Re Daniel Kent, 2025 CanLII 69685

Ontario Review Board

Re: Daniel Kent

ORB File No: 3428

Hearing held on: Tuesday, June 10, 2025

Place of hearing: Centre for Addiction and Mental Health (Via Zoom Video Conference)

Pursuant to: Section 672.81(2.1) of the Criminal Code

Before: Alternate Chairperson: Mr. G. Beasley Members: Dr. R. Kunjukrishnan Dr. J.C. Rose Ms. J. Ferguson Ms. R. MacIntyre

Parties Appearing: Accused: Daniel Kent Counsel: Ms. A. Szigeti

The person in charge of hospital: Counsel: Ms. A. Marshall

Attorney General of Ontario: Counsel: Mr. M. Feindel

REASONS FOR DECISION

(Dated July 18, 2025)

Introduction

1On September 14, 2001, the accused, Daniel Kent, was found not criminally responsible on account of mental disorder on a charge of aggravated assault, contrary to the Criminal Code of Canada. By reason of a Disposition of the Ontario Review Board (“ORB”) dated October 23, 2024, Mr. Kent was ordered to be detained at the General Forensic Unit of the Centre for Addiction and Mental Health (“CAMH”), Toronto. His Disposition included privileges up to living in the community in supervised accommodation approved by the person in charge.

2On May 15, 2025, the manager of the Office of the Person In Charge of CAMH advised the ORB that on May 7, 2025, Mr. Kent was admitted on an inpatient basis to the hospital and was currently detained as of the date of the letter. As a result, on June 10, 2025, the ORB convened a hearing at CAMH for the purpose of a review of the Restriction of Liberty (“ROL”), pursuant to s. 672.81(2.1) of the Criminal Code. Ms. Szigeti was in attendance at the hearing, which was conducted by video conference technology, and requested that Mr. Kent be permitted to be absent. Pursuant to s. 672.5(10)(a) of the Criminal Code Mr. Kent was excused from the hearing. Ms. Marshall appeared as counsel for the hospital and Mr. Feindel as counsel for the Attorney General of Ontario.

Circumstances of the Index Offence

3The circumstances of the index offence are taken from last year’s Reasons for Disposition as follows

“At the time of the index offence, Mr. Kent was living in an apartment with his brother, Steven Kent. Steven Kent reported that his brother had become more aggressive and provocative. On the day of the incident, he described his brother as “foaming and intense.” He was speaking of Allah, God and “the Judger of Gods.” He also spoke of grandiose themes, such as owning various nightclubs in Toronto. The accused did have a knife on his person; however, his brother was largely unconcerned for his own safety, feeling that he was familiar enough with Mr. Kent’s behaviour to know whether he was at risk of being harmed. On June 12, the accused approached his brother, who was sleeping. He stabbed his brother in the left upper back. The knife entered the chest cavity and the victim’s lung eventually collapsed. Daniel Kent continued to stab his brother, striking him in the left side of his neck and across the left eyelid. His brother was able to escape the apartment and call police.”

Current Diagnoses

4The current diagnoses are taken from the Hospital Report as follows:

Schizoaffective Disorder

Cannabis Use Disorder

Personal History and Background

5Mr. Kent’s personal history and background are comprehensively reviewed in the Hospital Report from October 2024, which was filed as part of the Record of the hearing. For that reason, the details will not be reviewed. By way of summary, he is a 52-year-old man born in Dallas, Texas who moved to Toronto with his mother and brother at the age of three. He has a Bachelor of Science degree from the University of Toronto obtained in 1995. Mr. Kent first became ill in 1996, displaying both mood and psychotic symptoms. He has had multiple hospital admissions following periods of noncompliance with medication and substance use, particularly cannabis and cocaine. These admissions occurred both before and after his NCR finding. In August 2011, Mr. Kent attempted suicide by jumping in front of an oncoming subway train, suffering severe injuries in the process including bilateral below knee leg amputations, a head injury, and a fracture of his right arm.

Circumstances of the Readmission

6The circumstances of Mr. Kent’s readmission to hospital are set out in the Restriction of Liberty Report filed as an exhibit. In April 2019, Mr. Kent was readmitted to CAMH from the community and remained in the hospital until March 2021. Following a discharge to community housing he was readmitted between November 2021 and January 2022. On April 7, 2022, Mr. Kent was again admitted to the hospital due to mental state deterioration in the context of escalating cannabis and cocaine use. Following a case conference in May 2022, a care plan was established which provided that should Mr. Kent test positive for substance use in the future he would be readmitted to hospital. His discharge from hospital would be contingent on having three successive negative UDS screens. With the implementation of this plan, Mr. Kent was discharged but readmitted to the hospital on a number of occasions, the last being May 2 to June 26, 2023, due to relapse of cannabis use.

7Between June 2023 and May 2025, Mr. Kent had a stable and successful clinical course in the community. There were no positive urine drug screens and no admissions to hospital. He voiced ongoing motivation to maintain abstinence from recreational substances including cannabis, in order to avoid readmission to hospital.

8On May 6, 2025, Mr. Kent provided a UDS sample which tested positive for cannabis. Although he appeared to be at his psychiatric baseline, the treatment team decided to implement the previously mentioned plan, and the decision was made to readmit him to hospital. On attendance at his residence by staff on May 7, 2025, he was found asleep in a friend’s apartment with cannabis in his lap. The apartment itself was full of cannabis smoke. Mr. Kent was cooperative with his readmission to the hospital.

Position of the Parties

9At the outset of the hearing, Ms. Marshall submitted that the decision to readmit Mr. Kent to the hospital was necessary and appropriate and the least restrictive option available to the parties at the time. She also submitted that his ongoing detention was warranted. Mr. Feindel supported the decision of the hospital to readmit Mr. Kent but reserved his position with respect to the ongoing detention. Ms. Szigeti took no position and indicated that she did not have instructions to argue that the decision to readmit was not warranted.

Evidence

10The evidence on behalf of the hospital was presented by Dr. Valoo. She was the co-author of the Restriction of Liberty Report and stated that she has been Mr. Kent’s outpatient psychiatrist since July of 2024. By way of update, she testified that Mr. Kent remained admitted to the hospital as of the date of the hearing on the CCCU-6, which was a general non forensic unit. Pursuant to the treatment plan, Mr. Kent was providing UDS screens every day from Monday to Friday. He had provided a negative screen on Thursday, June 5, but the Friday, June 6 screen was positive. Dr. Valoo stated that Mr. Kent did not have any off unit passes which was the policy at the unit where he was being detained. She said he remained stable and pleasant, and the treatment team had no concerns regarding possible use of cannabis in the hospital. Dr. Valoo stated that Mr. Kent had a slow metabolism. The plan was that he would be discharged back to his residence when he provided two consecutive negative screens. His housing remained available to him. Dr. Valoo explained that the reason for requiring two negative screens was so that the treatment team could properly assume that all previously consumed cannabis had been eliminated from his system and moving forward, any positive screen would be suggestive of a further relapse. Dr. Valoo stated that historically Mr. Kent had not been forthcoming with his use of cannabis. This was his first ROL in the past two years.

11Dr. Valoo acknowledged that Mr. Kent had been under the jurisdiction of the ORB since 2001. She stated that the current plan for rapid readmission was to prevent an escalation in use and a decompensation in mental status. This could be accomplished by admitting Mr. Kent back into the hospital. Dr. Valoo stated that as set out in the 2024 Hospital Report, Mr. Kent had numerous hospitalizations as a result of marijuana use. For Mr. Kent, cannabis use worsens his symptoms of his mental illness.

12Dr. Valoo was asked about the plan which had been implemented to return Mr. Kent to the hospital. She stated that Mr. Kent had a very good understanding of the plan and, in fact, said that it motivated his abstinence from cannabis use. She stated that there were no other viable options to manage Mr. Kent’s risk to the community. If he were discharged it would be difficult to monitor him for relapse. Dr. Valoo stated that the treatment plan benefitted Mr. Kent.

13Mr. Feindel asked about Mr. Kent’s current unit at the hospital. Dr. Valoo said that he had been on a general unit since readmission. His privileges consisted only of the opportunity to use a balcony attached to the unit. There were no off-unit privileges permitted for any persons on that unit. Mr. Feindel asked if Mr. Kent were on a different general unit in the hospital, whether or not he would have grounds privileges escorted by staff. Dr. Valoo said that he would. With respect to the UDS screening, Dr. Valoo said that she thought that the positive result was a “low positive.” The testing only produced as positive or negative results without a quantitative number. She stated that the team was expecting a negative result with the next test and Mr. Kent would then be discharged to his residence. Dr. Valoo acknowledged that this was a prolonged admission without privileges for Mr. Kent. The team had decided to show some flexibility and to accept two negative drug screens instead of the originally planned three negatives. She reiterated that the negatives were necessary in order to allow the team to monitor for any relapse once Mr. Kent returned to the community.

14In response to questions from Ms. Szigeti, Dr. Valoo stated that the positive drug screen was from a sample taken on May 6. Dr. Valoo agreed that all samples taken before May 2 had returned negative results. When asked about the positive sample on June 9, Dr. Valoo agreed that it was an unusually lengthy period of time to have a positive result, and although uncommon was not unheard of. Again, she stated Mr. Kent has a slow metabolism. Ms. Szigeti asked, somewhat rhetorically, if Mr. Kent had no privileges because of his slow metabolism? Dr. Valoo responded yes. Dr. Valoo agreed that on all prior episodes where Mr. Kent had been smoking cannabis there had not been any violent behaviour. She did not know when the last incident of violence occurred but agreed that it was probably many years ago.

15Dr. Valoo stated that when Mr. Kent was admitted to the hospital there were no forensic beds available. Mr. Kent was cooperative with the admission and, at the time it occurred, his mental status was stable. He was acutely intoxicated by cannabis on admission and his behaviour was guarded in the emergency department, but he fairly quickly returned to baseline. Ms. Szigeti asked if there was any obligation on the hospital to make a forensic bed available for a patient being readmitted. Dr. Valoo stated there was not. Dr. Valoo agreed that this was a planned admission. When asked if there was any other mechanism for readmission other than through the emergency department, Dr. Valoo stated that it was the policy of CAMH to first take a patient to the ER for assessment and then it was up to the bed managers to decide where the patient went. Dr. Valoo stated that the clinicians had no role in that decision. When asked by Ms. Szigeti if the result was that there was no bed available for 34 days in a general forensic unit in the hospital, Dr. Valoo stated that was correct. The unit where Mr. Kent is presently detained is meant to be an acute inpatient psychiatric unit. By acute she indicated that they were not necessarily the most unwell but in a medical sense it meant people with active psychotic issues.

16Ms. Szigeti asked how the original plan of three negative UDS screens came about. Dr. Valoo stated that this was from 2022 when the plan was first developed. She acknowledged that it should be revised. She stated that each team would use their clinical judgment to decide if two negative screens were sufficient. When asked if it might have been possible for Dr. Valoo’s outpatient team to take Mr. Kent out of the unit for accompanied grounds privileges, Dr. Valoo stated that it might have been possible but would have required some coordination among staff.

17In response to questions from the panel, Dr. Valoo stated that she did not know if there were any voluntary patients on the unit where Mr. Kent was detained. She was equally unaware if any voluntary patients could leave the unit. She said the unit policy was no off-unit passes. Dr. Valoo stated that the policy was the result of a shortage of staff to support patients being allowed to go off the unit. A panel member asked Dr. Valoo about Mr. Kent's comment that his reason for using was “because it was time.” Dr. Valoo stated that she was not 100 percent confident that Mr. Kent would not return to cannabis use. She said his motivation is flexible, but he would like to maintain abstinence for another two years. When asked about the substantial amount of cash which Mr. Kent had with him at the time he was readmitted to hospital, Dr. Valoo stated that Mr. Kent has just received his ODSP cheque and was prone to impulsive financial acts. Dr. Valoo stated she did not know how long the average length of stay would be for other patients on the CCC6 unit. She also stated that she was unaware of any attempts to transfer Mr. Kent to a different forensic bed within the last two weeks or whether a forensic bed was available at the time that he was placed on CCC6. Finally in response to a question from the panel, Dr. Valoo stated that in conversation with Mr. Kent the day before the hearing, he expressed some frustration about the length of his stay but overall said that he enjoyed the staff on the unit he was on and seemed to be handling the extended stay quite well.

18In re-examination Ms. Szigeti asked Dr. Valoo about the size of the balcony which provided access to the outside to Mr. Kent and other patients on CCC6. She estimated that probably 10 average-sized people would be able to stand on the balcony. Dr. Valoo confirmed that she is aware of the CAMH Patient Bill of Rights and stated that Mr. Kent has been told why he has not been allowed any off-unit privileges and that he will be discharged as soon as the next negative UDS screen sample is received. Dr. Valoo also stated that she believed that Mr. Kent’s right to the outdoors was accomplished by access to the balcony on the unit. She did not know if his right to exercise was being accommodated.

Submissions

19Ms. Marshall maintained her position stated at the outset of the hearing that the decision to readmit Mr. Kent was necessary and appropriate and the least restrictive option available to the team at the time that it happened and on an ongoing basis. With respect to the evidence about the lack of privileges, Ms. Marshall submitted that unfortunately CAMH has a limited number of forensic beds available for treatment of inpatients. Ms. Marshall stated that Dr. Valoo and the treatment team were working to discharge Mr. Kent back to the community as soon as a second negative UDS sample was provided.

20Mr. Feindel submitted that he supported the position of the hospital that the decision to readmit Mr. Kent to the hospital was justified in accordance with the treatment plan which had been developed. He further supported the position of the hospital that it was necessary for the treatment team to establish a baseline negative UDS screen sample in order to be able to effectively monitor Mr. Kent once he was discharged to the community. However, Mr. Feindel submitted that Mr. Kent was being detained on a unit which had considerably more security than he required and was therefore not the least onerous or restrictive option appropriate to Mr. Kent. He stated that the evidence supported the conclusion that if Mr. Kent were on a forensic unit he would have significantly more privileges than which he currently enjoys. Mr. Feindel also made submissions about the evidence which indicated that as a clinician, Dr. Valoo did not have any input as to where Mr. Kent was to be detained. Mr. Feindel submitted that it was clear that the jurisdiction to administer dispositions issued by the Ontario Review Board rests in the Office of the Person In Charge or their delegate. He submitted that it was a problem if the Office of the Person In Charge or their delegate was not able to administer the Disposition. In summary, he stated that the decision of the “bed manager” ought not to trump the authority of the Office of the Person In Charge.

21Ms. Szigeti submitted that Mr. Kent had not provided her with instructions to contest the decision to readmit him to hospital or the circumstances of his ongoing detention in the hospital. Ms. Szigeti submitted that it was not appropriate for the hospital to simply “shrug their shoulders” and say that we do not have enough beds on the forensic unit; therefore we have admitted a patient to a civil unit with no off-ward privileges. She submitted that the decision which the Board was required to make was whether or not the circumstances of admission at the outset and on an ongoing basis were the least onerous and least restrictive and commensurate in the circumstances and commensurate with public safety.

Analysis and Decision

22The panel is unanimous in finding that the decision to readmit Mr. Kent to the hospital on May 7, 2025 was necessary and appropriate and the least restrictive option available to the hospital in all the circumstances at the time that it was made. This was the position taken by counsel for the hospital and supported by counsel for the Attorney General of Ontario. Counsel for Mr. Kent submitted that she did not have instructions to challenge the initial decision of the hospital. Mr. Kent has been under the jurisdiction of the Ontario Review Board since 2001. Even a cursory review of the lengthy Hospital Report establishes that he has a long history of mental illness exacerbated by the use of substances, primarily cannabis. He has had multiple admissions to hospital both before and after the finding of NCR. As set out above, in 2022, the treatment team established a plan to attempt to break the cycle of admission and discharge.

23From the evidence of Dr. Valoo, the original intention was that if Mr. Kent tested positive for cannabis during one of the routine UDS samples then he would be readmitted to hospital. He would remain in hospital until he had provided three negative samples in a row which would provide the treatment team with a baseline to be certain that he had metabolised cannabis which he had consumed. He would then be discharged back to the community.

24From August, 2022 to May 2023, Mr. Kent was readmitted to the hospital on four different occasions. Starting on June 26, 2023, Mr. Kent established an almost two-year period of abstinence from substance use. During that time he consistently provided negative UDS samples and remained in the community with no readmissions to the hospital. Unfortunately, early in May of 2025 Mr. Kent’s UDS sample returned a positive result. When the team attended his apartment to implement the readmission process, Mr. Kent was found in a friend’s apartment in an obvious state of intoxication from the consumption of cannabis. The apartment was full of cannabis smoke and Mr. Kent was asleep in his wheelchair with cannabis in his lap. More cannabis was found in his possession. When asked why he had used cannabis he responded, “it was time.” To his credit, Mr. Kent was cooperative with the treatment team in packing up his belongings and accompanying his case manager to the emergency department. Following a brief stay in the emergency department, Mr. Kent was admitted to the hospital. As previously stated, the panel found that the readmission was necessary and appropriate and warranted in all the circumstances.

25Mr. Kent was not admitted to a forensic unit at CAMH. Dr. Valoo testified that the decision as to where a patient is placed is not made by the clinical service responsible for the admission. She stated that it is made by the “bed manager.” Mr. Kent was admitted to CCC6, a unit intended for civil patients suffering from an acute psychiatric episode. Dr. Valoo testified that this unit does not allow any off-unit privileges for any of the patients residing there. There is a balcony which allows patients to be outside.

26As of the date of the ROL hearing, Mr. Kent had been detained in the hospital for 34 days. Although he had provided a negative sample several days before the hearing, the sample taken the next day was positive. Dr. Valoo testified that this length of time for a patient to metabolise the cannabis which had been consumed was, while longer than would normally be expected, not uncommon. She justified that it seemed that Mr. Kent was a “slow metabolizer.” In acknowledgement of the length of time which Mr. Kent had been in the hospital, Dr. Valoo testified that the team had modified the original plan and was prepared to discharge Mr. Kent back to his residence once he provided one further negative sample. Results of the UDS sample taken the day before the ROL hearing had not yet been received. It was anticipated that this would be negative and allow the team to discharge Mr. Kent.

27The panel is unanimous in finding that the ongoing readmission of Mr. Kent in furtherance of a well-established plan of treatment was necessary and appropriate in the circumstances. However, the panel is unanimous in finding that admission to unit CCC6 was not warranted. The evidence is clear that public safety did not require that Mr. Kent be detained on a unit where he was denied any off-unit privileges and restricted to going out onto a balcony with other inpatients as his sole “privilege.” Dr. Valoo candidly acknowledged that were Mr. Kent on a forensic unit he would have without doubt earned privileges of at least staff accompanied in the hospital and grounds. Given the policy on CCC6, he was denied this opportunity.

28During the course of the evidence and submissions, both Ms. Szegeti, on behalf of Mr. Kent, and Mr. Feindel, on behalf of the Attorney General of Ontario, had pointed questions and submissions critical of the decision to admit Mr. Kent to CCC6 and the lack of privileges extended to Mr. Kent. Ms. Szigeti's submissions included reference to the CAMH Patient Bill of Rights and its application to those persons admitted to the hospital. Mr. Feindel queried the role of the “bed manager” vis-à-vis the implementation of the provisions of an ORB Disposition made under the Criminal Code of Canada and delegated to the Office of the Person In Charge or their delegate. The panel is unanimous in acknowledging the assistance the panel received from both counsel on the issue of the ongoing admission.

29In conclusion, the panel is unanimous in finding that the decision to restrict the liberty of Mr. Kent by admitting him to the hospital was necessary and appropriate and warranted. The panel was also unanimous in finding that the ongoing detention of Mr. Kent in the hospital in circumstances where he was unable to earn and exercise privileges, which would have otherwise been or should have been available to him, was not the least onerous and restrictive option in all the circumstances.