Re: Emanuel Medeiros, 2026 CanLII 59668

Ontario Review Board

Re: Emanuel Medeiros

ORB File No: 8962

Hearing held on: Thursday, May 14, 2026

Place of hearing: Southwest Centre for Forensic Mental Health Care 401 Sunset Drive, St. Thomas

Pursuant to: Section 672.47(1) of the Criminal Code

Before:

Alternate Chairperson: Mr. J. Weinstein Members: Dr. R. Chandrasena Dr. P. Wright Mr. E. Siebenmorgen (by Zoom videoconference) Ms. B. Little

Parties Appearing:

Accused: Emanuel Medeiros Counsel: Mr. J. Conway

The person in charge of hospital: Counsel: Ms. J. Zamprogna

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

REASONS FOR DISPOSITION

(Dated June 17, 2026)

Introduction

1. On February 18, 2026, Emanuel Medeiros, now 61 years of age, was found not criminally responsible on account of mental disorder (“NCR”) in the Ontario Superior Court on a charge of second-degree murder, contrary to the Criminal Code. The Court did not make a Disposition and referred that matter to the Ontario Review Board (“ORB” or “the Board”). He was admitted to the Forensic Assessment Unit of the Southwest Centre for Forensic Mental Health Care (“Southwest Centre” or “the Hospital”) on April 8, 2026.

2. On Thursday, May 14, 2026, a panel of the Board convened in person at the Hospital to conduct Mr. Medeiros’ disposition hearing and to make a Disposition, pursuant to s. 672.47 (1) of the Criminal Code. The issues at the hearing for the Board’s determination were: (a) whether Mr. Medeiros represented a significant threat to the safety of the public within the meaning of s. 672.5401 of the Criminal Code; and (b) if so, the necessary and appropriate Disposition that is also the least onerous and least restrictive, having regard to the factors in s. 672.54 of the Code. Mr. Medeiros was present and represented by his counsel, Mr. Conway.

3. In addition to the documents from the Crown and the trial court forming the Record of the hearing, the documentary evidence at the hearing consisted of the Hospital Report, dated April 15, 2026 (Exhibit 1) and five Victim Impact Statements (collectively Exhibit 2), which were redacted by the parties to ensure compliance with s. 672.5 (14) of the Criminal Code. In addition, the panel heard oral evidence from Dr. Ajay Prakash.

Positions of the Parties

4. At the start of the hearing, counsel for the parties stated their initial, tentative positions. Hospital counsel confirmed the recommendations in the Hospital Report, which consisted of a Detention Order with several privileges and conditions. The recommended most liberal privilege was indirectly supervised passes into Elgin County. The recommended conditions were a substance use abstinence requirement, the provision of samples for testing, and a firearms/weapons prohibition. Hospital counsel proposed one amendment to Mr. Medeiros’ recommended accompanied community privilege to permit a delegated agency or organization to accompany him.

5. Counsel for the Attorney General adopted the Hospital’s recommendations and proposed an additional condition requiring that Mr. Medeiros not associate or communicate, directly or indirectly, with three named individuals (a nephew, a brother, and a sister of Mr. Medeiros) except with their written and revocable consent, to be provided to the person in charge of the Southwest Centre.

6. Counsel for Mr. Medeiros adopted the Hospital’s position, expressly noting that the threshold “significant threat” issue was not in dispute, and proposed that Mr. Medeiros’ indirectly supervised privilege be extended to Middlesex County as well as Elgin County. Mr. Medeiros’ counsel was not expressly opposed to the Attorney General’s proposed non-association/non-communication condition.

7. At the conclusion of the evidence, Mr. Medeiros’ counsel stated that he was withdrawing the request for indirectly supervised privileges into Middlesex County. He also stated that he would leave to the Board the issue of a non-association/non-communication condition. Counsel for the Hospital maintained its initial position and took no position with respect to the Attorney General’s requested condition. Counsel for the Attorney General maintained her initial position and made submissions in support of the requested non-association/non-communication condition.

Findings

8. Following deliberations, the panel found that Mr. Medeiros represents a significant threat to the safety of the public and that the necessary and appropriate Disposition is a Detention Order with the terms and conditions as recommended in the Hospital Report and as slightly modified as noted above. In addition, the panel added a non-association and non-communication term as requested by counsel for the Attorney General in relation to certain of Mr. Medeiros’ family members. These are the Reasons for these findings.

The Index Offence and Victim Impact Statements

9. Counsel for the Crown and for Mr. Medeiros prepared an extensive Agreed Statement of Facts which was entered as an Exhibit at the trial. Helpfully, this Agreed Statement is incorporated into the Hospital Report. It occupies seven (7) of the Report’s 32 pages. It includes information about Mr. Medeiros’ history, including his mental health history. As the Hospital Report is in evidence, it is unnecessary to reproduce the Agreed Statement in these Reasons. In the interest of brevity, it is sufficient to highlight the following facts:

a) The victim was Mr. Medeiros’ mother. At the time of her death, she was 82 years of age and Mr. Medeiros was 59.

b) Mr. Medeiros is diagnosed with schizoaffective disorder, bipolar type and has a history of auditory and visual hallucinations and suicidal ideation.

c) Mr. Medeiros was involuntarily admitted to the Parkwood Institute in London, Ontario, between October 3, 2023, to November 17, 2023, due to decompensation in his mental health. He was readmitted to the Parkwood Institute on November 29, 2023, again due to mental health decompensation.

d) On January 8, 2024, Mr. Medeiros was discharged to live with his mother at her address in the Municipality of North Middlesex. He was living at that address on January 11, 2024 (the date of the homicide). At approximately 8:00 p.m. on that date, he went to the Lucan Ontario Provincial Police (“OPP”) Detachment where he used the external detachment phone and called the OPP Communications Centre to report that he had murdered his mother at the residence. When asked by the dispatcher why he murdered her, he stated, “I wanted her to be with my father.”

e) Police officers arrived at the residence at approximately 9:14 p.m. They found Mr. Medeiros’ mother, deceased in a bedroom of the residence. Her body was laying in her bed in her night gown, covered in blood, with severe blunt force trauma to her skull. Blood was observed spattered on the ceiling, south-facing bedroom wall, and on the headboard of the bed. A claw hammer with a rubber handle was located in the garage on top of a wood cabinet. The hammer had blood on it.

f) Mr. Medeiros was arrested that evening and taken to the Lucan OPP Detachment. While in the cells, he made the following utterances:

• “I’m guilty. There’s lawyers devil worshipers operating in London and Strathroy”;

• “I killed my mother with a hammer”;

• “I went into her bedroom while she was sleeping. I was beating her in the head”;

• “We’re gonna get rid of these devil worshipers. That’s gonna get better environment”;

• “It had to be done to protect her”;

• “I’m the son of God”;

• “Maybe I possessed by the devil”;

• “Hail Satan, Hail Satan, Hail Satan”; and

• “I killed my mother to protect her from devil worshippers.”

g) Mr. Medeiros has a documented history of a psychotic disorder dating back to when he was only 20 years old. He was hospitalized numerous times to be treated for his illness.

h) Dr. Giovana de Amorim Levin, a forensic psychiatrist, authored an NCR Report on April 25, 2025 that included the following: “In my opinion, Mr. Medeiros was clearly suffering from decompensation of a major mental disorder at the time of the offence, namely schizoaffective disorder, bipolar type. Mr. Medeiros has a long history of schizoaffective disorder (initially diagnosed as schizophrenia), dating back decades, well documented by the several experienced mental health professionals who previously assessed him.”

i) In her NCR Report, Dr. Levin wrote, regarding the time of the offence: “Mr. Medeiros’ mind was operating based on a psychotic process, with delusional and irrational beliefs, which were congruent with the auditory hallucinations he was experiencing. Mr. Medeiros had experienced command auditory hallucinations in the past and had acted on those commands, including multiple attempts to end his own life. His command auditory hallucinations were well-documented in the medical records preceding the offence.”

j) According to Dr. Levin’s report, Mr. Medeiros reported feeling extremely distressed. He spoke to Jesus and angels, who reportedly told him to kill his mother. Mr. Medeiros indicated that he felt that he did not have a choice. It was either kill her in her sleep, without suffering, or be tortured “who knows for how long,” per his report. Mr. Medeiros grabbed a hammer and hit her on the head while she slept, as fast and as hard as he could, according to his account. Mr. Medeiros indicated that he was devastated by the “choice he had to make to protect her,” but at the time, he believed that he was saving her from pain and torture.

10. Mr. Medeiros’ extensive self-report is extracted from Dr. Levin’s report and helpfully reproduced in the Hospital Report. It need not be reviewed in these Reasons but will merit consideration by future panels of the Board.

11. The Victim Impact Statements depict his siblings’ and nephew’s shock at learning that Mr. Medeiros’ illness, of which his family members had been aware for many years, manifested itself through the taking of their mother’s and grandmother’s life. They were familiar with the fact that his illness had prompted several suicide attempts but did not at all anticipate that he would be violent toward another person, in particular his mother whom he loved very much and who continued to support him through his illness. Extracts from the Statements include the following:

• “As you will know through this court case my brother has been in and out of hospitals most of his life. At certain times in his life we would know like clockwork when he would become sick as it seemed to always be in September. . . Closer to the time of the incident he was in the hospital and my sister and I told Manny that he was not well. We had asked the hospital to keep him in as he was not well. . . They let him out.” [Statement of Emaculada Chesher]

• “As he became older his religious moments would get worse, they would be scary because he would have this look that I was all too familiar with that I knew he needed to get help. . . I am basically saying I felt in my life my brother would hurt himself but never felt he would hurt us. When my sister called I thought he finally succeeded with taking his own life but to hear he took my mother’s was a shock I will never get over.” [Statement of Geraldine Perkins]

• “[My mother] knew he was sick and therefore tried to do everything and anything to make his life as comfortable as possible. I can honestly say, without an ounce of envy that Emanuel was her favorite child and again, this was due to his illness. My brother truly loved our mother just as much as she loved him but on the night of January 11, 2024, Emanuel crossed a line none of us ever thought imaginable. . . . Over the past 40 years our family has tried endlessly to help Emanuel as he struggled through this debilitating illness.” [Statement of Nuno Medeiros]

• “On January 11th 2024, I found out the news that he had murdered my grandmother. I was at home on the couch after my mom had left to see what was happening when my dad picked up her call and had to break the news to me. I couldn’t react, couldn’t breathe just sat still and didn’t move for minutes. I tried to process it, but I figured I probably heard him wrong. I had heard stories of when he checked into the hospital after attempting to hurt myself or worse, however, nothing had ever happened like this. I believe a part of me died that day.” [Statement of Samuel Chesher]

12. All family members suffered the loss of the victim, who was their mother or grandmother. In addition, various family members have also experienced specific trauma, described as follows:

• “How this has affected me personally is that I was there at the scene. I saw all the police cars and the lights flashing. . . On the scene they explained to me that they needed a picture of my mom as she was unrecognizable and this stays with me. . . I struggled when I had to have my mother's house cleaned after the incident. I physically was in pain and in a depressed state. I had to visit a psychiatrist to help me deal with my emotions because I struggled with the guilt of not being able to stop it. I was losing sleep and would picture the situation over and over again. I physically didn’t want to go to work but it was a distraction to get me out. I had to increase my medication for anxiety and reflux.” [Statement of Emaculada Chesher]

• “Over the last 2 years, I have not brought myself to face him. I can’t bring myself to see him because he absolutely terrifies me to my core. I tried to bring myself to go, simply just talk about my life like we used to. I truly enjoyed doing it, but I just can't. . . Since this traumatic event, I was in therapy for several months after the incident, and I could never break the terror that followed me. I have had numerous night terrors that have taken place over the last 2 years, one as recently as 2 weeks ago.” [Statement of Samuel Chesher]

• “For me, the past two years have been a nightmare to say the least. How does a family try to navigate through something like this? There are no words to describe it. I lost my mom and my brother all in one night.” [Statement of Nuno Medeiros]

13. Family members have written of Mr. Medeiros’ prosocial character as being evident when he is well, and at the same time expressed their current fears now that his actions have resulted in his mother’s death:

• “Our family’s fears are, that he will be released to the public too soon or left on his own without our patents watching him. . . While he is under medical care and watched he is a peaceful loving man that would do anything for his loved ones. While he is sick or not properly medicated, he becomes a danger to all. We want to ensure his safety and the people around him. . . We are very fearful now of his possible actions and his way of making us feel guilty or unsupportive of his health.” [Statement of Chris Medeiros]

• “This is where I struggle the most is fear. Never in my mind would I have thought that my brother would have hurt my mother. He had patience for her and he always helped her when she needed it. He had never shown in the past any physical altercation as it was always internalized and harmed himself. This incident took us as a family to another level. We were not prepared for this and we could not understand what happened. He was able to hurt someone else and that scares us all. He was able to take someone else's life who cared for him deeply. He was very close with my son and my son struggles with why and how this happened. He is terrified of Manny and doesn't want to see him anymore. . . We as a family wonder what will happen in the future. . . Where will he live and how can we ensure he won't harm us? . . How can we confirm that he will not do this again? How can we be sure he will take his meds and go to the hospital when he is sick? He never did this in the past and what will make him do it now. We love our brother but we no longer feel safe around him.” [Statement of Emaculada Chesher]

• “I have always been religious, and I am always someone who will try to forgive. However, in this case, I will never be able to forget. The thought that he knows where my closest family is and how smooth, kind and especially smart he is scares me due to how he can take advantage of the system. I believe he has mental health challenges that he deals with everyday and I truly want him to be able to get the proper help; I hope that you will consider my message in its entirety, as I will still always love my uncle; however, I will never live a day without fear anymore.” [Statement of Samuel Chesher]

• “In closing, I, along with my siblings, deeply love my brother. However, going forward, it is imperative that Emanuel is properly supervised at all times.” [Statement of Nuno Medeiros]

Background Information

14. In brief terms, Mr. Medeiros is single, has never been married, and has no children. He has no criminal record. At the time of the index offence, he was living in a trailer on his mother’s property, approximately a half mile from her residence. He was born in Sao Miguel in the Azores, where he lived with his parents, two brothers, and two sisters. The family immigrated to Canada when he was 2 ½ years old, initially settling in London. They moved to the Strathroy area when he was 16 years of age. His father worked in construction and his mother as a seamstress, and his grandmother helped look after the children while his parents were at work. He described his parents as very good, loving and supportive. The family began to farm part-time, and Mr. Medeiros recalled positive memories of his family as a unit.

15. Mr. Medeiros described himself as an average student. He denied a history of behavioural problems as a child or teenager, though stated he had gotten into a few school fights and had been suspended once. He also reported having experienced bullying at school but could not recall specifics.

16. After graduating from high school, Mr. Medeiros studied engineering at the University of Western Ontario in London. Mr. Medeiros reportedly became psychotic during his second year and was unable to concentrate on his studies after being discharged from hospital, reporting that he was “not the same person” afterward. He recalled that his recovery took a long time and that he started working after he felt better. He worked at several jobs over the years but experienced prolonged periods of being unable to work due to recovery from psychotic decompensation. Mr. Medeiros stated that he had exacerbations of psychotic symptoms even while receiving active treatment with good compliance.

17. Mr. Medeiros lived with his parents for some years, then in London on his own, and then returned home with his parents when he became ill. This cycle reportedly repeated several times. The lengthiest period that he recalled living on his own was between the years 2000 and 2008. He then moved to the trailer at the family farm near Strathroy until the date of the index offence. He stated that living at the family property allowed him to visit his parents daily while maintaining some independence at his trailer.

18. Mr. Medeiros continued to have a close relationship with his parents. His close relationship with his mother continued after his father passed away in May of 2023, roughly eight months prior to the index offence.

Formal Psychiatric History

19. Mr. Medeiros and his siblings provided information to Dr. Levin, the author of the NCR report, concerning his lengthy history of mental health difficulties and hospitalizations prior to the index offence. According to her report, Dr. Levin reviewed Mr. Medeiros’ medical records from St. Joseph’s Health Care London, Strathroy-Middlesex ACT (Assertive Community Treatment), and Parkwood Institute, July of 2019 to April 30, 2024. By her count, these records consisted of over 2900 pages. She also reviewed his medical records from the detention centre. However, as Dr. Levin’s focus was on Mr. Medeiros’ mental state at the time of the offence, her review focused on the period from 2022 to 2024 (NCR Report, p. 13). In her report, she provided the following overview of the records:

“Mr. Medeiros’s records are extensive and indicate a history of a severe psychotic illness, with multiple suicide attempts, a history of delusions and hallucinations and frequent decompensations involving religious themes when he became acutely psychotic. There had been no history of violence towards others. His close relationship with his parents became clear throughout the records.”

20. In addition to her review of Mr. Medeiros’ medical records, Dr. Levin received information from his siblings as noted above. She summarized this information as follows:

“In the collateral history provided, Mr. Medeiros’ siblings indicated that he was not at his baseline, which caused them concern. The concern was centred on him possibly

committing suicide, since he had multiple prior attempts and had never been violent other than to himself, in the course of his illness. All siblings indicated that Mr. Medeiros was extremely close to their mother and helped her as much as possible. In the collateral information provided, they all agreed that Mr. Medeiros would never have hurt their mother had he not been ill.”

21. In her NCR report, Dr. Levin included a review of documentation covering the last two years of Mr. Medeiros’ psychiatric history prior to the index offence. The information from her review has been reproduced in the Hospital Report, which is in evidence as an Exhibit. In view of the issues at Mr. Medeiros’ initial hearing, it is not necessary to further summarize that information in these Reasons.

Evidence at the Hearing

22. Dr. Prakash stated that he was Mr. Medeiros’ attending psychiatrist since his admission on the Assessment Unit at the Southwest Centre. He adopted the Hospital Report with some changes that he drew to the panel’s attention. First, he pointed out that it was January 22 of 2024, not 2025 (as stated at p. 20 of the Report), when Mr. Medeiros was admitted to hospital while in detention. This was shortly after the index offence. He was discharged back to the detention centre at the end of April, also in 2024 and not in 2025 as reported. Secondly, in reference to the list of Mr. Medeiros’ medications at p. 27, Dr. Prakash stated that the Haloperidol had been switched from an oral formulation to injectable. This was to allow for injectable antipsychotic medications to play a greater role in Mr. Medeiros’ future care.

23. The final change that Dr. Prakash wished to make to the Hospital Report was at p. 29, in relation to the list of criminogenic factors. He said that instead of ending the sentence with “.. and possibly alcohol use” he would revise the phrase to “... and likely alcohol use” [emphasis added].

24. The Hospital Report states Mr. Medeiros’ diagnoses as follows:

• schizoaffective disorder – bipolar subtype; and

• history of alcohol abuse – in remission in a controlled environment.

25. Dr. Prakash addressed the two modifications to the proposed Disposition that had been suggested in the statement of opening positions. First, regarding the request that the indirectly supervised community privilege be expanded to include both Elgin and Middlesex Counties, Dr. Prakash said that there had been debate within the treatment team whether to even recommend any indirectly supervised community privileges for the next year. Dr. Prakash did not see Mr. Medeiros entering the community into Middlesex County over the next year. He thought that the Hospital’s existing privilege recommendations allowed for Mr. Medeiros to make significant progress over the next reporting period; however, should he progress to the point of being able to safely enter Middlesex County, the Hospital could request and early hearing to address this.

26. As for the Attorney General’s proposed “no contact” condition, Dr. Prakash was content to largely rely on the other parties to argue this issue. He advised, however, that members of Mr. Medeiros’ family have visited him in person at the Hospital. Dr. Prakash was not opposed to the requested condition, as the Hospital would be able to facilitate communication through a process of written consent.

27. Dr. Prakash reminded the panel that Mr. Medeiros had been at the Hospital for a relatively short time. In that time, he has begun to engage with Concurrent Disorders programming to address his alcohol use, one of his criminogenic factors. At the time of the hearing, he was said to have been in the early stages of developing insight into his alcohol use.

28. With respect to Mr. Medeiros’ mental state, another criminogenic factor, Dr. Prakash noted that while he has been stable for some time, both while in hospital and in the detention centre following the index offence, the treatment team was contemplating making medication changes, and such changes can be destabilizing. As he noted earlier in his evidence, the point of the medication changes is to allow injectable, long-acting medication to have a greater role in Mr. Medeiros’ future stability, as nonadherence had been a factor in the index offence.

29. Dr. Prakash said that psychological treatment, which has not yet begun, would also be part of Mr. Medeiros’ treatment plan. This could include trauma or grief counselling, as determined between the psychologist and Mr. Medeiros.

30. In reference to the result of the HCR-20 v. 3 risk assessment in the Hospital Report, Dr. Prakash stated that this is a dynamic assessment tool and its result could fluctuate over a span of days, weeks, or months.

31. In Dr. Prakash’s opinion, Mr. Medeiros would do well in a structured hospital setting. He has done so in the past while in hospital, going back to the onset of his illness or at least since 2008, as far as he was able to determine thus far. It is when Mr. Medeiros transitions back to community living that the three factors of stress, alcohol use and non-compliance with treatment could come into play. It was noted that prior to the index offence, Mr. Medeiros did have community psychiatric support in the form of his ACT team.

32. Dr. Prakash outlined the next steps for Mr. Medeiros. First, he would be transferred to a treatment unit at the Hospital. This could take upwards of weeks or months while awaiting a space there. In the meantime, his rehabilitation can proceed even while on the assessment unit, including the use of off-unit privileges. Dr. Prakash provided an explanation of the privilege levels at the Southwest Centre as follows:

(i) Level 1 - allows a patient to leave the unit to go to other areas within the hospital 30 minutes at a time, up to three times a day;

(ii) Level 2 – is similar to Level 1 but the patient may leave the unit for up to one hour at a time;

(iii) Level 3 – allows a patient off the unit all day but within the hospital, returning for medications, meals, and programming;

(iv) Level 4 - is a significant step in privileges, giving a patient access to hospital grounds for 30 minutes, three times a day;

(v) Level 5 – is similar to Level 4 but the patient may access hospital grounds for up to one hour at a time;

(vi) Level 6 – permits full access to the hospital grounds unlimited except to receive meals, medication, and programming.

33. Dr. Prakash explained that in-hospital privileges (Levels 1 to 3) are reviewed and discussed by the clinical team and are dependent on the patient’s progression and stability in his recovery. Moving from Level 3 to Level 4 requires a secondary review by hospital administrators, with input from the treatment team, as do movement to Levels 5 and 6.

34. Dr. Prakash reviewed the treatment goals for Mr. Medeiros for the coming year. They include optimization of medication, as previously noted, to reduce the risk of future non-compliance, as well as to address his alcohol use, which has included binge drinking in the past. Dr. Prakash added that psychological treatment would also be critical, so that Mr. Medeiros can develop insight into the reasons for his many decompensations over the years dating back at least to 2008.

35. Dr. Prakash stated that Mr. Medeiros is amenable to the plan for medication change and optimization. Speaking to his general insight, Dr. Prakash stated that that he could add little to what is stated at pp 26-27 of the Hospital Report. In a general sense, Mr. Medeiros’ insight is good in a superficial sense. However, there is more to be explored, since if Mr. Medeiros had good insight in a global sense, he would not have had such a lengthy history of decompensations and hospitalizations.

36. Dr. Prakash responded to questions from counsel for the Attorney General about Mr. Medeiros’ family. He had met members of the family earlier on the day of the hearing and agreed that they are grieving the loss of their mother. They have continued to be caring of their brother: they have visited and brought various items to him, including clothing. He agreed that he has heard from three family members that they seek some degree of control over when and where they have contact with Mr. Medeiros, including by phone.

37. In response to questions from Mr. Medeiros’ counsel, Dr. Prakash said that he was unaware of any inappropriate contact between Mr. Medeiros and his family members. He said that on the assessment unit and treatment unit, patients are not permitted to have cell phones or computers in their rooms or on their person, except while out in the community. Access to public phones can be monitored and supervised to some extent.

38. Counsel asked Dr. Prakash whether he could provide an estimate as to the speed with which deterioration from a stable mental state could occur with Mr. Medeiros. Dr. Prakash reviewed the information from the time of the index offence on January 12 (2024), noting that Mr. Medeiros had been discharged from hospital on January 8 and on January 4, Mr. Medeiros was still experiencing residual symptoms, though he expressed that he was getting better and would be able to resist any command hallucinations. It may be difficult to predict the degree or speed of decompensation. However, a goal of the forensic system is to target as much as possible all symptoms of a mental illness so that when a person’s liberties increase over time, there are no residual symptoms.

39. Dr. Prakash confirmed that from the history, Mr. Medeiros has at various times returned to hospital without resistance, has come to emergency departments on his own, has requested mental health appointments, and called Emergency Medical Services (EMS). Conversely, there have been times when he left the hospital against medical advice and has been non-compliant with medications.

40. Dr. Prakash responded to a panel member’s question about the Hospital’s access to any psychological testing conducted as part of the NCR assessment in this case. He said that Dr. Levin who conducted the assessment works in the community and not in a hospital, and he was unaware whether she had engaged the services of a psychologist for Mr. Medeiros’ assessment. Going forward, Dr. Prakash did not think that psychological testing was required in this case for diagnostic purposes, as Mr. Medeiros’ schizoaffective disorder diagnosis has been consistently documented by clinicians. Dr. Prakash did see some value in conducting personality testing, in view of some comments in the victim impact statements, and cognitive testing, in view of Mr. Medeiros’ score of 25/30 on the Montreal Cognitive Assessment (MoCA).

41. Dr. Prakash confirmed that the ability of Mr. Medeiros to exercise indirectly supervised passes into Elgin County was considered as the upper limit of his trajectory based on his progress thus far. If he is not ready to exercise that privilege, it would not be granted. He would first need to successfully manage privileges at Levels 1 to 6, which would themselves be provided in a stepwise fashion with appropriate safeguards. As of the time of the hearing, Mr. Medeiros’ only privileges were escorted off-unit trips to the hospital store and to the gym.

42. Dr. Prakash provided a brief overview of differences between the operation of the forensic and civil mental health systems, in view of the nature of this initial hearing. He explained that the forensic system operates under the Criminal Code, which is not the case with the general mental health system. Under the Criminal Code, the Hospital is governed by certain expectations and is accountable to the Ontario Review Board. Public safety is the paramount consideration, and the progression that the forensic system uses to ensure public safety is a slow and steady one, ensuring that there is a specific focus on risk factors. The forensic hospital system also places reemphasis on the provision of collateral information rather than relying simply on the individual’s self-report.

43. Dr. Prakash illustrated the gradual approach taken by using the example of the privilege levels described earlier. He pointed out that even in-hospital privileges do not begin in an indirectly supervised fashion. People start out being accompanied to see how they manage and then they may be unsupervised for a 30-minute period, sometimes being “shadowed” and sometimes not. Each privilege level has five or six stages to it. If for whatever reason, there are issues with a patient’s use of privileges, they can be paused or revoked. Once a patient has successfully managed full hospital and grounds privileges (Level 6) indirectly supervised, and the process of community passes is initiated, that process also begins with the person typically being accompanied into the community. Then, when not directly supervised, the person would still be subject to spot checks by staff to ensure that they are where they are supposed to be. For each patient, the number of accompanied outings would depend upon their overall stability and how honest and forthcoming they are.

44. In the present case, the treatment team was unanimous in recommending that Mr. Medeiros could have indirectly supervised community privileges within the year. As the team came to know him, even for a relatively short time, Mr. Medeiros impressed as a prosocial and caring individual with good insight into many aspects of his criminogenic profile.

45. Nevertheless, Dr. Prakash noted that with Mr. Medeiros, there is something going on with him, deeper than the superficial issues that have been observed, that caused him to have such a history leading to the index offence.

46. Dr. Prakash was asked questions by Mr. Medeiros’ counsel arising from the panel’s questions. He confirmed that the treatment team’s assessments would include information from multiple sources, including Mr. Medeiros’ family. Family input is usually critical to a client's progression They need a good personal support system and if there are personal supports, they usually have an insight into a person's mental condition that the treatment team may not possess. With the input of family, the treatment team is in the best position to assess a person’s appropriateness for exercising various privileges. Unlike the situation with the Mental Health Act which contains many constraints around admitting and detaining a patient in the hospital, a patient detained under the Criminal Code cannot decide when they come and go from the hospital. Their freedoms and liberties are dependent on how they present within the hospital.

47. By agreement of the parties, counsel for the Attorney General read aloud one paragraph from each of four of the five Victim Impact Statements that were filed as an Exhibit. Thereafter, no further evidence was led following that of Dr. Prakash.

Analysis and Conclusions

48. The panel was satisfied that Mr. Medeiros represents a significant threat to the safety of the public. As noted earlier in these Reasons, this issue was undisputed. Absent the oversight provided under Part XX.1 of the Criminal Code, it is highly likely that Mr. Medeiros would fall away from treatment for his long-standing major mental illness (which dates back decades) and experience serious deterioration of his mental state, as he has many times in the past. While he was previously thought, in his deteriorated state, to represent a risk of serious harm only to himself, the index offence tragically demonstrated that this is not the case. When unwell, Mr. Medeiros is subject to delusions and command hallucinations that can result in serious violence, with potentially lethal consequences, inflicted upon those to whom he has access.

49. As tragic as the index offence was, it was not the only manifestation of violence or threatened violence in the context of Mr. Medeiros’ psychotic symptoms. Notably, following his arrest for the index offence, Mr. Medeiros told the police constable that he continued to hear voices once arrested, and he asked to be in shackles because he was afraid that he would harm the police interviewer. While at the detention centre following his arrest and prior to being admitted to Parkwood Hospital in January of 2024, he became involved in a physical altercation with a correctional officer.

50. In reaching the conclusion above, the panel has had particular regard to the information in the Victim Impact Statements and the following evidence from the Hospital Report, as developed in the evidence of Dr. Prakash:

(i) Mr. Mederios has a major mental illness, schizoaffective disorder, which led to a serious violent offence. His illness includes a history of auditory and visual hallucinations, and of numerous hospitalizations for treatment of his disorder.

(ii) The medical records reviewed by Dr. Prakash indicate that Mr. Mederios has a history of problems with alcohol that likely contributed to historical periods of decompensation in his mental state, including association with psychosis in October of 2023 and a suicide attempt on November 24, 2023.

(iii) Mr. Mederios has a history of nonadherence to treatment both in areas of not taking his prescribed medications and complying with visits from treatment professionals. These two factors were noted prior to the index offence.

(iv) Currently, there are no plans for Mr. Mederios’ future living situation or professional community mental health support. These would be critical to maintaining his stability and mitigating his risk of violence.

51. The panel accepted the parties’ joint submission and concluded, independently, that the necessary and appropriate Disposition is a Detention Order. Nothing short of a Detention Order can properly manage Mr. Medeiros’ risk during these very early days of his treatment, which on the evidence has yet to be optimized. No party suggested that the Board could properly order a Conditional Discharge, and the panel is satisfied that there is no air of reality to such a Disposition.

52. The panel accepted that the terms and conditions proposed by the Hospital in its Report, and which were jointly recommended by the other parties, represent, in totality, the necessary and appropriate combination of terms to be attached to the Detention Order, subject to one addition, discussed below.

53. The panel found that it is necessary to include a term to enable certain of Mr. Medeiros’ family members to exercise control over contact and communication with Mr. Medeiros at this time. The condition proposed by counsel for the Attorney General can achieve this objective. The evidence, including that in the Hospital Report, the testimony of Dr. Prakash, and the Victim Impact Statements, makes it clear that Mr. Medeiros’ family collectively care for him and wish to be supportive of him. At the same time, they are grieving an enormous loss and are seeking to come to terms with how to relate to Mr. Medeiros going forward.

54. Before concluding these Reasons, the panel would comment on one aspect of the evidence. In view of the brief period between Mr. Medeiros’ admission to the Hospital and the hearing date, it is understandable that the Hospital’s Report for this initial hearing relied heavily upon the contents of Dr. Levin’s NCR report. However, as noted above at paras. 19 and 21, Dr. Levin’s report did not fully summarize the available history from the extensive medical records provided to her. Furthermore, even those records covered only the period from 2019 to 2024 (some five years). On the available evidence, Mr. Medeiros’ psychiatric history dates back some 40 years. It is to be hoped that as the Hospital’s treatment team becomes more familiar with Mr. Medeiros and his history, more documentation as to the lengthy history and development of his mental illness, its treatment and his various hospital admissions, will become available to both the Hospital and the Board.

55. In approaching this matter, the panel has considered the evidence through the lens of the factors in s. 672.54 of the Criminal Code.

DATED this 17th day of June 2026, at the City of Toronto, in the Toronto Region.

Eric Siebenmorgen

Legal Member

___________________________

Office of the Registrar

Ontario Review Board