Re: Khaled K. Karamali
ORB File No: 8603
Hearing held on: Tuesday, March 17, 2026
Place of hearing: Centre for Addiction and Mental Health
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. J. Goldenberg
Members: Dr. R. Wood Hill Dr. S. Wiseman Ms. A. Israel Mr. A. Mete
Parties Appearing:
Accused: Khaled K. Karamali Counsel: Ms. M. Addie
The person in charge of hospital: Representative: Dr. M. Choptiany
Attorney General of Ontario: Counsel: Mr. D. Brandes
REASONS FOR DISPOSITION
(Dated April 1, 2026)
On August 8, 2024, Khaled Karamali was found not criminally responsible on three counts of assault.
Mr. Karamali is currently subject to a Disposition of the Ontario Review Board dated January 21, 2025. That Disposition directed that Mr. Karamali be detained at the Forensic Service of the Centre for Addiction and Mental Health, Toronto (“CAMH”) with a number of privileges and prohibitions. That Disposition did not contain a term for community living.
On Tuesday, March 17, 2026, the Ontario Review Board convened a hearing at CAMH and conducted Mr. Karamali’s annual review.
Position of the Parties
At the outset of the hearing, the parties were canvassed as to their recommendations to the Board.
Dr. Choptiany appeared as the hospital representative as well as being Mr. Karamali’s most responsible physician. Dr. Choptiany advised of the hospital's position that Mr. Karamali remains a significant threat to public safety, and if the Board so finds, the necessary and appropriate Disposition is a continuation of a Detention Order to the Forensic Service of the Centre for Addiction and Mental Health, Toronto. At this time, the hospital is asking for one additional privilege, namely the privilege of living in the community in 24-hour supervised accommodation approved by the Person in Charge.
In response to a question from the Alternate Chair, Dr. Choptiany agreed that if the Board were to specify levels of security the hospital would be recommending a Detention Order on a Secure Forensic Unit but with discretion given to the person in charge to transfer Mr. Karamali to a General Forensic Unit should the Person in Charge come to the conclusion that Mr. Karamali’s improved conduct justified a transfer to the General Forensic Unit.
Mr. Brandes appeared for the Crown. He supported the hospital’s position.
Ms. Addie appeared for Mr. Karamali. Ms. Addie also supported the hospital’s recommendation. Ms. Addie advised that the issue of significant threat is conceded.
Index Offences
- The details of the index offences are taken from last year’s Reasons for Disposition as follows:
“There were three assaults. The dates are October 3, October 13, and December 4, 2023:
October 3, 2023 (August 8, found NCR)
Mr. Karamali assaulted a vulnerable female victim (Ms. L.C.) who was waiting for a TTC Wheel-Trans ride. The accused approached the victim from behind and punched her in the back of the head causing pain and bruising. Mr. Karamali fled the scene. The victim was taken to hospital by ambulance. She was diagnosed with a mild concussion.
October 13, 2023 (August 14, found NCR)
The accused struck a female four to five times in the forearm. This occurred after she awakened Mr. Karamali in front of her building and asked him to move. Mr. Karamali took exception and assaulted her and then fled the scene.
(August 8, found NCR)
Mr. Karamali argued with counter staff at a Tim Horton’s when he was placing his order.
He smashed the computer register screen and the pieces struck the victim (cashier). Mr. Karamali fled the scene but later returned to apologize for his actions.”
Evidence at Hearing
The Board admitted into evidence the Hospital Report dated December 20, 2025. The Hospital Report provides a great deal of information concerning Mr. Karamali, his personal history, his mental health history, details of the index offences and Mr. Karamali’s course in hospital subsequent to the date of the original NCR finding. As the Hospital Report was made an exhibit, it is not necessary to reproduce the information contained in the Hospital Report in these Reasons. We do note, however, a diagnosis of schizophrenia. We also note that during the hearing a member of the panel pointed out on page 5 of the Hospital Report a diagnosis not only of schizophrenia but also obsessive-compulsive disorder, post-traumatic stress disorder and dysphasia.
In addition to the documentary evidence the Board heard from Dr. Choptiany. Dr. Choptiany has been Mr. Karamali’s most responsible physician since August 2025. Dr. Choptiany provided an update. In August 2025, Mr. Karamali’s medication was switched to clozapine and as well the patient was continued on injectable medication.
The doctor noted that his patient has been experiencing some auditory hallucinations. As a result, Dr. Choptiany increased the clozapine medication to 450 grams daily. Previously Mr. Karamali was experiencing command hallucinations to self-harm. Dr. Choptiany noted that over the past two weeks Mr. Karamali says he has not suffered such hallucinations since the last two weeks. Dr. Choptiany noted over the past year there has been no aggressive conduct. Unfortunately, there was a significant AWOL and Mr. Karamali remained AWOL for approximately six weeks.
There is a minor issue in that Mr. Karamali frequently urinates in his own room. The doctor simply notes it is unclear why this is happening and also notes that this fact is not a risk enhancer.
The doctor has encouraged Mr. Karamali to participate in programming and recently Mr. Karamali agreed to expand from purely recreational programming and has agreed to participate in a cooking program.
The doctor advised that Mr. Karamali is currently using level 3 passes which permits accompanied passes on hospital grounds. Those passes have been used without any difficulty.
The doctor and the clinical team are now asking for the Board to include the privilege of living in the community in 24-hour supervised housing. The doctor also advised of his opinion that Mr. Karamali will be ready to move to a General Forensic Unit at some point in the next 12 months.
In response to questions from a panel member, Dr. Choptiany noted that he would describe his patient’s insight as “partial.” The patient has an awareness that he suffers from a mental illness. The patient also seems to suffer from a loss of memory in connection with inappropriate conduct. In response to questions from another panel member, Dr. Choptiany confirmed the AWOL lasted for six weeks and simply noted that the information provided by Mr. Karamali is “very sketchy.”
The doctor completed his evidence by noting that there was a very rough start to this year having regard to the AWOL. The doctor further noted that since his return from AWOL, Mr. Karamali has acted appropriately. The doctor repeated his belief that Mr. Karamali would be ready for a move to the General Forensic Unit at some point over the next 12 months. The doctor also advised of his understanding that the hospital would be unable to have Mr. Karamali go on to any waiting list for supervised housing until Mr. Karamali is transferred to a General Forensic Unit.
No other evidence was heard at this hearing.
Findings of the Board
At the conclusion of the evidence, the parties were again canvassed. All parties maintained their original position, namely that Mr. Karamali remains a significant threat to public safety, and if the Board so finds, the Board should issue a Disposition that would permit Mr. Karamali to be transferred from a Secure Forensic Unit to a General Forensic Unit if his improved condition justifies such a transfer.
In the Board’s opinion, the parties’ joint recommendation is well founded. We accept Ms. Addie’s advice that her client does not have a criminal record. We are aware, however, of considerable inappropriate conduct that for whatever reason did not result in a conviction. We are aware of one stayed charge. We have no doubt that Mr. Karamali does remain a significant threat to public safety.
This panel accepts the Board’s obligation to specify levels of security when making Detention Order Dispositions. We will direct detention on a Secure Forensic Unit but with the ability to transfer to a General Forensic Unit should the person in charge conclude that Mr. Karamali’s improved conduct justifies such a transfer.
We will include a privilege of living in the community in 24-hour supervised accommodation. In this regard we note the decision of the Ontario Court of Appeal in Simonic (Re) 2024 ONCA 573. We have no hesitation in accepting that a community living clause could be a motivating factor.
In reaching our Disposition, the Board has taken into consideration public safety, Mr. Karamali’s mental condition and his other needs, and Mr. Karamali’s reintegration into society.
DATED this 1^st^ day of April, 2026, at the City of Toronto, in the Toronto Region.
Mr. J. Goldenberg Alternate Chairperson
__________________ Office of the Registrar Ontario Review Board