S.W. v. Dr. Justin Weissglas

COURT FILE NO.: CV-21-00658573-0000

DATE: 20210816

ONTARIO

SUPERIOR COURT OF JUSTICE

IN THE MATTER OF an appeal from a decision of the Consent and Capacity Board pursuant to the Health Care Consent Act, S.O. 1996, c. 2, Sch. A, as amended

AND IN THE MATTER OF S.W., a patient at the UNIVERSITY HEALTH NETWORK – TORONTO WESTERN HOSPITAL, TORONTO, ONTARIO

BETWEEN:

S.W.

Appellant

– and –

DR. JUSTIN WEISSGLAS

Respondent

COUNSEL:

Self-represented

Glynnis P. Burt and Azin Samani, for the Respondent

Maya Kotob and Anita Szigeti, Amicus Curiae

HEARD: July 28, 2021

VERMETTE J.

[1] The Appellant, S.W., appeals the amended decision of the Consent and Capacity Board (“CCB”) dated March 30, 2021 (with Reasons for Decision dated February 24, 2021) confirming the finding that she was incapable of consenting to treatment of antipsychotic and mood stabilizing medications to treat a schizoaffective condition.

[2] Although S.W. was not represented by counsel before this Court, this Court had the benefit of receiving submissions from both S.W. personally and amicus curiae.

Factual Background

[3] At the time of the CCB hearing, S.W. was 26 years old. She was single with no dependents. S.W. holds a Bachelor of Fine Arts. Prior to her current hospitalization, she was living in an apartment with her sister and her sister’s boyfriend.

[4] The record before the CCB with respect to S.W.’s medical history shows a number of psychiatric issues in 2019. In its reasons, the CCB refers, among other things. to S.W.’s hospitalization from June 2 to 21, 2019, and to her doctor’s discharge summary which states that S.W. was “agitated, angry, disorganized, paranoid, suspicious and showed no insight into her illness.” S.W. received continuous outpatient care from July to December 2019. She stopped attending at that time because she was moving to a different city and had a referral to a program for schizophrenia in her new city.

[5] On February 1, 2021, S.W. was admitted to hospital on the authority of an order for psychiatric examination under the Mental Health Act, R.S.O. 1990, c. M.7, which was obtained by her sister due to concerns of poor self-care and medication non-adherence. During her hospitalization, S.W. was restarted on medication and improved, but she refused voluntary admission and was discharged.

[6] On February 6, 2021, there was an incident at the apartment where S.W. was living during which S.W.’s sister feared for her safety as a result of S.W.’s behaviour and actions. S.W.’s sister barricaded herself in her room and called the police. Following the incident, S.W.’s sister and her boyfriend temporarily moved out of the apartment due to safety concerns.

[7] On February 10, 2021, S.W.’s father had another order for psychiatric examination issued and S.W. was brought to the emergency department of Toronto Western Hospital.

[8] On February 11, 2021, a Form 3 “Certificate of Involuntary Admission” was completed with respect to S.W. on the basis of risk of harm to others. S.W. was admitted to the psychiatric intensive care unit with a plan to reassess capacity and decide on treatment. S.W.’s involuntary status was confirmed by the CCB and is not in issue in this appeal.

[9] On February 12, 2021, Dr. Latifa Jaafar assessed S.W. with respect to capacity and treatment. She made the finding that S.W. was not capable to consent to treatment and issued a Form 33 (Notice of Incapacity Finding). The Form itself only indicates that the patient, S.W., has been found not to be mentally capable to consent to treatment of a mental disorder – it does not include, and is not meant to include, any other information in support of the finding.

[10] Dr. Jaafar’s clinical notes with respect to her assessment of S.W. read as follows:

Writer met with [S.W.] this afternoon to discuss her capacity to treatment.

She does not believe she has a mental illness or symptoms of a mental illness. She believes she is stalked by “the dark web” and has been sexually assaulted by individuals on the dark web.

She believes people are addicted to technology and is impacting their brains.

She says her sister and “idiot” boyfriend are uneducated about the affect technology has had on their brains. She is trying to educate them but they won’t listen. She does not understand why she was placed on a form for being a danger to others as she believes she is the one who is in danger of being assaulted.

She does not believe she would benefit from medication as she does not need it. She believes art and music will help her instead.

At this point, I do not feel she is capable to consent to treatment.

I have issued a form 33.

[11] Dr. Justin Weissglas, the Respondent, took over S.W.’s care on February 17, 2021 (the day before the hearing) following S.W.’s transfer from the psychiatric area of the emergency room to the psychiatric intensive care unit.

[12] On February 17, 2021, Dr. Yunlin Xue, a resident physician under the supervision of Dr. Weissglas, conducted a further capacity assessment of S.W. which lasted 2 hours. Dr. Xue’s notes read, in part:

Capacity assessment:

[S.W.] states she is brought to hospital because her parents are “uneducated” and she was “misdiagnosed with paranoid schizophrenia”, a diagnosis that she denies. [S.W.] believes any previous diagnoses of mental illness was due to ‘colonial views’. […] The symptoms of schizoaffective disorder, bipolar type, that I believed she was exhibiting were pointed out to her, including paranoid delusions thought disorganization, grandiosity, hypertalkativeness, tangential speech, decreased sleep, and irritability. She denied these symptoms are linked to schizoaffective disorder and stated that these symptoms are linked to ‘anxiety and PTSD’. She was presented with the benefits and side effects of mood stabilizing medication and antipsychotic medication. Although she was able to understand the information, she denied it can be helpful for her. She previously trialed Latuda, which was documented to be beneficial and is an antipsychotic medication. However, she denied any benefits from Latuda and stated she was ‘better off without it’. She was unable to appreciate any consequences of not being on antipsychotic medication or mood stabilizers. When [S.W.] was questioned about the safety concerns leading to her hospitalization, she greatly minimized and denied them. She stated that her sister “called the police to check up on me when I go to the fridge or listen to music” but is unable to appreciate why police would be called to monitor these actions. She also does not see the link between these periods of agitation and aggression and medication non-adherence.

Assessment: 26-year-old female with a history of schizophrenia spectrum disorder presenting with symptoms consistent with mania and psychosis. Diagnosis is likely schizoaffective disorder. She is incapable to make treatment decisions with respect to mood stabilizers and antipsychotics as she lacks an appreciation of their benefit and risks of medication non-adherence. She continues to have ongoing paranoia regarding being cyberbullied and her family being against her.

[13] At the time of Dr. Xue’s capacity assessment, S.W. had already sought review by the CCB of her involuntary status and the finding of incapacity. Dr. Xue continued her on the existing Forms 3 (involuntary status) and 33 (incapacity finding), with a plan to discuss medication options following the review.

[14] Dr. Weissglas met with S.W. for approximately 30 minutes on February 18, 2021, the day of the CCB hearing. He summarized his discussion with S.W. as follows in his testimony before the CCB:

DR. WEISSGLAS: Thank you. I will be primarily relying on the written documentation. I just want to add, so I had the pleasure of interviewing [S.W.] earlier today and getting to know her a little bit better. And based on that assessment, I continue to find her incapable of consenting to both antipsychotic and mood stabilizing medications. And the finding is based on the second arm, the appreciation. To briefly summarize the discussion that we had today, which largely reflects the discussion that was had by my colleagues previously, [S.W.] identifies that she has experiences of trauma and anxiety, but strongly disagrees with the idea that she may have any symptoms of psychosis or mania or has had those in the past. She doesn’t unfortunately appreciate the extent or seriousness of her illness or even the presence of those symptoms. And so I do reconfirm the findings that were outlined in the notes that you’ve read previously.

Q. And today, as of today, your assessment as well, you find her incapable?

A. Incapable; yes.

Q. And what, what -- please walk me through, or to the Board, what did you explain to the -- to my client?

A. So, I asked her about her current symptoms and her current situation and she in detail outlined -- although it’s difficult to follow, themes of being persecuted, stalked online, as well as some information I couldn’t really follow. I proposed to her that I believe that this was -- that these were part of her psychosis, that it was her illness manifesting as feeling very unsafe, when in fact these situations were safe and making her behave in ways that are informed by that decision. She very clearly told me she did not believe that that was the case, that these were 100 percent true that these things were happening, that she didn’t believe that she had a mental health condition outside of anxiety and what she described as PTSD. I asked her what the symptoms of PTSD and anxiety were and she wasn’t able to elaborate. She then told me about something else that was [sic] seemed to be unconnected. I asked her if her medications have ever been helpful and I attempted to discuss the medications with her. She was able to identify some of the side-effects that she’s experienced with medication, but when asked if medication has ever been helpful she said, “No, it has never been helpful, it’s only ever made me worse and it’s only ever made me have mental health problems.”

So, she, she didn’t see any kind of connection to medication having improved -- cause any kind of improvement in the symptoms. She doesn’t recognize that she is suffering from any symptoms of a mental health condition, that, that she is suffering from and she doesn’t see any of her belief system as delusional in nature.

Q. Okay. And, sorry, you mentioned -- did you explain to her the effects of each medication that you’re proposing?

A. So, I, I attempted to have a discussion with her around that, but she was so obviously unable to appreciate how ill she was and she was so uninterested in that discussion that we weren’t able to get any further than what we got.

[15] During her testimony, S.W. explained as follows what she meant when referring to PTSD:

Q. So, is that, is that your way of describing PTSD, whether it’s correct or not?

A. Well, my, well my way of describing PTSD is, like, those are my traumas and, you know, the fact is I’m definitely suffering some form of past trauma that is influencing the fact that I can’t sleep at night or maybe I need a weighted blanket to reduce stress.

[16] When asked if she would accept an alternative medication or treatment plan, S.W. stated that she would not. She indicated that she would like to take care of her own needs by practicing meditation and taking care of her body, mind and spirit.

Legal Framework

[17] The right to refuse unwanted medical treatment is fundamental to a person’s dignity and autonomy: Starson v. Swayze, 2003 SCC 32 (“Starson”) at para. 75. The test for capacity to consent to treatment is set out in subsection 4 of the Health Care Consent Act, 1996, S.O. 1996, c. 2, Sched. A (“Act”):

A person is capable with respect to a treatment, admission to a care facility or a personal assistance service if the person is able to understand the information that is relevant to making a decision about the treatment, admission or personal assistance service, as the case may be, and able to appreciate the reasonably foreseeable consequences of a decision or lack of decision.

[18] Subsection 4(2) of the Act provides that a person is presumed to be capable with respect to treatment, admission to a care facility and personal assistance services. The presence of a mental disorder cannot be equated with incapacity: Starson at para. 77.

[19] Subsection 32 of the Act provides that “[a] person who is the subject of a treatment may apply to the [CCB] for a review of a health practitioner’s finding that he or she is incapable with respect to the treatment.” In an application to the CCB, the CCB may confirm the health practitioner’s finding or may determine that the person is capable with respect to the treatment and, in doing so, may substitute its opinion for that of the health practitioner: subsection 32(4) of the Act. At a capacity hearing, the onus is on the attending physician to prove on a balance of probabilities that the patient is incapable: Starson at para. 77.

[20] S.W.’s ability to understand the information that is relevant to making a decision about the treatment was not in issue before the CCB and is not in issue before this Court. The only issue is whether S.W. is able to appreciate the reasonably foreseeable consequences of a decision or lack of decision. In Starson at paras. 78-80, the Supreme Court of Canada made the following points with respect to this criterion:

a. It requires the patient to be able to apply the relevant information to their circumstances, and to be able to weigh the foreseeable risks and benefits of a decision or lack thereof.

b. The Act requires a patient to have the ability to appreciate the consequences of a decision, but it does not require actual appreciation of those consequences. In practice, the determination of capacity should begin with an inquiry into the patient’s actual appreciation of the parameters of the decision being made: the nature and purpose of the proposed treatment; the foreseeable benefits and risks of treatment; the alternative courses of action available; and the expected consequences of not having the treatment. If the patient shows an appreciation of these parameters — regardless of whether he weighs or values the information differently than the attending physician and disagrees with the treatment recommendation — he has the ability to appreciate the decision he makes. The Court of Appeal for Ontario has indicated that “this inquiry must start with some evidence as to the foreseeable benefits and risks of treatment and the expected consequences of not having treatment”: see Anten v. Bhalerao, 2013 ONCA 499 at para. 23.

c. A patient need not agree with the diagnosis of the attending physician in order to be able to apply the relevant information to their own circumstances.

d. While a patient need not agree with a particular diagnosis, if it is demonstrated that they have a mental “condition”,[^1] the patient must be able to recognize the possibility that they are affected by that condition.

e. A patient is not required to describe their mental condition as an “illness”, or to otherwise characterize the condition in negative terms. Nor is a patient required to agree with the attending physician’s cause of that condition.

f. Nevertheless, if the patient’s condition results in them being unable to recognize that they are affected by its manifestations, the patient will be unable to apply the relevant information to their circumstances, and unable to appreciate the consequences of their decision. [Emphasis added.]

Reasons of the CCB

[21] As stated above, the CCB received viva voce evidence of S.W. and Dr. Weissglas, S.W.’s attending physician at the time of the hearing. Dr. Weissglas also adduced in evidence a document brief containing supporting evidence regarding S.W.’s medical history, including medical notes. S.W. was represented by counsel provided by Legal Aid Ontario at the hearing.

[22] The CCB reviewed the evidence and the law with respect to: (1) S.W.’s involuntary detention pursuant to the Mental Health Act, R.S.O. 1990. C. M.7; and (2) the finding that she was incapable to make her own treatment decisions respecting the mental condition from which she was alleged to suffer. The CCB confirmed both the involuntary status and the finding of incapacity with respect to treatment. As stated above, the issue of S.W.’s involuntary status is not before this Court.

[23] The reasons of the CCB on the issue of whether the evidence established that S.W. was unable to appreciate the reasonably foreseeable consequences of a decision or lack of decision about the treatment in question read as follows:

SW testified that she suffered post-traumatic stress disorder. She did not attach the symptoms her family and treatment team reported to that condition. At no point during her current hospitalization or in her evidence at the Hearing did SW acknowledge the possibility that she suffered a mental condition the symptoms of which included paranoia, mania and aggression. She also denied being paranoid or manic. Or aggressive, other than to first protect JW from her boyfriend and then to protect herself from them, assertions we rejected in preference to JW’s explanation to Dr. Xue.

SW denied prior treatment provided any benefit to her. We had Dr. Banik’s discharge summary following SW’s 2019 hospitalization. In it Dr. Banik wrote in part that in hospital, “… She has been treated with oral and injectable Abilify. Over time she started to show gradual improvement. Prior to her discharge, her psychotic symptoms improved significantly.”

To paraphrase Justice Major in Starson, quoted above at p. 6, SW could not recognize she was affected by manifestations of a mental condition and was therefore unable to appreciate the consequences to herself of treatment decisions.

[24] The CCB also made the following findings with respect to credibility:

Dr. Weissglass [sic] testified credibly and there was ample corroboration in Exhibit 1 for what [sic] his evidence. SW testified forthrightly but she confabulated so that what she testified about would not appear to be based on delusional beliefs or be a display of symptoms of a major mental condition. She frequently interrupted the Hearing despite repeated admonitions to refrain, a lack of restraint I as Presiding Member warned her the Panel could consider in our deliberations. Where SW's evidence diverged from Dr. Weissglass's [sic] or the evidence of other health practitioners set out in Exhibit 1, we preferred theirs to hers.

Standard of review

[25] Section 80 of the Act sets out the statutory right of a party to a proceeding before the CCB to appeal to this Court on a question of law, fact, or both. On appeal, this Court may exercise the powers of the CCB, substitute its opinion for that of the health practitioner, the substitute decision-maker, or the CCB, or refer the matter back to the CCB with directions for a rehearing in whole or in part. On an appeal under the Act, the Court’s task is to review the CCB’s finding of incapacity in relation to the patient’s capacity at the time of the hearing: Starson at para. 119.

[26] The Respondent and amicus curiae agree that because the legislature has provided for an appeal from the decision of the CCB to this Court, the appellate standard of review applies to the CCB’s decision: see Canada (Minister of Citizenship and Immigration) v. Vavilov, 2019 SCC 65.[^2] Thus, as set out in Housen v. Nikolaisen, 2002 SCC 33, the standard of correctness applies to questions of law and the standard of palpable and overriding error applies to questions of fact and questions of mixed fact and law, unless an error of law can be extricated from the mixed question of fact and law, in which case the standard of correctness applies.

[27] It is clear on the face of the CCB’s Reasons that the CCB turned its mind to the appropriate test set out in the Act and explained in Starson. In my view, the CCB set out the applicable legal test correctly, and the issues in this appeal pertain to the application of the law to the facts and are questions of mixed fact and law. As a result, the standard of review is palpable and overriding error. This standard was described as follows by the Court of Appeal in Farsi v. Da Rocha, 2020 ONCA 92 at para. 35:

A palpable and overriding error is one that is clearly wrong, unreasonable, or not reasonably supported on the evidence: H.L. v. Canada (Attorney General), 2005 SCC 25, [2005] 1 S.C.R. 401, at para. 110. The Supreme Court recently explained in Salomon v. Matte‑Thompson, 2019 SCC 14, 432 D.L.R. (4th) 1, at para. 33, “[w]here the deferential standard of palpable and overriding error applies, an appellate court can intervene only if there is an obvious error in the trial decision that is determinative of the outcome of the case.”

Issues raised by amicus curiae

[28] Amicus argues that the capacity assessment and Form 33 issued by Dr. Jaafar on February 12, 2021 was inadequate. Amicus points out that Dr. Jaafar did not testify before the CCB and takes the position that Dr. Jaafar’s notes are deficient in many respects, including that they fail to deal with a number of points and are insufficiently detailed. Amicus also argues that the CCB could not consider any evidence of incapacity outside of Dr. Jaafar’s capacity assessment, and that the evidence provided by Dr. Weissglas and Dr. Xue could not “cure” or “rectify” Dr. Jaafar’s deficient capacity assessment.

[29] What amicus proposes is, in effect, to treat Dr. Jaafar’s clinical notes of February 12, 2021 like the reasons for decision of an administrative tribunal and as the only basis on which Dr. Jaafar’s finding of incapacity can stand or fall. I reject such a formalistic approach, which is not reflected in the case law and for which no authority was provided. Further, I note that Form 33, which needs to be provided to a patient in the event of a finding of incapacity, does not require that reasons be included.

[30] The case law is clear that, when the CCB makes a decision, the relevant time period relating to the assessment of the patient’s capacity or incapacity is at the time of the hearing: see Starson at para. 118; L.W. v. Kantor, 2016 ONSC 3228 at paras. 24-25 and 29; and Allen v. Joannou, 2021 ONSC 4730 at para. 42. As such, it is within the CCB’s mandate to review and rely on facts leading up to the hearing, and to consider the full record in assessing the issue of capacity at the time of the hearing: see Salem v. Hastings, 2015 ONSC 5071 at para. 22. See also, for instance, Gajewski v. Wilkie, 2014 ONCA 897 at para. 39, where the Court of Appeal noted that the CCB had considered a physician’s “second opinion” regarding the patient’s capacity to consent that was prepared at the request of the physician who had made the initial finding of incapacity.[^3]

[31] If the approach proposed by amicus were right, the scope of the permitted evidence before the CCB would be very limited, and the attending physician would not be allowed to expand on his or her notes. Further, taken to its logical extreme, the Board would not be able to consider evidence or testimony of the applicant which would support a finding of incapacity, but which was not exactly the same as what was noted in the health practitioner’s notes and/or what the applicant said at the time of the capacity assessment. Again, such formalism is not reflected in the case law.

[32] While it is true that they are not very detailed, Dr. Jafaar’s notes show that she applied the correct test when assessing S.W.’s capacity. Among other things, Dr. Jaafar found that S.W.: (a) did not believe that she had symptoms of a mental illness, and (b) did not believe that she would benefit from medication as she did not need it. Dr. Jaafar’s notes also document some of S.W.’s delusional beliefs. The notes should be read in light of the broader context that includes S.W.’s medical history and recent hospitalizations (two in February 2021), and the fact that S.W. was treated with antipsychotic and mood stabilizing medications in the past (and as recently as February 1, 2021, less than two weeks before Dr. Jaafar’s assessment).

[33] Dr. Jaafar’s findings were confirmed and reconfirmed by Dr. Xue and Dr. Weissglas before and at the hearing, and both provided additional information in support of these findings. Further, S.W.’s testimony at the hearing was consistent with these findings. The CCB was entitled to consider all this information when ruling on the issue of S.W.’s capacity to consent to treatment at the time of the hearing.

[34] As part of their argument that S.W.’s capacity assessment was inadequate, amicus argues that there is no evidence that the proposed treatment was sufficiently discussed with S.W.

[35] There was evidence before the CCB that treatment with antipsychotic and mood stabilizing medications would provide a benefit to S.W., and that such treatment had a positive impact on her in the past. Therefore, the situation in this case is different than in Anten v. Bhalerao, 2013 ONCA 499 at paras. 24-25 and Masih v. Siekierski, 2015 ONSC 2877 at para. 39, which are relied upon by amicus.

[36] Further, the evidence before the CCB shows that information was given to S.W. about the benefits and side effects of mood stabilizing medication and antipsychotic medication by Dr. Xue, Dr. Weissglas and likely Dr. Jafaar as she noted that S.W. “does not believe she would benefit from medication as she does not need it.” The fact that Dr. Weissglas and/or others were unable to engage in a detailed discussion with S.W. about medications because she was uninterested is not a basis to challenge the CCB’s finding of incapacity in this case: see Snell v. Head, 2018 ONSC 1516 at para. 30 and S.S. v. Mottaghian, 2021 ONSC 137 at paras. 29-30.

[37] As the Court of Appeal stated in Giecewicz v. Hastings, 2007 ONCA 890 at para. 42, “[t]his was not a case where it could be suggested that the appellant’s lack of appreciation of the risks and benefits reflected the ‘physician’s failure to adequately inform the patient of the decision’s consequences’”, which is a possibility discussed in Starson at para. 111. Rather, in the present case, S.W.’s lack of appreciation of the risks and benefits flowed from her inability, as a result of her condition, to appreciate consequences and perform a risk/benefit analysis of taking or not taking the medications: see D'Almeida v. Barron, 2010 ONCA 564 at para. 26 and Coburn v. Wilkie, 2016 ONCA 876 at paras. 19-21. As the Supreme Court of Canada stated in Starson at para. 79:

[I]f the patient’s condition results in him being unable to recognize that he is affected by its manifestations, he will be unable to apply the relevant information to his circumstances, and unable to appreciate the consequences of his decision.

[38] A review of the CCB’s decision in the context of the evidence it heard satisfies me that the CCB’s analysis was based in the evidence and reflects an application of the proper legal principles to that evidence. The CCB found that S.W. did not acknowledge that she suffered a mental condition the symptoms of which included paranoia, mania and aggression, and that she denied that prior treatment provided any benefit to her. Quoting from Starson, the CCB concluded that S.W. could not recognize that she was affected by manifestations of a mental condition and that she was therefore unable to appreciate the consequences to herself of treatment decision. I can see no palpable and overriding error in the CCB’s conclusions with respect to S.W.’s capacity to consent to treatment, and no obvious error in its decision that is determinative of the outcome of the case.

Additional issues raised by S.W.

[39] In her factum and oral submissions, S.W. raised concerns with respect to, among other things, privacy law, access to medical records, human rights law, patient rights matters and alleged violations of the Canadian Charter of Rights and Freedoms. As I explained to S.W. during the hearing, such issues do not form the subject of this appeal and are not properly before this Court.

[40] In her factum, S.W. also alleged that she was denied procedural fairness because the hearing was not conducted in a bilingual (English and French) format. However, there is no evidence before me that S.W. or her counsel requested at any time a bilingual hearing before the CCB. While this is sufficient to dispose of this point, I would add that I have serious doubts that S.W. has the capacity to participate in a hearing in French. S.W. filed a bilingual factum, but the French parts of her factum required substantial guesswork on the part of the reader in order to try to ascertain their meaning.[^4] I also note that at the hearing, S.W. chose to make her oral submissions mostly in English, but she read a couple of the paragraphs of her factum written in French. When this occurred, the interpreter was unable to interpret what she was saying and, when he was provided with the text of the relevant paragraphs of S.W.’s factum, he had difficulty understanding the meaning of the paragraphs and translating them in English.[^5]

Conclusions

[41] In light of the foregoing, S.W.’s appeal is dismissed.

[42] Neither party is seeking costs of this appeal. As such, I make no order as to costs.

Vermette J.

Released: August 16, 2021

[^1]: Condition refers to the broader manifestations of the illness rather than the existence of a discrete diagnosable pathology: see Starson at para. 79.

[^2]: S.W. did not address the issue of the applicable standard of review in her submissions.

[^3]: The evidence of two physicians was also considered in Starson.

[^4]: For instance, in a number of paragraphs drafted in French, S.W. used the noun “défenseurs” as the translation for the verb “advocates”.

[^5]: This is one example: “Cette situation est un crime du haine, qui remmencait les jour en crime durait trois ans. La l'hôpitals et la Commission du Consentement et de la Capacité dans le cadre d'une audience et documents nous non-accessible et nous non- équitable en billingue en français et l'anglais.”