Re: David Ramos, 2026 CanLII 18240

Ontario Review Board

Re: David Ramos

ORB File No: 7878

Hearing held on: Tuesday, January 20, 2026

Place of hearing: Centre for Addiction and Mental Health

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

Before: Alternate Chairperson: Ms. C. Finley Members: Dr. G. Chaimowitz Dr. L. Leong Ms. M. L. Bridger Mr. S. Doherty

Parties Appearing: Accused: David Ramos Counsel: Ms. A. Szigeti The person in charge of hospital: Counsel: Mr. D. Blumenkrans Attorney General of Ontario: Counsel: Ms. R. Weinberg

REASONS FOR DISPOSITION

(Dated March 2, 2026)

Introduction

1. On April 19, 2021, David Ramos was found not criminally responsible by reason of mental disorder on charges of assault with a weapon (x2), aggravated assault, attempted murder, possession of property obtained by crime over $5000, and failure to comply with probation, contrary to the Criminal Code of Canada.

2. On November 20, 2024, the Ontario Review Board (“ORB/the Board”) ordered that Mr. Ramos be detained at the General Forensic Unit of the Centre for Addiction and Mental Health, Toronto (“CAMH/the hospital”) with discretionary privileges up to and including the ability to reside in approved accommodations. That order was appealed by Mr. Ramos.

3. On December 1, 2025, the Ontario Court of Appeal allowed the appeal and remitted the matter for a new hearing before a differently constituted panel. The Court provided the following directions at paragraph 61¹:

   1. Conditional Discharge: Assess the effectiveness of a Young clause and treatment compliance condition, taking into account timelines, enforcement mechanisms, and Mr. Ramos’s treatment history.
   2. Family Accommodation: Make reasonable inquiries into the viability of Mr. Ramos living with his partner or relatives, including their understanding of his circumstances and ability to provide support.
   3. Liberty Interests: Carefully evaluate whether continued detention is justified in light of his ALC classification, compliance with treatment, and the relatively low risk he poses.
   4. Mr. Ramos’s Wishes: Give due consideration to his expressed wishes and ensure they are not treated as evidence of dangerousness. To support his participation, the Board may wish to allow him to speak at the start of the hearing, as suggested by former Board member, Professor Jamie Cameron.²
   5. Reporting: The hospital must provide a detailed report within 30 days of this judgment on its housing efforts and assessment of family accommodation.

4. On January 20, 2026, the Board convened a panel at CAMH. Mr. Ramos was present and represented by counsel, Ms. Szigeti. When asked if Mr. Ramos would like to make a statement at the start of the hearing, Ms. Szigeti indicated that Mr. Ramos chose not to do so.

5. At the outset of the hearing, counsel for the hospital submitted that the Mr. Ramos remained a significant threat to the safety of the public and the necessary and appropriate disposition is detention order with the same terms and conditions as that ordered by the Board on November 20, 2024.

6. Counsel for the Ministry of the Attorney General concurred in the hospital’s positions. In the alternative, were the panel find that the necessary and appropriate disposition is a discharge, the panel should impose a condition requiring that the hospital notify the ORB and the police of any breach by Mr. Ramos of his disposition.

7. Ms. Szigeti submitted that in light of the decision of the Ontario Court of Appeal, the necessary and appropriate disposition is a conditional discharge. She proposed any conditions include a Young³ clause, and advised that her client would agree to a consent to treatment term pursuant to s.672.55 of the Criminal Code.

Findings

8. The panel unanimously found that Mr. Ramos remains a significant threat to the safety of the public and the necessary and appropriate disposition is a discharge with conditions, including a Young clause, a consent to treatment clause, and a condition that Mr. Ramos obtain prior approval of an itinerary before leaving the Province of Ontario.

The Evidence

9. The evidence at the hearing consisted of a Hospital Report, dated September 27, 2025 (ex. 1), an Update to that Hospital Report, dated December 29, 2025 (ex. 2), and the viva voce evidence of Dr. Valoo, Mr. Ramos’ previous Most Responsible Physician.

The Index Offences

10. On April 4, 2020, Mr. Ramos took a car from his uncle’s body shop and drove behind the victim who was riding his bicycle. Mr. Ramos intentionally rammed the victim launching him 15-20 feet through air. Mr. Ramos then exited his vehicle and repeatedly struck the victim, who was on the ground and not moving, on and about the head with a large metal pole that he had retrieved from his car. The entire incident was captured on video surveillance.

11. At the time, Mr. Ramos had been subject to a probation order with a condition that he keep the peace and be of good behaviour.

12. Mr. Ramos later advised that at the time of the incident he had stopped taking his medications for approximately one year. He had been hearing voices that told him that his family was in danger and that the victim had already killed his uncle.

Background Information

13. The Hospital Report includes detailed information as to Mr. Ramos’ personal background and medical history and need not be reviewed in detail in these reasons beyond the following material points.

14. Mr. Ramos is a 34-year-old man who was born in the United States and came to Canada with his mother when he was an infant. He was raised primarily by his aunt and grandmother. Mr. Ramos reported having completed high school as well as a one-year certificate in autobody work from Centennial College in 2016. He completed a two-week Security Training program from Enforce Security School, which allowed him to become a licensed security guard. Mr. Ramos since has worked in a variety of jobs, both as a security guard and as an autobody technician.

15. Mr. Ramos reported that he had first experienced hearing voices in 2015. In April 2016, he was diagnosed with schizophrenia and substance use disorder. His girlfriend at the time reported that he chronically had a level of suspiciousness and paranoia. Over the following few years, Mr. Ramos had multiple brief attendances at the emergency department at Humber River Hospital. At times, he presented as agitated, hostile and aggressive and, at least on one occasion, required chemical and mechanical restraints.

16. Following the index offences, Mr. Ramos was held at the Toronto South Detention Centre where he was started on antipsychotic medication. He was admitted to CAMH in April 2021. During his admission at CAMH, Mr. Ramos was adherent with medications, calm, cooperative and his mental status remained stable. In November 2022, Mr. Ramos was discharged to a Good Shepherd residence that provided 24/7 support and supervision.

17. Mr. Ramos did well living in the community and was supported by the Forensic Outpatient Service (“FOPS”). He remained compliant with medication and treatment. He reported benefitting from his long-acting injectable medication which was administered every four weeks. Mr. Ramos said he would “hear voices” if he did not receive his medication.

18. Mr. Ramos secured employment at two different autobody shops while residing at this residence. He quit from one due to the long commute. He worked at the second job until March 2024, at which time he quit. He said he wanted to rest and wished to return to school.

19. At one point, staff at the residence became concerned about his missing curfew several times. Mr. Ramos disclosed that he had a girlfriend which was a surprise to both the residential staff and the outpatient team. Mr. Ramos complied with increased reporting and strict enforcement of the rules of the residence.

20. At this time, the forensic team determined that Mr. Ramos did not need the high support provided at his residence and made efforts to locate new, permanent housing for him.

21. In January 2024, staff at the residence met with Mr. Ramos’ caseworker to discuss concerns that they had with his behaviour, some of which Mr. Ramos denied. In April, Mr. Ramos was officially issued a formal warning of potential eviction. On May 8, 2024, when Mr. Ramos failed to return to the residence overnight, he was formally evicted. That night, police had arrested him on a warrant that was subsequently determined to be expired. He was brought to CAMH by police and admitted.

22. Throughout his admission, there have been no episodes of aggression, agitation or concerning behaviour. Mr. Ramos continues to be compliant with medication, and his mental status has remained stable. He stated that he was committed to remaining compliant with his medication as he did not want to have to experience jail again. He would take all possible measures to prevent that from occurring again.

23. On August 20, 2024, Mr. Ramos was approved for level 8 passes and he continued to use his pass privileges appropriately. He ultimately found a Baptist Christian church close to CAMH and began using passes to visit church on a weekly basis.

24. Due to his fluctuating motivation to find employment, Mr. Ramos was encouraged to do some volunteer work. He agreed and volunteered at the Trinity Café in October 2024.

25. Mr. Ramos was asked to abstain from cannabis while in the hospital notwithstanding his disposition allowing for use, due to the disruptive nature this would have on the unit milieu. Mr. Ramos demonstrated a good understanding of this expectation and agreed to the hospital’s request. His urine drug screens have been consistently negative for substances.

26. In February 2025, Mr. Ramos secured full time employment at an autobody shop in Etobicoke. Unfortunately, he found the work to be rigorous and the hours long, so he quit. He preferred to find part-time work. In July 2025, Mr. Ramos was offered a job at an autobody shop in Brampton. After a few weeks, he was informed that his work was not at the expected level, and he was dismissed.

27. In April 2025, Mr. Ramos requested a reduction in the dose of his medication. However, around that time, he experienced a 48-hour period with very minimal sleep. There was concern for a psychotic relapse. Although Mr. Ramos reported no manic or psychotic symptoms, staff noted further sleep dysregulation and unusual behaviours, including intense staring when he was interacting with others. He was advised to maintain his current dose, but he declined the suggestion. Critically, since he received the lower dose, his mental status has remained stable.

28. In June 2025, Mr. Ramos also began volunteering at a food bank once per week. However, he quit this position after two shifts.

29. Mr. Ramos continued to receive financial payments through ODSP. Following the filing of his 2025 taxes, Mr. Ramos was flagged by the CRA for outstanding child support payments of a total of $16,000. His ODSP payments became garnished as a result.

30. Mr. Ramos continues to have regular phone and video contact with his family who reside in the Scarborough area. The clinical team has had no contact with his family.

Accommodation in the Community

31. In the fall of 2024, applications to two separate housing providers were submitted on Mr. Ramos’ behalf. Neither accepted Mr. Ramos, with one indicating concern that his ability to use cannabis would increase his risk of psychiatric destabilization.

32. Four more applications were submitted to housing vacancies. None were successful. One invited Mr. Ramos to reapply in the future. Another raised concerns about the impact of cannabis use on the other residents.

33. Given the lack of success in securing housing, the team discussed the option of obtaining market-rent accommodations for Mr. Ramos. That would require Mr. Ramos to find employment. Mr. Ramos decided not to pursue that option as he did not want to work and wished to find an apartment that he could afford through ODSP payments only.

34. Mr. Ramos also raised the possibility of residing with his aunt. However, he declined to enable the clinical team to have a family meeting with his aunt that would have allowed the team to determine the suitability of her residence. He then advised the team that he did not want to live with her and preferred to live in Toronto. As a result, this option was not pursued further.

35. In September 2024 Mr. Ramos told his team that he had a girlfriend, Alicia Marchese, who lived in the community. They had met two years previously and had started a romantic relationship three months previously. He reported that she was fully informed and supportive of his mental health history and involvement with the ORB. When the clinical team met with Ms. Marchese, she indicated that she had made it clear to Mr. Ramos that they were not in a romantic relationship. She had a superficial understanding of Mr. Ramos’ involvement with CAMH. She wanted to provide emotional support to him while he was in the hospital but did not want to become an Approved Person. Ms. Marchese did not know if her lease agreement permitted co-tenants.

36. Following the decision of the Ontario Court of Appeal, the clinical team met with Mr. Ramos to discuss the possibility of his residing with his aunt. He advised the team that his aunt had already rented out the room, so it was no longer available. Further he repeated that he preferred to live in Toronto.

37. On December 16, 2025, the team again spoke with Ms. Marchese to determine whether Mr. Ramos could reside with her. She is currently residing in a 1-bedroom Toronto Community Housing apartment in Scarborough. She remained unaware if her tenancy agreement allowed for co-tenants. Ms. Marchese indicated that she would only be in a position to offer Mr. Ramos accommodation temporarily, in the range of a couple of months. She had a very limited understanding of Mr. Ramos’ involvement with the ORB.

38. The clinical team submitted three additional housing applications, Oakwood Arch, SHIP⁴ in Brampton and TRHP2⁵, located near CAMH. Dr. Valoo testified that Mr. Ramos had an interview with SHIP the day before the hearing and a second interview with TRHP was scheduled for the day after. The doctor indicated that it was difficult to predict whether Mr. Ramos would be chosen. Applications were governed by vacancies.

39. Dr. Valoo indicated that there remained the option to explore independent housing. That would require Mr. Ramos to obtain employment.

40. Dr. Valoo testified that Mr. Ramos had been designated ALC (Alternate Level of Care) in 2024. That designation can be helpful for housing providers and may afford some prioritization. Dr. Valoo indicated that Mr. Ramos did not require housing staff to be on site. The Forensic Outpatient Service team would be able to adjust the frequency of meeting with Mr. Ramos in the community, depending on the type of accommodation in which Mr. Ramos resided.

Young Clause

41. Dr. Valoo testified that Mr. Ramos has consistently complied with treatment, including receiving his long-acting antipsychotic medication. Even with the lower dose, his mental status has remained stable.

42. Dr. Valoo testified that she believes that Mr. Ramos would present himself to hospital if requested. However, whether he would do so if he experienced a decompensation in his mental status was harder to predict. Dr. Valoo indicated that Mr. Ramos had a history, prior to the index offences, of leaving hospital against medical advice or declining treatment. This suggests that he would be less likely to do so if he were experiencing a psychotic decompensation. Mr. Ramos has been abstinent from cannabis. Should he resume, it remains unknown if he will maintain his current mental status, particularly in light of the reduced dose of his medication.

43. Dr. Valoo agreed that should Mr. Ramos become non-compliant with medication, the hospital treatment team would be aware. She indicated that it would be difficult to predict how rapidly Mr. Ramos would experience a decompensation. However, she agreed that the hospital could quickly take steps to assess his mental status. He has been consistently compliant with his long-acting injections.

44. Dr. Valoo indicated that Mr. Ramos’ risk factors are a possible relapse of psychotic symptoms and a concern about the efficacy of his current dosage, and housing instability. In Dr. Valoo’s opinion, the addition of the condition consenting to treatment would be useful as it could improve Mr. Ramos’ chances of continuing to comply with treatment.

45. Should Mr. Ramos wish to remain at CAMH as a voluntary patient, pending securing supportive housing in the community, he would continue to be supported by the clinical team and have access to the same privileges.

Analysis and Conclusion

46. The panel carefully considered the Hospital Reports and the evidence of Dr. Valoo and unanimously concludes that Mr. Ramos remains a significant threat to the safety of the public. Mr. Ramos has an established diagnosis of schizophrenia. Symptoms of his schizophrenia have included auditory hallucinations, paranoid and persecutory delusions, delusions of reference, as well as disorganized thinking and behaviour. His current risk factors for violence include housing instability and concern about his current dose of medication, particularly should he resume consuming cannabis. As such, at this time, Mr. Ramos remains a significant threat to the safety of the public.

47. Having found that the threshold for significant threat has been met, the panel also had to determine the necessary and appropriate disposition taking into consideration the criteria set out in s. 672.54 of the Criminal Code. The panel finds that Mr. Ramos can be adequately managed living in the community on a discharge, provided he remains compliant with medication and continues to be supported and supervised by a forensic outpatient team.

48. Mr. Ramos has been waiting since May 2024 for supportive housing. His ability to reintegrate into the community has been unsuccessful. As a result, consideration must be given to examining ways of affording Mr. Ramos the ability to reside in the community and be well supported and supervised. The panel is acutely aware that there are some potential risks to the safety of the public despite Mr. Ramos’ previous stability while residing in the community.

49. The following passage from Young is apposite:

The situation faced by the Review Board was similar to that found in R. v. Breitwieser (2009), 2009 ONCA 784, 99 O.R. (3d) 43 (C.A.), a case referred to by the Review Board in its reasons. In Breitwieser, as in this case, the primary concern was the risk to the public should the accused stop taking his medication. This court said, at para. 18:

In our view, in any case where the primary issue is compliance with conditions, and there is an air of reality to the claim that a conditional discharge would be an appropriate disposition, the Board must address these two elements. First, the Board must canvass whether the accused will consent to appropriate conditions under s. 672.55. Second, it must address the potential mechanisms for the accused's return to the hospital in the event of non-compliance, and determine whether the patient is likely to agree to return or whether a combination of s. 672.55 and either s. 672.92 or s. 672.93(2) or another route of return would be sufficient in the circumstances. The Board must consider these elements in light of the legislative scheme and the requirement of s. 672.54 that, after taking into consideration the designated factors, the Board must make the disposition “that is the least onerous and least restrictive to the accused”.

50. Of note, at the time of the index offences, Mr. Ramos had been noncompliant with medication for approximately one year. However, there is no issue that Mr. Ramos has remained compliant with his medication since he came under the auspices of the ORB in April 2021. He has clearly stated an intention to continue to take his medication as he does not want to go through a repetition of his previous experience. His decision to lower his dose, against medical advice, has not resulted in a change in his mental status while he has remained abstinent and admitted to hospital. That will be tested, and must be monitored, once he is residing in the community. Further, should Mr. Ramos refuse to accept his medication, that will be immediately known to the treatment team.

51. Notably, Mr. Ramos has consented to the inclusion of a condition pursuant to s.672.55 of the Criminal Code. If he fails to comply with this condition, it will be a breach of his disposition.

52. The panel also has ordered that Mr. Ramos be subject to a Young clause which states that, upon the request of the hospital, Mr. Ramos will attend for psychiatric assessment and upon notice of the person in charge, attend for admission to the hospital. Again, if he fails to comply with this condition, he will be in breach of his disposition.

53. The relevant enforcement provisions in the Criminal Code are found in sections 672.92 and 672.93. Pursuant to s.672.92(1), when an officer arrests an accused who is in breach or anticipated breach of their disposition, the officer may release the accused from custody and issue either a summons or appearance notice and take the accused to a place designated in the disposition order.

54. Pursuant to s.672.92(2), if an officer does not release the accused by way of summons or appearance notice, he shall bring that accused before a justice within 24 hours. Section 672.93 directs that if a justice is satisfied that a condition has been breached, the justice may make an order that is appropriate in the circumstances, including an order that he be returned to hospital.

55. Of concern, an arresting officer would have to be aware of an accused’s disposition and that the accused was in breach of that disposition. Then, an officer would have to determine whether to exercise his discretion and release the accused and take him to hospital or hold the person in custody pending a hearing before a justice. The justice would have to be satisfied that the accused was subject to a disposition, that there had been a breach or anticipated breach of the disposition, and, critically, that it would be appropriate in the circumstances to return the accused to hospital as opposed to some other order that is appropriate in the circumstances. In the panel’s experience, judicial orders made pursuant to s.672.93(2) are rarely made, for a variety of reasons. For one, to be effective, they require that each player has appropriate information and training to recognize the risk to the community and act accordingly. That is not a given. By all accounts, whether a Young clause will be an effective means of managing an accused’s risk to the public must remain a very case sensitive assessment.

56. As regards Mr. Ramos, the panel appreciates that he is eager to progress through the forensic system and sees a conditional discharge as the next step in that regard. A Young clause ostensibly provides a tool for the treatment team to manage Mr. Ramos’ risk in the community, by providing a mechanism to require him to attend the hospital for an assessment and possible admission.

57. The panel is mindful that, since Mr. Ramos has been under the jurisdiction of the Board, he has shown a willingness to comply with the hospital. For example, he has voluntarily agreed to abstain from cannabis. He also has stated a willingness to remain at CAMH pending the decisions on his recent housing applications. Importantly, the panel accepts Dr. Valoo’s expert opinion that when Mr. Ramos’ mental status is stable, he is likely to present himself to hospital if requested.

58. Mr. Ramos has stated that he wishes to reside in supportive housing. He may remain at CAMH until that is effected. Ideally, he will be accepted by one of the residences that he recently interviewed with. The panel is acutely aware that not having stable supportive housing presents as a risk factor for Mr. Ramos. However, that risk must be managed in a way that does not involve the detention of Mr. Ramos which has continued for reasons largely beyond his control. Mr. Ramos has been detained for almost two years waiting for a placement in the community. The obvious gaps in community supports must be balanced against the need for Mr. Ramos to reintegrate into society, participate fully in community life, as well as his other needs, taking into account the safety of the public.

59. Should Mr. Ramos choose to temporarily reside with Ms. Marchese, or his aunt - although neither currently presents as long term solutions if solutions at all - or reside in some other residence, the forensic outpatient team will need to assess the level of support that he will require, including frequent reporting and visits, to manage his risk. Historically, Mr. Ramos has required minimal support but that may need to be adjusted depending on where he is residing.

60. Therefore, taking into consideration the criteria set out in s. 672.54 of the Criminal Code of Canada, which includes the need to protect the public from dangerous persons, the mental condition of the accused, the reintegration of the accused into society and the other needs of the accused, the panel finds that the necessary and appropriate disposition is a discharge with terms and conditions as found in the disposition.

DATED this 2nd day of March, 2026, at the City of Toronto, in the Toronto Region.

Ms. C. Finley Alternate Chairperson

__________________ Office of the Registrar Ontario Review Board

Footnotes

1. 1Ramos (Re), 2025 ONCA 820
2. 2Original footnote omitted
3. 3Young (Re), 2011 ONCA 432
4. 4Services and Housing in the Province
5. 5Transitional. Rehabilitation Housing Program