Re: Marc Caron
ORB File No: 6835
Hearing held on: Tuesday, July 8, 2025
Place of hearing: Brockville Mental Health Centre Via Zoom Video Conference
Pursuant to: Section 672.81(2.1) of the Criminal Code
Before: Alternate Chairperson: Ms. C. Finley Members: Dr. R. Wood Hill Dr. S. Wiseman Ms. N. Nathanson Ms. B. Little
Parties Appearing: Accused: Marc Caron Counsel: Ms. M. McMahon
The person in charge of hospital: Counsel: Ms. P. Miltenburg
Attorney General of Ontario: Counsel: Mr. K. Schultz
REASONS FOR DECISION
(Dated August 5, 2025)
Introduction
On October 6, 2015, the accused, Marc Caron, was found not criminally responsible on account of mental disorder on a charge of uttering threats to cause death or bodily harm, contrary to the Criminal Code of Canada.
Mr. Caron is currently subject to a disposition of the Ontario Review Board (“the Board”) dated April 17, 2025, which detains him at the Secure Forensic Unit of the Brockville Mental Health Centre – Member of the Royal Ottawa Health Care Group, Brockville, Ontario, with privileges up to and including living in the community in accommodation approved by the person in charge.
By way of letter dated June 2, 2025, the hospital notified the Board that Mr. Caron had eloped while exercising his indirectly supervised community privileges. By letter dated June 5, 2025, the Board was notified that Mr. Caron had returned to hospital. By letter dated June 11, 2025, the hospital notified the Board that Mr. Caron had been admitted to the Assessment and Stabilization Unit and that there had been a significant increase in the restrictions of his liberty that exceeded seven days.
As a result, the Board convened a hearing using zoom technology on July 8, 2025, pursuant to s. 672.81(2.1), to review the restriction. Mr. Caron was present and represented by Ms. McMahon. Also present at the hearing to support Mr. Caron was his fiancée, Ms. Cook.
The only issue to be determined was whether the decision by the hospital to significantly increase the restrictions of Mr. Caron’s liberty was warranted at the time and whether the increase of restrictions as of the day of the hearing was warranted.
Ms. Miltenburg, counsel for the hospital, submitted that the initial decision to readmit Mr. Caron was necessary and appropriate to manage his risk to the safety of the public and continued to be so. Mr. Schultz, on behalf of the Ministry of the Attorney General, concurred with the hospital’s position. Ms. McMahon agreed that the initial increase of the restriction of Mr. Caron’s liberty was necessary and appropriate but questioned the continued level of restriction.
Findings
- For the reasons that follow, the Board finds that the hospital’s decision to admit Mr. Caron to the hospital’s high secure unit on June 5, 2025 was necessary and appropriate and represented the least restrictive and least onerous measure available to the hospital in the circumstances. Further, the continued detention in hospital at the increased levels of restriction up to the day of the hearing was also necessary and appropriate and the least onerous.
The Evidence
- The evidence at the hearing consisted of the Hospital Report, dated June 24, 2025 (ex. 1), and the viva voce evidence of Dr. Carefoot, Mr. Caron’s treating psychiatrist.
The Index Offence
- The circumstances of the index offence are taken from this year’s Reasons for Decision and Disposition dated May 14, 2025, as follows:
At the time of the offences, Mr. Caron was serving a sentence in an unrelated matter, at the St. Lawrence Valley Correctional and Treatment Centre. During his stay at this facility, he was seeking treatment from Dr. C. Cameron. Dr. Cameron, when speaking with Mr. Caron, learned that he, since early childhood, has had homicidal thoughts to kill his mother. Dr. Cameron indicates that these urges are so ingrained that, not only does Mr. Caron think about them daily, he also dreams about them at night. Mr. Caron has described to Dr. Cameron that he will kill his mother, cut her up into pieces, cook her and eat her. Mr. Caron indicates he will not actively pursue his mother, but that, if he were to cross her path by random chance, he would not be able to control these urges. Mr. Caron also revealed to Dr. Cameron a recently thought-out plan to perhaps kill his brother Chris or his sister Tiffany, and when his mother attended their funerals, he would ambush her and kill her.
Background Information
Given the limited focus of this hearing, it is not necessary to review Mr. Caron’s background and psychiatric history. That information is included in the Hospital Report which was made an exhibit. However, it is useful to outline some of the material facts from his recent annual NCR hearing that are outlined in the Reasons for Disposition dated May 14, 2025.
Mr. Caron is a 40-year-old man who “has an extensive and varied criminal record commencing at a young age, including convictions for violent offences, drug-related offences and multiple breaches of court orders. He has spent a considerable amount of time in custody and has previously reported that he felt more comfortable in jail than in the community. He had many contacts with the criminal justice system that did not result in charges or convictions. He is a registered sex offender.”1
At 19, he stabbed his mother with a screwdriver and at 26, he had a detailed plan with his sister to kill his mother. Mr. Caron has a lengthy history of use of intoxicants including alcohol, cannabis, LSD, crystal methamphetamine, opiates and cocaine.
Following his initial NCR hearing, Mr. Caron was admitted to Waypoint. After the passage of time, when he was stable, medication compliant, and his homicidal ideation had subsided, the treatment team recommended a transfer to Brockville. The Board concurred, and on April 20, 2017, Mr. Caron was admitted to the Brockville Mental Health Centre – Forensic Treatment Unit.
By April 2022, Mr. Caron had progressed to the point where he was discharged to the FIT Team (FITT) home which is a 24-hour supervised residence on BMHC grounds. After an initial period where he did well, demonstrating commitment to his treatment plan and working with his treatment team on furthering his rehabilitation and recovery, he relapsed to use of substances and was re-admitted to hospital from June to October 2023. Following a successful 30-day LOA, he was discharged back to FITT in November 2023. Regrettably, his struggle to maintain abstinence from substances while residing in the less-structured setting of FITT continued and after a number of positive urine drug screens he was readmitted to hospital on January 26, 2024, where he remains to date. Of note, during the period he was actively using, Mr. Caron became uncharacteristically avoidant and deceptive with his treatment team, non-compliant with medication and externalized blame for his situation.2
Mr. Caron’s current diagnoses are as follows:
a. Unspecified Psychotic Disorder
b. Post-Traumatic Stress Disorder
c. Substance Use Disorder
d. Antisocial Personality Disorder
e. Sexual Sadism Disorder – in remission.
The Significant Increase in the Restriction of Mr. Caron’s Liberty
Dr. Carefoot, Mr. Caron’s attending psychiatrist, testified at the hearing that on June 2 at noon, she received positive results of a drug screen, that had been taken on May 28, 2025. Mr. Caron was contacted at his fiancé, Ms. Cook’s, home and the positive result was explained. The drug was methamphetamine. Dr. Carefoot asked him to return to hospital to discuss. Mr. Caron was initially resistant but ultimately agreed to return. Staff went to meet him on his way back but he did not appear. When contacted, Ms. Cook thought he was enroute. Mr. Caron was planning to go to Ottawa that day with his AA sponsor. When contacted, his sponsor was unaware of his whereabouts.
Dr. Carefoot asked the lab to redo the drug screen and this time, to provide the level of methamphetamine detected. She explained that initial screens do not normally include this level of detail. After several unsuccessful attempts to contact Mr. Caron, police were called.
On June 5, 2025, Ms. Cook reached out to the hospital. The call was referred to Dr. Carefoot. Ms. Cook asked Dr. Carefoot to call her back in three minutes. She did and spoke to Mr. Caron. She told him to return to hospital and one hour later, he returned.
Mr. Caron was admitted to Unit B4S, the most restrictive unit at Brockville. He was placed in an open quiet room, which was a seclusion room with the door open as this was the only room available on the unit. The following day, he was moved to a room. Dr. Carefoot noted that Mr. Caron’s affect was changed from baseline. He was angry at times and defensive. Sometimes he was tearful. He accepted some of the medications provided, but not all.
On July 4, 2025, Mr. Caron was transferred to the B4N unit, the second most secure of Brockville’s four units. As of July 7, he began accessing privileges, meaning he was able to have indirectly supervised grounds privileges 30 minutes, four times per day and staff accompanied community privileges. At the next conference, which is scheduled for July 29, there will be a discussion of indirectly supervised community privileges.
Mr. Caron’s insight has fluctuated. On June 17, there were concerns about his appreciation of the severity of his elopement. In the Hospital Report (p.86-87), he is described on that day as irritable, loud, intimidating and lacking in insight but on June 23 he apologized and seemed to have better insight into the seriousness of his elopement. However, later that day, staff reported that Mr. Caron told others that he was confined due to a false positive drug test raising concerns about limited insight. In her testimony, Dr. Carefoot indicated that since that time, he has accepted that his elopement caused safety concerns both to himself and to others.
The drug screen was conducted by Dynacare. The initial test did not provide information on the level of drugs. However, the Hospital Report indicates that after the second sample, Dr. Carefoot spoke with the toxicologist at Dynacare. The initial sample showed a low level of positivity for methamphetamine and the second sample did not meet the threshold for positivity.3 The toxicologist from Dynacare indicated to Dr. Carefoot that it could have been due to environmental causes or certain medications. Mr. Caron does not take the type of medications that would cause this. Dr. Carefoot said the cause was likely environmental. A urine test conducted on June 5 was negative for substances. Mr. Caron denied use of substances. He indicated that with the stress related to readmission to the high secure unit, he thought of using substances, but now that feeling has lessened. Dr. Carefoot indicated that the hospital’s serious safety concern relates to Mr. Caron’s reaction to the positive drug test, that being the elopement.
In terms of privileges, if things go well, Mr. Caron can have weekly visits with Ms. Cook and more indirect grounds privileges. These privileges will be discussed at the next conference to be held on July 29. Prior to the elopement, Mr. Caron was in discharge planning, residing on unit B3N, the community transition unit. Dr. Carefoot explained that Mr. Caron cannot currently be transferred to B3N, because a peer who has a no-contact order with Mr. Caron is on that unit. However, she noted that discharge planning could take place from the unit he is currently on or another unit that he may be transferred to. Dr. Carefoot is hopeful that discharge planning will take place in the next six months.
Dr. Carefoot reported that Mr. Caron had returned to his baseline as of July 7. He is pleasant, open and honest and there are no concerns regarding hallucinations. She indicated that the case conference had been moved up to July 29 from August because he is doing better. He appreciates the elopement concerns, he returned on his own and he did not take substances while he was away. He had a high level of privileges prior to his elopement. Dr. Carefoot would like to see Mr. Caron join a stress management group.
Counsel for the Ministry of the Attorney General asked about Mr. Caron’s time away. He had apparently spent time in the woods, avoiding police. He had had no anti-psychotics for three days, yet no symptoms re-emerged. However, his affect was labile. In terms of openness to medication, initially he agreed to 1\2 dose of paliperidone, then later he agreed to a full dose (since June 9 or 10). He exhibited some irritability and reported dark thoughts but no delusions or hallucinations.
Dr. Carefoot indicated that Mr. Caron could not be moved to the next less restricted unit available for him – that being B3S - by his next case conference but hopefully that move could take place by the following case conference, approximately eight weeks after July 29. He will, however, be able to gain privileges now and more following the July 29 conference.
Upon questioning by Ms. McMahon, Dr. Carefoot stated that Mr. Caron had been on a transitional unit B3N prior to his restriction of liberty. Most days, he spent significant time in the community. Starting on May 20, he could go to Ms. Cook’s for four hours per day, with phone check-ins. From May 20-June 1, he could go within 250 kilometres of the hospital, permitting him to go to AA meetings at least two times per week with his sponsor. This allowed him to go to Ottawa, Renfrew, as well as into Brockville. At that time, he was visiting his grandchildren and volunteering in the community garden. He had his own cell phone. There was no reason to suspect he was using substances. After his readmission on June 5, he had no cell phone use, no access to AA meetings in the community and no visits with his fiancé.
The treatment team assessed Mr. Caron on June 17 and Dr. Carefoot saw him on June 23 and 24. She was away from June 25-July 7. While she was away, Dr. Carefoot left notes permitting the team to effect his transfer to unit B4N (where he currently is housed). On July 3, the team put into place arrangements for the transfer. A bed was not immediately available, but the next day, July 4, Mr. Caron was transferred. Privileges were increased on July 7. Dr. Carefoot testified that the team usually waits to talk to the treating physician before restarting privileges.
While another doctor had responsibility for Mr. Caron while Dr. Carefoot was away, she testified that he did not restart indirect grounds privileges during that period. As of the July 7, he has privileges to access the community accompanied by staff, indirect grounds privileges 30 minutes, four times per day and weekly visits with family and friends at hospital. He is about to start his vocational shifts working again at the River Walk Café. He can now use his cell phone when he is off the unit exercising his privileges.
Dr. Carefoot indicated that Mr. Caron is not yet ready for indirectly supervised community privileges. If he were ready in the near future, Dr. Carefoot stated that she could ask to move up his case conference earlier than July 29 but that would displace another patient’s case conference. She stated that during the next three weeks between the hearing date and July 29, there would be an opportunity for the team to increase Mr. Caron’s indirect grounds privileges.
In responding to questions from the Board, Dr. Carefoot stated that Mr. Caron had indicated that his symptoms of PTSD had nothing to do with his elopement, but later he said he had had “dark thoughts” about the past. She testified that case conferences are conducted for all patients based on a schedule, usually every eight weeks, but that Mr. Caron’s has been moved up to July 29. Indirect hospital grounds privileges can be exercised at 30 minute intervals between 9 am and 8 pm or 9 pm except during medication and meal times. Ms. Cook is currently applying to be his approved person. Her criminal record check was received July 7. The next step is an interview/assessment by social workers and then a discussion of her suitability will take place at the next case conference. The assessment could be done before July 29, so July 29 is the earliest she could be designated as an approved person.
Ms. Miltenburg asked additional questions. On the issue of Mr. Caron’s privileges, Dr. Carefoot explained that there is no policy that the doctor who was overseeing her patients could not have allowed an expansion of privileges when Mr. Caron was moved to B4N on July 4. However, risk management is the rationale for the treating physician (in consultation with the treatment team) to change privileges. The attending psychiatrist is in the best position to assess risk. The role of the multidisciplinary treatment team at the case conference allows the hospital to do a risk management assessment. This is built into the system before changing privileges. Eight weeks between conferences is, in part, to monitor changes in privileges.
Submissions of the parties
Ms. McMahon, on behalf of Mr. Caron, submitted that while the initial restriction was warranted, the restriction between July 3 and July 7 was unwarranted and was not the least restrictive and least onerous. Ms. McMahon takes no issue with the current level of restriction. Ms. McMahon submitted that Dr. Carefoot and the treatment team were ready to transfer Mr. Caron on July 3 and that did not occur until one day later when a bed was available, and further that he did not receive expanded privileges in accordance with his new unit until July 7, when Dr. Carefoot returned and approved them. Ms. McMahon focussed on Dr. Carefoot’s evidence that while she did leave a note that Mr. Caron could be transferred, she did not leave notes regarding increasing his privileges.
On behalf of the hospital, Ms. Miltenburg submitted that the restriction of liberty as it occurred was warranted both at the time and, as it continues. She characterized the elopement as one of the most serious risks that warranted having Mr. Caron return to the hospital’s most restrictive unit. Regarding July 3-7, the hospital submits that treatment and privilege decisions must be made in a fashion that warrants a controlled and measured approach. She pointed out that the hospital has committed to increase Mr. Caron’s privileges and has moved up his next conference date from August to July 29.
Counsel for the Ministry of the Attorney General, Mr. Schultz, submitted that the July 3-7 restriction as it unfolded was warranted. He echoed Ms. Miltenburg’s submission that the elopement was one of the most serious breaches. He stated that it would have been irresponsible to allow increased privileges without the oversight of the treating physician. He supported a measured response.
Analysis and Conclusion
The Board carefully considered the Hospital Report and the evidence of Dr. Carefoot and unanimously finds that the decision to readmit Mr. Caron on June 5 to the most secure unit was necessary and appropriate and the least onerous and restrictive. Mr. Caron had eloped for three days after having been instructed to return to hospital to discuss a positive result on a drug screen. He missed three days of his anti-psychotic medication and while his psychotic symptoms did not seemingly re-emerge, he did experience what he referred to as “dark thoughts”. Upon his return, he was angry, defensive and at times, tearful. His affect was labile, and he did not initially accept a full dosage of his medication. On June 17, he was intimidating, irritable and lacking in insight. Dr. Carefoot reported receiving information that as late as June 23, Mr. Caron was not accepting full responsibility for the restriction and was attributing it to a false positive drug test, although that is no longer the case. These factors point to increased risk warranting the need to readmit him to a secure unit and stabilize him to ensure he regains insight into his illness and the need to comply with the terms of his disposition.
Further, the Board agrees that the continued detention of Mr. Caron in the units he has been assigned to was and continues to be necessary and appropriate. We find that the hospital acted appropriately on July 3 in waiting one day for a bed to become available before transferring Mr. Caron to unit B4N, from unit B4S. While we acknowledge Ms. McMahon’s concerns regarding July 4 to 6, which we note was Friday to Sunday, given Mr. Caron’s background and the circumstances of his three-day elopement, as well as his mental status upon return and in the days following, we agree with the hospital that a cautious and measured approach was warranted.
In this case, it was important for Dr. Carefoot as his attending physician to make the decision about increasing his privileges. She was best positioned to assess his level of risk and determine the best course of action. We note that Mr. Caron was transferred to a less secure unit on July 4 and we acknowledge the hospital’s action in expediting Mr. Caron’s next case conference which may well expand his level of privileges further.
In conclusion, the Board finds that the significant increase in the restrictions on Mr. Caron’s liberty by his readmission to the hospital’s high secure unit on June 5, was necessary and appropriate, and represented the least onerous and least restrictive response available to the hospital. Likewise, his continued restrictions as of the date of this hearing remain necessary and appropriate and the least onerous and least restrictive.
DATED this 5th day of August, 2025, at the City of Toronto, in the Region of Toronto.
Ms. N. Nathanson Legal Member
Office of the Registrar Ontario Review Board