Ontario Review Board
Re: Manuel M. Pereira
ORB File No: 8525
Hearing held on: Wednesday, January 28, 2026
Place of hearing: St. Joseph’s Healthcare Hamilton, West 5th Campus 100 West 5th Street, Hamilton
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. S. Clapp Members: Dr. H. Bloom Dr. A. Kerry Hon. A. Sosna Mr. A. Mete
Parties Appearing:
Accused: Manuel M. Pereira Counsel: Mr. A. Musitano
Person in charge of the hospital: Counsel: Mr. S. O’Brien
Attorney General of Ontario: Counsel: Mr. I. Shaikh
REASONS FOR DISPOSITION
(Dated March 3, 2026)
Introduction:
[1]. On February 14, 2024, Manuel M. Pereira was found not criminally responsible on account of mental disorder (“NCR”) on a charge of arson, contrary to the Criminal Code. Mr. Pereira is currently subject to a Disposition of the Ontario Review Board (the “Board” or “ORB”) dated February 5, 2025 detaining him at the Forensic Psychiatry Program at St. Joseph’s Healthcare Hamilton, West 5th Campus (“SJHCH” or the “hospital”) with privileges up to and including living in the community in approved accommodation. The Disposition contains other conditions including that Mr. Pereira abstain from substance use and refrain from possessing any incendiary devices. Mr. Pereira was living in the community at the time of the hearing.
[2]. On January 28, 2026, a panel of the Board convened at SJHCH for the annual review of Mr. Pereira’s Disposition pursuant to section 672.81(1) of the Criminal Code. Mr. Pereira attended the hearing and was represented by counsel, Mr. Musitano. A Portuguese interpreter was present and provided simultaneous interpretation for Mr. Pereira throughout the hearing. Mr. James Thorpe, Mr. Pereira’s brother-in-law, was also present.
[3]. The Hospital Report dated January 7, 2026 was marked as Exhibit 1. In addition to the documentary evidence, Dr. Wesley Sutton, Mr. Pereira’s attending psychiatrist, gave evidence.
[4]. The issues to be decided at the hearing were whether Mr. Pereira continued to represent a significant threat to the safety of the public as set out in section 672.5401 of the Criminal Code, and, if so, what was the necessary and appropriate disposition to manage that risk having regard to the criteria set out in s. 672.54 of the Criminal Code.
Positions of the Parties:
[5]. At the outset of the hearing, the parties were asked for their initial without prejudice positions. Mr. O’Brien on behalf of the hospital took the position that Mr. Pereira remained a significant threat to the safety of the public and that a Conditional Discharge with the terms and conditions set out at pages 17-18 of the Hospital Report was necessary and appropriate. The conditions included living at a specific residence, reporting to the hospital not less than once per month, abstaining from substance use, and attendance at the hospital for readmission if requested.
[6]. Mr. Shaikh supported the position of the hospital on behalf of the Attorney General.
[7]. Mr. Musitano stated that Mr. Pereira sought an absolute discharge. In the alternative, if significant threat was found, he supported the position of the hospital.
Findings:
[8]. For the reasons that follow, the panel concluded that the evidence did not establish that Mr. Pereira continued to pose a significant threat to public safety. Accordingly, pursuant to section 672.54(a) of the Criminal Code, Mr. Pereira was granted an Absolute Discharge.
Index Offence:
[9]. The detailed circumstances of the index offence were outlined in the Hospital Report (at pages 2-3) and can be summarized as follows. On April 29, 2023, Mr. Pereira set fire to his house. Mr. Pereira was the only occupant. Fire fighters had to retrieve him from the burning house and he was treated for smoke inhalation. Mr. Pereira told family members that he believed that his home was “under invasion” from bugs, animals, and people he saw.
Background:
[10]. The Hospital Report contained detailed information about Mr. Pereira’s background and personal history and will not be repeated here. In summary, Mr. Pereira is a 67-year-old divorced man who immigrated from Portugal in 1975. He has four living sisters. He worked as a brick layer for approximately 40 years. Mr. Pereira did not attend school and is unable to read or write in Portuguese or English. He was married for approximately five years and has two adult daughters whom he has limited contact with.
[11]. Mr. Pereira was a heavy drinker for many years. This led to the dissolution of his marriage, social problems, and criminal charges for impaired driving.
[12]. Mr. Pereira began seeing bugs, chickens, and people in his home starting in the summer of 2022. He was admitted to hospital with hallucinations and was diagnosed with Parkinson’s Disease. Prior to the index offence, Mr. Pereira was living in his home independently but received significant support from his brother-in-law, Mr. Thorpe, as well as other family members.
Criminal History:
[13]. Mr. Pereira’s criminal record was set out at pages 3-4 of the Hospital Report. Between 1988 and 2003, his convictions related primarily to driving while impaired or driving while disqualified.
Psychiatric History:
[14]. Mr. Pereira had no psychiatric history prior to the diagnosis of Parkinson’s Disease in February 2022.
[15]. The Hospital Report outlined the circumstances of two hospitalizations in March 2023 related to Mr. Pereira’s visual hallucinations and delusions. He was also noted to have cellulitis in his left leg. Following both hospitalizations, Mr. Pereira was discharged home to the care of his family with follow-up from his family doctor and a referral for home and community care support services.
[16]. The index offence occurred on April 29, 2023. Mr. Pereira was pulled from his house with an altered level of consciousness and taken to the hospital. He was treated for smoke inhalation and was placed on a Form 1 under the Mental Health Act (“MHA”). A psychiatric consultation opined that Mr. Pereira’s hallucinations and delusions were most likely a product of delirium due to cellulitis or Parkinson’s Disease (especially since he was being treated with Carbidopa-Levodopa) rather than a primary psychotic disorder.
[17]. Mr. Pereira was released on bail in May 2023 and lived with Mr. Thorpe. Mr. Thorpe was Mr. Pereira’s primary caregiver and he supported Mr. Pereira with all of his daily needs. Mr. Pereira’s initial ORB hearing was held on January 31, 2025. A Detention Order was issued as the hospital and treatment team required time to get to know Mr. Pereira, understand his compliance with medications and alcohol use, and assess his needs and housing situation. Mr. Pereira was never admitted to SJHCH for this purpose.
[18]. The Hospital Report stated Mr. Pereira’s diagnoses as: Major Neurocognitive Disorder, due to Parkinson’s Disease; and Alcohol Use Disorder, in sustained remission. He is capable of consenting to treatment and managing his finances.
Evidence at the Hearing:
[19]. The Hospital Report stated that Mr. Pereira lived with Mr. Thorpe until October 11, 2025 when he moved into an assisted living facility for seniors that offers 24/7 on-site staff support with meals, laundry, cleaning, medication, and recreational programming. Mr. Pereira’s power of attorney (his nephew) arranged extra personal support for Mr. Pereira in relation to his activities of daily living. The Hospital Report also stated that the facility has the capacity to restrict residents from leaving should there be concerns about memory, cognition, or wandering (but this was not a concern for Mr. Pereira presently).
[20]. The Hospital Report stated that Mr. Pereira cooperated with and attended all scheduled appointments. His mental status was stable throughout the reporting year with no evidence or concerns about symptoms of psychosis or mood disorder. Mr. Pereira’s Parkinson’s Disease and general health also remained stable through the year, although more recently there had been concerns about rectal bleeding. It was noted that Mr. Pereira experiences tremors in both of his hands and he benefits from the use of a walker for longer distances (Mr. Pereira attended the hearing with a walker).
[21]. The Hospital Report stated that the team assessed Mr. Pereira as low risk for alcohol consumption. Mr. Pereira had expressed a preference to avoid alcohol due to his Parkinson’s Disease, and all drug screens had been negative (with the exception of one test which could have been due to cooking with wine and was an isolated event).
[22]. The Psychological Risk Assessment Report included in the Hospital Report (at pages 13-16) included the following conclusions:
“…Mr. Pereira’s risk for general and violent recidivism is at the lowest ranking under a Detention Order OR a Conditional Discharge. In addition, the current analysis of risk and protective factors would be favorable to being granted an Absolute Discharge in time, in as long as all of the current medical and psychiatric factors remain stable for an extended period beyond that documented at the time of this report, assuring the lowest risk of violent recidivism with the least amount of supervision and oversight possible while professional and personal supports remain in place.”
[23]. The Psychological Risk Assessment Report also stated that: “only in the context of significant medical deterioration developing a delirium with concomitant psychosis would his risk profile change” (at page 16; emphasis in original).
[24]. It was the opinion of the treatment team that Mr. Pereira continued to represent a significant threat to the safety of the public because the risk of a psychotic relapse remained elevated for a number of reasons, as described in the Clinical Risk Summary at page 17 of the Hospital Report:
“Firstly, Mr. Pereira remains medically fragile, as he continues to experience periodic lower GI bleeding, that could certainly precipitate a recurrence of delirium, which would greatly increase risk of psychotic symptoms resurfacing. Furthermore, Mr. Pereira’s medication prescribed for Parkinson’s Disease (Sinemet), and medication for rheumatoid arthritis (Plaquenil) both can cause or exacerbate psychosis, especially in vulnerable individuals with a previous history of experiencing psychotic symptoms. Additionally, up to 60% of patients with Parkinson’s Disease experience symptoms of psychosis, especially in late-stage disease.
It is also worth noting that Mr. Pereira is at elevated risk of dementia in the context of limited education, previous delirium, and Parkinson’s disease. Given his baseline cognitive limitations (inability to read or write), monitoring his cognitive status with standardized tools will likely prove to be quite difficult. If Mr. Pereira’s cognitive status were to decline, this would also serve to elevate his risk of psychosis and associated violence.”
[25]. Due to the fact that Mr. Pereira was living in a supervised assisted living facility it was the opinion of the treatment team that his risk could be managed on a Conditional Discharge with specific terms and conditions.
[26]. Dr. Sutton reiterated the points from the Clinical Risk Summary during his testimony and noted that the index offence occurred when Mr. Pereira was experiencing hallucinations, delusions, and disorganization for a period of several months. He stated that the etiology of Mr. Pereira’s psychosis was not entirely clear, but was likely a combination of his Parkinson’s Disease, the medications he was taking (Levodopa), and delirium secondary to a cellulitis infection.
[27]. Dr. Sutton testified that several risk factors remain at the current time including the Parkinson’s Disease diagnosis, his Levodopa medication, and his medically fragile state. Specifically, Dr. Sutton testified that Mr. Pereira had recently been treated for a fairly serious bacterial gastrointestinal (“GI”) infection that had caused numerous episodes of bleeding.
[28]. Dr. Sutton acknowledged that Mr. Pereira’s move to the assisted living facility was risk mitigating due to the 24/7 supports, but he also noted that there are other residents living in the facility. Dr. Sutton testified that ongoing forensic supervision was warranted given the recency of Mr. Pereira’s move and his ongoing medical concerns.
[29]. When asked about the supports that Mr. Pereira has at the assisted living facility, Dr. Sutton stated that Mr. Pereira’s family doctor is the doctor that attends at the assisted living facility, and all of the other staff are professionals. He had not visited the facility and did not know if the staff have forensic experience. Mr. Thorpe also remains involved in Mr. Pereira’s care, and Dr. Sutton believed that the staff at the assisted living facility and Mr. Thorpe are aware of Mr. Pereira’s vulnerabilities to psychosis. Dr. Sutton also testified that Mr. Pereira’s nephew had arranged for a personal support worker (“PSW”) three days per week to assist with Mr. Pereira’s activities of daily living. Mr. Pereira also sees a neurologist, but Dr. Sutton did not know how often that occurred.
[30]. In response to questions from Mr. Musitano, Dr. Sutton confirmed that Mr. Pereira had not required any inpatient hospitalizations for mental illness, and there had been no evidence of any psychosis since the April 2023 index offence. Dr. Sutton agreed that Mr. Pereira’s medications had been changed after that. Dr. Sutton also agreed that Mr. Pereira’s family doctor would likely take action if he saw signs of psychosis. He also acknowledged that there had been no evidence of psychosis during Mr. Pereira’s recent GI bleeding episodes.
[31]. When asked what would be required for an Absolute Discharge recommendation, Dr. Sutton responded that he would like to see more clarity with respect to the GI infection (as it was a main risk factor for delirium), and more stability with respect to Mr. Pereira’s overall medical condition. Dr. Sutton stated that there were “lots of moving parts” with Mr. Pereira’s medical condition such that caution was required.
[32]. Although Dr. Sutton believed that the staff at the assisted living facility were professionals and did frequent check-ins, he was of the opinion that it remained important that forensic outpatient staff assess Mr. Pereira’s mental status over the next year under the authority of a Conditional Discharge. Dr. Sutton explained that Mr. Pereira was currently seen weekly by forensic outpatient staff, and he expected that would continue for a few months, following which they would gradually cut back over several months. Dr. Sutton agreed that Mr. Pereira is not a difficult or argumentative patient.
[33]. In response to questions from the panel, Dr. Sutton stated that Mr. Pereira seems happy at the assisted living facility and there was no indication that he or his family want him to leave. There had been no reports from the facility about any problems or concerns. When asked about Mr. Pereira’s current physical state and the likelihood that he could cause harm to a member of the public, Dr. Sutton responded that there had not been a significant change in Mr. Pereira’s physical abilities since the time of the index offence.
[34]. Dr. Sutton agreed that a condition prohibiting possession of incendiary devices would be appropriate if a Conditional Discharge was granted (in addition to the proposed condition prohibiting possession of any weapons).
Submissions:
[35]. Mr. O’Brien submitted that the forensic psychiatry treatment team still needs to “have eyes” on Mr. Pereira and watch for symptoms of psychosis given his recent move and his current active GI infection. He also noted that Mr. Pereira lives in a seniors residence and is surrounded by other vulnerable people. Mr. O’Brien submitted that an Absolute Discharge may not be too far down the road, but maintained the hospital’s position that a Conditional Discharge was necessary and appropriate at this time.
[36]. Mr. Shaikh supported the position of the hospital and submitted that the current circumstances were similar to those at the time of the index offence. He stated that these were early days in the new housing environment, and a Conditional Discharge was appropriate before moving to an Absolute Discharge.
[37]. Mr. Musitano submitted that the onerous significant threat threshold had not been met in this case. He noted that since Mr. Pereira’s release from the hospital after the index offence in 2023, all the way up to the current time, there had been no admissions, no issues, no criminal activity, and no evidence of psychosis. Mr. Pereira had been fully compliant with medications and appointments, and had seen every doctor he needed to see. Mr. Musitano submitted that all of Mr. Pereira’s needs were currently attended to with the move to the assisted living facility, the 24/7 staff support, Mr. Pereira’s family doctor, and Mr. Pereira’s family.
Analysis and Conclusions:
[38]. After carefully considering the Hospital Report and the evidence of Dr. Sutton, the panel was unable to make a positive finding that Mr. Pereira continued to represent a significant threat to the safety of the public.
[39]. In coming to this conclusion, the panel considered the decision of the Supreme Court of Canada in Winko v. British Columbia (Forensic Psychiatric Institute), 1999 CanLII 694 (SCC), [1999] 2 S.C.R. 625 (“Winko”). In that case, the Court stated that a significant threat to the safety of the public must be: more than speculative in nature and supported by the evidence; significant, in the sense of there being a “real risk of physical or psychological harm to members of the public that is serious in the sense of going beyond the merely trivial or annoying”; and the conduct giving rise to the harm must be criminal in nature. Further, the Court stated that there must be a positive finding of a significant threat to the safety of the public in order to support restrictions on an accused’s liberty. Anything else, for example uncertainty, cannot suffice.
[40]. In the Winko case, the Supreme Court of Canada also stated that in coming to a conclusion on the issue of significant threat, a Review Board should closely examine a range of evidence including the circumstances of the original offence, the past and expected course of the accused’s treatment, the present state of the accused’s mental condition, and the accused’s own plans for the future, the support services existing for the accused in the community, and the recommendations provided by experts who have examined the accused.
[41]. The index offence in this case was very serious. It occurred in the context of a fairly recent diagnosis of Parkinson’s Disease and the medications prescribed for it, as well as a cellulitis infection. Mr. Pereira was living alone and experiencing severe hallucinations and delusions that led him to set his house on fire.
[42]. Mr. Pereira’s current circumstances are quite different. His medications were changed following the index offence, and there has been no evidence of psychosis since then. Mr. Pereira is living in an assisted living facility for seniors where he receives 24/7 support from professional staff. He also receives support from a PSW three days per week, as well as his family doctor who has known him for a number of years. Further, Mr. Pereira’s family, especially Mr. Thorpe, remain closely involved in Mr. Pereira’s care. There are many “eyes on him”, including those that have an understanding of Mr. Pereira’s vulnerability to psychosis.
[43]. While the panel accepted the evidence that Mr. Pereira’s medical condition was fragile, and it was possible that he could experience another episode of delirium or psychosis given his diagnoses and medications, the panel was satisfied that any change in Mr. Pereira’s mental status or emerging psychotic symptoms would be noticed by someone involved in his care at an early stage and action would be taken. As was stated in the Psychological Risk Assessment Report, significant medical deterioration and the development of a delirium with concomitant psychosis would be required in order for his risk profile change (emphasis added). The panel noted that the current GI infection had been identified and investigated, and was being monitored and treated with medication. No evidence of psychosis had been observed, and no concerns had been raised by staff at the assisted living facility. The panel did not think that visits by the forensic outpatient staff once per week (or less) would make a significant difference in this regard. Further, the panel considered that given Mr. Pereira’s age, diagnoses, and current physical state, there was always the possibility that other medical conditions and potential infections could arise. It would be speculative to conclude that a real and significant threat of harm would arise every time he experienced a medical setback.
[44]. While the panel understood and appreciated the treatment team’s position and desire to monitor Mr. Pereira a little bit longer to ensure his stability, the panel found that Mr. Pereira’s risk factors were well managed in the community and the evidence did not support a finding of significant threat. Mr. Pereira was therefore entitled to an Absolute Discharge. The panel wishes Mr. Pereira well.
DATED this 3rd day of March 2026, at the City of Toronto, in the Toronto Region.
Ms. S. Clapp Alternate Chair
Office of the Registrar Ontario Review Board