Ontario Review Board
Re: Robert Pfaff
ORB File No: 4219
Hearing held on: Thursday, April 16, 2026
Place of hearing: Southwest Centre for Forensic Mental Health Care St. Thomas, ON
Pursuant to: Section 672.81(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: Robert Pfaff Counsel: Mr. W. Glover
The person in charge of hospital: Counsel: Ms. J. Zamprogna
Attorney General of Ontario: Counsel: Mr. J. Huber
REASONS FOR DISPOSITION
(Dated May 25, 2026)
Overview
On June 15, 2005, Robert Pfaff was found not criminally responsible on account of mental disorder (NCR) on a charge of assault causing bodily harm. His current Review Board disposition discharges him on limited conditions, including a requirement that he report to the person in charge of the Southwest Centre or their designate not less than twice per month. The disposition does not have a residence or abstention requirement, nor a consent to treatment condition.
On April 16, 2026, this panel of the Review Board convened at the Southwest Centre to hold a hearing and review that disposition. Mr. Pfaff attended with his counsel, Mr. Glover.
The issues to be decided at this hearing are whether Mr. Pfaff continues to pose a significant threat to public safety and, if so, what is the necessary and appropriate disposition, taking into account the criteria in s. 672.54 of the Criminal Code.
Both at the outset and at the conclusion of the hearing, the parties jointly submitted that as the test for significant threat is no longer met, Mr. Pfaff must receive an absolute discharge. We agree. These are our reasons.
Background
Mr. Pfaff is 65 years old. He is the youngest of seven children. In 1974, when he was 13 years of age, both his older brothers were involved in a serious car accident. Two weeks later, his older sister left school and moved to Alberta. The hospital report describes that Mr. Pfaff became more hostile, defiant, hyperactive, impulsive and destructive after that time.
Mr. Pfaff’s first mental health hospitalization was in 1976 (at the age of 16) after he struck his father with a pipe, leaving him unconscious. Mr. Pfaff was diagnosed with schizophrenia, catatonic type, and was hospitalized at the St. Thomas Psychiatric Hospital for much of the next 10 years. Starting in March 1986, he spent approximately 16 months in supervised community group homes, but was readmitted to hospital after an incident of rage, when he was yelling and swearing at other residents.
In April 1990, Mr. Pfaff was discharged to a Homes for Special Care residence in St. Thomas. He was able to remain at that home for almost 10 years, with intermittent admissions to hospital. However, in late January 2000, he was arrested by police and readmitted to hospital after he was charged for being very aggressive with an older co-resident. In December 2020, he was convicted of assault arising from that incident, his only criminal conviction before the index offence.
Mr. Pfaff remained in hospital until June 2002, when he was discharged to his own apartment with follow-up to be provided by a PACT team. Within weeks he was readmitted to hospital due to an escalation in his symptoms. Further attempts to maintain him in his own apartment ended with his demand to be returned to hospital in April 2003. During that admission he hit another patient. Through 2003 and 2004, Mr. Pfaff was in and out of hospital and his apartment, with incidents of aggression (including kicking a PACT staff member) and threats throughout.
Mr. Pfaff’s readmission to hospital that began in December 2004 was the admission during which the index offence occurred. On March 30, 2005, Mr. Pfaff and the victim were alone together in the ward dining room. After the victim entered the room, Mr. Pfaff hung up the telephone he was using, walked over to the victim and punched her in the nose and mouth, causing her to bleed heavily. Mr. Pfaff then walked out of the dining room to the nurses’ station to advise that he had hit a co-patient. He was charged and transferred to a forensic unit within the Regional Mental Health Care St. Thomas.
After the NCR finding in June 2005, Mr. Pfaff was subject to detention dispositions for many years due to his ongoing symptoms, impulsive behaviours and his lack of insight. After community living was added to his disposition in 2009, attempts were made to place him in various group homes or independent apartments, but he was repeatedly brought back to the hospital due to his verbal and physical aggression, and unsafe living conditions. At times those admissions were voluntary.
In February 2022, after a 10-month admission, Mr. Pfaff was accepted and began a transition to a long-term care (LTC) home in London. Although there were several incidents of conflict and/or tension early in his transition (directly related to Mr. Pfaff’s delusional and paranoid ideation about staff and co-residents), once he began to settle, the long-term care staff were able to manage and minimize the effects of his delusional thinking.
In late June 2023, Mr. Pfaff was readmitted to the Southwest Centre for assessment of his mental status and medication adjustment. His problematic behaviour and presentation had been escalating at the LTC home, putting his residency there at risk. He was experiencing increased paranoid ideation and latent anger, had destroyed property at the home, and there were increasing concerns about the safety of the other residents and staff.
After a full medication review to optimize his prescribed medication, and over time, Mr. Pfaff’s presentation returned to baseline. He was discharged back to the same LTC home in August 2023. He continued to be impacted by his symptoms of schizophrenia, voicing persecutory delusions and experiencing tactile hallucinations. Nevertheless, the treatment team felt it was appropriate to refer him to the Discharge Liaison Team (DLT) through specialized geriatric services at St. Joseph's Health Care London to support his transition to post-forensic care. It was anticipated that the transfer of his care would occur in April 2025.
In March 2025, the treatment team noted that Mr. Pfaff had changes to his presentation, including poor articulation, unsteady gait, and potentially further cognitive decline. Medication changes were made and tests were ordered. On March 9, 2025, Mr. Pfaff had an unwitnessed fall, another fall the next day, and a witnessed seizure. He sustained facial lacerations and bruising, and a nasal bone fracture.
Two days later, on March 11, Mr. Pfaff left his residence without permission. When he had not returned after a few hours, he was reported missing. Police conducted a search of the local area, located Mr. Pfaff at a Tim Hortons, and returned him to the LTC home. Upon his return, the treatment team and LTC staff noted that he displayed increasing paranoia about harm being caused to him and decided that he should be readmitted to hospital. That readmission occurred on March 12, 2025. Among other things, the team wanted to explore how Mr. Pfaff was able to leave his residence, which they had understood to be locked.
Course Since the Last Hearing
At the current hearing we received evidence in the form of an updated hospital report, as well as the oral testimony of Dr. Ajay Prakash, Mr. Pfaff’s attending psychiatrist. That evidence revealed as follows: Mr. Pfaff was discharged back to his long-term care home on April 28, 2025. Since that time, he has not required readmission.
Although the unit where Mr. Pfaff lives at the LTC home is not locked, in order to leave the home there are increased security measures. For anyone to leave the facility, the receptionist at the front door must let the person out, or the person must enter a code on a keypad to let themselves out. Mr. Pfaff does not have access to the code and he has been given a wander guard bracelet that he wears all the time, including at this hearing.
Over the course of the year, Mr. Pfaff continued to experience symptoms of schizophrenia. Consistent with his established baseline, he endorsed ongoing visual, tactile, and auditory hallucinations, and longstanding persecutory delusions. However, he also demonstrated improved use of more appropriate strategies to manage stress or agitation, and fewer maladaptive behaviours, such as property destruction. He expanded the range of staff he contacted for support beyond the forensic outreach team and demonstrated increased reliance on LTC staff and staff of the DLT, who became more involved in his care through the year. He was more open to discussing his concerns and showed reduced paranoia toward these staff, working collaboratively with them to identify concerns and solutions.
Cognitively, Mr. Pfaff’s functioning reflected a decline this year, including ongoing impairments in attention, memory, organization, planning and task completion. Attempts at re-direction could result in agitation and increased paranoia, particularly during periods of confusion. Despite this, staff at the LTC home consistently reported that Mr. Pfaff was not a problematic resident and they expressed satisfaction in working with him.
The rules of the LTC home require that residents access the broader community of London only when escorted. Though Mr. Pfaff occasionally accessed the community with forensic outreach team staff, in preparation for potential discharge from the forensic system, Mr. Pfaff’s family supports were increasingly present in his life this year. This resulted in an increase in his use of passes and privileges, including several day passes into the community, all of which went well. As described in the hospital report (p.56), “When observed in the community, Mr. Pfaff demonstrates excellent manners, follows social norms and picks up on social queuing. He is polite when engaging with community members and follows directions well.”
Analysis and Conclusion
In recommending an absolute discharge, Dr. Prakash and the hospital recognized that this is a somewhat unusual case. Currently, Mr. Pfaff presents with ongoing, residual symptoms of his illness, including auditory hallucinations and delusions. He continues to demonstrate affective, behavioural and cognitive instability (i.e. mood lability, sudden outbursts of anger and a distorted attribution style), albeit at a lower frequency this year. He is adherent with treatment, but has consistently stated that he continues to take his prescribed medication because he is forced to do so by the LTC home staff and the forensic mental health system. He does not believe he is mentally ill and has said that he would stop taking medication if discharged.
Dr. Prakash was clear that all of those issues were considered and addressed by the treatment team before arriving at the position that the onerous test for significant threat is no longer met. First, should he receive an absolute discharge, nothing in Mr. Pfaff’s day-to-day life will change. Much of his clinical care and oversight has now been assumed by the DLT, a specialized geriatric mental health team based out of the St. Joseph’s organization, that Dr. Prakash described as better equipped to deal with Mr. Pfaff’s care, supervision and risk. The lead psychiatrist on that team is a geriatric psychiatrist, who will take over prescribing his mental health medications. She has dealt with forensic patients before and understands the implications of an absolute discharge. The nurse on the DLT (who was present at the hearing) will be his primary care provider and point person.
The DLT has gotten to know Mr. Pfaff over the past few months and have developed a good relationship with him. The plan is for the team to provide consistent supervision and support going forward, and Mr. Pfaff now expresses an acceptance of the need for post-forensic professional supports and a willingness to continue to engage with the DLT.
In terms of medication, the expectation is that despite his prior statements, Mr. Pfaff will likely remain adherent with treatment prescribed and overseen by the DLT and administered by nursing staff at his LTC home. As described by Dr. Prakash, while Mr. Pfaff has a history of medication non-adherence and lacks insight into his illness and need for treatment, he has been compliant with treatment for the past 20 years and this is now part of his habit and routine. It is notable that he has remained adherent with medication on a conditional discharge without the need for a consent to treatment condition, under the substitute consent of the Office of the Public Guardian and Trustee.
Second, once discharged from the forensic system, Mr. Pfaff will continue to reside at the same locked long-term care facility where he has lived for just over four years. He is incapable in respect of finances, so could not choose or fund his own place to live. Staff at the LTC home who care for him have come to know Mr. Pfaff well. When intervention is necessary, they know how to talk with him and deescalate him. The facility has a behavioural support team embedded at the home who are called on intermittently for assistance, but Mr. Pfaff’s concerning behaviours are generally transient and managed through “structured environmental supports, staff intervention, and reassurance.” There is no evidence of aggressive, assaultive, or targeted violent behaviour toward others.
Finally, the view of the forensic team is that should Mr. Pfaff require readmission to hospital due to decompensation in the future, the Mental Health Act is available. Mr. Pfaff is incapable in respect of treatment, so could be involuntarily admitted under Box B, assuming the necessary criteria are met. According to Dr. Prakash, in that situation a bed would be available on a geriatric unit with specialized care.
As stated by the Supreme Court of Canada in Winko v. British Columbia, [1999] 2 S.C.R. 65, to support restrictions on the liberty of an NCR accused, there must be a positive finding on the issue of significant threat. Based on the evidence before us (as outlined above), we are not able to find that Mr. Pfaff, in his current mental state and with the proposed supports in place, poses a real risk of causing serious physical or psychological harm arising from a criminal offence if he is not subject to a Review Board disposition. As we do not find that the threshold test is met, Mr. Pfaff must be absolutely discharged.
DATED this 25th 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