Re: Victor Avidago, 2025 CanLII 66900

Ontario Review Board

Re: Victor Avidago

ORB File No: 6431

Hearing held on: Wednesday, May 21, 2025

Place of hearing: Centre for Addiction and Mental Health

Pursuant to: Section 672.81(1) of the Criminal Code

Before: Alternate Chairperson: Ms. S. Kert Members: The Hon. B. Allen Dr. P. Prendergast Dr. M. Mamak Mr. A. Bouvier

Parties Appearing: Accused: Victor Avidago Counsel: Mr. A. Pollard

The Person in charge of Hospital: Counsel: Ms. S.R. Zelaya

Attorney General of Ontario: Counsel: Ms. L. Earle

REASONS FOR DISPOSITION

(Dated July 7, 2025)

Introduction

1On November 7, 2013 Mr. Victor Avidago was found not criminally responsible by reason of mental disorder on a charge of second-degree murder contrary to the Criminal Code.

2Under s. 672.81(1) of the Criminal Code, a panel of the Ontario Review Board (the Board) was convened on May 21, 2025 at the Centre for Addiction and Mental Health (CAMH or the Hospital) to review Mr. Avidago's threat to public safety and the appropriate disposition under s. 672.54 of the Criminal Code.

3Mr. Avidago’s existing disposition dated June 17, 2024 provides that Mr. Avidago be discharged on conditions as set out in the disposition.

4The parties advanced a joint position that Mr. Avidago continues to pose a significant threat to the public and that a conditional discharge should be maintained on the existing conditions.

Disposition

5For the reasons set out, the Board concludes, under s. 672.54 of the Criminal Code, that Mr. Avidago continues to pose a significant threat to public safety and that the necessary and appropriate disposition is a continuation of the conditional discharge under the same terms and conditions as the existing disposition.

Current Diagnosis

6Mr. Avidago’s current diagnosis is schizophrenia, paranoid type.

The Evidence

7The Board has before it the Hospital Report dated April 19, 2025 which contains an account of Mr. Avidago’s personal and psychiatric background which need not be repeated in detail here. The Board also has the oral evidence of Dr. Nnamdi Ugwunze, the author of the Hospital Report. Mr. Avidago indicated he did not require the services of a Portuguese interpreter.

Index Offence

8The circumstances of the index offence are described in the Hospital Report and are summarized as follows:

9On March 22, 2011 Mr. Avidago's sister, wife, and daughters were in the kitchen. His wife had made a cake. Mr. Avidago took a knife, giving the impression that he was going to cut himself a piece of cake. Instead, he walked over to his wife and stabbed her repeatedly. A neighbour heard the screams. As the police arrived Mr. Avidago emerged covered in blood with a knife in his hand. He was asked to drop the knife and Mr. Avidago replied "Shoot me". The police tasered him. He sat in the police car with his eyes closed not saying anything. Ms. Avidago was pronounced dead at Credit Valley Hospital.

10Following the offence Mr. Avidago reported to doctors that he felt he was being followed, that his house was under surveillance and that he was hearing voices. He said he believed that the government was going to deport him and that "everything was about to happen". He explained that when he arrived home the day of the offence and heard his wife and daughters laughing in the kitchen, in order to bring about silence he grabbed a knife and began stabbing the first person. Mr. Avidago indicated he did not realize it was his wife. During his confused and paranoid communications with psychiatrists, Mr. Avidago indicated that he realized he had stabbed his wife. But that realization was not consistent as at times he continued to believe his wife was still alive.

Criminal History

11Mr. Avidago had no criminal history before the index offence.

Substance Use

12There is no indication in the Hospital Report that Mr. Avidago has ever misused alcohol, street drugs or prescription medications. Although he previously consumed alcohol with friends this did not present problems for him.

Mr. Avidago’s Personal and Psychiatric History

Before the Current Reporting Year

Personal History

13Mr. Avidago is a 61-year-old man of Portuguese descent born in Angola who moved with his family to Portugal when he was approximately 11 years of age and immigrated to Toronto, when he was 25 years old. He is a Canadian citizen.

14Mr. Avidago was married for nearly 19 years before his wife’s death. He maintains contact with his two daughters. Mr. Avidago has a grade 6 education and is currently unemployed and supported by ODSP benefits. During his marriage he was employed as a drywaller and was responsible for financially supporting his family.

Psychiatric History

15Mr. Avidago first encountered the psychiatric system in 2008 at Scarborough General Hospital when he became concerned about self-harm. He was diagnosed with paranoid schizophrenia and prescribed antipsychotic medication which improved his condition. A few months later he attended the emergency department and was diagnosed with depression and mild paranoia.

16Over 2009 Mr. Avidago experienced symptoms of a depressed mood, anxiety, insomnia, restlessness and paranoia. He was treated by his family physician with a variety of antidepressant and antipsychotic medications. That year he continued to report feeling severely depressed and paranoid but had improved with medication over the years of 2009 and 2010. In 2011 Mr. Avidago stopped taking his medications because he felt they slowed him down. He refused to attend his family doctor for fear of hospitalization. Mr. Avidago stopped talking and became catatonic.

17Mr. Avidago was found not criminally responsible on November 7, 2013. By way of overview, Mr. Avidago's residential environments post-index offence were a remand to Maplehurst Detention Centre for three years from March 22, 2011 until June 6, 2014 when he was admitted to a secure unit at CAMH. Mr. Avidago's cousin Carla Delgado and her husband became Mr. Avidago's substitute decision-makers for property in 2011 and Mr. Avidago remained medication competent. He was detained in a secure unit following a disposition of the Board dated February 8, 2016, until his transfer to a general forensic unit on February 14, 2017. He remained in a general forensic unit until he was discharged on June 27, 2019, to reside in approved accommodation at the Harbour Light Salvation Army residence in Toronto. In June 2020 he moved to Transitional Rehabilitation Housing Program (TRHP-1) housing at Weston Road in Toronto.

18Over the years from 2014 to 2019 while detained at CAMH Mr. Avidago continued to express paranoid ideation, interpreting other individuals as being hostile towards him and judging him, believing that other people could read his thoughts and that sometimes the radio and television were talking about him. He had delusions of reference and misidentification regarding his family. At times Mr. Avidago believed that his wife and family members were not his family members and that his wife was still alive.

19Over the years 2016 to 2018 Mr. Avidago’s antipsychotic medications were changed and optimized. Despite his concern about the sedating side effects of the antipsychotic medications he remained medication compliant. He achieved an increased reduction of his psychotic symptoms with clozapine. Mr. Avidago continued to experience some residual symptoms of psychosis and mood symptoms. Further optimization of his medications was limited by the side effects of the medications. Mr. Avidago began receiving ECT in 2017 which was discontinued due to concern about memory deficits and a lack of further clinical improvement. Mr. Avidago commenced Cognitive Behaviour Therapy for psychosis.

20Mr. Avidago did not act on any of his delusional ideation or express intentions to harm anyone. He appropriately used his community privileges and participated in psycho-social therapeutic and recreational rehabilitative programming at CAMH. In 2018 he began attending English as a Second Language (ESL) classes at a community centre and attended the Construction Craft Worker Extended Training program at George Brown College. Though Mr. Avidago progressed well in certain aspects of the program he discontinued attendance due to the pressures of feeling his English skills were not sufficient. Mr. Avidago obtained part-time employment at a drywall construction company in 2018.

21During 2018 and 2019 Mr. Avidago continued to receive support from and contact with his family and friends through social media and family visits. He began to develop positive relationships with some co-patients and was cooperative with staff. There were no issues or incidents on the unit or community outings during this period.

22During this period Mr. Avidago also began to display insight into his illness. He began to accept he has the major mental illness he identified as "schizophrenia". He also indicated his willingness to be medication-compliant into the future to avoid a relapse, with the stated aim of returning to his family. He however did not identify his medication as being the cause of improvement in his mental health.

23A housing application was submitted electronically in 2017. As noted earlier Mr. Avidago was discharged from CAMH on June 27, 2019 to reside in the Harbour Light Salvation Army residence, independent transitional housing. On discharge into the community Mr. Avidago was reluctant to attend ESL classes and to seek shifts with the drywall company. Mr. Avidago preferred to structure his time on his own, regularly taking walks, going to the gym, grocery shopping and visiting with family and friends. He began to demonstrate increased insight into his mental illness.

24The forensic outpatient services team (FOPS) identified his strengths as cooperation with the treatment team, good social support and strong coping skills. There were no behavioural concerns during the 2018 to 2019 reporting year. Mr. Avidago was punctual and consistent with attending all appointments with treatment team members.

25Mr. Avidago continued to progress in the community during the period 2020 to 2021. On June 19, 2020 Mr. Avidago transitioned from Harbour Light to TRHP1 housing which provided 24-hour support on site care involving medication monitoring, a curfew, urine collection and social programming. He was admitted to independent housing through the Forensic Supportive Housing (FSH) program in July 2021.

26Mr. Avidago continued to reside in his FSH apartment in Toronto for the entire duration of the 2022 to 2023 period without re-admission to the Hospital. His mental status remained stable and he regularly denied both homicidal and suicidal ideation. His insight into his mental health was fairly good and he agreed with his diagnosis of schizophrenia and was adherent to his medication throughout the reporting period which he took independently and as prescribed. Mr. Avidago had extensive regular contact and support from his daughters, aunts, uncles and other extended family members.

27In April 2022 Mr. Avidago was referred to an oncologist at Princess Margaret Cancer Centre and was diagnosed with cancer. He began chemotherapy treatment on September 19, 2022 and had a surgical procedure related to his cancer treatment on March 21, 2023. Before being transferred to Dr. Nnamdi Ugwunze in January 2023, Mr. Avidago was under the psychiatric care of Dr. Padraig Darby with followed up by the FOPS team.

28A concerning decline in Mr. Avidago’s mental stability emerged at the end of 2023.

29Mr. Avidago’s mental status remained stable until December 2023 when he contracted COVID-associated pneumonia, a urinary tract infection and developed delirium. Mr. Avidago’s confusion contributed to him not taking his medications as prescribed and the family began to notice the re-emergence of psychotic symptoms.

30On February 5, 2024 one of Mr. Avidago’s daughters contacted his case manager to inform her that family members had found knives hidden around his apartment and they were now concerned for theirs and their father’s safety. Mr. Avidago was brought to CAMH by police. He was eventually transferred to Mount Sinai’s General Medicine unit and then to their Inpatient Psychiatry unit on February 20, 2024.

31During the Mount Sinai hospitalization Mr. Avidago was re-established on his antipsychotic and antidepression medications following which he returned to demonstrating good insight into the importance of his medication and his mental illness. He consistently stated that he would continue to take his medication as prescribed and he consistently attended appointments with the FOPS team.

The Current Reporting Period – April 2024 to April 2025

32For the entire reporting period of 2024 to 2025 Mr. Avidago continued to reside in his FSH apartment in Toronto without re-admission to hospital. He remained under the care of Dr. Ugwunze and received case management from FOPS. Mr. Avidago remained an outpatient during this reporting period and he presented as mentally stable until late autumn 2024. A referral to the Canadian Mental Health Association’s (CMHA) non-forensic Assertive Community Treatment (ACT) team was made in January 2024.

33During a meeting with Dr. Ugwunze in November 2024 Mr. Avidago endorsed experiencing increased paranoia during the day particularly in crowds and around strangers. Those symptoms had slowly increased in intensity from when his medications were adjusted during his Mount Sinai hospitalization. His clozapine medication was increased in December 2024 which resulted in more effective management of his paranoid delusions to his baseline.

34Mr. Avidago's insight into his mental health was good and he accepted his diagnosis of schizophrenia. He was compliant with his medication and took it independently as prescribed throughout the reporting period. The side effects from his medication of weight gain, fatigue, drowsiness, constipation and hand tremors were manageable. Mr. Avidago undertook to continue to comply with his medications and consistently attended outpatient appointments with his psychiatrist. There were no concerning incidents during this period. Mr. Avidago maintained contact with his family and kept occupied with positive domestic and social activities.

35The Hospital Report describes as follows Mr. Avidago’s presentation during a Mental Status Examination in April 2025:

Mr. Avidago presented as kempt and appropriately dressed for the weather. A good rapport was established. He reports that his mood was "okay", his affect was blunted. Mr. Avidago denied having any thoughts of self-harm, suicide or violent ideation directed at others. He denied hallucinations but endorsed ongoing paranoid delusional beliefs that worsened this reporting period over several months believing that people talk about him and follow him especially when he is out in public. This returned to baseline following optimized clozapine dose in November and December 2024. He remains remorseful for killing his wife, acknowledging that he was mentally ill at the time. Mr. Avidago's insight has returned to pre-relapse levels. He complies with clozapine which he states "helps" without elaborating further albeit, complained of weight gain and tiredness which are links to this. [at p. 39]

36Describing a potential risk scenario the Hospital Report states:

If Mr. Avidago were to re-offend violently, it would likely transpire in the following way; Mr. Avidago would discontinue his antipsychotic medication and disengage from mental health services. Non-adherence to antipsychotic medication, critically Clozapine, would most likely lead to psychotic decompensation increasing his vulnerability to misperception regarding the intention of others in a paranoid and persecutory context, which was evident during his relapse for several months this year. This will inadvertently increase his risk of harm to members of the public as it will predispose him to act out violently in an impulsive manner. [p. 42].

Oral Evidence of Dr. Nnamdi Ugwunze

37Dr. Nnamdi provided a material update regarding a change to Mr. Avidago’s medication. He explained his medication was increased because Mr. Avidago was showing increased anxiety in early May 2025. His aripiprazole was increased from 5 to 10 mg from May 15th.

38Dr. Ugwunze testified that Mr. Avidago had a very positive reporting year in the community. His clozapine dosage was also increased from 200 to 400 mg which has proven effective in addressing his psychotic symptoms. Going forward, Dr. Ugwunze is hopeful that Mr. Avidago will be accepted for community oversight and treatment by the non-forensic community CMHA ACT team. The doctor indicated that Mr. Avidago has an appointment with ACT at the end of May 2025 and if he is accepted it will take six months before he can be accepted in to the program.

39A question was raised about possible future fluctuations in Mr. Avidago's mental status, given past experience with this, and was queried about how the treatment team plans to address this eventuality. Dr. Ugwunze testified there are "eyes on him for relapse" and that he sees him as frequently as possible. He sees Mr. Avidago every week sometimes by phone, his family sees him on weekends and his case manager, once a week. In view of Mr. Avidago's frequent contact with his family and an improvement in his reporting practices, Dr. Ugwunze indicated the treatment team also relies on those sources of information.

40The Board queried the instances when Mr. Avidago did not immediately report some experiences of decompensation. Dr. Ugwunze indicated that he did not know why Mr. Avidago did not report sooner and acknowledged that Mr. Avidago had failed to report in the past resulting in hospitalization. Dr. Ugwunze spoke positively about an instance on May 7, 2025 when Mr. Avidago waited a week to report an increase in his anxiety. Dr. Ugwunze regarded a week’s delay as an improvement over Mr. Avidago’s past reporting practices and opined that this is an indicator of growing trust in the outpatient team. Dr. Ugwunze stressed that Mr. Avidago continues to be encouraged to promptly report changes in his status to avoid the necessity of being hospitalized.

41The Board asked whether Mr. Avidago has declined to answer questions about decompensation. The doctor's evidence was that the case manager has had to "go deep" in asking many questions to gain information about Mr. Avidago's mental status.

42Regarding an amendment of paragraph 1(f) of the existing disposition Dr. Ugwunze was also asked about Mr. Avidago’s daughters who were placed in the care of an aunt after the index offence. He confirmed that the daughters no longer are in the care of their aunt as they now are adults, older than the ages stated in the Hospital Report, and likely no longer require their contact with their father to be at the discretion of the person in charge of the Hospital.

The Parties’ Positions

43As noted earlier the parties’ joint position is that Mr. Avidago continues to be a significant threat to public safety and that the least onerous and least restrictive disposition, that is necessary and appropriate in the circumstances, is to maintain a conditional discharge under the same terms and conditions as the existing disposition.

The Board’s Conclusion

44While mindful of the parties’ joint position the Board is required to come to an independent determination.

45Based on the evidence before us, the Board unanimously accepts the opinion, as stated in the Hospital Report, that Mr. Avidago remains a significant threat to public safety within the criteria outlined in Winko and as defined in s. 672.5401 of the Criminal Code. The Board considered the criteria, as set out in s. 672.54, namely, the paramount criterion of the safety of the public and Mr. Avidago’s community re-integration, his mental condition and his other needs.

46We accept, in accordance with s. 672.54 of the Criminal Code, that the least onerous and least restrictive disposition, that is necessary and appropriate in the circumstances is a conditional discharge on the same terms as the existing disposition.

47The Board arrives at that decision for the following reasons.

48In arriving at a determination on threat to the public the Board understandably considered the seriousness of the index offence. He took the life of his wife and the mother of his children. But in arriving at a determination the index offence cannot be considered in isolation from all the other relevant evidence.

49From 2008 Mr. Avidago experienced a lengthy history of severe symptoms of paranoid schizophrenia. In March 2011 days before the index offence Mr. Avidago stopped taking his medication and attending appointments with his family doctor. This resulted in a marked decline in his mental status. He became catatonic, delusional and suspicious of those around him.

50The Board recognizes the vast improvement in Mr. Avidago’s mental health and stability over the years.

51With medication changes and optimizations, Mr. Avidago’s mental status has generally been stable. His insight and cooperation with the treatment team have improved and he has developed positive social support and coping skills. He has successfully transitioned from detention at CAMH through various supervisory levels of community housing - from transitional housing in June 2019, to 24-hour support housing in June 2020, to independent housing in July 2021. Mr. Avidago has remained housed independently in the community until the present. To his benefit in the community, Mr. Avidago has enjoyed the close support of many family members.

52However the Board has some concerns about the recent potentially dangerous decompensation in Mr. Avidago’s mental status in February 2024 which required hospitalization. Mr. Avidago was experiencing paranoia and delusions when the family reported to the case manager that knives were found hidden around his apartment. He was brought to the hospital by the police. The family reported that Mr. Avidago had been in a confused state and not following his medication regime at the time.

53Of further concern is evidence that arose in November 2024 that Mr. Avidago endorsed increased paranoia during the day in crowds and around strangers. Of some significance here is that Mr. Avidago did not immediately inform his clinical team of this change in his status. He only brought this to the team’s attention after several months when he realized the symptoms were interfering with his daily functioning.

54The Board had some questions for Dr. Ugwunze about Mr. Avidago’s failure to report decompensation in a timely fashion and about the plan going forward to address the eventuality of this happening again possibly resulting in danger to the public. We are satisfied by Dr. Ugwunze’s evidence that Mr. Avidago is closely monitored by him and the case manager once a week and by family on weekends by phone and in person. The Board recognizes that Mr. Avidago’s general trajectory since the index offence has been positive. We take that into account in arriving at our support for a continued conditional discharge.

55The Board's concern about the threat to public safety during periods when Mr. Avidago decompensates and does not report it immediately, has been sufficiently assuaged by what Dr. Ugwunze has described as progress in this area. The team has encouraged Mr. Avidago to be prompt in reporting to avoid the hospitalization he experienced in February 2024. Earlier this month Mr. Avidago reported a decline in his mental status only delaying one week to do so. The Board accepts Dr. Ugwunze’s opinion that this is a sign of progress and an indicator of growing trust in the treatment team. Also important to the Board’s determination is that Mr. Avidago has not acted on any of his violent paranoid ideation.

56The Board wishes to praise Mr. Avidago for the significant progress he has made over this reporting year. However we want to express our concern about his tendency to avoid promptly reporting a decline in his mental status. It is to Mr. Avidago's benefit that he does this if his admission to the hospital in February 2024 provides any lessons. Mr. Avidago has been granted the privilege of living independently in the community and along with that privilege it is incumbent on him to ensure he complies with his medication regime and is forthcoming with the clinical team about what is going on in his mind and life, things that he might need help with.

57The Board extends its hope that Mr. Avidago’s relationship with the ACT team is a mutually beneficial one and that he will cooperate with the expectation that he maintain medication compliance and be open in his communications with that team in reporting changes in his mental health.

58Based on the Hospital Report and the evidence added in Dr. Ugwunze’s testimony the Board concludes, under s. 672.54 of the Criminal Code, that Mr. Avidago remains a significant threat to public safety and that currently the necessary and appropriate disposition, that is the least onerous and the least restrictive to mitigate risk to public safety, is to maintain the conditional discharge on the same terms as the existing disposition. On the matter of Mr. Avidago’s contact with his daughters being at the discretion of the person in charge of the Hospital, the Crown advised she had not had the opportunity to obtain the daughters’ views on the issue. The matter is therefore left for future consideration.

59The existing disposition satisfies the paramount criterion under s. 672.54, of protecting the safety of the public and further meets Mr. Avidago’s interests in community re-integration, supporting his mental health and his other needs.