Re Ronnie Acuna-Aguirre, 2026 CanLII 48369

Re: Ronnie Acuna-Aguirre

ORB File No: 7954

Hearing held on: Tuesday, April 14, 2026

Place of hearing: Waypoint Centre for Mental Health Care Via Zoom Video Conference

Pursuant to: Section 672.81(2.1) of the Criminal Code

Before:

Alternate Chairperson: Mr. D. Sandor

Members: Dr. P. Prendergast Dr. G. Nexhipi Ms. M. den Haan Mr. A. Mete

Parties Appearing:

Accused: Ronnie Acuna-Aguirre Counsel: Ms. B. Benincasa

Person in charge of hospital: Counsel: Mr. J. Thomson

Attorney General of Ontario: Counsel: Ms. K. Staats

REASONS FOR DECISION

(Dated May 21, 2026)

Introduction

1. On September 23, 2021, Mr. Acuna-Aguirre was found not criminally responsible by reason of mental disorder on a charge of murder.

2. Mr. Acuna-Aguirre is currently subject to a Disposition of the Ontario Review Board dated December 12, 2025, by which he was ordered to be detained at the High Secure Provincial Forensic Programs Division of the Waypoint Centre for Mental Health Care (“Waypoint” or the “Hospital”) with a number of prohibitions and privileges, including hospital and grounds privileges, beyond the secure perimeter, escorted by staff.

3. On February 25, 2026, the Board was notified by way of letter from the Hospital that Mr. Acuna-Aguirre was subject to a significant restriction of his liberties because of a seclusion which began February 16, 2026.

4. On Tuesday, April 14, 2026, the Ontario Review Board convened a hearing by Zoom video conference to review the restriction of Mr. Acuna-Aguirre’s liberty, pursuant to s. 672.81(2.1) of the Criminal Code.

5. Ms. Benincasa indicated that her client did not wish to attend the hearing. Ms. Benincasa advised that she had complete instructions from her client including to proceed in his absence. Under those circumstances, the panel exercised its discretion and permitted Mr. Acuna-Aguirre to be absent from this hearing pursuant to s. 672.5(10)(a).

Positions of the Parties

6. At the outset of the hearing, the parties were canvassed for their initial positions. The parties agreed that the sole issue to be determined was with respect to the restriction of liberty and that no changes to the Disposition were sought.

7. On behalf of the Hospital, Mr. Thompson submitted that the Hospital’s decision to place Mr. Acuna-Aguirre in seclusion was necessary and appropriate both initially on February 16, 2026, and until its conclusion on March 15, 2026.

8. Counsel for the Attorney General reserved her position pending completion of the evidence.

9. Ms. Benincasa stated that her client’s position was that he agreed with the Hospital’s decision that the restriction of liberty was necessary and appropriate.

Evidence at the Hearing

10. The Board relied on the Restriction of Liberty Report dated March 16, 2026, and Dr. Mishra’s oral testimony at the hearing. Dr. Mishra is Mr. Acuna-Aguirre’s most responsible physician.

11. He testified that the 2025 was a challenging year for Mr. Acuna-Aguirre. Mr. Acuna-Aguirre is incapable of consent to treatment and his sister acts as Substitute Decision Maker (“SDM”). Historically, Mr. Acuna-Aguirre has been variably adherent to Clozapine treatment. He stopped taking Clozapine in December 2025 and refused to restart the medication. It is difficult to ensure that a patient takes oral medication such as Clozapine if they choose not to do so. Mr. Acuna-Aguirre receives a long-acting injectable medication (“LAI”) and began Electroconvulsive Therapy (“ECT”) February 25, 2026, which has made a positive difference in Mr. Acuna-Aguirre’s presentation.

12. Historically, Mr. Acuna-Aguirre has required periods of seclusion following decompensation flowing from non-adherence to medication. Mr. Acuna-Aguirre had required seclusion from December 8, 2025 to February 9, 2026, and the Board concluded in its Decision dated February 12, 2026, that the restriction of liberty at that time was warranted.

13. Dr. Mishra testified that on February 16, 2026, Mr. Acuna-Aguirre’s behaviours were increasingly bizarre, and he was uncooperative and angry with staff. These behaviours are precursors to violence for him. Attempts at de-escalation were unsuccessful, even by staff with whom he has a good relationship, and Mr. Acuna-Aguirre refused PRN medication.

14. The treatment team determined that in order to mitigate risk to staff and co-patients, it was necessary to place him in seclusion. While in seclusion, he had access to books, an MP3 player, and a workstation. Staff did visual checks every 15 minutes, and seclusion was reviewed daily according to hospital protocol. An independent assessment of whether seclusion remains warranted is generally done after 72 hours, then at 7 days and 28 days. The Hospital is investigating why there was no 72-hour review done for this seclusion in order to prevent any future recurrence. Seclusion relief is offered daily.

15. Mr. Acuna-Aguirre has not required seclusion since March 15, 2026. He will shortly progress to exercising the privilege of off-unit unaccompanied passes for up to two hours.

16. In response to questions from counsel for Mr. Acuna-Aguirre, Dr. Mishra stated that there doesn’t seem to be a particular trigger for Mr. Acuna-Aguirre. He still had some symptoms when the prior seclusion ended, and the treatment team has noticed a longstanding ability for him to conceal symptoms. Eventually his symptoms overcome his conscious control. Although Mr. Acuna-Aguirre requested to discontinue the LAI medication, there is no plan to make changes. Mr. Acuna-Aguirre’s illness is treatment-refractory, and Clozapine kept him well and curbed aggression. After he discontinued Clozapine, there was a clear decline in his mental state.

17. In Dr. Mishra’s opinion, ECT is working very well, and Mr. Acuna-Aguirre is accepting of the treatment. He will receive ECT twice per week for six weeks. After that, the treatment team will review options with Mr. Acuna-Aguirre and the SDM, which could include weekly maintenance ECT treatments.

18. In response to questions from the panel, Dr. Mishra advised that Mr. Acuna-Aguirre is fully cooperative with ECT and shows fewer psychotic symptoms. Ideally, Mr. Acuna-Aguirre would be medicated with Clozapine, but his tendency to stop and start the medication adds instability and leads to setbacks in his progress. If ECT works well, it can be continued long term.

Final Submissions of the Parties

19. At the conclusion of the evidence, counsel for the Attorney General indicated that they were in support of the Hospital’s position that restriction of Mr. Acuna-Aguirre’s liberty from February 16, 2026 to March 15, 2026, was necessary and appropriate both at the outset and for its duration and the panel was therefore presented with a joint submission.

20. Ms. Benincasa noted that Mr. Acuna-Aguirre he is happy with his current unit (Beckwith).

Analysis and Conclusion

21. The panel accepts the evidence of Dr. Mishra, both through the Restriction of Liberty report and his oral evidence and find independently that Mr. Acuna-Aguirre’s liberty was restricted from February 16, 2026 to March 15, 2026, and that this was necessary and appropriate both at the outset and for its duration. We accept that Mr. Acuna-Aguirre’s mental condition deteriorated significantly as a result of medication non-adherence and that his behaviour could only be managed by seclusion in order to mitigate his risk to co-patients and staff.

22. We accept Dr. Mishra’s evidence that Mr. Acuna-Aguirre was provided with daily seclusion relief and had access to books and an MP3 player. As soon as his behaviour became more stable after beginning ECT, the seclusion was discontinued and Mr. Acuna-Aguirre returned to the Beckwith unit. The panel accepts based on the evidence that the ongoing stay in seclusion was the least onerous, least restrictive decision available to the Hospital in the circumstances.

DATED this 21st day of May 2026, at the City of Toronto, in the Region of Toronto.

Ms. M. den Haan Legal Member

Office of the Registrar Ontario Review Board