Re: Ali Kiamarz-Milani, 2025 CanLII 84101

Re: Ali Kiamarz-Milani

ORB File No: 3766

Hearing Held On: Wednesday, July 16, 2025

Place of Hearing: Waypoint Centre for Mental Health

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

Before:

Alternate Chairperson: Ms. C. Finley

Members: Dr. J. Ferencz Dr. B. Bordoff Ms. A. La Viola Mr. A. Bouvier

Parties Appearing:

Accused: Ali Kiamarz-Milani Counsel: Ms. J. Boissonneault

Person in charge of Hospital: Representative/Counsel: Mr. J. Thomson

Attorney-General of Ontario: Counsel: Ms. J. Armenise

REASONS FOR DISPOSITION

(Dated August 21, 2025)

Overview

1. Ali Kiamarz-Milani was found not criminally responsible on account of mental disorder on April 29, 2003, on a charge of assault with a weapon, contrary to the Criminal Code. He is currently subject to a disposition of the Ontario Review Board dated September 4, 2024, detaining him at the Waypoint Centre for Mental Health Care – High Secure Provincial Forensic Programs, Penetanguishene, Ontario. The terms of his detention order include hospital and grounds privileges, escorted by staff.

2. On May 20, 2025, the Board received a notification from Waypoint recommending Mr. Kiamarz-Milani be transferred to CAMH. A response from CAMH was received on the day of the hearing stating that Mr. Kiamarz-Milani is well known to them, acknowledging that he has ‘roots’ in Toronto, and although he has had a difficult course under the Board, they agreed that the necessary and appropriate disposition is a transfer to a less structured environment at this time.

3. At the outset of the hearing, Counsel for the Hospital, Counsel for the Attorney General and Counsel for Mr. Kiamarz-Milani all submitted that in their respective views – Mr. Kiamarz-Milani continues to represent a significant threat to the safety of the public and also agreeing that he could be managed on a Detention Order, at a less secure hospital.

4. However, Counsel for Mr. Kiamarz-Milani submitted that the Board should consider including a term that would permit her client access to hospital grounds, accompanied by staff or an approved person and indirectly supervised, as well as community passes accompanied by staff or an approved person – essentially increasing the suggested privilege levels.

Issues

5. On July 16, 2025, the Board convened at Waypoint for a hearing further to s. 672.81(1) of the Criminal Code to review the current disposition. The Board was asked to determine whether Mr. Kiamarz-Milani represented a significant threat to the safety of the public at the time of the hearing, and further, what is the necessary and appropriate disposition in the circumstances according to the factors set out in s. 672.54 of the Criminal Code.

Findings

6. After reviewing the evidence and submissions presented at the time of the hearing, the Board concluded that Mr. Kiamarz-Milani represents a significant threat to public safety. A Detention Order is required for the Hospital to be able to manage that risk to the public. The high secure setting at Waypoint is no longer necessary and appropriate. The Board concluded that he be transferred to the less secure environment at CAMH, with both staff escorted, and staff accompanied hospital and grounds access.

Personal Background

7. The Hospital Report dated May 27, 2025, was entered as an exhibit at the hearing, along with the response to the Rule 13 Notice recommending a transfer to CAMH. The following background information, including the events surrounding the index offence has been taken from the Hospital Report, summarized here as follows.

8. On the morning of January 23, 2002, Mr. Kiamarz-Milani and his mother (the victim), were discussing his probation officer’s impending visit to the home. Mr. Kiamarz-Milani is reported to have been angry that his mother invited his probation officer to attend the home. His mother went upstairs, where Mr. Kiamarz-Milani picked up a clothing iron and struck her on the back of the head, causing her to stumble forward. The victim managed to flee the home and called Mr. Kiamarz-Milani’s probation officer from a neighbour’s home. In turn, the probation officer contacted the police. Mr. Kiamarz-Milani was apprehended after jumping out of a window in an attempt to escape. His mother required two sutures to the back of the head.

9. Mr. Kiamarz-Milani is now about 43 years old. He was born in Iran, experiencing brief birth complications but achieving normal developmental milestones. At age five, he moved to Canada with his mother and sister as refugees, transitioning from an affluent lifestyle in Iran to financial hardship and subsidized housing in Canada. His father, an architect who remained in Iran and remarried, was reportedly abusive during his early childhood.

10. Academically, Mr. Kiamarz-Milani struggled significantly due to frequent absences associated with visits to Iran, eventually leaving school after partially completing Grade 10. Employment has been minimal, limited to brief part-time labour in 2013.

11. Mr. Kiamarz-Milani has an extensive history of substance abuse, beginning with alcohol use around age 11 and progressing to regularly using cannabis, hashish, and ecstasy by his teenage years. Substance use resulted in risky behaviour, including intoxicated driving and involvement in thefts and threats of violence to obtain drugs. Despite negative consequences, including arrests and psychiatric instability, he expressed ongoing desire to continue drug use.

12. His adulthood has largely been marked by repeated psychiatric admissions and supervision under the Board, with brief periods of community integration that typically ended in relapse, drug use, and legal complications. While he has had limited romantic experiences and expressed disinterest in marriage, he indicated openness to future long-term relationships. Mr. Kiamarz-Milani was re-admitted to CAMH in June of 2018 and has remained in hospital since. When in the community, Mr. Kiamarz-Milani resided with his mother. It is noted that his mother was a significant personal support for him. His mother passed away in 2019.

13. A check of the Canadian Police Information Centre database show that Mr. Kiamarz-Milani has a criminal record starting in 1995 when he was charged as a youth. His adult convictions include theft under, assault, threatening behaviours, firearms offences – some leading to time in jail or placements in group homes.

Psychiatric Background

14. Mr. Kiamarz-Milani’s current psychiatric diagnoses are Schizoaffective Disorder – Bipolar Type, Other (or unknown), Substance Use Disorder (moderate, in early remission), Antisocial Personality Disorder and Borderline Intellectual Functioning. He has been found incapable of making decisions about his medical treatment, and incapable of managing his finances. His sister is his substitute decision-maker. He is financially supported by the Ontario Disability Support Program.

15. Mr. Kiamarz-Milani was first admitted to the Oak Ridge facility (now known as Waypoint) on June 13, 2002, to assess his fitness to stand trial and criminal responsibility regarding the index offence. Initially found unfit, he was subsequently found fit to stand trial by the Board and was returned to court, where he was ultimately found not criminally responsible due to mental disorder. After periods of psychiatric treatment, he experienced numerous re-hospitalizations and discharges, frequently accompanied by substance use, absconding, and psychiatric instability. Between 2014 and 2018, although he was granted a conditional discharge, he frequently moved between living with his mother in the community and hospital re-admissions – he repeatedly relapsed, resulting in his Detention Order by the Board.

16. Despite periods of stability, his behaviour consistently deteriorated, necessitating repeated transfers between minimum, medium, and high secure units. Ultimately, after a prolonged stay at CAMH starting in June 2018, it was determined that he required increased support and security to manage his risk, and he was transferred to the high secure programs at Waypoint on August 22, 2022.

Evidence at the Hearing

17. Dr. P. Ismail gave evidence at the hearing. Mr. Kiamarz-Milani has been under his care since January 2024. Dr. Ismail testified regarding medication management, specifically addressing the discontinuation of temazepam. He explained that Temazepam had been a contentious issue due to how Mr. Kiamarz-Milani preferred to insufflate rather than orally ingest the medication. Attempts to administer the medication dissolved in water caused ongoing power struggles and increased agitation. Once Temazepam was tapered and discontinued, there was a significant improvement in his behaviour, with fewer incidents of aggression or agitation compared to the previous year.

18. Dr. Ismail described Mr. Kiamarz-Milani’s current psychiatric condition, noting that although psychotic symptoms persist (disorganized thoughts and nihilistic delusions) they are effectively managed with his current injectable medication (paliperidone every 21 days).

19. Dr. Ismail emphasized substantial improvements over the last year, including fewer and shorter seclusions, increased attendance in groups (particularly DBT and recreational programs), better social functioning, greater independence, and improved relationships with staff and peers. He attributed these positive changes primarily to programming participation and the discontinuation of Temazepam. Despite residual psychosis, Dr. Ismail considered his symptoms manageable at a less secure facility, noting that too much structure exacerbated his behavioural issues. He therefore supported the joint recommendation to transfer Mr. Kiamarz-Milani to CAMH.

20. With respect to privileges, Dr. Ismail recommended only escorted grounds privileges at this time, highlighting past issues such as elopement, lateness, and substance abuse. He explained that substances remain a significant risk factor, historically undermining Mr. Kiamarz-Milani’s progress by exacerbating psychotic symptoms and violent behaviours. Although acknowledging significant improvement in his relationship with his sister, Dr. Ismail expressed reservations about designating her as an approved person immediately, citing the past aggression directed toward family members. He suggested initially restricting privileges to escorted grounds and allowing CAMH to reassess further privileges based on progress. Dr. Ismail clarified that he saw no need to specify a male-only unit, as Mr. Kiamarz-Milani had not displayed inappropriate behaviour toward female staff or patients at Waypoint.

21. After further inquiries, Dr. Ismail agreed there were significant improvements in Mr. Kiamarz-Milani’s behaviour, social skills, and insight over the past year. He acknowledged that a transfer to CAMH would not only be safe but also beneficial, given proximity to family and culturally relevant support. He agreed the CAMH team could appropriately manage any increased privileges or family involvement as they deemed appropriate.

22. Regarding the discontinuation of Temazepam, Dr. Ismail clarified the improvement in behaviour was due to resolving power struggles related to its administration, rather than simply removing a sedative medication. Dr. Ismail further explained that while ‘escorted privileges’ would mitigate risk more effectively than ‘accompanied privileges’ – he agreed that CAMH staff would retain discretion regarding implementation should that privilege be included in Mr. Kiamarz-Milani’s disposition.

Submissions

23. Counsel for the Hospital recommended that only escorted grounds privileges by staff would be appropriate, referencing Dr. Ismail’s testimony that discretion should be left to CAMH regarding accompanied privileges. Concerns were expressed about designating an approved person, specifically the sister. The relationship has involved pushing limits and aggression similar to past issues with family members (the assault on his mother). While recognizing the benefit of motivational privileges, the Hospital supported the view that greater liberties would currently be inappropriate due to ongoing substance use risks. Counsel for the Attorney General concurred.

24. Counsel for Mr. Kiamarz-Milani reminded the Board of its dual obligations, emphasizing both public safety and Mr. Kiamarz-Milani’s liberty interests and rehabilitation. She supported the undisputed evidence that Mr. Kiamarz-Milani can safely be managed at CAMH and that moving to a less secure environment would facilitate his rehabilitation. Counsel urged the Board to provide CAMH flexibility to incrementally increase privileges to motivate his continued progress, noting that goal-oriented privileges positively influence his behaviour. Mr. Kiamarz-Milani could be safely managed with the addition of ‘accompanied privileges’ and the ‘approved-person’ designation – highlighting the sister’s supportive role and positive impact on his behaviour.

Analysis and Conclusion

(a) Significant Threat

25. The Board must first determine whether Mr. Kiamarz-Milani continues to pose a significant threat to the safety of the public as defined in Winko v. British Columbia (Forensic Psychiatric Institute), 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625. Based on the totality of the evidence, including the testimony of Dr. Ismail and the most recent clinical and risk assessment findings, the Board concludes that Mr. Kiamarz-Milani continues to meet the legal threshold for a significant threat.

26. Mr. Kiamarz-Milani suffers from a chronic and treatment-resistant psychotic illness characterized by fixed delusions, disorganized thinking, and auditory hallucinations. He has minimal insight into his illness and continues to demonstrate limited appreciation of the connection between his symptoms, his past violent conduct, and the need for treatment. Despite some progress in his therapeutic engagement, his behaviour remains influenced by delusional content and marked by reactivity, impulsivity, and occasional verbal aggression. He also has a longstanding history of antisocial behaviour, substance use, and institutional violence, with persistent challenges in managing frustration, adhering to supervision, and regulating affect.

27. We note that the HCR-20 assessment identified numerous static and dynamic risk factors across all domains, including an extensive history of violence, criminality, and instability in interpersonal relationships, as well as poor insight, persistent symptoms, and inconsistent responses to supervision and treatment. Of particular concern are his difficulties managing stress, his historical resistance to supervision, and his history of medication manipulation. Taken together, these findings support the conclusion that Mr. Kiamarz-Milani presents a risk of serious physical or psychological harm to others.

(b) Necessary and Appropriate

28. The Board must next determine the disposition that is the least onerous and least restrictive of Mr. Kiamarz-Milani’s liberty interests, which is consistent with public safety, his mental condition, and his reintegration into society, as required by s. 672.54 of the Criminal Code. In light of the evidence presented, the Board finds that Mr. Kiamarz-Milani's continued detention in a secure forensic facility remains necessary and appropriate.

29. We accept the consensus of the clinical team that Mr. Kiamarz-Milani no longer requires a high security setting to manage his risk. Although he continues to display residual symptoms of psychosis, his behaviour has stabilized significantly over the past year following the discontinuation of Temazepam and improvements in therapeutic engagement. The evidence suggests that his reactive behaviours are often triggered by excessive structure, and that a less restrictive setting may better support his ongoing recovery while mitigating distress and dysregulation. A transfer to CAMH, where he has family and social supports, and cultural familiarity, is necessary and appropriate given his improved recovery status.

30. At this stage in Mr. Kiamarz-Milani’s recovery, we find that the least onerous and least restrictive disposition for him includes hospital and grounds privileges both to be escorted and accompanied by staff only, when appropriate. While there has been marked progress, Mr. Kiamarz-Milani’s history of elopement, substance misuse, and aggression toward family members continues to warrant caution.

31. We are satisfied that CAMH will retain discretion to reassess privilege levels, including the designation of approved persons, based on his progress in a new environment. In this way, his liberty interests and rehabilitation goals can be balanced against the need to ensure public safety during this transitional phase. Accordingly, the Board orders Mr. Kiamarz-Milani’s transfer, under a continued Detention Order with hospital and grounds privileges as outlined in the new disposition, with the understanding that privilege levels may be revisited in accordance with clinical discretion.

DATED this 21st day of August 2025, at the City of Toronto, in the Toronto Region.

Ms. A. La Viola Legal Member

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Office of the Registrar Ontario Review Board