Ontario Review Board
Re: Robert DiCristofaro
ORB File No: 7633
Hearing held on: Tuesday, July 15, 2025
Place of hearing: Centre for Addiction and Mental Health 1001 Queen Street West, Toronto
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. P. Capelle Members: Dr. B. Sheppard Dr. T. Stirpe Hon. C. Nelson Mr. R. Chopra
Parties Appearing:
Accused: Robert DiCristofaro Counsel: Ms. C.E. Currie
The Person in charge of Hospital: Counsel: Mr. K. Dow
Attorney General of Ontario: Counsel: Ms. V. Culp
REASONS FOR DISPOSITION
(Dated August 26, 2025)
Introduction
On November 12, 2019, Mr. Robert DiCristofaro was found not criminally responsible on account of mental disorder, on charges of utter threat to cause death or bodily harm, criminal harassment (x6) and failure to comply with condition of judicial release (x28), all contrary to the Criminal Code of Canada (“Criminal Code”). Mr. DiCristofaro is currently subject to a Disposition of the Ontario Review Board (the "Board") dated February 1, 2024, detaining him at the Forensic Service of the Centre for Addiction and Mental Health, Toronto (“CAMH”) with privileges up to live in the community of the Greater Toronto Area in supervised accommodation approved by the person in charge.
On July 15, 2025, a panel of the Board convened a hearing pursuant to s. 672.81(1) of the Criminal Code. Mr. DiCristofaro was in attendance and was represented by his counsel, Ms. Currie.
Without Prejudice Position of the Parties
Mr. Dow, on behalf of the hospital, indicated that only one change was sought to Mr. DiCristofaro’s detention disposition: a reduction of the reporting frequency to not less than once per month. The recommendation was supported by Ms. Culp, on behalf of the Attorney General, by Ms. Currie, on behalf of her client who also conceded the ongoing presence of significant threat. The hearing therefore proceeded by way of a joint position that was maintained throughout.
Background and Index Offences
The circumstances of the index offences and Mr. DiCristofaro’s history are taken from last year’s Board Reasons, as follows:
“The circumstances of the index offences can be set out briefly. The accused/patient was involved in real estate transactions. He came to believe that the lawyer acting for him owed him some $65,000. Despite him being shown that this was not correct, he maintained this delusion. He demanded payment and threatened the life of people if he was not paid. He was cautioned by police, but when that was not effective, he was charged. A bail order was made that he have no contact with his former counsel and not attend his office. Nonetheless, he made repeated calls to and attended at that premises, thus violating his conditions of release.
Mr. DiCristofaro was remanded for an assessment of criminal responsibility. He was very uncooperative with hospital staff, to the point where he was considered threatening. He denied that he was lawfully held under a warrant of assessment or that there was any validity to the charges he faced. He continually challenged staff.
Hospital staff believed that Mr. DiCristofaro might suffer from Huntington’s Disease. His physical symptoms were consistent with this, but he refused any medical tests which could have confirmed such a diagnosis.
In the 2021/2022 reporting year, he again remained relatively stable, although irritable. Observations indicated that his physical condition was worsening, but he still refused testing. He accepted medication and was able to utilize passes. Unfortunately, he demonstrated poor insight into his physical and psychiatric limitations and his need for support. He expressed a wish to live with his elderly mother, who was simply unable to care for him. He indicated an intention to stop medication if he was discharged. While under the jurisdiction of the ORB, he had access to supports and medical care. If he was not so supported, all his risk factors would remain and he would not have the assistance needed to deal with these challenges. He would likely become delusional again and engage in similar criminal behaviour as he did at the time of the index offences.
The hospital report indicated (page 16) that Mr. DiCristofaro’s neurodegenerative disease was of great concern. A decline in his neurodegenerative condition could result in a relapse of his psychotic symptoms or other cognitive and behavioural difficulties. Further:
Huntington’s disease is a progressive neurodegenerative inherited disorder that tends to manifest in middle age. There are associated motor abnormalities, psychiatric, and cognitive changes. Irritability, anxiety, and depression are common early symptoms, as well as personality change, disinhibition, impulsivity, cognitive changes, and impaired insight. Occupational decline tends to occur early on. Movement abnormalities range from problems with fine motor tasks, choreiform movements, impaired gait, and postural instability. Associated symptoms may also include sleep and speech problems.
Mr. DiCristifaro’s history is significant for the onset of personality changes, cognitive decline, and impaired insight, in addition to psychotic symptoms, specifically delusions with respect to his lawyer. Over the past few years, he has also had a progressive movement disorder, characterized by choreiform movements often seen in those with Huntington’s Disease. Though Mr. DiCristofaro has refused testing to confirm this diagnosis, his clinical presentation is highly suggestive of the presence of this disease.
Psychotic Disorder Secondary to a Medical Condition
The underlying etiology of Mr. DiCristofaro’s psychosis is most likely Huntington’s Disease. He does not have a typical history of schizophrenia. According to collateral information, he did not demonstrate any prodromal symptoms in his adolescence or early twenties. His onset of psychotic symptoms was not until his 50s. His presentation over prior reporting periods included delusions regarding his lawyer, coupled with behavioural dyscontrol, disinhibition, irritability, and impulsivity. Mr. DiCristofaro has done well with antipsychotic medication treatment but needs to be monitored closely over time to ensure that the medication does not cause parkinsonian features and that it is optimized as needed (given that Huntington’s is a progressive disorder).”
Current Diagnoses
- Huntington’s Disease
- Psychotic Disorder due to Medical Condition (Huntington’s Disease)
Evidence at Hearing
Mr. Dow called Dr. Swayze to testify on behalf of the hospital. Dr. Swayze confirmed that he is the author of the Hospital Report and adopted its contents. He has been Mr. DiCristofaro’s outpatient forensic psychiatrist since this patient’s discharge to the Hawthorne Place Residence in September 2024. Hawthorne Place staff have expertise with Huntington patients. Assuming Mr. DiCristofaro can continue to be managed at Hawthorne Place he can remain there indefinitely. The primary risk management tools for Mr. DiCristofaro are management and supervision at Hawthorne Place with the assistance of the outpatient program and medication compliance.
Dr. Swayze was asked if Hawthorne Place had the resources to plan for Mr. DiCristofaro’s next placement if his physical situation declines. The doctor responded that he anticipates that Hawthorne Place would be familiar with that process.
At present, Dr. Swayze sees Mr. DiCristofaro in person once per month. Referencing page 18 of the Hospital Report Dr. Swayze testified that Mr. DiCristofaro can be verbally aggressive but can usually be de-escalated. Physical aggression is limited to throwing around his walker.
A conditional discharge is considered inappropriate at this time. However, in the coming year, if Mr. DiCristofaro’s mental and housing stability are maintained, it may be considered. Mr. DiCristofaro has been cooperative with the treatment team and the doctor intends to make Mr. DiCristofaro’s future as comfortable as possible. Dr. Swayze advised that he anticipates further deterioration because of Mr. DiCristofaro’s Huntington’s Disease. A panel member inquired why a conditional discharge disposition was not considered at this time. Dr. Swayze responded that the main concern is the ability to name the residence for this patient and thereby ensure his stability. Mr. DiCristofaro’s understanding of the physical manifestations of Huntington’s is improving. However, an understanding of the psychiatric manifestations associated with this illness is lacking although it may yet improve.
Ms. Currie asked about what steps were necessary for a conditional discharge to be recommended for her client Dr. Swayze responded that Mr. DiCristofaro would need to remain at his current residence with no behavioural concerns. Dr. Swayze added that Mr. DiCristofaro sometimes expresses a wish to live with his now elderly mother or within semi-independent living rather than at Hawthorne Place, which is where, according to Dr. Swayze, he is properly placed. Dr. Swayze agreed with the suggestion that Mr. DiCristofaro’s level of desire to move back in with his mother has abated over the years.
In redirect, Ms. Currie noted that her client is incapable of consenting to treating and noted that at the present time his elderly mother is his Substitute Decision Maker (SDM). Dr. Swayze responded that if Mr. DiCristofaro’s mother could no longer perform this role the treatment team would first approach his brother to see if he was willing to assume the responsibilities of an SDM. If not, there is an algorithmic chain of who is to be approached.
Closing Submissions
Mr. Dow, on behalf of the hospital, submitted that the initial position has not changed. Ms. Culp advised that she continued to support the hospital position as did Ms. Currie, who added that her client is happy where he lives and is being well cared for.
Analysis and Decision
(a) Significant Threat
Ongoing significant threat to the safety of the public cannot be speculative. It must entail a real risk of serious physical or psychological harm arising from conduct that is both serious and criminal in nature.
In determining whether Mr. DiCristofaro continues to represent a significant threat to the safety of the public the Board has carefully analyzed the evidence as it relates to the Supreme Court of Canada decision in Winko, 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625.
The Board unanimously finds that Mr. DiCristofaro continues to pose a significant threat to the safety of the public. In arriving at this determination, the Board considered the joint position of the parties and accepted the uncontroverted evidence of Dr. Swayze that Mr. DiCristofaro continues to pose a significant threat. The Board also relies on the Hospital Report and the Composite Assessment of Risk contained therein at page 21 in determining that Mr. DiCristofaro suffers from a psychotic disorder attributable to Huntington’s Disease. The Composite Assessment of Risk is reproduced below for ease of reference:
Accounting for the above risk assessments, Mr. DiCristofaro remains a significant threat to the safety of the public. Absent the current disposition, Mr. DiCristofaro would likely return to his mother’s residence, experience an inordinate amount of stressors given his medical condition, and fall away from treatment. In this context, it is likely that he will experience a decompensation of his mental state, and engage in aggressive and threatening behaviours towards a member of the public. Thus, the necessary and appropriate disposition to mitigate this risk to public safety is a continuation of the current disposition.
Given the foregoing, the Board unanimously accepts that absent an ORB Disposition, Mr. DiCristofaro would likely abandon his current residence to return to his elderly mother’s home. There, due to his historic response to stressors, he is likely to become non-compliant with prescribed medications. This would lead to decompensation and the re-emergence of behaviours similar to those seen at the time of the index offences. We are satisfied that absent an ORB Disposition, it is likely that Mr. DiCristofaro will cause serious physical or psychological harm to members of the public and such conduct will likely be criminal in nature.
(b) Disposition
Flowing from the Board’s finding that Mr. DiCristofaro continues to pose a significant threat to the safety of the public it must shape a Disposition for the year ahead. Its paramount consideration in doing so must be the safety of the public while also considering Mr. DiCristofaro’s needs pursuant to s. 672.54 of the Criminal Code.
The necessary and appropriate disposition for Mr. DiCristofaro provides him as much freedom as possible without subjecting the community to a real risk of dangerous behaviour.
In considering Mr. DiCristofaro needs, the Board was attentive to the joint position of the parties that this patient’s Detention Disposition not be changed. Further, we accept the uncontroverted evidence that a Conditional Discharge Disposition is premature. Mr. DiCristofaro has only resided at Hawthorne Place since September of 2024. A longer period of mental stability and housing stability at that are tied to his progression towards a possible Conditional Discharge. Mr. DiCristofaro now lives in a residence geared to meeting the needs of patients such as himself that suffer from Huntington’s Disease. Dr. Swayze expressed optimism that Mr. DiCristofaro’s insight vis-à-vis the psychiatric manifestations of his illness may yet improve. A longer period of stability in Hawthorne Place as it is evident that he is currently properly placed there. Given Mr. DiCRistofaro’s historic desire to return to live with his now elderly mother it is essential that the hospital retain the entitlement to specify where he can live and expeditiously return him to hospital if signs of decompensation are noted. These safeguards can only be ensured via a Detention Disposition.
Conclusion
Therefore, the Board unanimously determines that the necessary and appropriate Disposition required to manage the threat Mr. DiCristofaro poses to the safety of the public while still meeting his needs, remains a Detention Disposition, absent any changes.
In making this Disposition, the Board carefully considered the positions and submissions of the parties and the evidence of Dr. Swayze and is satisfied that this determination is both necessary and appropriate. The Board reviewed the provisions of s. 672.54 of the Criminal Code and carefully considered the need to protect the public from dangerous persons, Mr. DiCristofaro’s mental condition, his reintegration into society and other needs.
DATED this 26th day of August, 2025, at the City of Toronto, in the Toronto Region.
Mr. P. Capelle Alternate Chairperson
Office of the Registrar Ontario Review Board