Ontario Review Board
Re: Frederica A. Wolch
ORB File No: 3698
Hearing held on: Friday, May 23, 2025
Place of hearing: Centre for Addiction and Mental Health 1001 Queen Street West, Toronto
Pursuant to: Sections 672.48(1) and 672.81(1) of the Criminal Code
Before: Alternate Chairperson: Ms. S. Kert Members: Dr. P. Prendergast Dr. M. Mamak Hon. B. Allen Mr. A. Bouvier
Parties Appearing:
Accused: Frederica A. Wolch Counsel: Ms. L. McCullough
The person in charge of hospital: Counsel: Mr. K. Dow
Attorney General of Ontario: Counsel: Mr. M. Feindel
REASONS FOR DISPOSITION
(Dated July 8, 2025)
Overview
[1]. On January 9, 2003, Ava Wolch was found unfit to stand trial on Criminal Code charges of assault causing bodily harm and mischief. Since that time, Ms. Wolch has remained unfit to stand trial and subject to dispositions of the Ontario Review Board, most recently a disposition dated July 12, 2024, detaining her at the General Forensic Unit of the Centre for Addiction and Mental Health (CAMH), with privileges extending to living in the community in accommodation approved by the person in charge.
[2]. On May 23, 2025, this panel of the Review Board convened at CAMH to review Ms. Wolch’s fitness to stand trial and her disposition. As has been the case for many years, Ms. Wolch did not attend the hearing. Her counsel (Ms. McCullough) confirmed that to the extent possible (given the fitness issue) Ms. Wolch had adequately instructed her to proceed with the hearing and that she was prepared to do so. As all parties were content to have the hearing in the absence of Ms. Wolch, we made an order allowing her to be absent pursuant to s. 672.5(10) of the Criminal Code.
[3]. The issues to be decided at this hearing are whether Ms. Wolch remains unfit to stand trial, if she is likely to remain permanently unfit and, if so, whether she poses a significant threat to the safety of the public. We are also required to decide the necessary and appropriate disposition for the coming year based on a consideration of the factors in s. 672.54 of the Criminal Code.
[4]. At the conclusion of the hearing, the parties agreed that Ms. Wolch remains unfit to stand trial, that her fitness is unlikely to improve in the future, that the test for significant threat is met, and that the necessary and appropriate disposition is the continuation of the current detention disposition, unchanged.
[5]. We agree with the joint position of the parties on all issues. These are our reasons.
Alleged Offences
[6]. The allegations giving rise to the charges of assault bodily harm and mischief are described in the hospital report which was filed at the hearing. On March 24, 2002, Ms. Wolch is alleged to have gotten on a TTC bus in Toronto and failed to pay the fare. When she started acting strangely, security officers were contacted and a second bus was called to the scene. During a transfer of the other passengers, Ms. Wolch attempted to board the second bus. When the TTC driver attempted to block her from doing so, she bit his arm and ran from the scene.
[7]. The mischief charge involves allegations that Ms. Wolch continually went to a café over a three to four-week period and threw baked goods on the floor. She was removed from the café by security staff numerous times but continued to return to the café and repeat the behaviour.
Background
[8]. The hospital report details Ms. Wolch’s personal, psychiatrist and criminal history. At the time of the hearing, Ms. Wolch was 63 years old. She has a current diagnosis of schizophrenia. She is incapable to consent to treatment or to manage her financial affairs, and her brother is her substitute decision maker for both. Ms. Wolch has now been under the jurisdiction of the Review Board for approximately 22 years.
[9]. Ms. Wolch completed a university degree but developed symptoms of mental illness in her early 20s. She has an extensive history of mental health contacts and has been described as suffering from a severe treatment resistant form of schizophrenia. Her history is replete with episodes of non-adherence with antipsychotic medication resulting in her engaging in aggressive and sometimes assaultive behaviours in the community.
[10]. Despite this history, Ms. Wolch has no criminal record. However, her history of psychiatric admissions involved a number of assaults on other persons (i.e. hitting passersby with her purse; physically assaulting several people on the street; biting and hitting hospital staff), which precipitated her admission to hospital rather than contact with the criminal justice system.
[11]. Following the finding of unfitness in respect of the index offence in January 2003, Ms. Wolch was detained as an inpatient at CAMH until being discharged to live in the community in late 2006. For periods prior to her discharge, Ms. Wolch required locked seclusion. There were incidents of AWOL or attempted elopements and assaults on staff and co-patients. She generally exhibited symptoms of psychosis, including frequently responding to internal stimuli and being unable to tolerate interactions with caregivers.
[12]. The first attempt to discharge Ms. Wolch into the community occurred in November 2006 when she moved to High Park Manor with follow-up from the West End ACT team. Her stay at this home was problematic. She remained psychotic and severely impaired by her illness. She frequently refused to take medication and was adherent only because of staff’s presence. Numerous admissions to CAMH were necessary, including an admission to CAMH in January 2012.
[13]. In May 2012, suitable accommodation was found for Ms. Wolch at Regeneration Community Services (Regeneration). That placement was much more successful. With the assistance and supervision of the CAMH high intensity case management program, Ms. Wolch has been living at Regeneration since 2012.
[14]. Since the finding of unfitness, Ms. Wolch has never agreed or been able to tolerate being fully assessed by her attending psychiatrist. She says very little to other people and has a hard time tolerating any lengthy interactions. Despite this, she has been able to continue to live without incident at Regeneration. Much of this success is the result of the care program that has been arranged between Ms. Wolch’s housing and her treatment team.
[15]. In August 2023, Ms. Wolch was admitted to CAMH after missing three consecutive doses of clozapine. In hospital she was minimally engageable but cooperative with bloodwork. There was no indication of a change in her behaviour or her baseline mental state. Her clozapine was re-titrated back to her recommended dosage and she was discharged home in mid-September, 2023. Four days later, Ms. Wolch was readmitted to CAMH having again missed her clozapine for three consecutive days. There were no concerns about her behaviour in hospital and after being re-titrated to her recommended dosage she was discharged home on October 10, 2023. She was returned to CAMH two weeks later, having missed two days of clozapine. She received a reduced dose of clozapine that night and another dose the following day and, with a new care plan in place, was discharged back home the following evening.
[16]. The new care plan is relatively straightforward - Ms. Wolch is observed by staff at Regeneration not only taking her clozapine, but actually swallowing it. If she misses even one dose, or if she is only partially adherent or spits out the medication, staff at the home advise the treatment team who bring her to hospital the following day to ensure she receives the appropriate dose of clozapine.
Course Since Last Hearing
[17]. At the current hearing we received evidence in the form of an updated hospital report, as well as the oral testimony of Dr. Agrawal, who has been Ms. Wolch’s outpatient psychiatrist for the past 13 years. That information revealed as follows: Over the course of the clinical year, Ms. Wolch continued to reside in the same Regeneration residence. While she had nine emergency department visits during this period, some lasting overnight, there were no formal admissions to CAMH. The clinical team is of the opinion that the new care plan (which ensures Ms. Wolch’s rapid return to hospital after a single missed dose of clozapine) has significantly reduced the necessity of lengthier hospital stays, which were previously required to re-titrate Ms. Wolch’s medication after longer periods of treatment non-adherence.
[18]. There was no significant change in Ms. Wolch’s clinical presentation over the year. She continues to be unable to tolerate any significant interactions. She rarely sits in the common areas of her building but can frequently be seen in the halls or elevator on her way in or out of the building. Generally she does not respond to greetings or questions, but occasionally will say hello. In the presence of family, notably her brother, she may sit for a few minutes of a meeting but does not typically speak directly to her caregivers, instead speaking softly to family members.
[19]. As a result of this presentation, Ms. Wolch’s thought form and cognition have never been fully assessed by Dr. Agrawal directly. He reports that it is difficult to have a discussion with Ms. Wolch on any topic. Dr. Agrawal went to see Ms. Wolch as recently as March 7, 2025, and found her at the home. On that occasion even making eye contact with Ms. Wolch was difficult. He spoke to her briefly but she declined to meet with him and walked away and out of the building. Based on his knowledge of Ms. Wolch, as well as her ongoing presentation, Dr. Agrawal’s assessment is that Ms. Wolch is not able to communicate in any meaningful way in respect of any substantive issue. Apart from ordinary pleasantries, she is not able to engage in conversation. Even attending a hearing such as the ORB (as she did many years ago) would now be very difficult for her and she is unlikely to engage.
[20]. In addressing the statement in the hospital report that Ms. Wolch is “almost certainly permanently unfit,” Dr. Agrawal said that although Ms. Wolch has been on clozapine for many years, she continues to experience symptoms of her major mental illness. He described that it appears that she has a very severe and treatment-resistant type of mental illness. There is no other known treatment option that does or would provide as much benefit or effectiveness to her as clozapine, and the likelihood of improvement in her mental status at this stage is very low.
[21]. When Dr. Agrawal was asked about the suitability of Regeneration on a continuing basis for Ms. Wolch, he said that it is excellent housing where she has been able to live for many years. Staff at Regeneration know Ms. Wolch and treat her well, providing meals and medication supervision, all on a 24/7 basis. Importantly, Ms. Wolch views Regeneration and the community around it as her home and she is comfortable there.
Analysis and Conclusion
[22]. The threshold issue for the panel to determine is whether Ms. Wolch remains unfit to stand trial. We have no difficulty finding that she meets the test for unfitness described in Bharwani, 2023 ONCA 203. As has been the case for many years, Ms. Wolch is unable to tolerate any significant conversation to discuss fitness issues or anything else. She would not be able to tolerate or engage in the court process in any meaningful fashion, and is unlikely to be able to instruct counsel. Given her inability to sit for any period of time, even in discussions with family, there is also little likelihood that she could be meaningfully present to participate in a trial proceeding.
[23]. We also find that Ms. Wolch is likely permanently unfit to stand trial. As described by Dr. Agrawal, despite treatment with clozapine Ms. Wolch has remained unfit for many years, and it is very unlikely that her fitness will change in the foreseeable future. Indeed, as she ages it is likely that both her physical and mental health will decline.
[24]. We also agree that the test for significant threat continues to be met. Although she has been on clozapine for many years, Ms. Wolch continues to regularly protest and object to the medication. Approximately six to 10 times per year she will refuse her medication or take only a partial dose, demonstrating that her internal commitment to ongoing treatment is low. When not as well treated, Ms. Wolch is known to engage in violent behaviours. Without clozapine she would decompensate and find herself in a situation where she is likely to act with violence towards community members.
[25]. Though it has been many years since the index offences, in recent years there has been some illustration of Ms. Wolch’s irritability even with containment with the use of clozapine. There was an incident in 2019 where Ms. Wolch was observed throwing a spoon at a Regeneration staff member. In 2020, Ms. Wolch was reportedly aggressive towards a staff member, grabbing and hitting the person’s arm while riding an elevator. While the severity of these incidents is relatively low, they do indicate that but for the current system in place (including supervised housing, close observation and monitoring of clozapine adherence), the potential for significant violence remains.
[26]. Finally, on the issue of disposition, we agree with the parties’ joint submission that the current detention disposition remains necessary and appropriate for the coming year. We accept the evidence of Dr. Agrawal that the system now in place is largely responsible for the significant successes that have been achieved in this case. Despite remaining unwell, Ms. Wolch has been able to live in the community for many years. The detention disposition allows her to be returned to hospital immediately should she miss a dose of clozapine, and the level of support, observation and risk management that she receives would be very difficult to emulate in a non-forensic environment. The housing at Regeneration is also a critical risk management tool. Staff know her well and the home has become her community. These are protective tools not only for Ms. Wolch’s physical and mental health, but also for the safety of the public.
[27]. Accordingly, considering the four factors in s. 672.54 of the Code, we find that the necessary and appropriate disposition, which is also the least onerous and least restrictive in the circumstances, is to continue the current detention disposition, and so order.
DATED this 8^th^ day of July, 2025, at the City of Toronto, in the Toronto Region.
Ms. S. Kert Alternate Chairperson
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Office of the Registrar Ontario Review Board