Ontario Review Board
Re: Pierre Vezina
ORB File No: 3881
Hearing held on: Wednesday, May 28, 2025
Place of Hearing: St. Joseph’s Healthcare Hamilton, West 5th Campus
Pursuant to: Section 672.81 (1) of the Criminal Code
Before:
Alternate Chairperson: Ms. S. Clapp
Members: Dr. M. Attia
Dr. T. Stirpe
Mr. E. Siebenmorgen
Ms. R. Chopra
Parties Appearing:
Accused: Pierre Vezina
Counsel: Mr. A. Confente
The Person in Charge of hospital: Counsel: Ms. L. Barney
Attorney General of Ontario: Counsel: Mr. B. Adsett
REASONS FOR DISPOSITION (Dated July 7, 2025)
Introduction
On December 4, 2003, Pierre Vezina, now 62 years old, was found not criminally responsible on account of mental disorder (“NCR”) on a charge of possession of a weapon for a purpose dangerous to the public peace, contrary to the Criminal Code. He has now been subject to the jurisdiction of the Ontario Review Board (“ORB” or “the Board”) for over 21 years. Mr. Vezina was most recently subject to a Disposition of the Board dated May 21, 2024 pursuant to which he was ordered detained at the Forensic Psychiatry Program of St. Joseph's Healthcare Hamilton, West 5th Campus (“SJHCH” or “the Hospital”), subject to various conditions and privileges, up to and including community living within the catchment area of the Hospital in accommodation approved by the person in charge.
On Wednesday, May 28, 2025, a panel of the Board convened in person at the Hospital to review Mr. Vezina’s Disposition and make a new Disposition. The issues at the hearing were whether Mr. Vezina represents a significant threat to the safety of the public as that term is defined in s. 672.5401 of the Criminal Code and, if so, to determine the necessary and appropriate Disposition that is also the least onerous and least restrictive, as determined through a consideration of the factors in s. 672.54 of the Code. Mr. Vezina did not attend the hearing but was represented by his counsel, Mr. Confente.
The panel addressed Mr. Vezina’s absence at the outset of the hearing. Mr. Confente advised that his client was attending a volunteering opportunity and accordingly could not be at his hearing. Mr. Confente advised that he had Mr. Vezina’s instructions to proceed with the hearing. Neither of the other parties objected to proceeding in Mr. Vezina’s absence, and an order was made permitting Mr. Vezina to be absent from his hearing, pursuant to s.672.5 (10) (a) of the Criminal Code.
A second preliminary matter was dealt with quickly. Mr. Confente formally advised the panel that he was withdrawing his client’s request, previously made through a Rule 13 Notice, for an order transferring him to the Centre for Addiction and Mental Health (“CAMH”) in Toronto. Mr. Confente noted that no response to the request had been received from CAMH.
The evidence at the hearing consisted of the Hospital Report dated April 16, 2025, and the oral evidence of Dr. W. Sutton, Mr. Vezina’s attending psychiatrist.
Positions of the Parties
- At the start of the hearing, in response to an invitation to state their preliminary, without prejudice positions, counsel for all parties advised that they were jointly recommending a Detention Order with no changes from the current Disposition. The parties maintained their positions at the conclusion of the evidence. Accordingly, the panel was presented with a joint submission.
Findings
- For the following Reasons, the panel accepted the joint recommendation and found that Mr. Vezina represents a significant threat to the safety of the public and that the necessary and appropriate Disposition is a Detention Order containing the same terms included in the existing Disposition.
Index Offence
- The circumstances surrounding the index offence are taken from the Hospital Report (pp. 3-4) and the Reasons for Disposition dated June 25, 2024, and are reproduced as follows:
“The Crown Brief Synopsis and victim witness statements indicate that the charge for which Mr. Vezina was found Not Criminally Responsible arose out of an incident in which he went to his parents' home and threatened his father with a knife. It is also documented that on the evening prior to the commission of the offence, Mr. Vezina had tried to visit his sister but was denied entry because she did not trust him because of past behaviour. Mr. Vezina apparently started screaming at her and stated that he hated his sister and wished she was dead.
Then, on November 1, 2003, when her husband was outside washing windows, Mr. Vezina's sister observed him taking a pocketknife out and was talking to her husband and telling him he was "a crazy, stupid bastard". Apparently, the husband ignored Mr. Vezina's comments and in fact returned to the inside of the house. However, given his past behavior, the sister had already called 911 asking for assistance. Once that call was made, she contacted her parents to make sure that they were okay. Mr. Vezina's sister also had indicated that she did not want Mr. Vezina around any of the family, as everyone was afraid of him as he had been threatening towards them too many times.
The Crown Brief Synopsis documents state that on November 1, 2003, at approximately 10:50 hours the accused waved a jack knife (Swiss Army knife) with a blade of about two inches in length, approximately 12 inches away from his father's throat. While waving the knife back and forth he stated, "it’s a small knife but it could go deep". Mr. Vezina, Sr. feared for his safety.
As a result, the accused was arrested at 11:50 hours for having in his possession a weapon for a dangerous purpose. The knife was seized and submitted into property. The accused was then brought to police headquarters where at 1245 hours he spoke with his lawyer and then was lodged awaiting a video bail on November 2, 2003.
The witness statement of Mr. Vezina, Sr. indicates that his son had been showing him a knife which he had just bought, but when he started doing a slashing motion in front of his father's face, his father had tried to stay calm so that his son wouldn't get mad. It is also indicated that Mr. Vezina, Sr. had tried to talk about other things so that his son would stop moving the knife around.
Further information received from the witness statement of the patient's mother indicates that on October 31, 2003, Mr. Vezina had gone to their residence asking for food and drink. She gave him a Pepsi and a coffee but he didn't want that and wanted his father to take him out for coffee. His father really wasn't keen on this, but as the accused seemed to be getting agitated and in fact had taken the telephone book and ripped pages out of it and then banged it on the table, his father complied and went for coffee with him. The mother's statement further indicates that between 1:00 a.m. and 7:00 a.m. on November 1, 2003, her son called their residence on six different occasions.”
Background Information
Mr. Vezina’s background is set out in detail in the Hospital Report which was entered as an exhibit at the hearing and therefore forms part of the evidence. The contents need not be extensively restated here. In brief terms, Mr. Vezina was born and raised in the area of Sturgeon Falls, near North Bay, where he lived with his parents and five siblings. He completed grade 11, then left school to work with his uncle at a sawmill until 1987, when he became unemployed. Since that time, his income has been a disability pension related to his mental illness.
Records indicate that Mr. Vezina started using street drugs at approximately 13 years of age and has reportedly used them consistently since then. He consumed both marijuana and hashish, as well as excessive amounts of alcohol.
Mr. Vezina is single and never been married, but has been involved in at least three common-law relationships, all of which reportedly involved what the Hospital Report characterizes as “domestic discord” (at p. 7).
Prior to the index offence, Mr. Vezina had a history of threatening and intimidating his family members, as a result of which they are very fearful of him.
Mr. Vezina’s criminal record consists of approximately 50 convictions prior to the index offence. His first conviction was in 1979 when he was 16 years old. His record includes a variety of property offences including breaking and entering, many breaches of court orders, offences of violence including assault causing bodily harm, uttering threats, and criminal harassment. His last convictions prior to the index offence were on February 25, 2003, when he received a global six-month custodial sentence for assault, mischief under $5,000.00, failing to comply with a recognizance, and theft under $5,000.00.
Psychiatric History Prior to the Index Offence
Mr. Vezina has an extensive history of involvement with psychiatric services beginning in the early 1980’s. His records indicate that over the years, he has had admissions to the Sudbury Algoma Hospital and the (former) Clarke Institute of Psychiatry, as well as the North Bay Psychiatric Hospital. Starting in 1984 when he was 21 years old, Mr. Vezina has had approximately 24 admissions to the North Bay Psychiatric Hospital (now known as North Bay Regional Health Centre - North Bay Site), including his initial stay there following his NCR verdict. On four of these occasions, he was admitted to the Forensic Program as a result of involvement with the criminal justice system. On three occasions he entered on a judicial order for assessment of either fitness to stand trial or criminal responsibility, and on the other occasion he entered on a Medical Temporary Absence Pass from the North Bay Jail.
Regarding his other pre-NCR admissions to the North Bay hospital, Mr. Vezina usually entered on a Form 1 issued by a physician at the Emergency Department of a general hospital. In most of these circumstances, Mr. Vezina was brought by the police as a result of being physically aggressive, violent or threatening to other individuals. On four occasions Mr. Vezina was admitted as a result of suicidal behaviour. It is documented that he accidentally overdosed on prescription medication, not in an attempt to harm himself but rather to get high.
Notably, during Mr. Vezina’s multiple admissions, his behaviour was consistent in that he was demanding, lacked insight and judgment, was sarcastic, showed disrespect for ward rules and programs, lacked motivation to engage in honest discussion, and was intimidating and aggressive. During 11 admissions, he spent most of his time in seclusion. On three of those occasions, he required transfer to the Forensic Program so that he could be more appropriately managed.
Mr. Vezina’s lengthy history under the Board’s authority is chronicled in a helpful timeline at pp. 2-3 of the Hospital Report. In brief terms, he was initially detained at the North Bay Psychiatric Hospital (NBPH), later referred to as the North Bay Regional Health Centre (NBRHC) until the Ontario Review Board (“ORB” or the “Board”) ordered on October 13, 2016, that he be transferred to the Waypoint Centre for Mental Health Care (“Waypoint”). [More will be said below about the circumstances leading to this transfer.] After approximately seven months at Waypoint, the ORB ordered that Mr. Vezina be transferred to the Secure Forensic Unit at St. Joseph’s Healthcare Hamilton (“SJHCH”). Mr. Vezina was admitted to SJHCH from July 6, 2017, to August 22, 2018, before returning to the North Bay Regional Health Centre pursuant to a Board Disposition dated July 18, 2018. On January 22, 2021, the Board ordered that Mr. Vezina be transferred back to SJHCH. He was admitted to Harbour North 3 on September 3, 2021, under the care of Dr. Sutton.
It is noted that a community living privilege was included in Mr. Vezina’s Disposition following his 2005 ORB hearing. Despite this, Mr. Vezina made little rehabilitative progress for several years and engaged in antisocial behaviour and repeated breaches of the hospital’s rules of conduct. His behaviour included intimidating other patients into giving him money. Successive behavioural plans were implemented. His treatment team observed that his behaviour demonstrated the severity of his diagnosed antisocial personality disorder. He also experienced fluctuations in his mental state along with threats to harm staff or co-patients. Following a period of gradually increased indirectly supervised privileges for community employment assignments, Mr. Vezina was discharged to a TRHP (Transitional Rehabilitative Housing Program) home in June of 2015.
During the summer of 2015, while he appeared to be adjusting well to the home, he had trouble maintaining his medication compliance, appearing to mix up his morning and evening doses. He was readmitted to the hospital in early September for stabilization due to observed decompensation. He was again discharged in February 2016 but again readmitted in March, due to reported threats of bodily harm to another resident. It does not appear that he has lived in community accommodation since then.
Mr. Vezina was using indirectly supervised community privileges in the spring/summer of 2016, though he was still experiencing delusional thoughts, volatile mood, and continued his pattern of intimidation of co-patients. At the beginning of August, because of a report by a co-patient, a police search in a wooded area on hospital grounds revealed two hunting knives with six-inch stainless-steel serrated blades, some disposable razors, plastic bottles of urine, a cosmetic bag full of cosmetics, and an empty cigarette package with Mr. Vezina’s name printed on it. Mr. Vezina admitted to police that the knives were his and that he had hidden a switchblade knife in the dirt outside the hospital’s horticultural centre. Police located this knife. As a result of these discoveries and other reports of Mr. Vezina’s activities, including selling drugs to co-patients, he was transferred to Waypoint as noted above.
Mr. Vezina was transferred to SJHCH after it was determined that he could be managed in a less secure facility than Waypoint. His behaviour at SJHCH was characterized by “. . . a repeating pattern of complying with rules for a period of time until he gains a higher level of privilege, then after a short time he breaches the rules that apply to that level of privilege” (Hospital Report, p. 64).
It is noted that in the Risk Summary prepared prior to the hearing that resulted in his transfer back from NBRHC to SJHCH, Mr. Vezina reportedly acknowledged to his psychiatrist that he has a way of trying to manipulate others with the purpose of avoiding the rules and questioned if perhaps he has been self-sabotaging his progress as a means to remain in hospital where he receives care and support. He had indicated that he had nowhere to go and that he was scared to “leave this place” and that is why he has remained in hospital for so long (Hospital Report, p. 82). He requested a transfer back to this Hospital and indicated that if he did not receive an increase in community privileges, that he would continue with his request to transfer. It is also reported that discussions had been initiated regarding discharge planning, possibly to a transitional in-patient unit or a transitional home in the community of North Bay.
Evidence at the Hearing
Dr. Sutton began his evidence by stating that generally, Mr. Vezina’s clinical course fluctuated over the last reporting year. In addition, as documented in the Hospital Report, there were significant concerns regarding his bringing of contraband onto the unit.
Dr. Sutton referred to an incident in October of 2024 (described in detail in the Hospital Report and in the Reasons for Decision following a review hearing regarding a significant increase in the restrictions on his liberties) when Mr. Vezina returned late from a pass in a disoriented state after consuming an entire joint of cannabis and a room search disclosed the presence of contraband (cigarettes).
Dr. Sutton noted (and the Hospital Report provides specific further details) additional occasions when Mr. Vezina’s privileges were placed on hold or cancelled as a result of bringing more contraband onto the unit. According to the Hospital Report, Mr. Vezina admitted bringing items onto the unit for other patients.
Dr. Sutton updated the Hospital Report by stating that approximately a month before the hearing, Mr. Vezina started volunteering at a Good Shepherd program, which Dr. Sutton characterized as a “big step forward” for him. The doctor noted that this is important as Mr. Vezina has gotten into trouble when he has had a lot of unstructured time on his hands. Dr. Sutton testified that there is potential for extending the number of days per week when he can engage in this work, beyond the three days per week (for three hours at a time) as at the time of the hearing. Dr. Sutton also noted that Mr. Vezina travels on his own to and from the volunteering location.
Mr. Vezina has been on waitlists for housing with Good Shepherd, Transitional Rehabilitation Housing Program (TRHP) and Good Shepherd, Community Housing for Opportunities (CHO) since November of 2021 and March of 2022, respectively. Dr. Sutton updated the panel with respect to the housing prospects for Mr. Vezina, stating that even though he was not accepted for TRHP housing last year (due to the risk that he posed in taking advantage of vulnerable people), there was another potential opportunity arising in the next month or two. While Mr. Vezina appears ready for discharge to a community residence, he will require on-site supervision. A TRHP home provides 24/7 staffing that includes the preparation of one meal per day and support that includes medication supervision, which Mr. Vezina would require.
Dr. Sutton testified that Mr. Vezina now seems to be more invested than in the past about regaining his sobriety and refraining from rule-breaking behaviour. He is talking more openly about his cravings and anticipating his urges to use substances. The treatment team continues to be hopeful that Mr. Vezina’s early progress will be sustained. Dr. Sutton also stated that Mr. Vezina may actually do better outside of the Hospital, as his personality disorder makes it very hard for him to follow the numerous rules and restrictions in the Hospital.
Turning to the recommendation for a Detention Order, Dr. Sutton stated that the following statement in last year’s Reasons for Disposition (para. 43) continues to apply currently:
When asked by counsel for the hospital if the clinical team had considered a Conditional Discharge for the year ahead, Dr. Sutton responded in the negative. He commented that Mr. Vezina requires ongoing hospital detention at the present time and he is not currently a suitable candidate for discharge to the community. Further, he added that when the team considers Mr. Vezina ready for discharge, it will be critical for the hospital to retain the ability to oversee his placement in the community to ensure that he is appropriately supervised, supported, and monitored to safely manage his risk. Further, whenever Mr. Vezina is ready for discharge to community living, the doctor stated that it will be critical that the hospital have the authority of a Warrant of Committal to expeditiously readmit him to hospital should he present with signs of decompensation in his mental state whether as a result of noncompliance with medication, relapse to substance use, or otherwise. In the doctor’s opinion, safe risk management requires that the hospital be in a position to cause Mr. Vezina to be readmitted to hospital, whether or not he meets criteria for certification for an involuntary admission under the Mental Health Act (“MHA”).
In response to questions from counsel for the Attorney General, Dr. Sutton agreed that there is a continued need for the treatment team to be careful in moving toward discharge into the community, given Mr. Vezina’s difficulties, including the history of taking advantage of other patients. A TRHP residence would currently provide an appropriate accommodation for him as he moves forward.
Dr. Sutton stated that Mr. Vezina’s insight across the various domains is “not bad”. He recognizes that he has a mental illness and there have been no concerns about medication compliance. Dr. Sutton said that the real challenge is his personality pathology, demonstrated in the pattern of rule violations and consistently externalizing blame for his behaviour. Mr. Vezina was aware that with his Board hearing coming up, he had an opportunity to demonstrate appropriate behaviour.
In response to questions from Mr. Vezina’s counsel as to the need for a further community living assessment, Dr. Sutton stated that an assessment has already been done, providing the team with a good sense of Mr. Vezina’s needs and required supports. These are mainly in the area of medication supervision. Dr. Sutton did not believe that the risk of non-adherence comes from negative symptoms of Mr. Vezina’s illness but is primarily a personality issue. Dr. Sutton would not be surprised if there were a cognitive element here, but noted that Mr. Vezina is capable and does okay on a day-to-day basis, and he was not interested in a cognitive assessment.
Mr. Vezina’s counsel asked about contact with Mr. Vezina’s family. Dr. Sutton stated that there was a family visit in the previous six months to help celebrate Mr. Vezina’s birthday. His parents are elderly and live in the North Bay area, so visits are difficult, but Mr. Vezina keeps in telephone contact with them.
Dr. Sutton noted, in response to an observation by a panel member about Mr. Vezina’s demonstrated hesitancy in 2024 when the previous TRHP opportunity became available, that the treatment team will be having these conversations with him in the future, especially n the weeks and months leading up to any discharge to the community.
In response to a panel member’s questions about therapeutic programming, Dr. Sutton said that Mr. Vezina does engage in 1:1 sessions but was uncertain as to how much of the content he “takes away”.
No further evidence was led following Dr. Sutton’s testimony.
Analysis and Conclusions
Noting that there was no dispute in relation to this issue, the panel had no difficulty in reaching its own independent conclusion that Mr. Vezina represents a significant threat to the safety of the public. Mr. Vezina has a long-standing diagnosis of a serious mental illness which is further exacerbated by his substance abuse challenges and antisociality. He has a very extensive and serious criminal history with numerous convictions for violent offences. He also has a history of medication non-compliance when living in the community.
The index offence, although it occurred almost 22 years ago, involved the use of a knife as a weapon with which he threatened the victim. A weapon such as a knife has the potential to cause significant physical or psychological harm to a victim. More recently, in 2016, he was transferred from the North Bay Regional Health Centre to the Provincial Programs Division of Waypoint after purchasing large hunting knives in contravention of his Disposition, which prohibited the possession of weapons. He further hid these knives, along with a switchblade knife, on the hospital property in North Bay.
The panel acknowledges that Mr. Vezina has not engaged in overt acts of violence in some time. He has, however, at times been verbally aggressive and threatening, as well as sexually inappropriate, with hospital staff. Notably, as described at para. 32 of last year’s Reasons, Dr. Sutton stated that in May of 2024, Mr. Vezina threatened to kill a staff member with a gun. From a risk assessment perspective, it is concerning that even in the highly structured, supportive environment of the inpatient unit, Mr. Vezina has demonstrated, within the last year, considerable hostility and verbal aggression, sexually inappropriate behaviour toward younger female staff and at times, physical aggression towards property.
Mr. Vezina’s past and more recent relapses into substance use is also a significant risk factor. Future relapses with respect to cannabis, particularly in combination with his underlying personality pathology and in the context of mental status destabilization brought on by medication non-compliance, would elevate his violence risk.
The panel finds that in the absence of the close oversight and structure provided within the forensic system, Mr. Vezina would likely become non-compliant with his medications, leading to a destabilization in his mental state, with emerging agitation and behavioural disinhibition in the context of mania and /or psychosis. There is a substantial likelihood, based on all the evidence, that he would then engage in serious criminal activity that would result in serious harm of a both physical and psychological nature.
Turning to the matter of Disposition, the panel accepts Dr. Sutton’s evidence, and finds that a Detention Order is currently absolutely necessary in order to protect the public.
A review of Mr. Vezina’s lengthy course in various hospitals during his time under the Board’s authority shows that he has demonstrated periods of emotional and affective instability while being frequently rude, argumentative, and irritable. He has demonstrated limited insight into his behaviour and has been inclined to externalize blame – specifically blaming the hospital or doctors for his continued hospitalization and involvement with the ORB system. In every hospital, he has continued to engage in rule defying behaviour. His fluctuations in mental status, repeated rule violations, and disregard for others have all been identified as enduring barriers to his progress to community living over the years.
Mr. Vezina’s deeply entrenched antisocial inclinations including deception, manipulation, and repeated rule violations have at times served to sabotage attempts by staff to support his pro-social endeavours, such as securing employment, and maintaining relationships with family. A recent example of this is provided by the circumstances that led to the cancellation of his privileges in October of 2024.
It is nevertheless encouraging that Mr. Vezina has continued to express a desire to seek meaningful employment over the years. He has also demonstrated an ability to adhere to unit rules for prolonged periods of time and can remain abstinent from substances, though he obviously requires support in all these areas. He will also require supervision, in the community, of his medication compliance. It is essential that the Hospital, therefore, have the ability to both approve his community accommodation and to readmit him quickly to respond to any changes in his level of risk to the community.
Accordingly, the necessary and appropriate Disposition is a Detention order in accordance with the parties’ joint submission. The panel is confident that given the chronicity of Mr. Vezina’s antisocial traits and the long-standing institutionalization, future steps toward discharge will be pursued with caution, including the use of conditional pathways such as transitional housing, monitored substance use testing, and occupational engagement programs.
In approaching this matter, the panel has considered the evidence through the lens of the factors in s. 672.54 of the Criminal Code.
DATED this 7th day of July 2025, at the City of Toronto, in the Toronto Region.
Eric Siebenmorgen
Legal Member
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Office of the Registrar
Ontario Review Board