HUMAN RIGHTS TRIBUNAL OF ONTARIO
B E T W E E N:
Jennifer Finan and Michelle Boyce Complainants
-and-
Ontario Human Rights Commission Commission
-and-
Cosmetic Surgicentre (Toronto) Incorporated and Robert H. Stubbs Respondents
DECISION
Adjudicator: David A. Wright Date: July 22, 2008 Citation: 2008 HRTO 47 Indexed as: Finan v. Cosmetic Surgicentre (Toronto)
Human Rights Tribunal of Ontario 655 Bay Street, 14th Floor Toronto ON M7A 2A3 Phone (416) 314-8419 Fax (416) 314-8743 Toll free 1-866-598-0322 TTY (416) 314-2379 / 1-800-424-1168 E-mail hrto.registrar-transition@ontario.ca Website www.hrto.ca
APPEARANCES
Jennifer Finan, Complainant ) On her own behalf Michelle Boyce, Complainant ) On her own behalf
Cosmetic Surgicentre (Toronto) Incorporated ) Awanish Sinha and and Robert H. Stubbs, Respondents ) Eli Mogul, Counsel ) Melanie Shulman, Counsel ) (to May 14, 2008)
Ontario Human Rights Commission ) ) Eric del Junco, Counsel ) (from May 14, 2008)
INTRODUCTION
1Dr. Robert H. Stubbs is a plastic surgeon who, for many years, ran a private facility specializing in elective cosmetic plastic surgery not covered by government health plans. He performed various types of surgeries, but came to have a particular expertise in various procedures on the genitals of both men and women. Dr. Stubbs did not, however, perform surgeries on transsexual patients. Accordingly, when Michelle Boyce attended at his office in February of 2003 to consult him about plastic surgery on her labia, he refused to treat her. Similarly, when Jenn Finan attended at an appointment several weeks later to inquire about breast augmentation and told him that she was a transsexual woman, he terminated the consultation. Dr. Stubbs states that he did so because he was not qualified to perform these surgeries on transsexual patients, nor would it have been medically appropriate, given the nature of his practice and facility and the fact that he was not part of a team specializing in gender reassignment.
2The Ontario Human Rights Commission (“Commission”) and the complainants argue that the respondents discriminated on the basis of sex in the provision of services. They say that his decision not to treat the complainants upon learning that they were transsexuals, his failure to conduct further physical examinations before making that decision, and the manner in which he conveyed the information that he would not treat them were all violations of the Human Rights Code, R.S.O. 1990, c. H.19 (“Code”). They dispute that Dr. Stubbs has shown that he could not safely perform the surgeries. They also submit that even if I accept his evidence in this regard, the Code requires the respondents to demonstrate that Dr. Stubbs could not, without undue hardship, obtain further training or make adjustments to his practice to offer the requested services and that they have not done so.
THE EVIDENCE
3Ms. Finan’s complaint, dated September 29, 2003, and Ms. Boyce’s complaint, dated September 30, 2003, were referred to the Tribunal by the Ontario Human Rights Commission by letter dated February 22, 2007. Both allege discrimination on the basis of sex in the provision of services contrary to sections 1 and 9 of the Code. The hearing took place on February 12, March 26, June 9, and June 26, 2008.
4Surprisingly, given the nature of the issues in the case, the Commission chose to call no witnesses other than the complainants. In particular, despite its assertion that Dr. Stubbs might have been able to provide the requested surgeries and that he should have examined the complainants further before deciding he could not treat them, it did not call any expert medical evidence. The respondents did not call evidence from anyone other than Dr. Stubbs. The case must therefore be resolved based upon an analysis of the evidence of Ms. Boyce, Ms. Finan, and Dr. Stubbs. While Dr. Stubbs is not an expert on medical issues relating to transsexuals, the Commission and complainants did not dispute that he is highly qualified in his field of practice, plastic surgery.
A. The Parties
5Michelle Boyce identifies as intersex. She was born with male external genitalia and raised as male. She had genital reconstruction surgery in the United States in October of 2002.
6In the months after the surgery, Ms. Boyce experienced some pain during urination and sexual intercourse and wanted adjustments to the appearance of her labia. She did not want to return to the American surgeon, as she had some concerns about the care he had provided. She read an article on an internet web site which referred to the fact that Dr. Stubbs performs labiaplasty, defined in the article “as a reduction of the labia minora, the flaps of skin which form the lips of a woman’s genitalia and cover the clitoris and vaginal opening”. The article noted that large labia could cause pain, and this applied to her. She phoned Dr. Stubbs’s office and made an appointment for a consultation.
7Jenn Finan identifies as a woman with a transsexual medical history. She was born with a male body and grew up male. She started taking hormone therapy in 2001, and had various sex reassignment surgeries after that time. In the spring of 2003, she was concerned about the size of her breasts and wanted them to be larger. Her general practitioner mentioned one or two physicians who performed breast augmentation, including Dr. Stubbs.
8Dr. Stubbs did his medical training and training in the specialty of plastic surgery at the University of Toronto. He received his M.D. in 1973, and a specialty in plastic surgery in 1979. He taught at the University of Toronto in the Department of Surgery from 1982 to 1992.
9In 1984, Dr. Stubbs was a founder of Cosmetic Surgicentre (Toronto) Incorporated (“Cosmetic Surgicentre”), which closed in 2007. He describes it as Canada’s first ambulatory surgical facility. There, he performed elective cosmetic surgery not covered by health insurance. Originally, he focused on facelifts, eyelifts, and simple breast procedures. Later, liposuction and rhinoplasty were added. After doing some training in China, he developed a specialty in penis enlargement. About seven years ago, he began performing plastic surgery on female genitals. He became particularly known for a procedure in which he reduced the size of the labia minora for cosmetic reasons, known as labiaplasty in his practice.
10Dr. Stubbs testified that he pioneered various plastic surgery techniques. He also testified that he routinely turned down patients for various reasons, including concerns about their emotional stability or honesty, aspects of their medical history, other medical conditions, or his own qualifications.
B. Cosmetic Surgery on Transsexuals at Cosmetic Surgicentre
11Dr. Stubbs testified that gender reassignment is a “super specialized” field, outside his expertise, and is too complex for a physician to take on alone. He learned in medical school that it requires a team approach of various medical professionals, and he was not part of such a team. He testified that from a medical point of view, the anatomy of a post-surgical transsexual woman is different from that of a born woman in many ways. A neo-vagina is created from scrotal tissue, which is different than the tissue of a born woman. Similarly, the chest and pelvis and bones of a born woman are different from those of a person born with male anatomy. Gender reassignment is complex, involving many different systems in the body. He testified that there are a large number of procedures that may be part of gender reassignment surgery, and that they may be considered as such many years after initial surgeries. He does not specialize in this area and is not currently qualified to do so.
12Accordingly, there is no feminizing or masculinizing cosmetic plastic surgery procedure that Dr. Stubbs would consider offering to transsexuals. Most or all of the procedures he offers fall within this restriction: even plastic surgery on a nose has gender-related aspects. As a result, he has never knowingly performed plastic surgery on a transsexual person. He received many inquiries from transsexual patients but referred them elsewhere.
13Commission counsel suggested to Dr. Stubbs that he could have “easily” trained himself to conduct the surgeries. Dr. Stubbs disagreed, noting that it would not have been feasible for him to learn to do so, that gender reassignment is a “sub sub specialty”, and that in his view it would be dangerous to perform these surgeries in an ambulatory clinic like his.
C. Michelle Boyce’s Office Visit
14Upon arriving at Dr. Stubbs’s office on February 20, 2003, Ms. Boyce filled out the medical history form, and indicated at the bottom, “Postop TS, Oct 29, 2003, vaginaplasty”.
15Ms. Boyce testified that during the consultation, when she told Dr. Stubbs that she was a post-operative transsexual, he abruptly slammed his book shut and said that he did not treat transsexuals. Ms. Boyce’s recollection on the date of the hearing was that he had said “I don’t treat transsexuals. You people have a clinic in Montreal”. He left the room quickly, she said, and she ran down the hall after him. Her evidence was that they had a further discussion, during which they discussed his view that there was not an adequate psychiatric safety net for transsexuals in Toronto since the termination of the gender reassignment program at the Clarke Institute. She said he told her that he has extensive knowledge in the area and that “many have tried”. She emphasized that her psychiatric safety net was taken care of, and asked if he could look to see if there was anything he could do. He refused, and said she could see the receptionist for a refund of the consultation fee. Ms. Boyce was tremendously upset by the experience. She testified that it had a significant impact on her life. In particular, it has made her more wary of dealing with medical practitioners and reluctant to disclose her medical history unless necessary.
16Ms. Finan made relatively detailed notes immediately after the incident. They do not refer to the alleged reference to “you people”, the slamming of the book, or the “many have tried” comment.
17Dr. Stubbs testified that he was “blunt” when speaking with Ms. Boyce, but denied slamming down a book (which he does not generally carry) or a file. He testified that he is a surgeon, not a family doctor, psychiatrist, a “hand holder”, or a “sympathizer”. He explained that his practice was diverse in terms of sexual orientation and ethnicity, and denied any prejudice against transsexuals.
18He said that he had made a decision that he could not help her and wanted to be “very clear”. He was concerned that she had not clearly identified her transsexual medical history on the form or when making the appointment, thereby withholding crucial medical information. “Postop TS” did not make this evident, in his view. He was also concerned by the fact that she made derogatory comments about the specialized clinic in Montreal for gender reassignment; she said something like “they’re butchers and I wouldn’t send my dog there”. He denied acting with anger or hostility, stating that he had a profound concern that the transsexual community was not being served properly, and that this was leading to them not following proper protocol when seeking a physician. His notes of the visit record that he explained to Ms. Boyce that at this time he does not accept transgender patients as there is no support network in Toronto, and that he suggested the Montreal clinic or returning to the United States where she had her first surgery.
19Dr. Stubbs emphasized in his oral evidence that he was not qualified to perform the surgery that Ms. Boyce wanted, that doing so would have put her at risk, and that the surgery requires a team approach. In response to questions from Ms. Boyce, he denied that had he known further detail about her intersex condition, this could have changed this medical conclusion that he could not perform the requested surgery.
D. Jenn Finan’s Office Visit
20Ms. Finan testified that she made the appointment in late February or early March for her visit on March 20, 2003. Ms. Finan knows Ms. Boyce, and was aware of what had happened during her visit. However, she was asking for a different procedure and did not know what Dr. Stubbs’s response might be, and also believed that Ms. Boyce might have misread the situation.
21Upon arrival, Ms. Finan completed a “breast surgery questionnaire”, which asked various general medical questions and asked about the “particular breast problem”. Her responses did not advise that she previously had sex reassignment surgery (“SRS”).
22Ms. Finan testified that she waited for Dr. Stubbs in an examination room. They exchanged pleasantries and he asked her some questions. He noted that she was 40 years old, and asked why the size of her breasts was an issue at this point in her life. When she responded that she was a transsexual woman, Dr. Stubbs became angry. He wanted to know if she had told the receptionist that she was a “gender reassignment”. She said she had not. He said he does not do breast augmentation on “gender reassignments”. She asked what that had to do with anything and how it was relevant. Dr. Stubbs said it was extremely relevant, and raised his voice a bit. He said that “gender reassignments” are so deeply psychologically damaged they require an entire team of medical professionals to “hand hold” and create a safety net for any surgery they may seek.
23Ms. Finan then said to Dr. Stubbs that she was not seeking sex reassignment surgery. She said that she was already legally female and was not coming for this surgery. She just wanted breast augmentation, a service he offered to other women.
24Ms. Finan testified that Dr. Stubbs said that he did not deal with gender reassignments. He said that he was “very sorry” but since the government delisted sex reassignment surgery there was nothing in place in Toronto. He said, “There’s a clinic in Montreal for you people and I recommend you go there”. Ms. Finan again said that she only wanted breast augmentation. Dr. Stubbs explained that there were basic physiological differences in anatomy between men and women and he had no specialized training in such things. She continued to ask him to at least examine her. She described him as gruff and angry and upset when asking her questions about her previous surgeries. She testified that told him that what he was doing was wrong. He said that if she did not like how he had treated her, she should write to the government.
25Ms. Finan said that Dr. Stubbs told her to talk to the receptionist for a refund of her consultation fee. She said that he went to the receptionist and said that she was “a gender reassignment” in a voice loud enough to be heard by people waiting. Ms. Finan explained that she was upset and “traumatized” by her experience.
26Dr. Stubbs denied expressing anger or hostility to Ms. Finan. He said that she was very personable and cheery, but that he was “bewildered” that he had two people revealing their medical status as transsexuals at the “last minute” within a short period of time. He said that they had a chat about why he did not do this surgery. He referred to the political situation and the government delisting of SRS. He told Ms. Finan that it was “not his fault he was not the right doctor”. He stated that the person staffing the front desk was a nurse, and that the office was designed in such a way that members of the public could not hear conversations with her. Dr. Stubbs’s notes of the visit record that he “explained I do not accept them until adeq[uate] psych[iatric] care in Toronto”.
27Dr. Stubbs testified that the anatomy of the male and female chest is different, including differences in the bone structure. He also stated that he could not adequately handle the anaesthesia required for such a procedure. He noted that he also considers himself unqualified and refuses to do surgery on the chests of male patients who ask for implants that simulate bodybuilding.
E. Findings of Fact
28Dr. Stubbs gave logical, reasonable, and compelling evidence, from his medical background, about the anatomical differences between men and women, the limits of his expertise and skills, and the limits of an ambulatory surgical facility. He explained that knowledge of the complainants’ medical history as post-operative transsexuals was sufficient for him to know that he could not safely offer the services they were requesting and he terminated the consultations at that point. Dr. Stubbs’s evidence about his training in medical school regarding the prevailing medical view that there is a need for a team approach to SRS and the relationship of different surgeries to each other was also strong and unshaken in cross-examination. While I understand that the complainants disagree that it is appropriate, I accept Dr. Stubbs’s evidence that it is the current approach in the medical community.
29Dr. Stubbs’s evidence was based upon his medical background and training, and his obligation, as a professional, not to offer services that were beyond his qualifications and that could put a patient at risk. This evidence was uncontradicted by any medical evidence from the Commission or complainants. Although, from a legal and social perspective, the complainants are female and must be treated as such, Dr. Stubbs’s evidence convinced me that for the purpose of the procedures they were seeking, the complainants are different from other women from a medical perspective.
30This evidence was not “impressionistic”, as characterized by counsel for the Commission, but rather stemmed from Dr. Stubbs’s own knowledge of the professional field in which he practices. For professionals, knowledge of the limits of one’s own expertise and skills is an important part of good practice, fulfilling professional obligations, and serving the public adequately. There is no reason to doubt his evidence in the absence of contradictory expert evidence.
31Accordingly, I find as facts, based upon the evidence called in this case, that Dr. Stubbs was not qualified to offer the medical services that were requested by the complainants. I find that being advised that the complainants were post-operative transsexuals asking for feminization surgery was sufficient for him to make this determination, based upon his professional training and knowledge of medicine in general and plastic surgery in particular. I also accept Dr. Stubbs’s evidence that, from the perspective of his medical expertise in cosmetic plastic surgery, all or nearly all procedures that he offers are considered feminizing or masculinizing.
32I also accept Dr. Stubbs’s evidence that as soon as he learned that the complainants were transsexuals, he was aware that he was unqualified to treat them. I find that a physical examination could not have provided Dr. Stubbs with further information that would have assisted him in making a medical judgment about whether he was qualified to treat them. It would have been inappropriate to carry out such examinations on Ms. Boyce’s genitals or Ms. Finan’s breasts when he had determined that he could not treat them. I also accept Dr. Stubbs’s evidence that the surgery could not have been safely carried out in his ambulatory facility and extensive training and change in his practice would have been necessary for him to obtain the necessary expertise.
33Both complainants testified about other doctors who offered them various medical services, who they say had not previously treated transsexuals and were not part of a “team”. In the absence of any evidence about these physicians’ training, qualifications, their perspective on the medical services requested, and the reasons they made the decision, this evidence is of no assistance in resolving the issues in this case and I give it no weight.
34With regard to the manner in which Dr. Stubbs conveyed the information that he could not provide the requested surgeries, I find it unnecessary to resolve the disputes in the witnesses’ evidence. In oral argument and evidence on this aspect of the case, the Commission and complainants alleged discrimination in services through the general manner in which Dr. Stubbs treated them, not any particular comment. All three witnesses’ testimony confirms that Dr. Stubbs was “blunt”, abrupt, and annoyed with the complainants and their attendance at his office to seek a surgery he believed he could not provide. I accept the complainants’ evidence that his approach was upsetting and was one of the principal reasons why they found their visits to Dr. Stubbs so devastating. Had Dr. Stubbs conveyed the information about why he could not treat them differently, the complainants may have found their visit to his office a much different and more positive experience.
35However, considering all of the evidence I have heard, I do not believe that the abrupt nature of Dr. Stubbs’s interaction with Ms. Boyce and Ms. Finan constituted discrimination against the complainants as transsexuals. There is no evidence that the manner in which he refused services to the complainants was different from his treatment of other patients, and accordingly, any inference of discrimination must come from the interactions themselves. I have taken into account the entire context, including the way in which the complainants described their interactions with Dr. Stubbs and the manner in which he expressed himself while testifying at the hearing. Dr. Stubbs expresses his views abruptly, and has strong opinions about the obligations and responsibilities of doctors and patients. I believe that it is more probable than not that the nature of the interactions stemmed from a doctor wishing to move on to his next patient and frustration with the fact the complainants asked for his services without, in his view, understanding all the relevant medical considerations. Although Dr. Stubbs was abrupt and dismissive, I find that he did not treat the complainants in a stereotypical or humiliating manner on the basis of their transsexual identity. The tone of the interaction was not discriminatory.
VIOLATION OF THE CODE
36Having made these findings of fact, I turn now to the legal analysis. The Commission and complainants argue that the fact that Dr. Stubbs did not offer the surgeries to the complainants because they are transsexual constitutes prima facie discrimination, and triggers an obligation on the respondents to justify the denial of services. They say that they did not provide a sufficient justification for two principal reasons. First, they say, the respondents did not offer sufficient proof that Dr. Stubbs was in fact not qualified to provide the surgeries and that he made his decisions for genuine medical reasons. Second, they argue that even if he did show he was not qualified, the duty to accommodate to the point of undue hardship contained in the Code required him and/or the corporate respondent to make further investigations to determine whether and how such services could be offered, and may have required him to obtain training or make changes to his practice.
37The parties agree that, if there was a denial of services on the basis of sex within the meaning of s. 1 of the Code, the applicable legal framework is that set out by the Supreme Court of Canada in British Columbia (Public Service Employee Relations Commission) v. BCGSEU, 1999 CanLII 652 (SCC), [1999] 3 S.C.R. 3 (“Meiorin”) and British Columbia (Superintendent of Motor Vehicles) v. British Columbia (Council of Human Rights), 1999 CanLII 646 (SCC), [1999] 3 S.C.R. 868 (“Grismer”). In particular, they agree that there is no need to consider the application of the framework of analysis developed in the context of s. 15 of the Canadian Charter of Rights and Freedoms.
A. Prima Facie Discrimination
38It has been established that transsexuality falls under the ground of “sex” under the Code: Forrester v. Peel (Regional Municipality) Police Services Board (No. 2), 2006 HRTO 13 at paras. 404-415. Accordingly, discrimination in services against transsexuals falls within s. 1 of the Code.
39The respondents argue that there was no prima facie discrimination in services, and therefore no obligation on the respondent to demonstrate a justification or defence. They state that in order to establish that a service was denied, the Commission must demonstrate the service was in fact offered by the respondent, by showing that labiaplasty or breast augmentation on the complainants was medically equivalent to the services offered on born women. In light of the fact that the Commission and complainants called no expert medical evidence demonstrating that the surgical procedures Dr. Stubbs offered were equivalent to those the complainants sought, they say, it has not been proven that Dr. Stubbs in fact offered the service the complainants were seeking and there is no prima facie discrimination.
40I disagree. To demonstrate prima facie discrimination in medical services when the basis for the denial is a prohibited ground, there is no obligation upon a complainant to call expert evidence to show that the service they were seeking is equivalent to that offered by the physician. The Commission and complainants have established prima facie discrimination on the basis of sex by demonstrating that Dr. Stubbs, a physician who performs plastic surgeries on the genitals and breasts of other women, denied their surgeries because the complainants were transsexual: Ontario (Human Rights Commission) v. Simpsons Sears Ltd., 1985 CanLII 18 (SCC), [1985] 2 S.C.R. 536 at para. 28. This is clear from the evidence of the complainants, and confirmed by the evidence of Dr. Stubbs. I accept that there is an obligation on the respondents to justify his refusal to offer the surgeries in accordance with the jurisprudence.
41As a result of my factual findings about the interaction between the parties during the office visits, I find that discrimination on a prohibited ground was not a factor in the abrupt manner in which Dr. Stubbs spoke to Ms. Boyce or Ms. Finan and accordingly there is no prima facie discrimination in relation to this aspect of the case.
B. The Respondents’ Justification
42The respondents have the onus to demonstrate that Dr. Stubbs’s refusal of services was justified. As set out at para. 20 of Grismer, to establish its defence, the respondent must prove that:
(1) it adopted the standard for a purpose or goal that is rationally connected to the function being performed;
(2) it adopted the standard in good faith, in the belief that it is necessary for the fulfillment of the purpose or goal; and
(3) the standard is reasonably necessary to accomplish its purpose or goal, in the sense that the defendant cannot accommodate persons with the characteristics of the claimant without incurring undue hardship.
43In this case, the test requires that the respondents demonstrate, on a balance of probabilities, three things. First, they must show that the reason for the denial of the medical services was rationally related to the surgeries. Dr. Stubbs’s reasoning, based upon protecting the health and safety of patients and fulfilling his professional and legal obligations to act within his professional expertise, clearly meets this test.
44Second, they must show that Dr. Stubbs denied the surgeries in good faith including the absence of a discriminatory desire not to treat transsexuals because of their identity. My findings of fact above make it clear that Dr. Stubbs acted in good faith.
45Third, the respondents must establish that Dr. Stubbs was in fact not qualified to perform the surgeries and that, as a legal matter, he could not accommodate the complainants without undue hardship. I find that Dr. Stubbs’s credible evidence regarding the limits of his skills and his clinic are sufficient to meet the respondents’ onus to prove that he was in fact not qualified to perform the surgeries.
46The Commission and complainants argue that even if he was not qualified, the duty to accommodate required that Dr. Stubbs do more to determine whether he might have been able to obtain more training or carry out an experimental procedure in order to offer the requested surgeries to transsexuals. They submit that just as Dr. Stubbs pioneered and became trained in performing various surgeries such as penis enlargement, he could have done the same to become qualified to offer the services the complainants sought.
47Ms. Boyce and Ms. Finan spoke passionately, both in evidence and in argument, about the barriers that they and other members of the transsexual community have faced in getting access to medical care. Their testimony suggested that such barriers may result from discriminatory attitudes, ignorance, lack of attention and lack of government funding for certain services. Ms. Boyce and Ms. Finan’s evidence emphasized how, from the perspective of many transsexuals, the health care system has failed them in various ways. However, this case requires a determination of whether one cosmetic surgeon, operating a private health care facility, was obligated to obtain further qualifications in order to provide such services and whether it was a violation of the Code for him not to do so. I am called upon to decide whether Dr. Stubbs violated the law, not to address systemic issues about access to health care or to make a public policy decision about the delivery of health care.
48The parties agree that the issue of whether a professional must obtain new qualifications to meet the duty to accommodate has not been considered in the case law and that, therefore, it is an issue of first impression. The analysis of this question, of course, is always based upon the facts of the particular case. I accept Dr. Stubbs’s evidence that being able to offer the services would have required significant training and changes to his practice, and therefore need not determine whether the result or analysis would be the same if the changes were only minimal.
49I find that the accommodation that the Commission and complainants seek, namely that Dr. Stubbs obtain significant new qualifications and training and change the nature of his practice, would have amounted to undue hardship. The duty to accommodate in the provision of services does not require that an individual professional make substantial changes to his or her practice or obtain significant training. This would result in improper interference in the professional autonomy of Dr. Stubbs in determining the nature of his career and medical practice. Such a requirement could also encourage physicians to agree to perform procedures for which they are not qualified or minimally qualified, which would not be in the interest of safe medical care for those in the position of the complainants. Given that the Code does not require Dr. Stubbs to make the type of modifications to his practice necessary to treat the complainants, I find that Dr. Stubbs had no duty to make any further investigations. The respondents have demonstrated that the necessary steps for Dr. Stubbs to safely provide services to the complainants would result in undue hardship within the meaning of the Code and that no further investigations were required.
50I conclude that the respondents have met their onus to justify the prima facie discrimination under the test in Meiorin and Grismer. Accordingly, I find that the respondents did not violate the Code.
ORDER
51The complaints are dismissed.
Dated at Toronto, this 22nd day of July, 2008.
“Signed By”
David A. Wright Vice-Chair

