Ontario Review Board
Re: Richard Carangay
ORB File No: 6935
Hearing held on: July 8, 2025
Place of Hearing: St. Joseph’s Healthcare, Hamilton, Ontario (Virtual Hearing)
Pursuant to: Section 672.81(2.1) of the Criminal Code
Before: Alternate Chairperson: Ms. C. Finley Members: Dr. R. W. Hill Dr. S. Wiseman Ms. N. Nathanson Ms. B. Little
Parties Appearing: Accused: Richard Carangay Counsel: Mr. R.W. Browne Person in charge of hospital: Counsel: Mr. S. O’Brien Representative: Dr. O. Lee, Resident Attorney General of Ontario: Counsel: Ms. A. Lepchuk
REASONS FOR DECISION
(Dated: July 25, 2025)
Introduction
On March 23, 2016, the accused, Richard Carangay, was found not criminally responsible on account of mental disorder, on a charge of Possession of a Weapon for Dangerous Purpose, contrary to the Criminal Code of Canada.
Mr. Carangay is currently subject to the terms and conditions of a Disposition of the Ontario Review Board (“ORB” or the “Board”) dated July 29, 2024. The Disposition detained Mr. Carangay in the Forensic Psychiatry Program at St. Jospeh’s Healthcare, in Hamilton (the “Hospital”) with privileges up to and including community living in accommodation approved by the Person-in-Charge.
By letter dated April 8, 20251, the hospital informed the ORB that on March 12, 2025 Mr. Carangay was re-admitted to the hospital due to a noticeable change in his mental status during an assessment with his Forensic Outpatient Program Case Manager. The duration of the increased restriction on Mr. Carangay’s liberties exceeded 7 days as of March 20, 2025. The letter constituted notice pursuant to s. 672.56 (2) of the Criminal Code.
By letter dated April 28, 20252, the hospital informed the Board that Mr. Carangay had been discharged back to the community to reside in the family home in Niagara Falls on April 7, 2025.3 The letter further indicated that on April 22, 2025, Mr. Carangay was readmitted to the Forensic Inpatient Unit, Orchard 3 after having presented to the Forensic Outpatient Clinic with a noticeable change in his mental status. As the duration of the increased restriction on Mr. Carangay’s liberties would exceed 7 days as of April 30, 2025, the Person-in-Charge pre-emptively provided notice pursuant to s. 672.56 (2) of the Criminal Code.
Mr. Carangay’s Restriction of Liberties (ROL) hearing in relation to the March 12, 2025 ROL initially scheduled for April 29, 2025 was adjourned. The Reasons for Adjournment set out the details.
On July 8, 2025 the Board convened a virtual hearing by Zoom to hear both Restriction of Liberty matters.
Preliminary Matters
At the outset of the hearing, Mr. Carangay’s counsel, Mr. Browne, advised that Mr. Carangay would not be attending the hearing as he found it stressful but he had asked Mr. Browne to handle the matter.
Counsel for the Hospital and the Ministry of the Attorney General agreed. The Alternate Chair indicated that the matter could proceed in Mr. Carangay’s absence pursuant to s. 672. 5(10) of the Criminal Code.
The Hospital suggested that a combined hearing occur for the two ROL proceedings. The Alternate Chair agreed.
Positions of the Parties
All parties agreed that the only matters at issue were the two ROLs.
The Hospital’s position was that both ROLs were necessary and appropriate and the least onerous and least restrictive at the time and in the case of the ROL that is currently in place, having commenced on April 22, 2025, continues to be warranted.
On behalf of the Ministry of the Attorney General, Ms. Lepchuk agreed with the Hospital’s position.
Mr. Browne, on behalf of Mr. Carangay, took no position.
Evidence
Two Hospital Reports signed by Dr. O. Kolawole dated April 23, 2025 in relation to the March 12, 2025 ROL and June 30, 2025 in relation to the April 23, 2025 ROL, were admitted as Exhibits 2 and 3 respectively.
Dr. Olivia Lee gave evidence. She has been involved in Mr. Carangay’s care since mid-March when he was admitted for the ROL at that time.
She is a PGY6 Fellow (Resident) working under the supervision of attending psychiatrist, Dr. Kolawole. Dr. Lee adopted the contents of the Hospital Reports.
March 12, 2025 ROL
Prior to the admission, Mr. Carangay had been living with his mother with support from the Niagara Assertive Community Treatment Team (ACTT). In her testimony, Dr. Lee explained that he received support 5 to 6 times per week (three times per week and one weekend from ACTT with additional support from the Forensic Team).
On March 12, 2025, at a routine appointment at the hospital, as recorded in the Hospital Report, Mr. Carangay demonstrated
notable signs of intermittent confusion and had difficulty remembering recent events. Mr. Carangay explained that he had suffered a significant fall while ice skating a few days prior. He reported that he hit his head on the ice and had nosebleeds when he got home. …the team was concerned about his mental status and his physical health… Mr. Carangay made tangential comments about being told by his church not to talk to the Forensic Outpatient Team. He insisted he wanted to leave the hospital when admission was recommended; he became angry and agitated...eventually settled enough to walk to the unit escorted by the team.4
Mr. Carangay was examined at the emergency department and had a CT scan. He was cleared medically. On March 13, 2025 he received his scheduled intramuscular injection. He was irritable and agitated and was observed yelling at staff. He had had difficulty sleeping the night prior and was incontinent of stool and urine. In the ensuing days, he continued to have unstable mental status with disorganized thoughts, irritability and agitation. He became paranoid and barricaded himself in his room, believing staff to be intruders. He was disoriented to place and situation. He was eventually transferred to a seclusion room for his and others’ safety. He remained in seclusion for 48 hours and was permitted to come out on March 17, 2025, which was successful. There were no further management issues on the unit.5
Mr. Carangay “regained insight into the circumstances of his admission (hitting his head on the ice) and was agreeable to wear a helmet in the future.” 6
Dr. Lee indicated that Mr. Carangay was discharged on April 7, 2025. There were no further concerns about his physical health (i.e. nosebleeds had resolved, he was not experiencing headaches) and his mental status had stabilized.
In her testimony, Dr. Lee stated that, looking back and given the second ROL, it was likely not enough time to stabilize Mr. Carangay.
A week following his discharge, the Forensic Outpatient Team noticed at a home visit that Mr. Carangay was euphoric with somewhat pressured speech and moving around the house extremely quickly. Two days later, at an outpatient appointment, he was disorganized and very anxious.7 Dr. Lee testified that on April 16 (not April 15 as indicated in the Hospital Report), he was seen by Dr. Kolawole. He was “notably anxious, agitated and somewhat confused…He was clearly off his mental state baseline but denied using substances or missing his medication.” The following day, Mr. Carangay and his mother were seen at an appointment at the request of the team. They reported some recent stressors which had resolved and on this day, Mr. Carangay appeared improved. However, on April 19, 2025, staff from the ACTT were unable to contact Mr. Carangay or his mother and when they attended his home, he was observed outside the house in his boxers before going in and when the ACTT worker knocked, entry was refused. 8
Mr. Carangay presented to the Forensic Outpatient clinic on April 22, 2025 for assessment. He was observed to be “disorganized, disoriented in time place and person, tangential, confused and requiring redirection but cooperative with some gentle persuasion. His insight into the nature and quality of his mental disorder and his acute presentation has been poor.” His mother reported that he had a fall the day before. The ACTT had been unable “to engage with Mr. Carangay effectively in the community to observe and support medication administration.” Bruising, swelling and cuts on his knee and leg were observed. Mr. Carangay was admitted to hospital on April 22, 2025. 9
In her testimony, Dr. Lee stated that Mr. Carangay later disclosed up to three previous falls. A CT Scan on April 24, 2025 revealed no abnormal findings.
Dr. Lee testified that Mr. Carangay had a difficult time in the first few days of hospitalization. His speech was slurred and he was unstable on his feet. He had an episode of urinary incontinence. He had near toxic levels of lithium requiring a reduction in his dosage. There was some indication that he was confused by how to use the medication blister packs provided. On April 23, he was verbally aggressive and he attempted to put water in the electrical outlets. He was placed in a seclusion room. He became sexually disinhibited and threw urine at the door. He had fears that his urine would electrocute him. On April 28, he was crawling on the floor in the evening.
On April 29, he was offered an opportunity to leave seclusion. This was successful and he has been out since that time. Over the course of the last month, he was observed to be “argumentative, irritable and at times verbally aggressive towards staff. Occasionally, he continues to present as increasingly disorganized and paranoid.”10 His levels of lithium have varied and recently were found to be high again, possibly attributable to dehydration.
Dr. Lee testified that Mr. Carangay will require a very individualized discharge plan and that, at present, he needs to be stabilized and his medications adjusted before consideration of discharge.
In responding to questions by Mr. Browne, Dr. Lee indicated that the CT scans showed no evidence of brain bleed but agreed that concussions would not appear on a CT scan. While he did not have classic head injury or concussion symptoms, Dr. Lee indicated that Mr. Carangay could have a concussion caused by the falls that had destabilized his mental status. In response to questioning, Dr. Lee indicated she was not an expert in head injuries.
In questioning Dr. Lee, Mr. Browne raised the issue as to whether the focus was primarily on mental health rather than Mr. Carangay’s medical issues. In regard to the care he received for the falls, Dr. Lee indicated that he had been seen by an ER doctor and had CT scans that showed no issues. She stated that he was being followed by a Nurse Practitioner who addresses medical issues in consultation with the attending psychiatrist.
Dr. Lee agreed the high levels of lithium should be examined. They could be caused by illness, vomiting or dehydration. There was no evidence of vomiting. She was not aware whether Mr. Carangay had a family doctor.
In responding to questions from Panel Members, Dr. Lee stated that a neurological consultation could be of assistance as could a follow-up with OT (i.e.occupational therapy). Dr. Lee noted that additional supports might need to be put into place in the home given that the mother is elderly and that medications might require review as provided in the blister packs, with additional education as to how to use them. In earlier evidence, she had indicated that Mr. Carangay is a co-owner of the home with his brother and mother and that he wants to be there. One member suggested that a memory assessment be potentially included in the report for the next annual review.
Final Submissions
The hospital submitted that both Restrictions of Liberty were warranted at the time and in the case of the second ROL, continue to be warranted. They represent the least onerous and least restrictive measures. The Hospital submitted that stabilizing Mr. Carangay’s mental status remains a work in progress.
Ms. Lepchuk, Counsel for the Ministry of the Attorney General, echoed the Hospital’s submissions.
Mr. Browne indicated that he took no position on behalf of Mr. Carangay. However, he submitted there were dangers of conflating Mr. Carangay’s physical and mental health and that these should be kept separate. Mr. Browne expressed concerns about tunnel vision. He submitted that there should be a neurological assessment. He suggested that the second ROL would not be justified if the issue is a medical issue.
Findings of the Board
The Board is unanimous in finding that both ROLs were warranted and the least onerous and least restrictive measures. The ongoing ROL is both the least onerous and least restrictive and is necessary and appropriate.
The Board accepts Dr. Lee’s evidence. In respect of the March 12-April 7, 2025 Restriction of Liberty, we accept the Hospital’s evidence that Mr. Carangay’s mental status changed and deteriorated. We note that Mr. Carangay was noticeably disorganized, confused, tangential and continued to decompensate to the point that he was barricading himself in his room, and experiencing paranoia about intruders. He was placed in seclusion for 48 hours. Once his mental status was stabilized, he was discharged back to his residence.
In respect of the second ROL commencing on April 22 and which was still in place at the date of this hearing, we find that Mr. Carangay’s mental state in the days leading up to the April 22 ROL showed evidence of significant mental status deterioration. He was in a euphoric state at the April 14 home visit. On April 19, he was observed outside his home in his boxers, then refused entry to the ACTT. His presentation on April 22 was confused, disorganized, disoriented and tangential. He was injured from falling. In the first few days of his admission, he deteriorated much further putting water in electrical units, throwing urine and being sexually disinhibited and crawling on the floor. We accept Dr. Lee’s evidence that medication adjustments are required, particularly given his high levels of lithium. We agree with Dr. Lee’s proposition that when he stabilizes, Mr. Carangay will require a well-considered individualized discharge plan that will likely require additional supports in the home and with the provision of his medication.
Given the falls and the fact that he has hit his head, the Board recommends that the hospital consider referring Mr. Carangay to a neuropsychologist for a comprehensive neuropsychological assessment, to include cognitive functioning and memory. The Board is of the view that the ACTT support should be stepped up.
DATED this 25th day of July, 2025, at the City of Toronto, in the Region of Toronto.
Ms. N. Nathanson Legal Member
Office of the Registrar Ontario Review Board
Footnotes
- Record, Item # 4
- Record, Item # 4
- The Hospital’s letter dated April 8, 2025 indicates that Mr. Carangay was discharged on April 8, 2025. However, the letter of April 22, 2025 and the evidence indicate that April 7, 2025 was the actual discharge date.
- Exhibit 2, Hospital Report, April 23, 2025, p.2
- Exhibit 2, Hospital Report, April 23, 2025, p. 2
- Exhibit 2, Hospital Report, April 23, 2025, p. 2
- Exhibit 3, Hospital Report, June 30, 2025, p.2
- Exhibit 3, Hospital Report, June 30, 2025, p.2
- Exhibit 3, Hospital Report, June 30, 2025, p.2
- Exhibit 3, Hospital Report, June 30, 2025, p.3