In May and June 1997 this 41year old man was found mentally unfit to stand trial on charges of sexual assault and breach of a condition of an undertaking. He was detained on those charges in St. Thomas Psychiatric Hospital between June 1997 and January 1998. Following a hearing by the Ontario Review Board on December 22, 1997, he was transferred from St. Thomas Psychiatric Hospital to Penetanguishene Mental Health Centre. Oak Ridge Division. On January 20 1998, he was admitted to The Forensic Assessment Program. At the time of admission, you noted That Dr Verma was anxious and did not communicate with you except with crayons and signs. I understand that since that time he has Communicated in the same manner, occasionally uttering 'Yes' or 'Yup' in response to questions but otherwise relying on signs, written letters and words, and drawings. Evidently he is able at least sometimes to comprehend spoken questions and instructions, since on some occasions he has been observed to nod his head appropriately and gives other nonverbal indications that he has understood oral communications. You have advised me that he prefers to communicate through written or printed messages directed to him in the form of notes, or by pointing to letters that spell out words, and he responds by using the same techniques. He has made a number of requests in that manner, and has presented no significant management problem except for the time demands imposed by this laborious method of communicating. On February 18, he shoved a staff member in anger and was secluded. On February 20, he spelled out to his nurse “I was strangled and raped in jail and have a 10 minion dollar lawsuit against the jail." According lo the nurse, he smiled and gave a thumbs-up sign before walking away.

I found the following background information in Dr. Verma's hospital file:

Dr. Verma was born and raised in India. No detail about his birth and early development are documented in the file. By his own account, his father was an accounting clerk and his mother was a teacher. He has described his father as a very angry man who physically abused his sons. I understand that his parents reside British Columbia and a younger brother practises medicine in New York. According to records from St. Thomas Psychiatric Hospital, while he was detailed in that hospital, Dr. Verma complained to police that his father and brother were harming him, and advised his mother to divorce his father. No other relevant family history is documented.

Dr. Verma has reported that he was bullied by other children because they envied his cleverness and academic excellence. By his father’s account, his problems with other children arose from his need to appear intelligent and later he had similar difficulties white attending medical school where his arrogant behaviour alienated his teachers. I understand that he came to Canada in 1983, and a few months later he married his current wife in British Columbia. I believe that marriage was arranged by their families while he was a medical student in India and she was training as a nurse in British Columbia. They have three children ranging in age from approximately 5 to 11 years. According to his father, Dr. Verma domineered and severely restricted his wife. In 1996, they separated and she moved with the children to her parents' home in British Columbia. 1 understand that following the separation he was charged with criminal harassment and was released on condition that he would not associate or communicate with his wife and children, I also understand that sometime later in the same year, his wife and children moved back to Ontario and lived with Dr Verma in Kitchener. His wife worked as his medical secretary al that time. In November 1996, while investigating the charges of sexual assault, police learned that Dr. Verma was living with his wife and children and he was charged with failing to comply with the undertaking not associate or communicate with his wife and children.

By all available accounts, Dr. Verma excelled in his medical studies and successfully completed his medical training in India before emigrating to Canada. Later he enrolled in speciality programs in internal medicine and in Neurology, studying for periods of time in British Columbia, Alberta, Saskatchewan and Manitoba. I understand that despite his diligent work in those studies, Dr. Verma encountered a number of professional setbacks.

In or around 1989 (?) Dr. Verma sat in the examinations in the Royal Colleges or Physicians and Surgeons of Canada, and American Board of Psychiatry & Neurology. He passed the written examinations in neurology but was unsuccessful in tne oral examinations. Later Dr. Verma told his physician in Kitchener that one of his supervisors considered him incompetent and engineered his failure on the oral examination by including the examiners.

After failing the examination, Dr. Verma was unable to obtain a medical practitioner’s license in British Colombia and practised general medicine for a period of time in Ontario. Later he retuned to British Columbia and received a medical licence in that Province which was subsequently revoked on grounds of disgraceful conduct and moral turpitude. Dr. Verma told his physician in Kitchener that afler he pressured the Colleges cf Physicians a Surgeons to grant him a license, they put him under a microscopy, looking for a pretext to revoke his licence.

I understand that after losing his medical license in 1993, Dr. Verma practised general medicine in Toronto and Mississauga and finally in the Kitchener-Waterloo area where the charges of sexual assault arose in 1994 and 1995.

The records from St. Thomas Psychiatric Hospital and Royal Ottawa Hospital indicate that, during the course of those professional setbacks, Dr. Verma began showing signs of medical and/or psychiatric disturbances, which have continued and progressed until this time.

In 1993, Dr. Verma was an inpatient in University Hospital in Vancouver for two weeks. He was complaining of right-sided headaches and neuromuscular problems that interfered with writing and shaving himself. Examinations and investigations, including CT examination disclosed no medical explanation for his symptoms. Final diagnoses were major depressive disorder, alcohol abuse, conversion disorder and narcissistic personality traits. Verma was discharged on Nortryptyline and Clonazepam, with recommendations for cognitive behavioural and marital Therapies. No other details about his psychiatric problems or the psychiatric care he received are documented in. the file. No records from University Hospital are included in the file.

In 1993 or 1994, Dr. Verma was practising medicine in Toronto far a period of time. Later he told a psychiatrist in Kitchener that a medical colleague in Toronto reported to Ontario College of Physicians & Surgeons that Dr. Verma was mentally unbalanced. The psychiatrist has indicated that as a result of that allegation, Dr Verma was examined by Dr. Collins in February 1996, and by Dr. Lesser around the same time, and neither psychiatrist found evidence of mental disorder at that time. No reports from or Collins and Dr. Lesser are included in the file.

Dr. Verma's wife has reported that in 1994, while he was establishing a medical practice in Kitchener, he showed signs at memory impairment and his speech was slow.

The hospital records indicate that, in his written correspondence with his estranged wife in 1996, Dr. Verma enclosed news clippings describing a brutal domestic murder that occurred in Vernon B.C. As a result of that alleged behaviour, he was charged' with criminal harassment and was released on condition that he would not associate or communicate with his wife and children.

Dr. Verma's wife has reported that in 1996 he engaged in reckless spending, made business plans that might have reflected impaired judgement, contacted people by telephone in the middle of the night, and embarrassed his children by appearing in public in his dressing gown.

In May 1596, after the charges of sexual assault arose and his wife left him, Dr. Verma disappeared for a few days. Later he explained that he went away to think. His mother took him to Kitchener-Waterloo Health Centre where he was admitted with suicidal thoughts and inability to cope with the stress of court proceedings and marital breakdown. During the 5-day hospital slay he showed no evidence of depression or suicidal risk. He was described as seeking attention, uncooperative with hospital rules, demanding and threatening. He complained to the Medical Director before signing himself out of hospital. His psychiatrist felt that he displayed evidence of many personality problems. Later Dr. Verma was examined as an outpatient by Dr. Heath. He told Dr. Heath that before arriving in hospital he was considering suicide by cutting an artery, swallowing poison or crashing his car, and had faxed a letter to his wife's lawyer making what sounds like a suicide threat. He suggested that Dr. Hearh should engineer his wife's return by giving her false medical information and indicating that Dr Verma’s recovery depended on his wife’s presence and support. Dr. Health noted signs of anxiety or depression, and offered a diagnosis of adjustment disorder associated with unspecified personality disorder.

In June 1996, Dr Verma was readmitted to Kitchener-Waterloo Health Centre with suicidal thoughts. His mother had recently returned 1o BC and he fell unable to cope He showed no evidence of depression or psychosis, and after one month he was discharged with follow-up by Dr. Surapaneni.

Sometime in 1996, Dr. Verma was admitted lo Cambridge-Waterloo Regional Detention Centre. According to records from Royal Ottawa Hospital, he was detained in Cambridge -Waterloo Regional Detention Centre a1 least twice on drug charges and on those occasions, he acted normally. No details concerning those oftenses are described in the file.

I understand that Dr. Verma was re-admitted to Cambridge-Waterloo Regional Detention Centre on November 27, 1996.

An admission note includes some historical data. This may indicate that Dr. Verma was verbally responsive to questions at that time.

An undated medical note, evidently written by the jail physician on or around the date of admission, described Dr. Verma as, "nonverbal” and somewhat un-cooperative during examination. The physician noted a tender swelling on the bridge of Dr. Verma’s nose, left peri-orbital bruising, and no gross neurological abnormalities.

Another note written on December 1, appears to describe the onset to the language abnormalities and other odd behaviours that Dr. Verma currently exhibits. According to the note Dr. Verma was observed lying on a bench with dried blood on his face from a nosebleed and exhibiting a slight swelling over the left supraorbital area. His pupils responded very slowly to light and he moved his limbs very slowly.

Initially he appeared dazed and answered only "Yes" to questions. Later he became verbally unresponsive, responded only to painful stimuli, was incontinent and drooling, and his respirations became irregular and deep. He was transferred lo Cambridge Memorial Hospital. Upon his return he was again answering "Yes" to questions and was unresponsive to directions. A nurse observed that his right arm and foot seemed weak and he still complained of tenderness over his left forehead.

On December 3, Dr. Verma was described as verbally unresponsive except for the "Yes yes" utterances, and staring with an emotionless bewildered expression as if hallucinating, Catatonic schizophrenia was considered as a diagnosis.

On December 10, Dr. Verma was still answering, "Yes yes”, and was also tapping out indecipherable answers on the table and drawing pictures to indicate his needs. The next day, he was transported to Brantford General Hospital for CT examination but he refused to cooperate with the procedure.

According to other information in the hospital file, while he was incarcerated in Cambridge-Waterloo Regional Detention Centre, Dr. Verma alleged that another inmate had beaten him. He removed his personal belongings from the cell and flushed other materials down the toilet. There was evidence of minor head and facial injuries. He looked confused, responded slowly and inappropriately to questions, and answered every question with a faint “Yes". He defecated in the floor in full view of staff members in the emergency department at Cambridge Memorial Hospital, defecated in a parking lot beside a jail van while observed by jail personnel, and was observed lying in his own urine and excrement in Jail.

On December 16, 1996, Dr. Grancy examined Dr. Verma in jail. He found that Dr. Verma answered “Yes" indiscriminately to every question, typed on an imaginary keyboard on the table, and drew irrelevant sketches in response to directions. He also communicated in gestures that were more meaningful -For example; he pounded his head to indicate that he had been beaten. Dr Glancy suggested diagnoses of ‘Ganser Syndrome’, ‘Brief Reactive Psychosis’ or ‘Subdural Haematoma after head injury’, and recommended that Dr. Verma should be remanded to Royal Ottawa Hospital for fitness evaluation.