Ontario Review Board
Re: Cathy Fletcher
ORB File No: 8862
Hearing held on: Wednesday, April 15, 2026
Place of hearing: Southwest Centre for Forensic Mental Health Care St. Thomas, ON
Pursuant to: Sections 672.47(1) and 672.48(1) of the Criminal Code
Before:
Alternate Chairperson: Ms. S. Kert
Members: Dr. S. Simpson Dr. S. Wiseman Ms. K. Tomaszewski Ms. C. Plyley
Parties Appearing:
Accused: Cathy Fletcher Counsel: Mr. A. Andreopoulos
The Person in Charge of Hospital: Counsel: Ms. J. Zamprogna
Attorney General of Ontario: Counsel: Mr. J. Huber
REASONS FOR DISPOSITION
(Dated May 5, 2026)
On November 17, 2023, Cathy Fletcher was charged with assault with a weapon arising out of an incident in which she is alleged to have grabbed a butcher knife from the kitchen, ran at her husband and cut his hands, forearm, right eye and right side of his head. When police arrived, her husband was bleeding from his head and eyes. At the time, Ms. Fletcher was 69 years old and her husband was 73. They had been married for almost 50 years and were living together in the family home.
After her arrest, Ms. Fletcher was taken by police to the Chatham-Kent Health Alliance where she was admitted on a Form 1 under the Mental Health Act (MHA). Ms. Fletcher was known to that facility, having previously received treatment related to a severe traumatic brain injury that she sustained after a fall in 2015. In hospital after her arrest, her daughter-in-law reported that in the year leading up to the charge, Ms. Fletcher had been increasingly paranoid about her husband and progressively more verbally and physically violent toward him.
When the Form 1 lapsed in mid-November 2023, Ms. Fletcher remained in hospital as a voluntary patient. She was not a behaviour problem on the unit, but had a fixed delusion about her husband stealing all of her money, and she continued to threaten to harm her husband if she went home. She was found incapable in respect of placement/long term care, and remained in hospital until she was discharged to a supported seniors residence in Thamesville in early February 2024. She has continued to live there since that time.
During interviews in January, February and March 2025, Dr. W. Komer conducted a psychiatric assessment of Ms. Fletcher. Although initially the assessment was to be for sentencing purposes, during the assessment it became apparent that the question of fitness was a concern, and Dr. Komer provided an opinion on fitness. In a report dated March 14, 2025, he expressed the view that Ms. Fletcher was unfit to stand trial, stating:
During the three interviews, Ms. Fletcher expressed herself in a manner reflective of her lacking the ability to rationally communicate with counsel or the court and be meaningfully present in court and participate in her trial.
On June 30, 2025, Ms. Fletcher returned to court for a fitness hearing. In addition to his report, Dr. Komer provided oral testimony at the hearing and confirmed his view that she remained unfit to stand trial. He noted that in addition to the cognitive impairment that she experienced from the traumatic brain injury, Ms. Fletcher had a change of personality (some aggression and paranoia) and some memory impairment. He said she would have difficulty communicating with counsel and following what goes on in court.
Based on Dr. Komer’s assessment and testimony, Ms. Fletcher was found unfit to stand trial on June 30th and was referred to the Review Board for an initial hearing. She continued living in the community. In late November 2025, the Review Board ordered an assessment of Ms. Fletcher’s mental condition to assist in determining an appropriate disposition. That assessment was conducted by Dr. Ajay Prakash in January 2026.
On April 15, 2026, this panel of the Review Board convened an in-person fitness hearing at the Southwest Centre for Forensic Mental Health (Southwest Centre or the Hospital). Ms. Fletcher was present and was represented by her counsel, Mr. Andreopoulos. Her daughter-in-law was also present to support her. Hospital staff were able to provide Ms. Fletcher with a personal headset to allow her to better hear the proceedings, as she experiences both articulation and hearing difficulties.
The questions for the Board are whether Ms. Fletcher remains unfit to stand trial, and what disposition is necessary and appropriate in the circumstances. As this was a first hearing we did not make findings on the issues of permanent unfitness or significant threat.
The parties jointly submitted that Ms. Fletcher remains unfit and that a conditional discharge is the necessary and appropriate disposition, including (among others) conditions requiring that she: i) live at her current supervised residence; ii) have no contact with her husband, except with his written revocable consent; iii) on her consent, take treatment as recommended by the person in charge or a designate pursuant to s.672.55 of the Criminal Code and; iv) immediately attend at the Southwest Centre and participate in a psychiatric assessment if directed to do so by the person in charge of the Southwest Centre or their designate.
Based on the evidence we agree with the parties that Ms. Fletcher continues to be unfit to stand trial, and that the necessary and appropriate disposition is a conditional discharge as outlined by the parties. These are our reasons.
Background
Ms. Fletcher is just shy of her 72nd birthday. Dr. Komer’s report indicates that she had a history of developmental delay (possibly a learning disability), and Ms. Fletcher told him that she has had speech problems since her childhood. Her current diagnoses include: i) neurocognitive disorder due to traumatic brain injury, with behavioural disturbance (psychotic and mood symptoms), currently mild to moderate; ii) history of depression; and iii) likely neurodevelopmental disorder (with reports of learning disability, difficulties with comprehension, lower cognitive abilities).
Ms. Fletcher married her husband (the victim of the current charge) in May 1973, at the age of 19. They had one son who died at one day old, and a son (JF) who died tragically at the age of 44 in 2019 from an anaphylactic reaction. JF’s wife remains very supportive of both of her in-laws.
In late December 2015, Ms. Fletcher was admitted to the London Health Sciences Centre. She was sent there from the Chatham-Kent Health Alliance after falling down two steps, hitting the back of her head on concrete and being found unresponsive after an unknown duration. Ms. Fletcher was difficult to rouse and quite combative when she was at home after the fall. A CT scan of her head showed multiple brain injuries and a skull fracture. She was intubated, ventilated and treated in the ICU, apparently in an induced coma. In mid-January she was transferred back to the Chatham-Kent Health Alliance to await admission to the Regional Acquired Brain Injury Program at the Parkwood Institute in London.
Ms. Fletcher spent some time as a resident in the Parkwood Institute Program, then continued her rehabilitation as an outpatient. She experienced seizures (possibly due to her head injury), which were well-controlled with medication, as well as more minor head injuries related to frequent falls. Her long-time GP, Dr. Bailey opined that, “[After] the first head injury [in 2015] she spent a long time in rehab at Parkwood in London but was never really well – her behaviour deteriorated after that and she became more unpredictable.”
Although Ms. Fletcher has no prior criminal record, on September 26, 2022, the police attended at her home “related to her being out of control and breaking and throwing things” (Dr. Komer report, p.4). The police helped her husband to clean up broken plates and other items in the residence.
In September 2023, a nurse practitioner with the Mental Health and Addictions Program at the Chatham-Kent Health Alliance assessed Ms. Fletcher at her home. She had been referred due to “suspicious and abusive behaviour towards her husband” in the preceding months. Ms. Fletcher acknowledged that she could become angry with her husband and had previously hit him. She was also worried about her husband giving away their money and was tearful, distracted and tangential in conversation. The nurse practitioner described her as a poor historian. Ms. Fletcher was assessed as having a major depressive disorder and cognitive impairment and was subsequently prescribed Zoloft. The incident leading to the index charge occurred just a few weeks later.
Evidence of Dr. Ajay Prakash
When Dr. Prakash interviewed Ms. Fletcher by video in mid-January 2026, he had the significant assistance of her daughter-in-law who repeated his statements/questions to Ms. Fletcher, and “translated” her answers back him. Ms. Fletcher was aware of where she was living, that meals were provided to her and that she was responsible for taking her own medications that came in blister packs. When asked questions related to fitness, Ms. Fletcher said she did not know what she was charged with but added, “I didn’t cut him up, I didn't cut his hands up with a knife, he said I did.” When reminded of the charge, she said she had a weapon but didn’t use it and put it away. She was unaware of her plea options, was able to name some potential consequences, but had difficulty with some of the other Taylor-type questions. In his report, Dr. Prakash expressed the view that Ms. Fletcher was unfit to stand trial.
After re-interviewing Ms. Fletcher on April 3, 2026 (again with the assistance of her daughter-in-law), Dr. Prakash arrived at the same conclusion. He said that the second assessment largely mirrored the first in terms of Ms. Fletcher’s presentation and functioning. He also noted her daughter-in-law’s view that Ms. Fletcher, “is able to answer concrete questions adequately, however, when more complicated/advanced questions are asked the conversation does not progress.”
Days after the second interview, Ms. Fletcher’s daughter-in-law contacted Dr. Prakash to advise that she had received information from one of Ms. Fletcher’s primary caregivers at the seniors residence where she is living. That individual reported that:
Ms. Fletcher’s aggression toward another resident (Michael) had been building over the last few months;
Michael was generally quite nice to Ms. Fletcher but will sometimes do his own thing (he has some cognitive delays);
Ms. Fletcher will get upset with Michael when he isn't paying attention or listening to her;
On one occasion within the previous two weeks, Ms. Fletcher and Michael were seated together at the dinner table and Ms. Fletcher was upset. She threw a glass, threw his pills and started yelling at Michael;
This occurred very quickly and the caregiver was able to calm Ms. Fletcher down just as quickly; and
The caregiver requested an appointment for Ms. Fletcher to see her family doctor to inquire about medications that might help moderate her anger. An appointment has been set at the family health clinic for late April.
- In testimony at this hearing, Dr. Prakash advised that Dr. Bailey (Ms. Fletcher’s family doctor) retired in December 2025, that Ms. Fletcher’s medications are currently being prescribed by another doctor at the same family health clinic (though she has not yet been assigned to another GP), and that her medications are disbursed by staff at her residence. Currently Ms. Fletcher’s capacity with respect to her medications is presumed, but the issue of capacity can be reassessed once Ms. Fletcher comes under the care of the forensic team. Dr. Prakash said that he would have no difficulty providing support around medications to the prescribing doctor or taking over prescribing medications for Ms. Fletcher’s mental condition.
Fitness to Stand Trial
Based on the evidence, and having regard to the definition of fitness as set out in s. 2 of the Criminal Code and elaborated on by the Supreme Court of Canada in R v Bharwani (2025 SCC 26), we find that Ms. Fletcher remains unfit to stand trial.
Ms. Fletcher can answer some, though not all, of the ordinary fitness questions. Importantly, she appears to be unaware that she has been charged with any offence, and when asked why she is living at her current residence, she said that her husband had kicked her out. When fitness coaching was attempted, she did not retain the information. This inability is directly related to the effects of Ms. Fletcher’s severe traumatic brain injury, as well as a history of developmental delay predating her fall in 2015.
Even if Ms. Fletcher were able to learn the answers to the Taylor-type questions, there is little likelihood that she could apply those concepts to her own situation, follow and participate meaningfully in any court proceedings, or understand and instruct counsel regarding her legal options. This was illustrated during Dr. Prakash’s meetings with Ms. Fletcher and her daughter-in-law. Dr. Prakash noted that the two women were able to have a back and forth conversation if the topic was focused and if the questions asked were closed ended. However, her daughter-in-law was clear that if Ms. Fletcher was asked open ended questions, “It’s like she gets lost in her thoughts and can’t understand what I am asking.”
The Necessary and Appropriate Disposition
We also agree with the joint position of the parties that considering public safety (which is paramount), as well as Ms. Fletcher’s mental condition, her reintegration into the community and her other needs, a conditional discharge disposition is necessary and appropriate in the circumstances.
At present, Ms. Fletcher does not need to be detained in the Hospital. At her current residence (where she has lived since February 2024), Ms. Fletcher is provided with her meals and laundry service. After an initial adjustment period, she was cooperative with the residence routines. Staff at the home are familiar with Ms. Fletcher and, to date, have been able to address any issues of concern without the need for hospital admission. A residence condition will require Ms. Fletcher to continue to live at the same home, which is important given the scarcity of appropriate residences to meet her needs. A consent to treatment condition is necessary to ensure that Ms. Fletcher remains adherent with medication prescribed and offered to her at the home, particularly if further optimization or changes are recommended by the forensic team over the next year.
The new information indicating that Ms. Fletcher has been showing aggression toward another resident at the seniors home, and that this was building over the last few months is, of course, very concerning. Ms. Fletcher was behaving in a similar way toward her husband in the months leading up to the index charge. Moreover, given the nature of the facility in which she lives, many of the other residents at the home are vulnerable individuals, including Michael. If Ms. Fletcher continues to engage in similar behaviour, or if her behaviour escalates, it may be necessary for her to be admitted to the Hospital for assessment and stabilization. We accept the evidence of Dr. Prakash that in those circumstances, Ms. Fletcher would be certifiable under the MHA, given her risk to others. To ensure that Ms. Fletcher is assessed by a physician in a timely way (as required by the MHA), we have included a requirement that she attend at the Hospital and participate in an assessment when directed to do so.
Finally we note that Ms. Fletcher and her husband have not seen or spoken to each other since she was charged. Information in Dr. Prakash’s reports indicates that Mr. Fletcher has recovered well physically and mentally since the incident, but he has not expressed a desire for his wife to return to the family home. A no-contact condition, which assumedly mirrors one of Ms. Fletcher’s bail terms (requiring her husband’s written consent for contact) will be included to give Mr. Fletcher the option of being in touch, should he choose to do so in the future.
DATED this 5th day of May, 2026, at the City of Toronto, in the Toronto Region.
Ms. S. Kert
Alternate Chairperson
Office of the Registrar
Ontario Review Board