Martel v. Ontario (Community and Social Services), 2012 HRTO 735

HUMAN RIGHTS TRIBUNAL OF ONTARIO

B E T W E E N:

Robert Martel and Glen Poloz

Complainants

-and-

Ontario Human Rights Commission

Commission

-and-

Her Majesty the Queen in Right of Ontario as Represented by the Minister of Community and Social Services

Respondent

LEAD CASE DECISION

Adjudicator: David A. Wright

Date: April 12, 2012

Citation: 2012 HRTO 735

Indexed as: Martel v. Ontario (Community and Social Services)

APPEARANCES

) Lesli Bisgould, Cynthia Wilkey, Robert Martel and Glen Poloz, Complainants ) Jackie Esmonde, Daniel ) Simionan and Sheila Drohan, ) Counsel

Ontario Human Rights Commission ) Cathy Pike, Counsel

Her Majesty the Queen in Right ) of Ontario as Represented by the ) Robert E. Charney and Minister of Community and ) Courtney Harris, Counsel Social Services, Respondent )

INTRODUCTION

1This case is about the application of the test set out in Ball v. Ontario (Community and Social Services), 2010 HRTO 360 (Ball) for determining complaints that the special diet allowance under Ontario social assistance violates the Human Rights Code, R.S.O. 1990, c. H.19, as amended. The question is whether the complainants and the Commission have established each component of the test at para. 89 of Ball, in relation to the condition with which the complainants have been diagnosed: chronic hepatitis C. I find they have done so, and the complaints are allowed with respect to that condition. In my view, an analogous remedy to that in Ball should be awarded here, except that the government should have six months to make the necessary calculations of benefits and changes to the program, and the Tribunal will remain seized to deal with any disputes.

BACKGROUND

2An explanation of the special diet allowance program and its background is set out in detail in Ball and there is no need to repeat it here. What is important to emphasize is that these complaints were filed before changes to the program took effect in 2011.

3Both complainants have been diagnosed with chronic hepatitis C. Mr. Poloz has also been diagnosed with cirrhosis. Both receive Ontario Disability Support Program benefits. During the relevant period, they received $10 per month under the category of "hepatic disorders". Since the changes to the program in 2011, they have received no benefits on account of this condition, because the category of hepatic disorders was removed from the schedule as part of those changes.

SCOPE OF THE ISSUES

4The complainants and Commission filed an expert report that relates to the following conditions: hepatitis B & C, liver failure, liver fibrosis, cirrhosis, and alcoholic liver disease. The original report filed suggested that it related to all hepatic disorders, "including" these conditions, but the expert, Elke Sengmueller, subsequently clarified that her evidence related only to the listed disabilities. The complainants and Commission urge me to make findings regarding all six conditions. I decline to do so and limit my findings to whether there is evidence that the complainants' disability – chronic hepatitis C – meets the test established in Ball. The parties will need to draw their own conclusions about what effects my reasoning may have on other cases and litigate those issues if necessary.

5In Ball, at para. 11 I held as follows:

My decision in these cases relates to the specific discrimination alleged by the lead complainants, given their disabilities. Although the lead complainants and the Commission presented evidence and submissions on some other conditions and circumstances, in my view it would not be appropriate for the Tribunal to make findings about matters that do not arise in the three lead Complaints. The application of this Decision to the facts of other Complaints should be made if such disputes are directly before the Tribunal. Although the principles discussed and remedies ordered in this Decision may affect others, I make no findings about any facts that are not raised in the Complaints of the three lead complainants.

6At para. 175 I stated:

The Tribunal's role, given the facts of this case, should be as an arbiter of whether individuals' rights are violated by the program, not in designing or evaluating the program as a whole.

7The complainants and Commission have not convinced me that this reasoning was wrong, and I remain of the view that this is the appropriate approach to adjudicating cases in this special diet litigation. It may be different if the conditions were treated together in all or most of the medical and nutritional literature. However, in this case one of the principal pieces of evidence in support of the complainants' case is the Dieticians of Canada, Hepatitis C: Nutrition Care, Canadian Guidelines for Health Care Providers (2003) ("Hepatitis C Guidelines"). As I will outline below, this evidence is critical to my determination that discrimination has been established in relation to chronic hepatitis C. To rule on other conditions would require me to evaluate, separately, whether the evidence on them meets the Ball test. This would require obiter determinations of fact that in my view would not be appropriate. Moreover, I note that Dr. Hurowitz, the respondent's expert, stated in oral evidence there are other chronic liver disorders that, he implied, might properly be included together with these conditions because of their similar effects on the liver and so any conclusion might not be comprehensive in dealing with chronic liver disorders.

ANALYSIS

8In Ball I held, at para. 89, that an applicant or complainant must prove the following in order to establish disability-based discrimination related to the special diet allowance:

(1) The claim of discrimination is based on a disability or disabilities;

(2) There is general recognition in the Ontario medical community that modifications to a regular healthy diet should be made because of the claimant's disability or disabilities;

(3) The diet leads to additional food costs as compared with a regular, healthy diet for a person without the disability or disabilities;

(4) There is no funding for the additional costs, or the funding is significantly disproportionate to the actual costs (up to the maximum of $250).

9There is no dispute that the claims are based on a disability, chronic hepatitis C. Accordingly, the first stage of the test is met.

10The central dispute between the parties is about the second stage. Is it generally recognized in the Ontario medical community that modifications to a regular healthy diet should be made because of chronic hepatitis C? Two experts provided reports and gave oral evidence on this issue: Elke Sengmueller, a Registered Dietician, called by the complainants, and Dr. Eric Hurowitz, a Gastroenterologist, called by the respondent.

11The complainants and Commission suggest that this stage of the test need not be proven where a condition is or was on the special diet schedule during the relevant period and the claim is that the condition was significantly underfunded. I disagree, and to the extent that the questions set out at para. 179 of Ball may be read to suggest that was not necessary, that is because my drafting of these questions did not contemplate a situation where the government may argue that a condition that did not fit within the purpose of the program had been included in error. It is clear from the evidence I have heard throughout the special diet proceedings that certain conditions were included in error. The government must be entitled to remove such conditions, subject, of course, to challenge on the basis that they nevertheless fall within the purpose of the program and excluding them is therefore discriminatory. It would be illogical and inconsistent with the test and analysis set out in Ball to find discrimination on the basis of underfunding when the benefit itself did not and does not fall within the purpose of the program. If a condition is included in error and does not fall within the purpose of the program, it cannot be discrimination to underfund the condition.

12I turn now to the question of whether the complainants have demonstrated that there is general recognition in the Ontario medical community of the need for modifications to a regular healthy diet for chronic hepatitis C. Ms. Sengmueller's report suggests that people with the conditions she identifies have energy needs 10-40% higher than average and 20-50% higher protein needs. It says that nutritional supplementation is "frequently required" and that maximum servings from the four groups of Canada's Food Guide are recommended for patients with these conditions. She states that dietary intervention focuses on increased vegetables and fruits, increased whole grains and adequate fibre, increased consumption of meat and alternatives, and increased consumption of dairy and alternatives.

13In her Reply Affidavit, Ms. Sengmueller summarizes her conclusions as follows:

It is my opinion that there is, in fact, a consensus that it is vitally important that individuals with hepatitis B & C, alcoholic liver disease and cirrhosis maintain a balanced diet with adequate energy, protein, carbohydrate, fat, vitamins, minerals and fluids. Although Dr. Hurowitz has not given any further particularity to his definition of a regular healthy diet, there is a consensus among dieticians in Canada in respect of what a regular healthy diet means for individuals with these conditions. The precise consensus supports maximizing the servings in Canada's Food Guide.

14Dr. Hurowitz addressed whether there are modifications to a regular healthy diet as a result of the conditions generally recognized by the Ontario medical community. Dr. Hurowitz's report states that, in his opinion, there is no specific diet recognized for hepatitis C and he takes issue with the conclusions in the Hepatitis C Guidelines and Manual of Clinical Dietetics. His conclusions are summarized as follows in his report:

In summary, the research cited for dietary modification does not include recommendations for patients with hepatitis C except, possibly, for those with very advanced disease (cirrhosis). For cirrhotic patients, the advice is to guide the patient after individual assessment. No assertions were made in any of the articles with respect to alterations or supplementation of specific carbohydrate, fibre, lipid, electrolytes, vitamins or minerals. Instead, by their own admission the authors conclude that "persons with hepatitis C can eat a normal, well-balanced diet according to Canada's Food Guide for Healthy Eating and do not need specific dietary management."

As there is no therapeutic diet for liver disorders, I disagree with the modifications to the servings of nutrition as a therapy for achieving individual nutritional goals. Patients' conditions are to be considered individually. Specific recommendations made for physiological reasons, either to prevent complications of Liver Disease, or to enhance patients' health should be made after careful consideration of the individual's past medical history, current health status and treatment goals. This is the practice that I follow in my office. It also seems to be the common principle informing the practices of my colleagues. When petitioned on their practice patterns for the treatment of Liver Disorders through dietary modification, there were no affirmative responses amongst 41 gastroenterologists; no specific diet or dietary modification was offered to most patients with liver disorders, except for those with cirrhosis. At a meeting of the Toronto East Gut Club on October 27, 2011 the issue was discussed by asking, "Do you advise dietary advice for liver disorders?" Reponses included the following comments: "Only with cirrhosis", "…salt reduction if edema or ascites is present", and "not unless they have liver failure".

In addition, the most popular database, UpToDate, which provides medical information for subscribing physicians and patient advice for the public, provides no dietary or nutritional advice for patients suffering liver disorders, except for those with cirrhosis. From the public's standpoint, the website of a hepatitis C support group advises that, "a diet that follows the general guidelines for good nutrition based on the newly revised Food Guide Pyramid is generally recommended for people with stable chronic hepatitis C".

15As I outline in greater detail below, the literature filed by the complainants and relied upon by Ms. Sengmueller makes clear that there are increased energy and protein requirements for individuals with chronic hepatitis C in comparison with a regular healthy diet. In my view, the clearly expressed nutritional recommendations contained there are more convincing than the statements of Dr. Hurowitz about his practice and his informal survey, and also more convincing than Ms. Sengmueller's conclusions and evidence about her practice. They support a finding that there is a general recognition of a need for dietary modification in individuals with chronic hepatitis C such as Mr. Martel and Mr. Poloz because of their need for increased protein and energy.

16Primarily, I rely upon the Hepatitis C Guidelines which, I find, reflect a general consensus of the Ontario medical community, given the manner in which they were developed. The development and nature of the Guidelines are described in the document as follows:

How the Guidelines Were Developed

Health Canada, Community Acquired Infections Division, awarded funding to Dieticians of Canada to develop these guidelines and supporting patient education material. The guidelines also form the basis of an online professional education component.

• The guidelines and patient handouts were developed with the technical support of a national advisory committee of representatives from organizations working to improve the quality of life for persons infected with HCV: Canadian Association for the Study of the Liver, Canadian Association of Hepatology Nurses, Canadian Hemophilia Society, Canadian Liver Foundation, Dieticians of Canada, Health Canada – Community Acquired Infections Division, and Hepatitis C Society of Canada.

• The guidelines were also reviewed by health professionals practicing in this area, including a working group of registered dieticians, and endorsed by the participating organizations. The patient handouts have been tested through focus groups with persons infected with HCV.

• The process generally followed the Proposed Framework for Dietetic Practice Guidelines developed by Dieticians of Canada [...]

Scientific Evidence

These guidelines are designed to provide information to assist decision making and are based on the best information available at the time of publication. Wherever possible, the guidelines are based on scientific evidence.

• They are founded on the extensive literature review conducted as part of the needs assessment, as well as a thorough search to locate new scientific evidence.

• In general, the following types of documents, listed in descending order of priority, shaped the guidelines: current federal government standards and policy statements, consensus reports, peer-reviewed literature reviews, peer-reviewed primary research, non-peer reviewed literature reviews, and non-peer reviewed primary research.

• In the absence of scientific evidence, best-accepted practice is presented.

• The document is not designed to be an all-encompassing practical guide. However, Practice Essentials are outlined, including tips and advice for health-care providers based on scientific evidence and accepted practice.

17I address protein first. Protein needs from macronutrients are measured in grams of protein per kilogram of body per day (g/kg/day). The recommended daily allowance for healthy adults is 0.8 g/kg/day (Hepatitis C Guidelines, p. 11). The Hepatitis C Guidelines state that individuals with chronic hepatitis C, with or without cirrhosis, require 1.2 to 1.5 g/kg/day of protein. These recommendations or recommendations similar to them are confirmed in various other articles and consensus documents filed, including the Manual of Clinical Dietetics (2003) (1.2 to 1.5 g/kg/day for patients with "liver disease"), and the PEN Knowledge Pathway (1.2 to 1.5 g/kg/day for patients with "chronic liver disease, including alcoholic liver disease and hepatitis b and c virus"). I find that the complainants have established that there is a general consensus there is a modification to the amount of protein required as part of a regular healthy diet for hepatitis C patients.

18There was some dispute over whether the recommendation of 1.2 to 1.5 g/kg/day is a modification of diet. In addition to the statement in the Hepatitis C Guidelines, I rely upon the fact that the government's Special Diets Expert Review Committee recognized that protein needs of 1.0 g/kg/day or more represent an increase over a regular healthy diet, when it evaluated another condition, Chronic Wounds and Burns (see Ball for a discussion of the makeup and role of this committee). In its report (p. 43), the Committee recognized that protein needs for stage I wounds and burns of 1.0 g/kg/day, protein needs for stage II wounds of 1.2 g/kg/day, and protein needs for stage III and IV wounds of 1.5 g/kg/day all constituted modifications to a regular healthy diet. The Committee's recommendations were accepted by the government in designing the current special diet schedule and support my finding that this type of increase in protein consumption constitutes a modification to a regular healthy diet.

19A similar analysis applies to energy requirements. The Hepatitis C Guidelines recommend that individuals with chronic hepatitis consume 25-40 kcal/kg/day, or 1.1 to 1.4 times their basal energy expenditure (BEE). Similar recommendations are reflected elsewhere: The Manual of Clinical Dietetics recommends 25-35 kcal/kg/day for acute and chronic liver disease, or adding 20% to the basal energy expenditure. The PEN Knowledge Pathway recommends 35-40 kcal/kg/day.

20It is unfortunate that the complainants did not present evidence of the number of kcal/kg/day recommended for an individual without any medical conditions. However, I accept Ms. Sengmueller's uncontested evidence that whenever an increase to BEE is recommended this represents an increase in energy requirements. In concluding that this is a modification to a regular healthy diet, I also rely upon the Special Diets Expert Review Committee, which recognized that energy requirements of 25-30 kcal/kg/day represent an increase above a regular healthy diet. In its report (p. 43), the Committee found that energy needs of 25-30 kcal/kg/day for stage I wounds, of 30-35 kcal/kg/day, and energy needs of 35-40 kcal/kg/day for stage III and IV wounds all constituted modifications to a regular healthy diet.

21Dr. Hurowitz disagrees with the statements in the Hepatitis C Guidelines, the Manual of Clinical Dietetics and elsewhere about increased protein and energy requirements; however, he provided no literature that takes issue with them. He suggests that the studies upon which the recommendations in these sources are based relate only to people at the severe end of the spectrum in terms of liver disease and these are the only circumstances in which dietary changes may be required. He bases his opinion on his academic training, 24 years of clinical experience dealing with liver disorders, discussion of treatment practices with colleagues, and his interpretation of the peer-reviewed literature, including that relied upon by the authors of the guidelines. However, in my view the clear expression of consensus on diet by the multidisciplinary group that developed the hepatitis C guidelines, and that is relied upon by Ms. Sengmueller, is more convincing and I find, on a balance of probabilities, that it reflects what is generally recognized in the Ontario medical community.

22Through an able cross-examination of Ms. Sengmueller and in final submissions, the respondent also pointed out various statements in the literature that suggest eating a balanced diet and that do not specifically refer to a need for increased protein or energy or eating the maximum servings of Canada's Food Guide. However, these statements must be considered in light of the clear statements and directions about the level of protein and energy needs of people with the complainants' condition. None of the statements highlighted by the respondent contradict the general conclusion clearly expressed in the Hepatitis C Guidelines and elsewhere that protein and energy needs per kg of body weight are above normal levels when individuals have chronic hepatitis C.

23The literature relied upon by Ms. Sengmueller and that I have accepted specifically contradicts Dr. Hurowitz's conclusion that protein and energy needs can only be calculated individually. The Hepatitis C Guidelines, for example, state at p. 11 that indirect calorimetry is recommended to assess energy needs most accurately but that the formulas they suggest can be used if it is not available. As noted in Ball, in designing large-scale social benefit programs informed general assumptions must be made, and this is what has been done in this program in relation to numerous conditions and how it was explicitly designed. It is not an answer to a claim to suggest that an individual analysis would be preferable.

24In finding discrimination, I am not relying upon or giving weight to the complainants' suggestion that a regular healthy diet consists of the minimum servings in Canada's Food Guide or that the appropriate dietary modification for all individuals with hepatitis C is to eat the maximum servings in Canada's Food Guide. There are many people who eat the maximum servings under Canada's Food Guide as part of a regular healthy diet. The number of servings a person should choose varies depending principally upon age and sex, and it is clear from the complainants' evidence, which I have accepted above, that protein and energy requirements depend upon body weight. I do not find that Ms. Sengmueller's assertion that every person with hepatitis C should eat the maximum servings in Canada's Food Guide is proven on the evidence. Instead, the literature she relies upon suggests it suggests that for some people, the amount should be more than that maximum while for others it may be less. What is important, in my view, at this stage of the analysis, is that the evidence supports an individual person's protein and energy intake requirements are generally recognized as higher if they have chronic hepatitis C than if they do not. While the conversion of the recommendations to servings in Canada's Food Guide may be useful in giving patients advice and in making assumptions to develop costings for the special diet program, it is unhelpful in analyzing this stage of the test.

25For these reasons, I conclude that the complainants and Commission have shown, on a balance of probabilities, that it is generally recognized in the Ontario medical community that protein and energy needs are higher for people with chronic hepatitis C than without it.

26There is no dispute that increased protein and energy requirements as set out in the Hepatitis C Guidelines lead to additional food costs as compared with a regular healthy diet. In addition to Ms. Sengmueller's uncontested evidence that the costing is $87.90 per month, this has been recognized by the Expert Review Committee which recommended an amount of $87.90 for stage I and II wounds and burns based on energy requirements of 25-30 kcal/kg/day and protein requirements of 1.0 g/kg/day, and of $190.50 for stage III and IV wounds based on energy requirements of 30-40 kcal/kg/day and protein requirements of 1.2 to 1.5 g/kg/day. It is also not disputed that the $10 per month on the previous schedule is significantly disproportionate to the actual costs. Accordingly, the third and fourth stages of the test are met.

27For these reasons, I find that the complainants and Commission have demonstrated that each element of the Ball test has been met and shown that the complainants have been discriminated against because of disability.

REMEDY

28Notwithstanding the position of the complainants and Commission that the Tribunal should make an order about the particular amount of special diet allowance that should be provided to the complainants and others with their condition, in my view the remedy awarded should be similar to that in Ball, to allow the respondent to determine what the appropriate modifications should be to the special diet allowance schedule.

29In Ball the Tribunal held as follows at paras. 163-164, 167 and 172-175:

This case is about government policy and the design of complex social welfare schemes. The comments about the institutional roles and competence of courts and Legislatures in Doucet-Boudreau v. Nova Scotia (Minister of Education), 2003 SCC 62, at paras. 31-34 apply with equal force to this Tribunal and to remedies under the Code in this context:

Fortunately, Canada has had a remarkable history of compliance with court decisions by private parties and by all institutions of government….

This tradition of compliance takes on a particular significance in the constitutional law context, where courts must ensure that government behaviour conforms with constitutional norms but in doing so must also be sensitive to the separation of function among the legislative, judicial and executive branches…

In other words, in the context of constitutional remedies, courts must be sensitive to their role as judicial arbiters and not fashion remedies which usurp the role of the other branches of governance by taking on tasks to which other persons or bodies are better suited. Concern for the limits of the judicial role is interwoven throughout the law.

[Emphasis added.]

The Supreme Court has also directed human rights tribunals to ensure that their remedies are effective, creative when necessary, and respond to the fundamental nature of the rights in question. In Quebec (Commission des droits de la personne et des droits de la jeunesse) v. Communauté urbaine de Montréal, 2004 SCC 30, at para. 26:

Despite occasional disagreements over the appropriate means of redress, the case law of this Court, although the law is undoubtedly still in its early stages of development in this area, stresses the need for flexibility and imagination in the crafting of remedies for infringements of fundamental human rights… Thus, in the context of seeking appropriate recourse before an administrative body or a court of competent jurisdiction, the enforcement of this law can lead to the imposition of affirmative or negative obligations designed to correct or bring an end to situations that are incompatible with the Quebec Charter.

There is no precise, easily calculable amount that the Tribunal can apply to determine what retroactive and future benefits should be. The costing of the diet is within the institutional competence and discretion of the respondent, provided it complies with the Code in doing so. Accordingly, in my view, the appropriate order is that the respondent, within 90 days following this Decision, provide the complainants with retroactive benefits and future monthly benefits that reflect the Code principles set out in this Decision.

Given the violations that have been found in this case, the appropriate order to remedy this breach is that, commencing within three months, those administering ODSP and OW shall provide special diet benefits for individuals with hypoproteinemia, hyperlipidemia, hypertension, and obesity in accordance with the Code principles set out in this Decision. The respondent accepts that, while the Tribunal cannot order that legislation or regulations be amended (Malkowski, supra, at para. 34), it can order that the program be administered in accordance with the Code.

The remedy I have awarded relates to the violations of the Code that have been proven. Of course, the principles set out may require other changes to the special diet program. The government may choose various ways of addressing this, such as, for example, revising the schedule to include a more comprehensive list of disabilities or to deal with any gaps through a discretionary category. The request for the Tribunal to take a detailed role in the development of a revised special diet program is, in my view, unnecessary and inconsistent with the role of the Tribunal in relation to the Legislature and executive. These are matters for which the Tribunal is not well suited. Requiring experts outside the government to design policy or retaining jurisdiction in order to supervise changes to the program would be an improper interference in the role of the Minister.

The complainants express scepticism that the government would act appropriately without a detailed order, citing, among other things, the few changes to the schedule since 2005 despite the undertaking at that time that it would be reviewed regularly. I do not share the complainants' concerns. I note, in particular, the strong tradition of compliance with court orders in Canadian society discussed in Doucet-Boudreau. Moreover, should the respondent fail to act reasonably or appropriately following this Decision, the principles in Mackin may support awards of general damages in other cases.

Should the government fail to take reasonable and appropriate action, there remain many Complaints and Applications about the special diet allowance before this Tribunal in which other remedies could be requested. Moreover, under the current human rights system, an application may be filed with the Tribunal by any recipient of social assistance who believes that his or her rights have been violated, and seek appropriate remedies in that proceeding. The Tribunal's role, given the facts of this case, should be as an arbiter of whether individuals' rights are violated by the program, not in designing or evaluating the program as a whole. Accordingly, I will make no other orders.

30The government will have to make various choices as a result of this Decision. It will have to decide on the appropriate level of costing in view of the fact that I have found that the Hepatitis C Guidelines establish a range of increased protein and energy requirements for individuals with chronic hepatitis C. The basis on which I have allowed the complaints is different than that on which Ms. Sengmueller based her initial recommendations and costing. Moreover, the respondent will need to determine, in light of the evidence I have accepted, the scope of the category it will include on the schedule and whether it will include other chronic liver diseases in view of the fact that some evidence provided in this case reflected increased protein and energy requirements for them.

31Events following the Ball decision showed that the period of three months awarded in that case for the respondent to comply with the future compliance remedy was too short for the government to make the necessary policy decisions. See Ball v. Ontario (Community and Social Services), 2010 HRTO 1277. As noted in that Decision at para. 8, the period of three months was "very short, and was shorter than periods for which declarations have been suspended in similar circumstances in constitutional cases". Having considered all of the circumstances, I am of the view that the period for the respondent to comply should be six months. In view of the need for policy development and the possibility of disputes over the implementation of my order, I believe it is appropriate to remain seized for a period of one year in the circumstances of this case to ensure the Tribunal can deal with any such disputes. Otherwise, the remedy should be the same as in Ball.

32I also note that this is not a final Decision in respect of either complaint, as both complainants have other conditions that may be brought forward.

ORDER

33The Tribunal makes the following Orders in the lead cases:

1. The complaints are allowed in part.

2. Within six months of this Decision, the respondent shall provide the complainants with retroactive and ongoing special diet allowance for chronic hepatitis C in accordance with the Code principles set out in this Decision.

3. Commencing within six months, those responsible for administering the Ontario Disability Support Program and Ontario Works shall provide special diet benefits for individuals with chronic hepatitis C in accordance with the Code principles set out in this Decision.

4. I remain seized of these aspects of the complaints for one year to deal with any disputes with respect to the implementation of these remedies.