Ontario Review Board
Re: Roble Adam
ORB File No: 6501
Hearing held on: Wednesday, February 18, 2026
Place of hearing: Centre for Addiction and Mental Health Via Zoom Videoconference
Pursuant to: Section 672.81(2.1) of the Criminal Code
Before:
Alternate Chairperson: Mr. J. Weinstein
Members: Dr. K. Hand Dr. G. Nexhipi Ms. M. den Haan Ms. C. Plyley
Parties Appearing:
Accused: Roble Adam Counsel: Mr. D. North
The person in charge of hospital: Counsel: Ms. M. Warner
Attorney General of Ontario: Counsel: Mr. D. Brandes
REASONS FOR DECISION
(Dated March 9, 2026)
Introduction
On March 24, 2014, Mr. Roble Adam was found not criminally responsible on account of mental disorder, on a charge of first-degree murder, contrary to the Criminal Code of Canada (“Criminal Code”).
Mr. Adam is currently subject to a Disposition of the Ontario Review Board (the “Board”) dated May 27, 2025, which ordered that he be detained at the Secure Forensic Unit of the Centre for Addiction and Mental Health, Toronto (“CAMH”). This Disposition provides Mr. Adam with various privileges, including to live in the community, in 24-hour supervised accommodation approved by the person in charge.
Pursuant to s. 672.56(2) of the Criminal Code, CAMH notified the Board by letter dated December 12, 2025, that Mr. Adam’s liberty had been restricted: on December 3, 2025, Mr. Adam was admitted to CAMH on an inpatient basis.
On February 18, 2026, a panel convened a hearing by video conference to review the restriction of Mr. Adam’s liberty, pursuant to s. 672.81(2.1) of the Criminal Code.
Mr. Adam was present at the hearing and was represented by his counsel, Mr. D. North.
A ROL Hospital Report ("ROL Report"), dated January 24, 2026, was entered as Exhibit 1. A Hospital Report (“Hospital Report”), dated April 28, 2025, was entered as Exhibit 2.
The issues at this hearing were whether the hospital’s decision to increase restriction on Mr. Adam’s liberty was warranted, necessary and appropriate at the time of its onset, on December 3, 2025, and whether it continued to be so until December 24, 2025.
For the reasons set out below, the Board finds that the restriction on Mr. Adam’s liberty on December 3, 2025, was significant as well as necessary and appropriate. The Board also found that the initial restriction represented the least onerous and least restrictive measure at the time it was imposed and that it continued to be so until its end, on December 24, 2025.
Position of the Parties
- Counsel for the hospital, for the Attorney General and for Mr. Adam advised that this was a joint recommendation: all agreed that the initial restriction of liberty was necessary and appropriate; it represented the least onerous and least restrictive measure at the time it was imposed, and it continued to be so until December 24, 2025.
Index Offence
- The circumstances giving rise to the Index Offence are extracted from the most recent Reasons for Disposition, dated June 19, 2025:
“According to the police report, Mr. Adam was charged with First Degree Murder of 51-year-old Larisa Belekova on Wednesday February 3, 2010 at 13 Homewood Avenue, Toronto (DARA Residence). This was Mr. Adam’s residence. Ms. Belekova was the house manager. Police were called about a stabbing at 13 Homewood Avenue. They located the victim’s traumatized body. She was transported to St. Michael’s hospital where she succumbed to her injuries. Staff at the house advised that Mr. Adam had been in Ms. Belekova’s office, where an argument ensued; staff observed Mr. Adam leaving the office and found the victim suffering from a traumatic injury. Mr. Adam was located in an upstairs bedroom with blood on his body."
Reason for Original Restriction of Liberty
- Mr. Adam was admitted to hospital via the Emergency Department on December 3, 2025, for reinitiation and titration of clozapine after he had missed three doses.
Course In Hospital
- The ROL Report sets out Mr. Adam’s course in hospital. The following extracted paragraphs are relevant to this hearing:
“Mr. Adam was admitted to Geriatric Unit A via the Emergency Department for reinitiation and titration of his antipsychotic medication, clozapine, after he had missed doses on November 29 and 30, accepted on December 1, but then refused again on December 2. He had been more suspicious regarding the clozapine vial and believed “something (was) off.” He agreed to resume the medication in hospital.
Mr. Adam’s course in hospital was uneventful. He accepted clozapine, which was titrated up slowly, increased by 25 mg every 3 days up to 150 mg daily. The titration was briefly paused due to elevated creatinine kinase enzyme, which was found to be chronic, and improved after his statin was discontinued. He also received his long-acting injectable antipsychotic medication, Invega Trinza on December 23, 2025. There was no evidence of psychosis or mood symptoms. He did not engage in any aggressive or violent behaviours. At the time of discharge, he felt good, he did not experience any side-effects from the medication. He was aware that he was being discharged to LOFT and did not have any concerns.”
- Mr. Adam was discharged back to his LOFT residence on December 24, 2025.
Evidence at the Hearing
- The Board had available to it the evidence and documents forming the Record, the Exhibits, and oral evidence from Dr. Choptiany. Dr. Choptiany is Mr. Adam’s outpatient and attending psychiatrist through the Forensic Outpatient Clinic. He co-authored the ROL Report and testified as follows:
a) Mr. Adam is also supported by a geriatric psychiatrist, Dr. Rostas.
b) In late November and early December, while living in the community, Mr. Adam refused doses of his medication, clozapine, on three occasions. These refusals were motivated by paranoia about the medication, as he did not believe he was being given the medication ordered, clozapine.
c) Missing doses of clozapine requires re-titration and monitoring because of potential side effects, especially for someone with medical complexities, like Mr. Adam.
d) Attempts to resume the medication in the community were unsuccessful, leading to Mr. Adam’s readmission to CAMH for safe titration.
e) This was the first time since Mr. Adam’s transition to the community that readmission was necessary. Previously, encouragement from staff and Dr. Rostas usually led to adherence before reaching this threshold.
f) Upon readmission to CAMH, Mr. Adam cooperated and resumed taking clozapine. The titration process was uneventful, except for a change in creatinine kinase (“CK”) levels, which was attributed to his statin medication. His CK levels normalized after discontinuation of the statin.
g) At discharge, Mr. Adam’s mental status was stable, with no psychotic symptoms or paranoia. He accepted the discharge plan and returned to the community.
h) Since discharge back to the community, Mr. Adam has adhered to his medication regimen. He has experienced no side effects and expressed no concerns about the medication or his living situation.
i) Mr. Adam receives his clozapine in a suspension form. He is able to verbally communicate his refusal to take his medication and explain why. He indicated at that time that something was “off” about his medication which is why he refused to take it.
- No other evidence was called.
Analysis and Conclusions
Pursuant to the decision of the Ontario Court of Appeal in R v MLC, 2010 ONCA 843, as well as Regina v Campbell, 2018 ONCA 140, the Board agrees that a restriction of liberty has taken place. The Board found that the initial restriction of liberty, on December 3, 2025, and the ongoing restriction until December 24, 2025, represented the least onerous and least restrictive intervention in the circumstances. They were both warranted and necessary for public safety.
Missing clozapine for more than three days is considered a full treatment interruption, requiring a re-start at a low dose, rather than a continuation of the previous, maintenance dose.
Re-starting a full dose of clozapine after a short break can lead to severe, potentially fatal adverse effects; accordingly, it was necessary to admit Mr. Adam to CAMH for a safe reintegration and titration of the clozapine after he missed three doses.
DATED this 9th day of March, 2026, at the City of Toronto, in the Region of Toronto.
Mr. J. Weinstein Alternate Chairperson
Office of the Registrar Ontario Review Board