Ontario Review Board
Re: Stephen Sapielak
ORB File No: 7718
Hearing held on: Friday, May 9, 2025
Place of Hearing: Centre for Addiction and Mental Health
Pursuant to: Section 672.81(1) of the Criminal Code
Before: Alternate Chairperson: Ms. L. Banks Members: Dr. T. Verny Dr. G. Nexhipi Mr. K. McKenna Mr. W. Apted
Parties Appearing: Accused: Stephen Sapielak Counsel: Mr. A. Confente
Person in charge of Hospital: Counsel: Ms. A. Marshall Attorney-General of Ontario: Counsel: Mr. M. Feindel
REASONS FOR DISPOSITION (Dated June 18, 2025)
Introduction:
On April 9, 2020, Stephen Sapielak was found not criminally responsible on account of mental disorder (“NCR”) on charges of indecent act and failure to comply with probation (x2) contrary to the Criminal Code of Canada. He is currently subject to a Detention Order Disposition dated May 27, 2024, which orders him transferred from St. Joseph’s Healthcare Hamilton to an all-male unit at the Centre for Addiction and Mental Health (“CAMH” or the “hospital”) and provides various terms and conditions, including the opportunity to reside in the community of Southern Ontario in supervised accommodation approved by the person in charge.
On May 9, 2025, the Board convened a hearing to conduct the annual review of Mr. Sapielak’s Disposition pursuant to section 672.81(1) of the Criminal Code. Mr. Sapielak was present at the hearing and represented by his counsel, Mr. Confente.
The issues to be determined at the hearing were whether Mr. Sapielak continued to represent 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 which was also the least onerous and least restrictive taking into account the factors set out in section 672.54 of the Criminal Code.
For the reasons set out below, the Board unanimously finds that Mr. Sapielak represents a significant threat to the safety of the public. The Board finds that the necessary and appropriate Disposition is that he be bound by the terms of his existing Detention Order Disposition, albeit deleting all references to his detention at St. Joseph’s Healthcare, Hamilton.
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 Mr. Sapielak continued to represent a significant threat to the safety of the public and that the necessary and appropriate Disposition was a continuation of the current Detention Order on the same terms, albeit deleting all references to his detention at St. Joseph’s Healthcare, Hamilton.
Counsel for the Attorney General supported the hospital position.
Counsel for Mr. Sapielak advised that his instructions were to seek an Absolute Discharge.
All parties maintain their respective initial positions in closing submissions.
Index Offences:
- The allegations giving rise to the index offences are summarized in last year’s Reasons for Disposition, as follows:
“On November 18, 2019, Mr. Sapielak was sitting in the waiting room of the Niagara Health System, a general hospital in St. Catharines. He was there for pre-existing ankle and back injuries. The waiting room was busy with several patients ranging in age from infancy to elderly. The charge of indecent act arose after Mr. Sapielak was observed to be masturbating under his clothes in the waiting room, and someone alerted the police. At the time, Mr. Sapielak was subject to a probation order requiring that he keep the peace and be of good behaviour. On arrest, Mr. Sapielak was searched and admitted to having a syringe somewhere in the lining of his jacket, but he could not recall whereas he had recently used crack cocaine.
On March 26, 2019, the accused was convicted of Unlawfully in a Dwelling House. He received a probation order and one of the terms was not to be within 100 metres of that location. On November 26, 2019, the police discovered Mr. Sapielak within 100 metres of this building and he was arrested for breaching a term of his probation.”
Background Information:
The details of Mr. Sapielak’s personal, psychiatric and criminal history are set out in the Hospital Report dated April 28, 2025 (the “Hospital Report”) which was entered as an Exhibit at the hearing and need not be repeated in detail here. As well, we have relied extensively on last year’s Reasons for Disposition. Briefly stated, Mr. Sapielak is 55 years old. He has two siblings. He was raised primarily by his mother after his father (who was reportedly verbally and emotionally abusive to Mr. Sapielak) left the family when Mr. Sapielak was young.
Mr. Sapielak was born with an inherited medical condition known as osteogenesis imperfecta (also known as brittle bone disease). This condition greatly impacted his health and development as a child and resulted in him experiencing a number of bone fractures from falls and assaults. Although he was able to complete grade 9, there is information that Mr. Sapielak was bullied, and both physically and sexually abused in school.
Mr. Sapielak has a longstanding substance abuse history. According to health records, he began using alcohol and other substances heavily when he was approximately 18, including regular use of alcohol, cocaine, crack cocaine, crystal methamphetamine, heroin and prescription opiates.
Prior to the Index offences, Mr. Sapielak was homeless and was accessing the shelter system in St. Catharines. At the time he was receiving psychiatric follow-up care from the ACT team in St. Catharines. Health records from the ACT team indicate that Mr. Sapielak was transient and that the team often drove around the community in an effort to locate him to administer his long-acting antipsychotic medication. They were not always successful. Mr. Sapielak apparently received his injectable medication approximately two weeks before the index offences but was abusing substances.
Criminal History:
- Mr. Sapielak also has an extensive criminal record, commencing in 1987 and consisting of over fifty convictions. Many of his convictions were for non-violent offences (failure to comply, theft, break and enter). However, he was also convicted of offences involving violence, including robbery (in 1990 and 1992), eight convictions for assault between 1990 and 2015, and a conviction for arson in 2004. There are also reports that historically Mr. Sapielak threatened and assaulted his siblings and mother, and he has a history of acting aggressively while on inpatient units and at housing facilities.
Psychiatric History:
Mr. Sapielak’s first psychiatric hospitalization was in 1993, after he attempted to blow up his father’s apartment by turning on the burners of the gas oven. He was subsequently hospitalized several times following increased psychotic symptoms and mental health deterioration, suicidal and homicidal ideation, aggressive and inappropriate behaviour, and an inability to care for himself. Mr. Sapielak also presented to emergency psychiatric services on multiple occasions with suicidal ideation and threats.
Between 2006 and 2018, Mr. Sapielak received outpatient psychiatric follow-up in the community from the Community Schizophrenia Services and Assertive Community Treatment Teams (“ACTT”) in Hamilton and St. Catharines. Mr. Sapielak was frequently incarcerated during the same period.
In the community, Mr. Sapielak struggled to maintain both independent and supportive housing. Despite his ongoing involvement with intensive mental health case management services and support from his family, Mr. Sapielak’s housing arrangements were short-lived due to his aggressive and problematic behaviours, as well as his substance abuse.
Current Diagnoses:
- Mr. Sapielak’s current diagnoses are:
Schizophrenia, active and treatment resistant Unspecified Neurocognitive Disorder Stimulant Use Disorder, in remission in a controlled environment Opiate Use Disorder, in remission in a controlled environment
- The Hospital Report indicates that psychological testing showed that that Mr. Sapielak has serious deficits with memory and attention, as well as moderate deficits with language reasoning and undertaking spatial relations. This impairment is likely to cause problems with his daily functioning such as efficient social interactions, and recalling fundamental recent life details.
Evidence at the Hearing:
The evidence at the hearing consisted of the Hospital Report, supplemented by the oral evidence of Dr. M. Kravtsenyuk, Mr. Sapielak’s attending psychiatrist. The doctor advised that she has been involved in his care since his transfer to CAMH from St. Joseph’s on August 8, 2024.
Mr. Sapielak continues to be assessed as incapable to consent to his psychiatric treatment and his mother acts as his substitute decision maker (“SDM”). The mainstay of his treatment is a long-acting injection of the antipsychotic medication, Zuclopenthixol decanoate, which he receives every 10 days. He also takes a daily oral dose of the antipsychotic medication, Loxapine. He also utilizes PRN medication when needed.
Dr. Kravtsenyuk noted that Mr. Sapielak was briefly trialled on clozapine in the past and although there was some improvement in his symptoms and behaviour. Unfortunately, due to his brittle bone disease, he had a high risk of pneumonia and due to the risk of aspiration resulting from hypersalivation, treatment with clozapine had to be withdrawn. At the present time, there are no changes being contemplated with respect to his medications. The doctor stated that his physical conditions are being closely monitored.
While his symptom load has improved with adherence to his prescribed medications and use of PRN medications, Mr. Sapielak continues to experience significant residual psychotic symptoms. Including, auditory and visual hallucinations, delusions, cognitive deficits, anxiety and agitation. He presents with ongoing behavioural and affective instability and has frequent conflicts with staff and co-patients. His cognitive deficits are particularly pronounced with regard to memory and executive function. His cognition is expected to decline further as he ages.
The Hospital Report indicates that “While he typically presented as calm, pleasant and cooperative, his behaviour could become labile, marked by episodes of irritability, impulsivity and threatening conduct. He consistently displayed intrusive inpatient and impulsive behaviours with poor judgement and limited insight. … Mr. Sapielak demonstrated long engagement in unit activities and often became frustrated or rude when his needs were not met.
Mr. Sapielak displayed persistent persecutory delusions and accusatory thinking. He frequently accused staff of stealing, poisoning his food, or plotting against him, often escalating to direct threats.
He demonstrated grandiose delusions involving female staff, such as claiming romantic relationships or cohabitation.”
Mr. Sapielak has also posed as a threat of harm to himself and, on October 6, 2024, he reported a desire to cut his own throat. PRN medication was given and with staff support, he settled.
Mr. Sapielak is currently detained on a secure forensic, all-male, unit at the hospital. There have been no significant concerns with regard to his interactions with female hospital staff.
The Hospital Report is replete with examples of concerning behaviours over the year in review marked by “…intrusive behaviours and fluctuating emotional regulation, requiring continuous monitoring, redirection and structured support”. It states that “Mr. Sapielak frequently exhibited verbal and physical aggression, often in response to perceived slights or unmet demands. He routinely escalated quickly when limit-setting was required, typically engaging in yelling, verbal threats, door slamming, and aggressive posturing.”
Dr. Kravtsenyuk stated that to her knowledge, Mr. Sapielak was only involved in one physical altercation over the year in review. Specifically, the Hospital Report indicates that on February 12, 2025, he became physically assaultive with a co-patient.
Mr. Sapielak fluctuated with regard to his engagement in therapeutic, recreational and social programming over the past reporting period. He did attend programming aimed at social skills development, symptom management, and cognitive rehabilitation. These included CBT Stress and Coping, CBT Our Choice, TN Communicating and Connecting, Start Now, and Concurrent Disorders Skills Group. As well, he participated in recreational and unit-based activities.
The doctor testified that Mr. Sapielak has also been engaged as a cleaner on the unit and he has been commended for his good work.
To his credit, Mr. Sapielak has been engaged in individual therapy sessions with the team’s behavioural therapist. The behavioural therapist works with Mr. Sapielak on his adaptive coping strategies and he has responded well in his engagement to date.
Mr. Sapielak progressed to Level 4 passes, allowing for accompanied hospital grounds passes nearly daily. He also used staff accompanied community passes, approximately 14 times, but when doing so staff noted consistent difficulties with boundary adherence and behavioural expectations. He understands that if he does not use privileges appropriately, that they will be temporarily withheld.
In response to questions related to the discretionary passes set forth in paragraph 5(f) of his current Disposition which provide for indirectly supervised passes for up to 7 days, the doctor stated that the passes might have been included in the past to motivate Mr. Sapielak to work towards a family visit or, potentially, to use the passes as part of the discharge planning process. The doctor thought the passes might be motivational for Mr. Sapielak.
To his credit, Mr. Sapielak has maintained his abstinence from substances over the year in review; however, this success must be seen within the context of the hospital’s structured and closely monitored stetting. He has verbalized cravings and intentions to use illicit substances but it is very limited opportunity to relapse given the high degree of supervision he receives. Of note, however, on October 11, 2024, Mr. Sapielak was found attempting to snort crushed Tylenol. He has said that he snorts the medication to "kill the worms in his nose" and stated he planned to inhale the medications to remove them. Further, on March 8, 2025, while on a staff accompanied pass in the community, Mr. Sapielak commented to staff that he had a craving to use cocaine.
Mr. Sapielak continues to express extremely limited insight into his mental health, cognitive, and substance use difficulties, and history of nonadherence to medication. However, the doctor noted that with intensive structure and support, he is cooperative and compliant with his medications.
The doctor commented that Mr. Sapielak continues to present as a risk to both staff and patients and himself. He requires close monitoring on a secure forensic unit.
Should he be granted an Absolute Discharge, the doctor stated that Mr. Sapielak does not have a residence in the community. His cognitive deficits are so profound that he requires intensive professional supports. The doctor testified that Mr. Sapielak would require supervised and supported accommodation if living in the community to assist with medication supervision, provision of meals, and ADLs.
In terms of housing wait lists, Dr. Kravtsenyuk was not able to advise as to Mr. Sapielak’s status on same but she commented that he will require high support, staff-supervised facility that can assist with his chronic medical and mental health needs.
Dr. Kravtsenyuk specifically endorsed the findings in the Hospital Report which states:
“Overall, Mr. Sapielak’s long-term risk for future violence is high. Without the supervision of the Board, Mr. Sapielak will immediately pose a significant threat to the safety of people he encounters, predominantly because of the ongoing active psychotic symptoms and his poor social behaviour. His desire to seek substances, opioids in particular, also places him at high risk of conflict. It is also likely to occur in any non-secure and unstructured setting where if Mr. Sapielak to stop his medications, it is likely that he would experience rapid intensification of his current symptoms of psychosis. Taken in totality, the clinical team opines that Mr. Sapielak represents a significant threat to the safety of the public as defined in Section 672.540. At the present time, Mr. Sapielak appears to require ongoing structured and supportive settings and monitoring of his mental state for any fluctuations given his age, co-morbidity and prolonged institutionalization.”
Dr. Kravtsenyuk indicated that in the treatment team’s assessment, the only appropriate Disposition is a Detention Order given Mr. Sapielak’s mental disorder, cognitive difficulties, delusions and current risk of aggression. He continues to require in-patient admission at this time.
Mr. Sapielak also testified at the hearing. He stated that if he received an Absolute Discharge, he would get housing. If he could not access his money, he testified that he could live on the streets, maybe in Niagara.
If he was discharged, he would continue to take his medications, including Trazadone and Abilify because he likes those medications. He was not certain what would happen if he stopped his medications.
If he was not feeling mentally well, he said he might go outside or walk to his father’s home to speak to his father.
When asked, he stated that he works as a cleaner on the unit and it is “ok” work. He also agreed that he goes to programs at the hospital but commented that he preferred the programs offered at Hamilton.
He stated that he does not know why he was arrested. He stated that he was a “test-tube baby”. Much of his testimony was unclear and was difficult to follow.
No further evidence was called by the parties.
Analysis and Conclusions:
In the Board’s assessment, the evidence clearly supports a finding that Mr. Sapielak constitutes a significant threat to the safety of the public as defined in the Criminal Code and elucidated by the Supreme Court in Winko. Despite supervised compliance with his prescribed treatment, Mr. Sapielak continues to act out with both verbal and physical aggression and he continues to experience active symptoms of his mental illness. Given his propensity to respond aggressively and impulsively, particularly when stressed or frustrated, he engages in indiscriminately assaultive behaviours. Mr. Sapielak’s presentation is further complicated by significant cognitive impairment, including borderline intellectual function.
Having found that Mr. Sapielak constitutes a significant threat to the safety of the public the Board has only two alternative dispositions available to it. Section 672.54 of the Criminal Code provides that where a finding of significant threat has been made the Board must either order the Board must impose the Disposition which is the least onerous and least restrictive available to manage risk. The Board finds that there is no air of reality at the present time, to a less restrictive Conditional Discharge Disposition. Mr. Sapielak requires a prolonged hospital admission. He continues to require admission on an all-male unit at the hospital on the same terms and conditions as set out in the current Disposition albeit deleting all references to Mr. Sapielak’s detention at St. Joseph’s Healthcare, Hamilton.
In making this Disposition, the Board has reviewed the provisions of s. 672.54 of the Criminal Code and has carefully considered the need to protect the public from dangerous persons, Mr. Sapielak’s mental condition, his reintegration into society and his other needs.
DATED this 18th day of June, 2025, at the City of Toronto, in the Toronto Region.
Ms. L. Banks Alternate Chairperson
Office of the Registrar Ontario Review Board