Ontario Review Board
Re: Jeremy Montgomery
ORB File No: 5084
Hearing held on: Friday, May 30, 2025
Place of Hearing: St. Joseph’s Healthcare Hamilton, West 5th Campus
Pursuant to: Section 672.81 (2.1) 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: Jeremy Montgomery Counsel: Mr. A. Confente
The Person in Charge of hospital: Counsel: Mr. S. O’Brien
Attorney General of Ontario: Counsel: Mr. I. Shaikh
REASONS FOR DECISION (Dated July 7, 2025)
Introduction
On June 23, 2008, Jeremy Montgomery was found not criminally responsible on account of mental disorder (“NCR”) on a charge of assault with a weapon, contrary to the Criminal Code. He has therefore been subject to the jurisdiction of the Ontario Review Board (“ORB” or “the Board”) for approximately 17 years. Mr. Montgomery is subject to a Disposition of the Board dated October 9, 2024 pursuant to which he is 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 24/7 supervised accommodation approved by the person in charge. This Disposition is the first to have provided for community living for Mr. Montgomery since he came under the Board’s jurisdiction.
By way of a letter dated February 6, 2025, the Hospital provided Notice to the Board, pursuant to s. 672.56 (2) of the Criminal Code, of an increased restriction on Mr. Montgomery’s liberties that exceeded seven (7) days. On Friday, May 30, 2025, a panel of the Board convened in person at the Hospital to inquire into the circumstances and to determine: (a) whether the Hospital’s actions constituted a significant increase in the restrictions upon Mr. Montgomery’s liberties; and (b) if so, whether the increased restriction was warranted and justified, both at the time that it occurred and for its duration. Mr. Montgomery was present and represented by his counsel, Mr. Confente.
The evidence at the hearing consisted of the Hospital’s Restriction of Liberties (“ROL”) Report dated May 20, 2025, the Hospital Report dated September 16, 2024, and the oral evidence of Dr. W. Sutton, who had been Mr. Montgomery’s attending psychiatrist until his transfer to the Waterfall 3 unit at the Hospital in April. Dr. Sutton authored the ROL Report.
Circumstances of the Increased Liberty Restrictions
- According to the February 6th letter from the Hospital:
“On January 28, 2025, Mr. Montgomery engaged in an unprovoked attack against a co-patient. He entered the dining room and quietly walked over the area where three co-patients and a staff member were playing a board game. Mr. Montgomery then began to stab a co-patient several times with a pen. The staff member immediately called a Code White.”
Mr. Montgomery was escorted to seclusion by unit and security staff. He endorsed auditory hallucinations that led to his attack on the co-patient. He remained in seclusion as of the February 6th letter.
Positions of the Parties
- At the start of the hearing, counsel for the Hospital, supported by counsel for the Attorney General, took the position that there had been a significant increase in Mr. Montgomery’s liberty restrictions and that the Hospital’s actions were warranted in the circumstances, for the duration of those increased restrictions which concluded on April 10, 2025. Counsel for Mr. Montgomery advised that his instructions were to not contest the justification for the Hospital’s actions in the circumstances. No party suggested that the Disposition itself should be reviewed. The parties maintained their positions at the conclusion of the evidence.
Findings
- For the following Reasons, the panel accepted what was essentially a joint recommendation and found that the Hospital’s actions in first placing Mr. Montgomery into seclusion, keeping him there until February 11, 2025, and then keeping his room locked until his transfer to another unit were warranted and represented the least onerous and least restrictive measure for the management of Mr. Montgomery’s risk to the safety of the public. The panel found that the measures taken by the Hospital did, indeed, constitute a significant increase in the restrictions upon his liberties.
Index Offence
- The circumstances surrounding the index offence are taken from the Reasons for Disposition dated November 4, 2024, and are reproduced as follows:
"On February 4, 2008, Mr. Montgomery threw a beer bottle at a woman who was riding her bike. When she confronted him and told him the police had been called, he waved a knife at her in a threatening manner.
Two days later he entered a grocery store and threatened to damage the premises. He also attempted to rob a female customer of her groceries. An older gentleman advised police that earlier in the evening, he had been held up by Mr. Montgomery who had been in possession of a knife.”
Background Information
Aspects of Mr. Montgomery’s personal history, psychiatric background and course under the Board are summarized in last year’s Reasons for Disposition and that history is captured in greater detail in the Hospital Report. As the Hospital Report is in evidence at the hearing, the information need not be summarized for the purpose of these Reasons. Those portions that provide necessary context for the issues at this hearing are highlighted below.
Mr. Montgomery is now 38 years old. He was 21 at the time of the index offence. He is incapable to make treatment decisions, and his mother is his substitute decision maker (SDM). He is also financially incapable, and the Public Guardian and Trustee (PGT) is his SDM for financial matters. His current diagnoses are:
- schizoaffective disorder – bipolar type;
- intellectual disability (mild);
- cannabis use disorder (in early remission);
- cocaine use disorder (in remission); and
- antisocial personality disorder.
Mr. Montgomery’s mother contacted the Children’s Aid Society in 1992 (when he would have been five or six years old), when she began having difficulty managing her son’s behaviour. He did not follow direction and used profanity when talking to her. He got into fights at school and was disobedient and insolent with teachers and the principal. His involvement with CAS resulted in his placement in several different foster homes and residential care at the Regional Children’s Centre in 1997. A discharge report from the Children’s Centre described Mr. Montgomery as “physically aggressive, impulsive, non-compliant, with temper tantrums and at the borderline in academic functioning”. In 1998, Mr. Montgomery was suspended for bringing a knife to school. When transferred to another school, he was suspended for “persistent opposition to the instruction of teachers and the principal”.
At a young age, Mr. Montgomery was diagnosed with borderline ADHD (attention deficit hyperactivity disorder), possible learning deficits, oppositional defiant disorder, cognitive difficulties and antisocial behaviour. He became a Crown Ward in 2002 and lived in various group homes and in residential care.
Mr. Montgomery began using substances when he was 16 years old and was diagnosed with substance abuse disorder in 2003, when he was 17 years old.
Prior to the index offence, Mr. Montgomery had a criminal record commencing in 2001 (when he was still a youth). It includes multiple convictions for assault and threatening behaviour, as well as theft, mischief, and failing to comply with orders of different kinds. In addition, he incurred two separate charges of assault while subject to the jurisdiction of the Board, in 2019 and 2020 (during a stay at the Southwest Centre for Forensic Mental Health Care), that were eventually stayed in November of 2020. Mr. Montgomery’s history is characterized by numerous instances of violence and threats perpetrated against medical staff, co-patients, police, and other members of the public.
Mr. Montgomery was initially detained at the Waypoint Centre for Mental Health Care (“Waypoint”) following his first ORB hearing. He remained there until 2017, when he was transferred to SJHCH. In 2018, he was transferred to the Southwest Centre for Forensic Mental Health Care in St. Thomas. Following the assaults at that facility noted above, it was determined that he required a more secure environment to manage his risk, and he was returned to Waypoint in October of 2020. There was no reported assaultive behaviour in an institutional setting after January of 2021, while he was still at Waypoint.
Mr. Montgomery was transferred from Waypoint to SJHCH on April 26, 2023, initially to the Waterfall 3 unit. On September 25, 2023, he was transferred to Harbour North 3 under Dr. Sutton’s care. Despite his violent ideation, which requires ongoing monitoring, Mr. Montgomery had not engaged in physically violent aggression since arriving at SJHCH, until the incident that prompted this hearing.
Evidence at the Hearing
Dr. Sutton testified that Mr. Montgomery had experienced some improvement in his condition since arriving at SJHCH. As the Hospital Report notes, Mr. Montgomery was, however, vehemently opposed to the clozapine that was being administered and was frequently noted to be non-compliant, even with the liquid form of the medication. His mental condition, which was never in remission even on medication, fluctuated with his treatment compliance.
Mr. Montgomery’s clozapine was replaced with Haldol in 2024. According to the Hospital Report, Mr. Montgomery initially stated that he liked the Haldol, but after a few months it became evident that he was non-compliant with the treatment, There was then a fairly steep decline in his presentation. He was bothered by voices and delusional beliefs that he was under threat by fellow patients, including the patient whom he eventually attacked. He reportedly believed the co-patient was harming babies and meant to harm his family.
As noted above, the attack on the co-patient occurred in the dining room on January 28, 2025. Staff described Mr. Montgomery calmly walking up to the victim and observing a board game the victim was playing. Mr. Montgomery then abruptly began to stab the victim repeatedly from behind in the neck and cheek areas with a pen. When asked later why he assaulted the victim, Mr. Montgomery reported that he was hearing voices informing him the victim was going to "put my family on fire".
In response to a question, Dr. Sutton testified that the victim was taken to the Emergency Room in downtown Hamilton and he believed that he had superficial cuts and abrasions to his cheek and neck and required bandages and steri-strips.
Dr. Sutton testified that the decision was made to put Mr. Montgomery back on clozapine after this incident and it took several weeks to titrate the dose up to a therapeutic level. He was quite unwell and spent 15 days in seclusion while the clozapine dose was increased to 400 mg., which Dr. Sutton believed was Mr. Montgomery’s optimal dose. Mr. Montgomery was then bought out of seclusion and returned to his own room, which however was kept locked due to the risk of unprovoked violence to others. That risk was deemed high if Mr. Montgomery was placed back into the general unit milieu, as he consistently stated the attack on the victim was justified, while failing to show any remorse or understanding of the wrongfulness of his actions. He also mentioned several other co-patients on the unit whom he believed were engaging in nefarious acts and who meant him harm.
Early on in this process, a decision was made to transfer Mr. Montgomery to another unit in the Hospital, but it was necessary to wait until a bed became available. Mr. Montgomery still held residual beliefs about the victim of the stabbing, and other patients on the unit had witnessed the attack and were fearful of him.
While Mr. Montgomery’s room remained locked during the day, arrangements were made for him to have extended periods of time out of the room accompanied by recreational and nursing staff for walks, and to spend time in the television lounge, always with staff. Dr. Sutton testified that during these times out of his room, Mr. Montgomery was able to go for walks to the outdoor courtyard.
When Mr. Montgomery was transferred to Waterfall 3 on April 10, 2025, his room was no longer locked and he was able to go out onto the unit. With the continued administration of clozapine, Mr. Montgomery slowly returned to his baseline in the two months prior to the date of the ROL Report, which stated that while his delusional ideation remained, he became less invested in their intensity.
In response to a question, Dr. Sutton confirmed that Mr. Montgomery is also on a long-acting injectable antipsychotic medication, taken every three weeks. Dr. Sutton stated that even with that medication, Mr. Montgomery still needs the clozapine.
Dr. Sutton testified that as of the hearing date, Mr. Montgomery was back to using Level 2 (secure side of the Hospital building) escorted privileges. The ROL Report noted that he appeared motivated to refrain from further aggression in order to obtain more off-unit privileges.
No further evidence was led following Dr. Sutton’s testimony.
Analysis and Conclusions
The panel had no difficulty accepting the parties’ joint position and found that the Hospital’s decision to place Mr. Montgomery into seclusion on January 28, 2025 was necessary. In the immediate aftermath of his actions that day, there was no realistic alternative for containing his risk. He had just engaged in a sudden, unprovoked and violent attack on another patient in a common area (dining room) where other patients were also present.
Thereafter, Mr. Montgomery spent 15 days in seclusion. Dr. Sutton explained the duration of this period, which out of context seems lengthy on its face. Given the deterioration of Mr. Montgomery’s mental state during the period preceding the attack on the co-patient, and the attendant symptoms, it was reasonable for the treatment team to attempt to manage Mr. Montgomery’s clear risk to others by reintroducing the same medication that had previously enabled Mr. Montgomery to experience more sustained stability.
The panel accepts Dr. Sutton’s evidence that it was necessary to make the medication change and to maintain Mr. Montgomery in seclusion while the dosage was titrated to a therapeutically effective level. In this regard, the panel notes, as was stated at para. 36 of the most recent Reasons for Disposition, that Mr. Montgomery suffers from a treatment resistant form of schizoaffective disorder.
Once Mr. Montgomery could be taken back to his own room from seclusion, it remained unsafe to permit him to have unrestricted access to his unit, given his continuing danger to others and the reasonable fear that other patients had of him. While awaiting space so that Mr. Montgomery could be transferred to another unit, the Hospital kept his room locked. The panel finds that these continued measures were necessary and warranted, up to and including April 10, 2025, when Mr. Montgomery was transferred to another unit. The treatment team worked to mitigate and minimize the additional restriction on Mr. Montgomery’s freedom occasioned by keeping his room locked, by providing him with staff-accompanied opportunities to leave the room for walks and to enjoy the amenities of the television room.
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
Office of the Registrar
Ontario Review Board