SIU Director’s Report - Case # 20-TCD-124
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Mandate of the SIU
Under the Police Services Act, the Director of the SIU must determine based on the evidence gathered in an investigation whether an officer has committed a criminal offence in connection with the incident under investigation. If, after an investigation, there are reasonable grounds to believe that an offence was committed, the Director has the authority to lay a criminal charge against the officer. Alternatively, in all cases where no reasonable grounds exist, the Director does not lay criminal charges but files a report with the Attorney General communicating the results of an investigation.
Freedom of Information and Protection of Personal Privacy Act (“FIPPA”)Pursuant to section 14 of FIPPA (i.e., law enforcement), certain information may not be included in this report. This information may include, but is not limited to, the following:
- Confidential investigative techniques and procedures used by law enforcement agencies; and
- Information whose release could reasonably be expected to interfere with a law enforcement matter or an investigation undertaken with a view to a law enforcement proceeding.
- Subject Officer name(s);
- Witness Officer name(s);
- Civilian Witness name(s);
- Location information;
- Witness statements and evidence gathered in the course of the investigation provided to the SIU in confidence; and
- Other identifiers which are likely to reveal personal information about individuals involved in the investigation.
Pursuant to PHIPA, any information related to the personal health of identifiable individuals is not included.
Personal Health Information Protection Act, 2004 (“PHIPA”)
Other proceedings, processes, and investigationsInformation may have also been excluded from this report because its release could undermine the integrity of other proceedings involving the same incident, such as criminal proceedings, coroner’s inquests, other public proceedings and/or other law enforcement investigations.
The Unit’s investigative jurisdiction is limited to those incidents where there is a serious injury (including sexual assault allegations) or death in cases involving the police.
“Serious injuries” shall include those that are likely to interfere with the health or comfort of the victim and are more than merely transient or trifling in nature and will include serious injury resulting from sexual assault. “Serious Injury” shall initially be presumed when the victim is admitted to hospital, suffers a fracture to a limb, rib or vertebrae or to the skull, suffers burns to a major portion of the body or loses any portion of the body or suffers loss of vision or hearing, or alleges sexual assault. Where a prolonged delay is likely before the seriousness of the injury can be assessed, the Unit should be notified so that it can monitor the situation and decide on the extent of its involvement.
This report relates to the SIU’s investigation into the circumstances surrounding Regis Korchinski-Paquet’s death on May 27, 2020.
Notification of the SIUOn May 27, 2020, at 6:35 p.m., the Toronto Police Service (TPS) notified the SIU of the death of a woman identified as Ms. Regis Korchinski-Paquet. The TPS reported that, at 5:15 p.m., TPS police officers responded to apartment on the 24th floor of 100 High Park Avenue in Toronto in relation to a violent family disturbance. Upon arrival, police officers noticed a female on the balcony. The female fell from the balcony and was pronounced dead at the scene.
The TeamNumber of SIU Investigators assigned: 4
Number of SIU Forensic Investigators assigned: 2
Four investigators and two forensic investigators were assigned, launching an investigation and arriving at the scene at 7:48 p.m. on May 27, 2020. Additional staff assisted, reviewing the volume of email messages and voice messages received to determine whether the writers witnessed the incident.
As a result of information provided by TPS, a Subject Officer (SO) was designated because he had the most interaction and dialogue with Ms. Korchinski-Paquet prior to her death. Represented by counsel, the SO consented to the release of his memo book entries related to the incident and requested an interview with the SIU, which was conducted on May 29, 2020.
Civilian Witness (CW) #7 (Ms. Korchinski-Paquet’s mother) and CW #2 (Ms. Korchinski-Paquet’s brother) were interviewed on June 18, 2020, with their counsel present. Both CW #7 and CW #2 provided the SIU a copy of typewritten statements at that time. The statements were adopted and read into the record.
On July 7, 2020, counsel for the family advised the SIU that Ms. Korchinski-Paquet’s father, CW #1, did not consent to an interview with the SIU but did consent to providing the SIU with a typewritten statement.
Complainant:Regis Korchinski-Paquet 29-year-old female, deceased
Civilian WitnessesCW #1 Provided written statement
CW #2 Interviewed
CW #3 Interviewed
CW #4 Interviewed
CW #5 Interviewed
CW #6 Interviewed
CW #7 Interviewed
CW #8 Interviewed
CW #9 Interviewed
CW #10 Interviewed
CW #11 Interviewed
CW #12 Interviewed
CW #13 Interviewed
CW #14 Interviewed
CW #15 Interviewed
Witness OfficersWO #1 Interviewed
WO #2 Interviewed
WO #3 Interviewed
WO #4 Interviewed
WO #5 Interviewed
WO #6 Interviewed
Subject OfficersSO Interviewed, and notes received and reviewed
The SceneThis incident occurred in an apartment on the 24th floor of the 25-storey residential apartment building at 100 High Park Avenue in Toronto. The apartment was situated at the far south end on the east side of the building. A neighbouring apartment was situated adjacent and to the north side of the apartment.
The apartment consisted of a kitchen, living room, two bedrooms and a washroom. A balcony was accessible from the living room. The inner door to the balcony opened to the interior, hinged at the left side. A screen door opened outward, onto the balcony and was also hinged at the left side, when looking out to the balcony. A large picture window was situated to the right of the door when looking out (east).
At the time of examination, a large flat screen television that appeared to have been previously situated by the south living room wall was lying on the floor with the screen shattered. A portable air conditioner was operating as it lay on its side on the living room floor, between the television and balcony door, as seen in the following photograph.
Figure 1 - The apartment where the incident occurred. A portable air conditioning unit is on its side and a television is on the ground.
Furniture, a bicycle and numerous other items appeared to have been stored on the balcony, leaving very limited space for persons to occupy. The following photographs show the balcony.
Figure 2 - The balcony of the apartment. Numerous items, including a bicycle and various pieces of furniture, are present.
Figure 3 - A closer look at the area of the balcony that Ms. Korchinski-Paquet traversed. There is a 1.1 metre railing with a tall metal partition separating the balcony from a neighbouring apartment's balcony.
The balcony railing rose 1.1 metres above the deck with a plastic top rail. A higher, metal partition was affixed along the north side of the balcony, separating it from the neighbouring apartment balcony to the north. 
The following photograph shows the netting that had since been installed, forming a barrier to prevent anyone from crossing at that area. The netting extended across the front area of CW #10’s balcony as well, from the top of the railing to the underside of the 25th floor balcony deck above.
Figure 4 - The metal partition that separated the balcony from the neighbouring apartment's balcony. Netting surrounds the neighbouring apartment's balcony and acts as a barrier.
On examination by the SIU, the netting was found to be undisturbed. Pieces of cooked salmon were found entangled in the netting. Similar salmon was also observed in a frying pan on the stove in Ms. Korchinski-Paquet’s apartment.
The balcony deck extended a short distance beyond the outer face of the railing, as seen in the following photograph.
Figure 5 - A closer view of the balcony's railing. It was examined for fingerprints.
Ms. Korchinski-Paquet came to rest on the lawn at the front, southeasterly area of the property, 62 metres below the top of the railing. The body was positioned about 6.5 metres from the outer edge of the balcony and about 1.4 metres north of the northern edge of the balcony, vertically aligned with the area of the neighbouring balcony. 
Witness CanvassesIn efforts to identify witnesses to this incident, the SIU canvassed areas of the building in which this incident occurred as well as neighbouring buildings with sightlines to Ms. Korchinski-Paquet’s apartment. Specifically, apartments situated on the north side of 70 High Park Avenue and west side at 95 High Park Avenue were canvassed.
Posters appealing for witnesses were posted in common areas of all three buildings.
A Crime Stoppers tip forwarded to the SIU by TPS was also investigated. The tip included a screenshot from a web cam image that appeared to be located in the vicinity and could have captured a view of Ms. Korchinski-Paquet’s balcony. The source of the post was identified. Although the camera view included the upper section of 100 High Park Avenue, there were no saved recordings around the time this incident occurred, likely due to the distance.
911 Call Recordings 
In the initial call, at 5:13 p.m., CW #7 said she needed the police at her home. When asked what the problem was, she said, “My son and daughter are fighting,” and that her daughter was throwing bottles at the time. Yelling was heard in the background. CW #7 said she only needed police to attend and said, “You can take them both the hell out of here. I can’t do it no more. I’m done,” and, “I want them both gone out of my fucking house.”
At about this point in the recording, a second 911 call was received, this one from Ms. Korchinski-Paquet.
Still in the initial call, CW #7 again asked for the police to attend immediately. She maintained the open line while yelling was heard between a number of individuals. When the call-taker asked what was going on, CW #7 said, “Listen, my son and daughter are fighting and I can’t take it. I’m a [age]-year-old woman and I’m too small... My son and daughter. My house is all broke up. And I can’t do this no more and I won’t. Too old. I’m a [age]-year-old woman.”
CW #7 identified her children as Regis Korchinski-Paquet and CW #2.
While on the call, CW #7 yelled at someone, “Get out of my fucking house,” “Never come back to my fucking house. Never,” and, “You will never get back in my house. Ever.”
When asked if anyone was injured, CW #7 said, “Yea I guess somebody’s injured. I don’t know.” When asked if she needed an ambulance, CW #7 said, “I don’t know if I need an ambulance because I left my house. I can’t stand in there. I’m [age] years old.”
CW #7 also told the call-taker, “They got into an argue [sic] and all I know a fight broke out. They were just fighting and I - like I seen it too many times and I can’t deal with it no more.” When asked what they fought over, CW #7 said,
“My daughter had a seizure this morning and so this is how, basically, it all started. And he knows just to leave her alone. But now she’s calling me all kinds of names, calling me a bitch and everything else, right. So, I don’t want her -- I want the police to take -- literally take her out of my house. I don’t want her here. I don’t want no kids living in my house… Okay. She’s got to go tonight.”
When asked again if an ambulance was needed, CW #7 said, “I just want the both of them out of my house. I don’t want no contact with neither one of them again.”
When asked if anyone had weapons, CW #7 said,
“No, no weapons. But bottles were thrown, knives were pulled out, my -- punches in the face. All kinds of foolishness… I don’t know who treats people like this. Glass is all over in front of my door, they broke bottles. Like just no -- no respect. And -- neither one of them can stay here. I just want the police to come and I don’t care where you take either one of them but I don’t ever want them back here. None of them. I don’t care where they go to live but they’re not coming here. I’m done.”
Ms. Korchinski-Paquet placed the second 911 call. At 5:15 p.m., while her mother was on a separate 911 call, Ms. Korchinski-Paquet said she needed police to attend as she was being attacked. Panting, she said, “I can’t breathe,” and that her brother attacked her. She said she needed an ambulance to attend and yelled at someone, “You can’t get in you dumb fuck.”
Shortly after the end of that call, a third 911 call was placed. CW #7 was still on her call when CW #2 called 911. He requested police attend as “there’s a physical altercation between me and my sister.” He said, “She initiated the assault with two knives, right. But I also did protect myself, right. So. But I’m not going anywhere. I’m going to stay right here.” He said he was in the stairwell while his mother was in the corridor and his sister was in the apartment with two knives and broken bottles. When asked if anyone was injured, he said he was but did not need an ambulance.
CW #2 said this was not the first time this occurred, and that they fought over the television volume being too loud. He said his sister had two epileptic seizures that day, and that they have to leave the apartment after she experiences seizures so she can calm down. On this day, she had not calmed when they returned.
He identified his sister as Regis Korchinski-Paquet and said he had taken the knives from her and throw them into the apartment before he exited. To the best of his knowledge, Ms. Korchinski-Paquet had the knives in the apartment.
When asked if Ms. Korchinski-Paquet had any mental issues, CW #2 said, “Not that she’s diagnosed with, no. Besides – besides the elepsy [sic], right. It’s a health condition.” When asked if anyone consumed alcohol or drugs, he said, “No. No. My sister has been smoking weed. That’s about it. Nobody else has. But she smokes weed because she’s epileptic, right. So, it’s not like she been doing it for, to get high or anything like that. She’s been doing it for pain, right.”
The fourth 911 call was received at 5:22 p.m. from Ms. Korchinski-Paquet while her brother was still on the third 911 call and her mother was on her initial call.
In her second 911 call, Ms. Korchinski-Paquet said, “I need to call the police. My mom just attacked me.” When asked if anyone needed an ambulance, Ms. Korchinski-Paquet said, “I’m not sure. I can’t even speak right now but my mother she just attacked me and so did my brother.” She said when she told her brother to turn off the television, he jumped up and started punching her in the head and choking her. When asked if any weapons were involved, Ms. Korchinski-Paquet said, “Yes. They – they – they pulled out knives.”
In response to an inquiry whether children were present, Ms. Korchinski-Paquet said there were as her brother just moved in with his children. With respect to whether anyone had been drinking alcohol or using drugs, she said, “Yes, my brother and my mother both have been drinking. They’ve been drinking all morning and smoking weed.” When asked about her own drug use, Ms. Korchinski-Paquet said she was only taking magnesium for her seizures. When asked if anyone was diagnosed with mental health issues, Ms. Korchinski-Paquet said, “Me. Yes. I have epilepsy.”
Ms. Korchinski-Paquet placed a fifth 911 call at 5:30 p.m. By this time, police were already on scene. She identified herself as Regis Korchinski-Paquet and said she was just attacked, punched and choked by her mother and brother, who had been drinking since 10:00 a.m. She said, “I need to pee. I have to piss,” before ending the call.
Subsequent to these calls, a number of 911 callers reported Ms. Korchinski-Paquet’s fall.
At 5:41 p.m., three separate callers reported a person fell from a balcony.
In his call, CW #3 reported he “just saw someone jump to their death” before adding that police were already responding.
At 5:21:08 p.m., a dispatcher advised responding police officers a woman was still armed with knives and was in the apartment while the brother was in the stairwell with cuts and the mother was in the corridor. Further updates advised CW #2 started the fight and refused an ambulance, that Ms. Korchinski-Paquet experienced seizures, and that she had the knives.
Another update at 5:24:15 p.m. advised, “Again, it’s a brother-sister dispute. Both had knives at one point. The female may still have the knife. She’s supposed to be still in the apartment, brother in the stairwell, mom in the hallway.”
During the time of Ms. Korchinski-Paquet’s third 911, call, a police officer, now known to have been WO #3, advised dispatch they would receive another call as Ms. Korchinski-Paquet was not satisfied with the help they were providing.
At 5:32 p.m., the SO reported they were on scene with two individuals, that no knives were present, and an ambulance was not required.
At 5:39 p.m., WO #3, reported, “She’s scaling the balconies here.” About 35 seconds later, he reported, “The daughter made her way out to the patio and climbed over the railing and it appears she’s trying to get to the neighbour’s unit. She’s hanging on the side of the patio.”
WO #4 subsequently reported, “Can we get an ambulance ASAP. The girl fell.”
In-Car Camera System (ICCS) Audio Recordings 
Examination of the recordings revealed an episode of chaotic dialogue during which nothing resembling pleas for help were heard before a female voice, believed to be CW #7, asked, “What is she doing?” A male responded, “She went to the neighbour’s,” to which the same female said, “She can’t get to the neighbour’s.” A male, believed to be CW #2, then added, “It’s blocked off,” before CW #7 repeated that.
The dialogue suggested CW #7 was nearby and aware Ms. Korchinski-Paquet traversed the balcony railing and may have been attempting to access the neighbouring balcony.
After Ms. Korchinski-Paquet’s fate was known, CW #7 was heard on WO #1’s ICCS audio as she knocked at CW #10’s door saying, “[CW #10’s first name]. Regis jumped.” Later, she called her pastor and a relative to tell them of the death.
Detailed observations are noted in the “Event Chronology” section (below).
Toronto Community Housing Security Video Recordings
Recordings from the 24th floor corridor camera captured the police presence and interaction with the family.
Details of observations are set out in the “Event Chronology” section (below).
A post-mortem examination was conducted by the Ontario Forensic Pathology Service on May 28, 2020. By way of report dated June 15, 2020, the cause of death was attributed to “multiple blunt impact trauma.”
As a result of CW #7’s allegation that Ms. Korchinski-Paquet was thrown from the balcony, the post-mortem examination examined for other potential injuries.
The Summary and Opinion section of the report noted the following:
“…demonstrated multiple blunt impact trauma, including injuries to the head, neck, torso, and extremities. The fatal injuries can be accounted for by a descent from height and are the consequence of force transmission in the final deceleration upon impact. A constellation of injuries is present and typical of so-called ‘axial loading’ where force is transmitted up the vertical axis of the body upon impact. The injuries were necessarily and rapidly fatal. Immediate or nearly immediate death would be anticipated. A grouping of small discoid bruises on the left forearm may have occurred as the result of blunt injury that was not related to a descent from height, such as pressure from fingertips in the context of the forearm being grasped firmly by a hand. The mechanism of injury for the small discoid bruises on the left forearm is not known with certainty. None of the injuries show evidence of an inflammatory (healing) response from the body and, as such, all occurred recently. Pathological examination alone cannot determine the sequence of events leading up to or precipitating the initiation of a descent from height. There were no other injuries (such as sharp force injuries or firearm injuries). There were no anatomically apparent natural diseases.”
The report further noted that detection of cannabinoids and acetaminophen did not alter the cause of death.
A second autopsy was conducted on the body of Ms. Korchinski-Paquet, at the request of the family, by the Office of the Chief Medical Examiner, Province of Newfoundland and Labrador. The autopsy was performed on July 15, 2020, and the subsequent autopsy report was received by the SIU on August 7, 2020.
The report concluded that Ms. Korchinski-Paquet’s cause of death was “multiple blunt force trauma”. The report further concluded that: the extent and distribution of internal injuries, especially injuries (fractures) of the bones were consistent with a fall from height; and, the distribution and characteristics of the internal injuries “point towards the primary impact with the ground occurring while landing on the feet from falling from the height.”
The author of the report was asked by the family to address the following specific questions:
1. Was there any evidence that Ms. Korchinski-Paquet was struck in the face or head before impact on the ground?2. Was there any evidence of a physical struggle?3. Is there an explanation of the abrasion on her forehead and cut to her inner mouth area?4. Was there evidence of Ms. Korchinski-Paquet urinating immediately prior to her death?5. Whether he could explain anything to do with an injury on her arm and the markings identified?
The forensic pathologist provided the following verbatim answers to the family’s questions:
1. Most of the injuries on the body were located on the front surface of the body. The head suffered only minor external injuries. The injury of the upper lip frenulum and the superficial laceration of the lower lip (best depicted on the images taken during the first autopsy) are considered minor and not life-threatening injuries. While these injuries could occur before the impact on the ground, they may also occur due to the impact on the ground. If they occurred before the fall, because of a possible altercation, then these injuries, which are bloodletting injuries, may have left the bloodstains somewhere in the residence where the incident occurred.
2. On the left upper arm, there is a group of oval contusions situated in succession, one below the other, resembling fingertip marks (“grab marks”). These injuries may have occurred during a struggle as one being forcefully grabbed by the arm. On the right upper back, there is a recent contusion that was depicted on the original post-mortem image but not explored during the first autopsy. While most of the injuries on the body were located on the front surface of the body, this injury is present on the back. Therefore, it must have occurred before the impact on the ground. This is a blunt force injury, inflicted by a blunt force, which may include the direct impact onto the body by a blunt object (i.e. fist, foot, knee, etc.) or by the body impacting a surface/object, before the fatal impact on the ground. Other injury of unknown origin: On the left lateral chest, there was a patterned type of injury composed of similar, square-shaped abrasions positioned below each other. These injuries may have occurred before or after the fall, with the object of a similar shape impacting the body or body lending (sic) on it.
3. See answer on #1. The injuries of the forehead and the scalp, based on their location on the head (prominent regions of the head), are most likely the result of the head impacting the ground.
4. According to the original autopsy report, the urinary bladder was empty.
5. See Question #2.
Materials obtained from Police ServiceUpon request, the SIU obtained and reviewed the following materials and documents from the TPS:
- Computer-Assisted Dispatch (CAD) Report;
- Communication recordings of 911 calls and radio (dispatch) transmissions;
- TPS video and audio recordings;
- TPS records regarding Ms. Korchinski-Paquet;
- Email from TPS-Crime Stoppers Tip;
- Email Thread from TPS regarding ICCS Recording from WO #2's Cruiser;
- Intergraph-CAD Event Details Report;
- Notes of the SO, WO #1, WO #2, WO #3, WO #4 and WO #5; 
- TPS Policy – Emotionally Disturbed Persons;
- TPS Policy – Emotionally Disturbed Persons-Appendix A;
- 2019 TPS In-Service Training Program - Critical Thinking and De-Escalation;
- Training records of subject officer and all five involved witness officers; and
- TPS supplementary reports.
TPS Procedure regarding Emotionally Disturbed Persons:
- Emotionally Disturbed Person (EDP) includes any person who appears to be in a state of crisis or any person who is mentally disordered.
- Mental Disorder means any disease or disability of the mind. [Source: Mental Health Act, ss. 1(1)] A person suffering from a mental disorder may have to live with a long–term breakdown of coping skills including perception, decision making and problem-solving abilities.
- Person in Crisis means a person who suffers a temporary breakdown of coping skills but often reaches out for help, demonstrating that they are in touch with reality. Once a person in crisis receives the needed help, there is often a rapid return to normalcy.
The procedure governs police interaction with and apprehension of “emotionally disturbed persons” and addresses situations where officers observe verbal cues, behavioural cues or other behaviours that provide them with reasonable cause to believe a person is apparently suffering a mental disorder.
The procedure provides that a supervisory officer must attend calls for service where there is information that an emotionally disturbed person is armed or may be armed with a weapon.
The procedure references an officer’s authority under section 17 of the MHA. Section 17 provides as follows:
Where a police officer has reasonable and probable grounds to believe that a person is acting or has acted in a disorderly manner and has reasonable cause to believe that the person,
(a) has threatened or attempted or is threatening or attempting to cause bodily harm to himself or herself;(b) has behaved or is behaving violently towards another person or has caused or is causing another person to fear bodily harm from him or her; or(c) has shown or is showing a lack of competence to care for himself or herself,and in addition the police officer is of the opinion that the person is apparently suffering from mental disorder of a nature or quality that likely will result in,(d) serious bodily harm to the person;(e) serious bodily harm to another person; or(f) serious physical impairment of the person,and that it would be dangerous to proceed under section 16, the police officer may take the person in custody to an appropriate place for examination by a physician.
The procedure recognizes that the Mobile Crisis Intervention Team (MCIT) program is a “collaborative partnership between participating hospitals and the Toronto Police Service. The program partners a specially trained police officer and a mental health nurse that may assist in responding to calls for service involving individuals experiencing a mental health crisis.”
Pursuant to the procedure, the MCIT will assist responding officers with:
- assessing the situation;
- attempting to stabilize and defuse the crisis;
- providing supportive counselling as needed; and
- connecting the individual to appropriate follow-up services.
The procedure states, “When feasible and consistent with officer and public safety, members with MCIT training and/or additional mental health training may take the lead role in situations involving an individual experiencing a mental health crisis.”
The policy dictates that a police officer investigating an emotionally disturbed person who believes the person is suffering from a mental disorder shall be guided by section 17 of the MHA.
According to the procedure, an officer responding to a “complaint of a suspected [emotionally disturbed person] is to:
- Request notification and attendance of the MCIT, if available; and
- Conduct background checks to assess whether the person has access to firearms or has a history of violence or use of weapons. If so, the officer is to notify the [Emergency Task Force] and request the attendance of a supervisory officer.
An officer encountering a suspected emotionally disturbed person shall:
- Take all steps to ensure the situation is safe;
- Determined the need to immediately apprehend under the MHA or arrest under the applicable statute; and
- Consult with the MCIT, if available.
TPS Description of MCIT Program 
According to the website, MCITs have not historically been “first responders”. Rather, they are brought in following the attendance of priority response unit officers, who are dispatched in relation to all calls for service, including 911 emergency calls, if the first responders believe that it is safe for the nurse. More recently, the program is said to have evolved since its inception in 2000 such that MCITs may now also be dispatched as “co-responders” in relation to calls involving individuals experiencing mental health crisis, but only if the calls do not involve weapons.
WO #6 was not on duty on the date of this incident and therefore had no duty notes. However, he was designated and interviewed in this investigation as a result of his current assignment as the TPS MCIT coordinator. He had 20 years of training and experience in the crisis response program. WO #6 provided the following information.
WO #6 had ten operational teams assigned to the MCIT with each team responsible for two to four divisions in Toronto. The MCIT unit serves approximately three million people in the Toronto area, with each team responsible for approximately 300,000 people. Each team consisted of a first-class constable and a psychiatric nurse. The psychiatric nurses are sponsored through the Ministry of Health while the officer could be a third-class constable if that member had prior experience in the mental health field.
The MCIT was partnered with six area hospitals in Toronto. The teams worked out of multiple divisions and would respond where needed. Each team was embedded, meaning they travelled together in the same mobile unit.
A team would be dispatched through the 911 system, which the public cannot access. Dispatchers were trained to recognize key words that would trigger a response for the MCIT team, such as mental health or behavioural mental health.
Unknown trouble or weapons calls would not activate the unit. That would be the responsibility of a Primary Response Unit (PRU). A call dispatched for a disturbance call or a weapons call would not generate an MCIT immediate response.
For the team to respond through the PRU, there would have to be no weapons on scene, since the nurse is not a sworn police officer and carries no use of force options.
PRU members are trained to recognize behavioural cues that may activate MCIT. Behaviour and co-lateral information would be required by a PRU member for an MCIT response.
Supervisor approval was not required to activate MCIT.
MCIT training starts at the Ontario Police College through recruit training. Follow-up training was completed every year at TPS through its in-service training program and additional training was completed by the MCIT Unit through outreach at the divisions. This additional training was a result of coroner’s inquests, or legislative concerns.
TPS has no written policy that governs the MCIT. They fall under the mandate of the Emotionally Disturbed Persons policy.
WO #6 explained that epilepsy was not considered a mental health disorder. Its signs and symptoms may appear to be a mental health concern; however, it is a physical issue where a person should be taken to a hospital.
Training in De-escalation
As far as communication is concerned, the emphasis is on principles of de-escalation. Rapport-building with a person in crisis, for those who retain the ability to understand and behave rationally, can involve techniques such as asking the subject’s name, reassuring them that they are safe and will not be harmed, engaging in active listening, keeping one’s voice calm and moderate, asking open-ended questions, use of a hook to build trust (talk about the person’s likes and things in common) and empowering the person in crisis to take control of the outcome.
The training records of the involved police officers revealed they all successfully completed use of force training that included de-escalation tactics and dealing with emotionally disturbed persons.
Materials obtained from Other SourcesThe SIU also received and reviewed the following records from other sources:
- Report of Post-mortem Examination from the Coroner’s Office dated June 15, 2020;
- On August 7, 2020, a report of a second autopsy performed on the body of Ms. Korchinski-Paquet by the Office of the Chief Medical Examiner, Province of Newfoundland and Labrador;
- Work product from Ministry of Finance in relation to enhancement of ICCS audio;
- Ambulance Call Report and Incident Report from Toronto Paramedics Services; and
- Video recordings captured by security cameras at 100 High Park Avenue.
Toronto Paramedic Services – Ambulance Call Report (ACR)
The report indicated the patient, Ms. Korchinski-Paquet, was in the apartment talking on the phone with her father, while her mother was in and out of the apartment yelling. CW #6, a paramedic who was in the apartment with Ms. Korchinski-Paquet, wrote she attempted to speak to Ms. Korchinski-Paquet but she was distracted, yelling into her phone and exchanging words with her mother. The next note indicated:
“Pt then went onto the balcony and closed the door. When pt went onto the balcony, I overheard police say, ‘everyone out of the apartment’ and I left to stand in the hall. My partner had been in the hall the whole time and neither of us got any verbal information from the pt herself at any point. A few minutes later, police realized she had fallen off the balcony and we went to the ground floor to assess her.”
Review of the ICCS recordings, communications and 911 call audio recordings, and the closed-circuit video recordings from 100 High Park Avenue, was invaluable in understanding and detailing the events as they unfolded in and around the apartment. Specifically, using an instance in which WO #4 knocked at the neighbouring apartment as a baseline event, which was depicted on the building security video recording and captured by his ICCS wireless microphone, the investigation was able to cross-reference information recorded across all these platforms to produce the following chronology of events. 
- At about 5:35:01 p.m. the building security video captured Ms. Korchinski-Paquet entering  her apartment followed by the SO after she had squatted in the corridor;
- WO #3 was closest to the apartment door, while WO #1, WO #2 and WO #4 approached;
- WO #3 entered the apartment while the other three police officers opened the stairwell door and appeared to engage with CW #7 and CW #2;
- When the paramedics arrived with a stretcher, CW #2 descended steps in the stairwell and approached them;
- About a minute later, he returned to the stairwell;
- At about 5:37:52 p.m., the building security video recording captured CW #7 entering her apartment, as seen in the following screenshot:
Figure 6 – A still image from the security video recording depicting CW #7 entering her apartment.
- At about 5:38:11 p.m., after standing in the doorway threshold for about nine seconds, CW #6 entered the apartment;
- CW #5 remained in the building corridor with three police officers, including WO #1, while the stairwell door remained open;
- At about 5:38:46 p.m., WO #1 moved toward the apartment door and looked in;
- At 5:38:48 p.m., WO #1’s ICCS microphone recorded the SO telling Ms. Korchinski-Paquet she should talk to the paramedic, CW #6, as she had experienced seizures;
- At about 5:38:50 p.m., CW #7 exited the apartment, as seen in the following screenshot:
Figure 7 - A still image from the security video recording depicting CW #7 exiting the apartment.
- 5:38:53 p.m., WO #4’s ICCS recorded a male, likely him, asking someone, likely CW #7, if she was “OK”, to which she responded, “No…”;
- At 5:39:05 p.m., WO #4’s ICCS captured a sound consistent with the air conditioner toppling over;
- At 5:39:06 p.m., a male voice is heard to say, “Hey, hey, hey”;
- At about that same time, 5:39:07 p.m., CW #7, followed by CW #2, entered the apartment, as seen in the following screenshot:
Figure 8 - A still image from the security video recording depicting CW #7, followed by CW #2, entering the apartment.
- At 5:39:09 p.m., WO #4’s ICCS recorded CW #7 asking, “What is she doing?”;
- At 5:39:11 p.m., WO #1’s ICCS then recorded WO #1 saying, “She’s jumping balconies,” while a male voice said, “She went to the neighbour’s”;
- At about 5:39:15 p.m., Ms. Korchinski-Paquet’s descent likely already began by the time CW #7 started speaking in the next reference; 
- At about 5:39:15 p.m., WO #1’s and WO #4’s ICCSs recorded CW #7 saying, “She can’t get to the neighbour’s,” followed by CW #2 adding, “It’s blocked off.” CW #7 repeated, “It’s blocked off”; 
- At 5:39:16 p.m. on the communications recordings, WO #3 reported, “She’s scaling the balconies here”;
- At 5:39:17 p.m., immediately following that transmission, the SO’s ICCS video captured Ms. Korchinski-Paquet’s descent as she entered view from about the sixth-floor level, as seen in the following screenshot:
Figure 9 - A still image from the SO's ICCS video which depicts Ms. Korchinski-Paquet falling.
- At 5:39:18 p.m., a sound was heard on the SO’s and WO #4’s in-car microphones, likely the sound of Ms. Korchinski-Paquet’s impact with the ground;
- One second later, WO #4’s ICCS captured video of an elderly woman with a walker at the front of the building reacting to something to her south, likely Ms. Korchinski-Paquet’s impact with the ground;
- At 5:39:27 p.m., CW #6 exited the apartment into the hallway;
- At about 5:39:50 p.m., the building security video recording captured CW #7 exiting her apartment again, as seen in the following screenshot:
- WO #4 then exited the apartment and walked to the neighbouring apartment with WO #5;
- At about 5:40:01 p.m., WO #5 was seen on the building security video knocking at the neighbouring apartment;
- At about 5:40:14 p.m., the SO exited fully from the apartment into the hallway;
- At 5:40:35 p.m., WO #4 was heard on his ICCS and seen in the building security video knocking at the neighbouring apartment again; 
- At 5:41:12 p.m., CW #2 exited the apartment into the hallway;
- At 5:41:13 p.m., WO #4 re-entered Ms. Korchinski-Paquet’s apartment as CW #7 and CW #2 stood together in the hallway just outside the apartment door;
- At 5:41:39 p.m., on the SO’s and WO #4’s ICCSs, WO #4 was heard requesting an ambulance after realizing Ms. Korchinski-Paquet had fallen;
- At 5:41:46 p.m., WO #2, WO #3 and WO #4 emerged through the apartment door and joined the others in the hallway making their way north toward the elevators; and
- At 5:43:45 p.m., WO #4’s ICCS captured the paramedics arriving at Ms. Korchinski-Paquet on the ground.
The video recordings revealed that CW #7 was in her apartment with Ms. Korchinski-Paquet for 58 seconds, between 5:37:52 p.m. and 5:38:50 p.m., at which time she exited. She then re-entered the apartment at 5:39:07 p.m., just about the time that the evidence suggests Ms. Korchinski-Paquet was entering onto the balcony and 11 seconds before Ms. Korchinski-Paquet’s body impacted the ground below. It is estimated the descent took about three-and-a-half seconds. This suggests that Ms. Korchinski-Paquet’s fall began between 5:39:14 p.m. and 5:39:15 p.m.
CW #2 also entered the apartment after his mother, at 5:39:10 p.m., and exited at 5:41:12 p.m.
CW #6, the female paramedic, entered the apartment at 5:38:11 p.m. and exited at 5:39:27 p.m.
The investigation revealed the situation with Ms. Korchinski-Paquet developed rapidly. CW #6 entered the room at 5:38:11 p.m. Less than a minute later, after a brief interaction in which a police officer asked her to speak to the paramedic, Ms. Korchinski-Paquet made her way onto the balcony and, by 5:39:15 p.m., had fallen.
Ms. Korchinski-Paquet was captured on video landing at 5:39:18 p.m. She lay on the ground for over four-and-a-half minutes before the paramedics reached her.
Section 25(1), Criminal Code -- Protection of persons acting under authority
(a) as a private person,(b) as a peace officer or public officer,(c) in aid of a peace officer or public officer, or(d) by virtue of his office,
Section 215, Criminal Code - Failure to provide necessaries
(c) to provide necessaries of life to a person under his charge if that person
(i) is unable, by reason of detention, age, illness, mental disorder or other cause, to withdraw himself from that charge, and(ii) is unable to provide himself with necessaries of life.
(b) with respect to a duty imposed by paragraph (1)(c), the failure to perform the duty endangers the life of the person to whom the duty is owed or causes or is likely to cause the health of that person to be injured permanently.
Sections 219 and 220, Criminal Code -- Criminal negligence causing death
(a) in doing anything, or(b) in omitting to do anything that it is his duty to do,
(a) where a firearm is used in the commission of the offence, to imprisonment for life and to a minimum punishment of imprisonment for a term of four years; and(b) in any other case, to imprisonment for life.
Section 17, Mental Health Act -- Action by police officer
(a) has threatened or attempted or is threatening or attempting to cause bodily harm to himself or herself;(b) has behaved or is behaving violently towards another person or has caused or is causing another person to fear bodily harm from him or her; or(c) has shown or is showing a lack of competence to care for himself or herself,
(d) serious bodily harm to the person;(e) serious bodily harm to another person; or(f) serious physical impairment of the person,
Analysis and Director's Decision
The aforementioned-interviews proved pivotal to an understanding of the circumstances surrounding the incident. As did interviews with two paramedics, one of whom was inside Ms. Korchinski-Paquet’s apartment, and two independent civilian witnesses, that latter pair having been in the area of the building and observed Ms. Korchinski-Paquet’s fall. The investigation also benefited from video recordings captured by security cameras situated in the apartment building, video recorded by the ICCSs of cruisers parked at the scene, ICCS-related audio recordings produced by the wireless microphones worn by two of the involved officers, and audio recordings of the 911 calls that were made and the police radio communications that ensued. The TPS policy regarding police response to “emotionally disturbed persons” was reviewed and the coordinator of the TPS Mobile Crisis Intervention Team was interviewed.
My understanding of what occurred on the day in question is a product of my assessment of the evidence. Wherever possible, I relied heavily on the objective sources of information at the SIU’s disposal, namely, the video and audio recordings. For example, my determination of the location of parties and what they said as events unfolded was based primarily on a review of the security video recording from the apartment building and the audio recorded via wireless microphones worn by two officers. In those instances where a contest in the evidence could not be resolved one way or the other, either by reference to the video or audio recordings, or the accounts of independent eyewitnesses, I set out the nature of the conflict. With that in mind, I propose to deal first with a number of issues before turning to a chronological recitation of the events of the day.
I accept that systemic racism exists and continues to challenge the relationship between racialized communities and the institutions of our justice system, just as it does in other sectors of society. Our leaders have acknowledged it, as have our laws. As is set out in the preamble of Ontario’s Anti-Racism Act, 2017, “Systemic racism is a persistent reality in Ontario, preventing many from fully participating in society and denying them equal rights, freedoms, respect and dignity.”
However, the task before me was a narrow one, namely, to determine whether there were reasonable grounds on the evidence collected by the SIU to believe that any one or more of the officers who responded to Ms. Korchinski-Paquet’s apartment committed a criminal offence in connection with her death. It was not to conduct a broad inquiry into systemic discrimination on the part of the police service. There are other forums with the institutional mandates and expertise to conduct those inquiries. 
Having said that, the SIU cannot and must not turn a blind eye to issues of race to the extent they are manifest in a specific case under investigation. With respect to the circumstances culminating in Ms. Korchinski-Paquet’s death, the investigation turned up no indications of overt racism being brought to bear by any of the involved officers. That is not to suggest that questions of race were entirely absent in the encounter. There is evidence that Ms. Korchinski-Paquet attempted to court favour with the police at one point by informing them that her father was coming and he was “white”. The officers, it must be noted, indicated that they did not hear any such words. Needless to say, if true, the utterance is a testament to the importance of efforts to build and nurture trust in the relationship between the police and members of the Black and Indigenous communities.
There were allegations in the wake of Ms. Korchinski-Paquet’s death that she was pushed off the balcony by the police. The evidence establishes that this did not occur. Instead, the evidence indicates that no one other than Ms. Korchinski-Paquet was on the balcony when she scaled over the railing and attempted to sidestep along the outer ledge over to her neighbour’s balcony, lost her balance, and fell. That was the evidence of the SO and WO #3, who were present in the apartment at the time, confirmed by the paramedic who was in the apartment having been brought in to attempt to calm Ms. Korchinski-Paquet. It was also the evidence of an independent civilian eyewitness, who was walking on High Park Avenue near the apartment building in question when she looked up and saw Ms. Korchinski-Paquet on the outer side of the balcony railing moving quickly along the railing to her right before seeing her fall. Neither CW #7 nor CW #2, present in the apartment at the time of Ms. Korchinski-Paquet’s fall,  observed police officers enter onto the balcony. The video and audio recordings suggest, however, that CW #7 and CW #2 might have been able to see and/or were at least aware that Ms. Korchinski-Paquet had gone onto the balcony and was attempting to get to the neighbouring balcony right around the time the events were happening.
There were also allegations that moments before she fell, Ms. Korchinski-Paquet was heard to repeat, “Help me, mom,” or words to that effect, a few times. The investigation was unable to resolve whether these words were, in fact, uttered. A civilian witness – CW #12 - claimed she heard, “Mom help. Mom, please help me,” several times from a neighbouring apartment in the moments before Ms. Korchinski-Paquet’s death. However, the security video recording from the apartment building establishes that she had left the apartment well before the police arrived. These utterances were also not captured on the ICCS wireless microphones worn by two officers involved in the incident  and none of the officers who were in the area, including the officer who was in the apartment closest to Ms. Korchinski-Paquet, the SO, or the paramedic, indicated they heard these words spoken. There is indication, however, that Ms. Korchinski-Paquet, while on the phone with her father, did ask him to help her.
Finally, a few words about the SIU. The Special Investigations Unit was created in 1990. It is completely independent of the police and composed of civilian investigators. While the majority of the SIU’s lead investigators – those most responsible for the direction of any investigation – come from non-policing backgrounds – most of the Unit’s as-needed complement of investigators are retired police officers. I understand the concern that some have with former police officers being involved in oversight investigations, and the SIU will continue with its efforts to redress the imbalance that presently exists in its corps of as-needed investigators. However, these investigators are people of good conscience who come to the SIU with a wealth of investigative experience and expertise looking to contribute their talents to the work of the office. I have confidence in their professionalism and objectivity. Moreover, there are statutory provisions in place meant to ensure the Unit’s independence. Thus, for example, the director can never have been a police officer and investigators with policing backgrounds cannot partake in investigations of their former service(s). Finally, it is important to recognize the advice of Justice Tulloch, a highly regarded jurist from our Court of Appeal, in his recent report on the oversight system in Ontario. On this very issue, Justice Tulloch was satisfied that the SIU could function effectively with former police officers among its investigative ranks provided they were properly screened and trained to ensure their independence.
Officers were dispatched to the scene at about 5:16 p.m. The SO and WO #3 were the first at the apartment building, arriving on the 24th floor at about 5:29 p.m. They were met outside the elevators by CW #7 and Ms. Korchinski-Paquet, who was yelling down the hall toward her apartment.  Ms. Korchinski-Paquet told the officers that her brother had assaulted her. At the southern end of the hall was CW #2. As the officers, CW #7 and Ms. Korchinski-Paquet made their way down the corridor, the SO used his arm to prevent Ms. Korchinski-Paquet from moving past him toward CW #2 as CW #2 moved in their direction. Seconds later, WO #3 did the same and proceeded to direct Ms. Korchinski-Paquet further north up the hallway. WO #3 remained with Ms. Korchinski-Paquet as the SO accompanied CW #7 and CW #2 further south down the hallway and eventually into their apartment. At about this time, WO #2 arrived and joined WO #3 in speaking with Ms. Korchinski-Paquet near the elevators. Ms. Korchinski-Paquet told the officers she had experienced seizures earlier in the day and damaged the television when her brother refused to lower the volume. The SO spoke with CW #2, who confirmed Ms. Korchinski-Paquet’s seizure and the argument over the television volume, adding that his sister had grabbed knives from the kitchen.
WO #1 and WO #4 were the next two officers to arrive on scene, at about 5:34 p.m. The other three officers were standing further south in the corridor and, CW #7 and CW #2, further south still. Ms. Korchinski-Paquet again tried to get past the officers but was prevented from doing so by the SO, who used his body to block her path. Seconds later, WO #4, who together with WO #1 had reached the other officers, engaged Ms. Korchinski-Paquet and escorted her further north up the hallway. Ms. Korchinski-Paquet indicated that she needed to urinate and threatened to relieve herself in the corridor if she was not permitted back into the apartment. The SO agreed and accompanied Ms. Korchinski-Paquet inside the apartment, as did WO #3 a short time later. The time was about 5:35 p.m.
While the SO and WO #3 were inside the apartment with Ms. Korchinski-Paquet, WO #4 spoke with CW #7 and CW #2 in the stairwell adjacent to the apartment. CW #7 wanted her daughter to be brought to the Centre for Addiction and Mental Health, noting that Ms. Korchinski-Paquet suffered from seizures. In response, WO #4 asked, “What about mental health?”
Also at about 5:35 p.m., paramedics – CW #5 and CW #6 - arrived on the 24th floor with a stretcher and made their way south down the hallway. At about 5:36 p.m., CW #2 stood up from the staircase on which he was sitting in the stairwell and approached CW #5 to be examined.
Ms. Korchinski-Paquet had called her father – CW #1 - inside the bathroom and was still on the call when she exited. CW #7 entered the apartment at about 5:37 p.m., and she and Ms. Korchinski-Paquet argued with each other. About 20 seconds later, CW #6 entered the apartment. The SO attempted to persuade Ms. Korchinski-Paquet to speak with CW #6 given her seizures earlier in the day. CW #7 exited the apartment into the hallway at about 5:38 p.m. Within seconds of her departure, WO #1, WO #2 and WO #4 entered through the apartment door.
Ms. Korchinski-Paquet refused to speak with CW #6. Instead, she backed away from the officers, toppled a standup portable air conditioning unit by the balcony door, and exited through the door onto the balcony. CW #7 entered the apartment again at this time followed by CW #2. The SO told Ms. Korchinski-Paquet to re-enter and attempted to open the door - a hinged screen door that opened into the balcony - but Ms. Korchinski-Paquet kept it closed using her body weight. Very quickly, Ms. Korchinski-Paquet scaled the balcony railing and the SO lost sight of her. At about this time, CW #7 asked, “What is she doing?” A male voice replied, “She’s going to the neighbour’s.” WO #1 said, “She’s jumping balconies.” CW #7 indicated, “She can’t get to the neighbour’s,” followed shortly by CW #2 saying, “It’s blocked off.” Believing Ms. Korchinski-Paquet was attempting to cross over to the neighbouring balcony to the north, WO #3 reported this information over his radio. The time was about 5:39 p.m.
At word that Ms. Korchinski-Paquet was on the balcony crossing over to an adjacent balcony, WO #4 directed everyone out. He and another officer knocked on the front door of the adjacent apartment but received no answer.  WO #4 returned to Ms. Korchinski-Paquet’s apartment and made his way onto the balcony, where he noticed a metal partition dividing the adjoining balconies with netting completely around the balcony to the north making it inaccessible from the outside. Believing Ms. Korchinski-Paquet had nowhere to go, he looked down and saw her body on the ground below.
Ms. Korchinski-Paquet’s descent to the ground was captured in part by a video recording from the ICCS of the SO’s cruiser. The recording first depicted Ms. Korchinski-Paquet falling past the 6th floor of the building. She made impact with the ground at about 5:39:18 p.m., about 40 seconds before the officers first knocked on the neighbour’s front door.
Some using the elevator, others using the stairs, the officers, paramedics and CW #7 made their way to the ground floor. Ms. Korchinski-Paquet’s body was lying on a patch of lawn in line with the balcony immediately north of her balcony; she had fallen approximately 60 metres. The paramedics on scene tended to Ms. Korchinski-Paquet and found her without vital signs. A cardiac monitor was used and found that Ms. Korchinski-Paquet was asystolic.
Ms. Korchinski-Paquet was pronounced deceased at the scene at 6:05 p.m.
The Autopsies and Opinions of Forensic Pathologists
In his report of the second autopsy, the forensic pathologist was also asked to opine on oval shaped bruising located on Ms. Korchinski-Paquet’s left arm and a recent contusion apparent on the right upper back. He reported that the bruising to the arm resembled fingerprint marks and may have occurred during a struggle, the result of Ms. Korchinski-Paquet being forcefully grabbed by the arm. With respect to the shoulder bruise, the pathologist concluded it occurred before Ms. Korchinski-Paquet’s impact with the ground and was the result of blunt force.
The Analysis of Potential Criminal Liability
Did the police overstep their authority?
Pursuant to section 25(1) of the Criminal Code, police officers are immune from criminal liability for force used in the course of their duties provided such force was reasonably necessary in the execution of an act that they were required or authorized to do by law. Having personally heard the 911 calls to police and reviewed the transcripts of those calls, I am satisfied that the officers who responded to Ms. Korchinski-Paquet’s apartment were there lawfully. As far as they knew, they were responding to multiple reports of assault, some which claimed Ms. Korchinski-Paquet had attacked her brother, others indicating that Ms. Korchinski-Paquet had been attacked by her brother and/or mother, all of which mentioned the presence of knives in the course of the altercation or altercations.
Arriving at the 24th floor hallway and meeting with CW #7, CW #2 and Ms. Korchinski-Paquet, it was apparent to the officers that emotions were running high between the parties. Ms. Korchinski-Paquet was yelling at her brother and her brother was yelling back. Shards of broken wine bottles and red wine were on the corridor floor.  The officers stepped between the siblings to prevent any renewal of hostilities and set about trying to figure out what had happened.
At one point, after the SO had finished speaking with CW #2 inside the apartment to get his side of the story, he stepped into the hallway intending to speak with Ms. Korchinski-Paquet. Ms. Korchinski-Paquet yelled at CW #2 and tried to approach him. The SO used his body to block her path and Ms. Korchinski-Paquet backed down. This constituted a measure of force on the part of the officer, but one which I am satisfied was reasonably necessary in the circumstances. The SO was within his rights in attempting to preserve the peace and prevent a further altercation between the siblings, and he did so with minimal force and without injury. To her credit, Ms. Korchinski-Paquet did not press the issue and tensions abated, but only momentarily.
There is the question of the fingertip-type bruising and a contusion on the back of Ms. Korchinski-Paquet’s right shoulder, indicative, on the pathology evidence, of a possible physical struggle before the fall. As there was no witness evidence of such a struggle between any of the officers and Ms. Korchinski-Paquet, and given the distinct possibility that these injuries may have been incurred in the assault or assaults that reportedly occurred among the family members ahead of the police arrival, I am unable to infer from this evidence that there was any physical altercation between the officers and Ms. Korchinski-Paquet inside the apartment or on the balcony.
Aside from the physical force used to keep Ms. Korchinski-Paquet away from CW #2, it is also true that the officers exercised non-physical control over the movements of Ms. Korchinski-Paquet, CW #7 and CW #2 upon their arrival on the 24th floor by deciding, for example, who would and would not enter the apartment at times during their interaction. Thus, for example, when Ms. Korchinski-Paquet entered the apartment to use the bathroom, steps were initially taken to keep CW #2 and CW #7 in the stairwell. I do not believe the officers’ conduct in this regard was unlawful. More specifically, I am satisfied that Ms. Korchinski-Paquet, CW #7 and CW #2 were under lawful detention at the time.
In R v Mann,  3 SCR 59, the Supreme Court of Canada confirmed that a police officer has a limited power to detain an individual for investigative purposes if the officer has a reasonable suspicion that the person is connected to a crime. The detention must be reasonably necessary with a view to such considerations as the extent to which the interference with individual liberty is necessary to the performance of the officer’s duty, the liberty interfered with, and the nature and extent of the interference. In the instant case, the officers were aware via the information that came in on the 911 calls that they were responding to deal with an assault that had involved physical violence and weapons. On their arrival at the scene, the broken glass on the hallway floor and the enmity on display between the family members would have reinforced the notion that an unlawful assault had occurred. While knives were not present in the hallway, their presence in the apartment had yet to be ruled out by the officers. On this record, it would seem the officers had a lawful basis to temporarily detain Ms. Korchinski-Paquet and her family, and to control their access to the apartment, while they tried to figure out whom among them were the victims and whom among them were the perpetrators of the reported assault.
Did the police do enough?
The issue turns to whether the officers could have done more to prevent Ms. Korchinski-Paquet’s death and, if so, whether their failure to do so amounted to a criminal offence. There are two offences that arise for consideration on this theory of liability, namely, failure to provide the necessaries of life and criminal negligence causing death contrary to sections 215 and 220 of the Criminal Code, respectively. I deal first with the former.
As an offence of penal negligence, simple negligence will not suffice to ground liability for failure to provide the necessaries of life. Rather, the offence is premised, in part, on conduct that amounts to a marked departure from the level of care that a reasonable person would have exercised in the circumstances: R v Naglik,  3 SCR 122; R v F(J),  3 SCR 215.  In the instant case, the liability analysis boils down to the following question: ought the officers have apprehended Ms. Korchinski-Paquet at some point before she scaled the balcony railing?
In asking this question, I accept as arguable that in the environment that prevailed in and around the apartment at the time, Ms. Korchinski-Paquet’s apprehension by the police may well have constituted a “necessary of life” as it would have prevented her putting her life in danger by scaling the balcony railing.  Of course, the officers were not simply free to apprehend Ms. Korchinski-Paquet outside the ambit of their legal authority.
While there were grounds for Ms. Korchinski-Paquet’s detention, I am not satisfied there was a lawful basis to assume complete control over Ms. Korchinski-Paquet’s movements via an arrest. The officers had conflicting information about who had done what to whom and were still attempting to sort that out when Ms. Korchinski-Paquet took the drastic action she did. Nor were the officers in a position to forcibly remove Ms. Korchinski-Paquet from the premises until she had calmed down. As with her mother and brother, Ms. Korchinski-Paquet’s name was equally on the lease. Was there some other basis upon which the officers could have acted?
Section 17 of the MHA provides, in part, that police officers may take a person into custody for psychiatric examination at hospital where they have sufficient grounds to believe the person is: acting or has acted in a disorderly manner, at risk of self-harming or harming another person, and suffering from a mental disorder that will likely result in serious harm to the person or another person. It appears that some of the officers who responded to the scene turned their minds to whether the MHA was applicable to the situation at hand. One of them, at least, WO #4, seems to have concluded it was not. Informed by CW #7 outside the apartment that Ms. Korchinski-Paquet suffered from seizures, the officer asked, “What about mental health?” There also appears to have been uncertainty in the minds of one or more of the 911 operators as to whether epilepsy was a mental health condition.
I am not a doctor nor versed in the medical community’s modern-day understanding of epilepsy and the seizures it produces. The limited layperson’s research I have conducted of the matter suggests that epilepsy is a neurological disorder with manifestations that can be mental as well as physical.  Be that as it may, I cannot fault the officers for failing to take Ms. Korchinski-Paquet into custody prior to her scaling the balcony railing. She had not given them any indication that she wished to harm herself and was professing to be the victim of an assault at the hands of her brother. There is no doubt she was irate and perhaps even behaving in a disorderly manner in the presence of the police, but that would not have been unusual for a person claiming to have been assaulted and demanding the police take action. Separate and apart from whether Ms. Korchinski-Paquet was suffering from a mental disorder, therefore, I am unable to reasonably conclude that the officers were derelict in failing to apprehend Ms. Korchinski-Paquet under the MHA at least until such time as they were satisfied that she was the aggressor of the violence that had preceded their arrival or at risk of self-harm. I am satisfied they never reached those conclusions, nor were there necessarily grounds for having done so.
For the foregoing reasons, there are no reasonable grounds to believe that the officers’ failure to take Ms. Korchinski-Paquet into custody for her own protection amounted to an offence under section 215 of the Criminal Code. The liability analysis turns to whether there is evidence of criminal negligence against any one or more of the involved officers in connection with Ms. Korchinski-Paquet’s fateful fall.
The want of care at the heart of criminal negligence causing death is more egregious than that which defines other species of negligent-type offences, such as the failure to provide the necessaries of life under section 215 of the Criminal Code. The latter are premised on a marked departure from a reasonable standard of care. The former is not made out unless the impugned conduct amounts to a marked and substantial departure from a reasonable standard of care. 
Regardless of the officers’ understanding of epilepsy or the precise nature of Ms. Korchinski-Paquet’s mental health at the time,  it was obvious that they were responding to a family dispute in which emotions were heated. Once the parties had been duly separated to prevent a continuation of further hostilities, de-escalation efforts would have been in order. The evidence indicates that the officers made efforts to defuse the situation. For example, once Ms. Korchinski-Paquet was inside the apartment with the SO,  and after the officer had been unable to establish any productive communication with her as she emerged from the bathroom on the phone with her father, CW #6, the female paramedic on scene, was brought in. As WO #1 explained, paramedics had in her experience been effective in de-escalating situations in which individuals had not reacted well to police presence. Unfortunately, CW #6 could make no inroads. The weight of the evidence, including the video recordings of the corridor and the audio recordings of dialogue at the scene captured by the wireless microphones of WO #1 and WO #4, also suggests the officers were not aggressive in their dealings with the family. There were objections raised with the number of officers who arrived on scene – six – and with the long gun  in the possession of WO #4. However, the officers were responding to an assault call involving multiple parties and the use of knives. In the circumstances, I am unable to characterize the nature and extent of the police resources deployed as an overreaction or heavy-handed.
There remains the question of the TPS Mobile Crisis Intervention Team (MCIT) program. The teams bring together officers specifically trained in de-escalation techniques with mental health nurses to rapidly respond to situations involving “emotionally disturbed persons”. They are part of the police service’s strategy for achieving positive outcomes when dealing with persons threatening self-harm or harm to others because of behaviour attributable to a mental or emotional crisis. Whether Ms. Korchinski-Paquet was in a mental health crisis strictly speaking, she was certainly “emotionally disturbed” in the language of the TPS MCIT policy and could have benefitted from the expertise brought to bear by the MCIT. It is conceivable, for example, that the intervention of a mental health nurse might have proven successful in achieving a level of engagement with Ms. Korchinski-Paquet that the officers on scene had been unable to achieve. However, the policy expressly precludes the deployment of the MCIT as first responders with respect to incidents involving the possible use of weapons. This was such a case. In the circumstances, I am unable to find fault with the decision not to initially dispatch the MCIT. Nor is there a basis to be critical of the failure on the part of the officers on the scene to call for such a team. After all, even though it was apparent that none of the parties had actually sustained any serious injuries, the officers had not yet located and secured the knives that had reportedly been brandished in the domestic disturbance that prompted their attendance.
Finally, the decision to disengage soon after Ms. Korchinski-Paquet moved to the balcony and scaled the railing is open to legitimate scrutiny. The decision to do so was made by WO #4 and followed an initial attempt on the part of the SO to enter onto the balcony after Ms. Korchinski-Paquet. Arguably, the situation called for a more proactive posture at that moment; one in which, perhaps, officers entered onto the balcony to try to coax or physically pluck Ms. Korchinski-Paquet back to safety. As it turned out, within seconds of scaling the railing and attempting to make her way over to the neighbouring balcony, Ms. Korchinski-Paquet lost her balance and fell.
On the other hand, Ms. Korchinski-Paquet had given the officers no reason to believe that she was intent on harming herself. Instead, as they correctly surmised, she was attempting to traverse to the neighbouring balcony. In their SIU interviews, some officers indicated withdrawal was pursued so as not to do anything that could startle or further provoke Ms. Korchinski-Paquet, who was at the time in a very precarious position perched on a narrow ledge on the outer aspect of the balcony railing 24 stories in the air. In his SIU interview, WO #4 noted that he had previously spent three years in the MCIT. It was his judgment at the time that the officers’ best recourse was to have the Emergency Task Force (ETF) dispatched to a situation that had suddenly become life-and-death. Certainly, the ETF is trained for these sorts of high-risk incidents and would have been able to bring to bear resources to attempt a rescue operation that the officers on scene were without. In this context, if the officers’ fell short in their decision, I am satisfied the decision was not one divorced of logic.
In the final analysis, I am satisfied on the totality of the evidence that the conduct of the officers who responded to Ms. Korchinski-Paquet’s residence did not amount to a marked and substantial departure from a reasonable level of care in the circumstances. The officers acted prudently, in my view, in keeping the parties separated while they sorted out exactly what had happened. Though their efforts were unsuccessful, they tried to de-escalate tensions by bringing in a non-police emergency responder to speak with Ms. Korchinski-Paquet. There is no suggestion of an undue show of force by the officers or unnecessarily aggressive behaviour in tone or movement. Arguably, they might have acted more proactively in the penultimate moments of the incident by venturing onto the balcony. That said, the concern that doing so might worsen the situation was not without merit. On this record, I am satisfied on balance that the officers did not transgress the limits of care prescribed by the criminal law.
- 1) CW #10’s apartment. [Back to text]
- 2) CW #10’s apartment. [Back to text]
- 3) The transcript of the calls are contained at Appendix A to this report. [Back to text]
- 4) The transcripts of the audio recordings captured by the ICCS wireless microphones worn by WO #1 and WO #4 are contained at Appendix B to this report. [Back to text]
- 5) WO #2’s vehicle was not equipped with ICCS. [Back to text]
- 6) WO #6 was not involved in the incident and therefore had no notes. He was designated a witness officer to speak with the SIU about the Mobile Crisis Intervention Team program. [Back to text]
- 7) Details about the MCIT program are contained at Appendix C to this report. [Back to text]
- 8) Patient – Ms. Korchinski-Paquet. [Back to text]
- 9) The timestamps were derived from WO #4’s ICCS. [Back to text]
- 10) While the video recordings from 100 High Park Avenue depicted the parties “entering” through the apartment door, the angle of the camera meant that it could not discern how far into the apartment the parties went on these occasions. [Back to text]
- 11) Not accounting for the influence of air resistance, it would have taken Ms. Korchinski-Paquet 3.5 seconds to free fall a total of 60.9 metres from the 24th floor to the ground below. The descent distance was derived from subtracting the measured height of the railing (1.1 metres) from the measured distance between the top of the balcony railing to the ground (62 metres) (see https://www.omnicalculator.com/physics/free-fall). If Ms. Korchinski-Paquet impacted the ground at 5:39:18 p.m., per the sound captured by WO #4’s and the SO’s in-car microphones, she is likely to have started her descent between 5:39:14 p.m. and 5:39:15 p.m. [Back to text]
- 12) Likely referring to netting installed around the neighbouring balcony. See scene photographs earlier in this report. [Back to text]
- 13) Baseline event from which event times were coordinated across various sources of audio/video recordings. [Back to text]
- 14) See, for example, the work of the Ontario Human Rights Commission, which is currently conducting an inquiry into systemic anti-Black racism within the Toronto Police Service. [Back to text]
- 15) The video recording captured by the building security camera of the 24th floor hallway places CW #7 and CW #2 in the apartment at this time, although it does not depict how far into the apartment they were nor establish whether they had a line of sight to what was happening in and around the balcony. [Back to text]
- 16) The audio recording is not determinative because it cuts out at portions. [Back to text]
- 17) The apartment was the southernmost unit on the 24th floor corridor at 100 High Park Avenue. It had a balcony along its east wall. [Back to text]
- 18) The resident, a friend of Ms. Korchinski-Paquet and her family, was inside her home. [Back to text]
- 19) According to the witness evidence, it appears Ms. Korchinski-Paquet had thrown a bottle at her brother during their dispute while he was in the hallway at one point. The video recording of the building depicted CW #2 throwing an object – possibly a bottle - at CW #7 at about 5:16 p.m. The object breaks as it hits the ground ahead of CW #7. [Back to text]
- 20) In fact, the SO also used his body at an earlier moment to prevent Ms. Korchinski-Paquet moving past him in the hallway toward CW #2, as did WO #3 and WO #4 at points during the events in the hallway. In my view, each of these acts were legally justified for the same reasons. [Back to text]
- 21) For purposes of this decision, I accept that Ms. Korchinski-Paquet was under the “charge” of the officers as Ms. Korchinski-Paquet was, in my view, under investigative detention at the time, and that the officers consequently owed her a “duty” to provide the necessaries of life under section 215. [Back to text]
- 22) There is an element of foreseeability involved in determining whether something is a “necessary of life” within a set of circumstances. Ms. Korchinski-Paquet’s apprehension may not have constituted a “necessary of life” if it was not reasonably foreseeable that she was at risk of scaling the balcony railing before she actually proceeded to do so. That said, I need not decide that question as I prefer to resolve the issue of the officers’ liability in relation to this offence on other grounds. [Back to text]
- 23) See: https://www.premierhealth.com/your-health/articles/women-wisdom-wellness-/think-epilepsy-is-a-mental-illness-think-again; https://epilepsyontario.org/mental-health/; https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093; https://www.epilepsy.com/article/2016/11/epilepsy-and-psychological-disorders#:~:text=Epilepsy%20is%20not%20a%20mental,with%20severe%20and%20uncontrolled%20epilepsy.; https://www.health.harvard.edu/newsletter_article/Epilepsy_and_psychiatric_disorders. [Back to text]
- 24) Criminal negligence, defined in section 219 of the Criminal Code, is not an offence per se. It is only criminal negligence that causes death or bodily harm that attracts criminal sanction (see sections 220 and 221 of the Code). In the instant case, whether the conduct of the officers could be said to have been a “cause” of Ms. Korchinski-Paquet’s death in the legal sense is one I need not answer given my conclusion with respect to whether the officers were criminally negligent. [Back to text]
- 25) I in no way intend to diminish the importance of officers having a reasonable and accurate understanding of epilepsy, and mean simply to observe it was not a pivotal factor in the criminal law analysis. If there is a need for more education and training among police with respect the nature of this condition, than that should, of course, occur. [Back to text]
- 26) When the SO followed her into the apartment, Ms. Korchinski-Paquet balked and demanded the officer leave. The SO explained his presence was necessary for safety’s sake. The officer’s decision was a prudent one; he had reason to believe that knives had been used in the assault that preceded the officers’ arrival and were potentially still in the apartment. [Back to text]
- 27) The weapon was a “sock gun”, also known as a “bean bag gun”, which was loaded with less-lethal rounds. [Back to text]
The signed English original report is authoritative, and any discrepancy between that report and the French and English online versions should be resolved in favour of the original English report.