Murray Legal Member
Office of the Registrar Ontario Review Board