COURT FILE NO.: CV-21-00077420-0000
DATE: 20220531
ONTARIO
SUPERIOR COURT OF JUSTICE
AND IN THE MATTER OF AN appeal from a decision of the Consent and Capacity Board, pursuant to the Health Care Consent Act, 1996, S.O. 1996, c.2, Schedule A, as amended and pursuant to the Mental Health Act, R.S.O. 1990, c. M.7, as amended
BETWEEN:
G.B.
Appellant
– and –
Dr. Khashayar Shariati
Respondent
Russell W. Browne, for the Appellant
Julia L. Lefebvre, for the Respondent
HEARD: May 19, 2022, via ZOOM
SHEARD J.
REASONS FOR DECISION
Introduction
[1] This is an appeal from a decision of the Consent and Capacity Board (the “Board”) dated October 29, 2021 (the “Decision”), with reasons released November 5, 2021 (the “Reasons[^1]”), in which the Board confirmed the finding of the Respondent, Dr. Shariati, that the Appellant, G.B. (“GB”), is incapable of consenting or refusing consent to treatment with antipsychotics.
[2] GB raises two issues on the appeal:
(1) Whether the Board erred in law in applying the test for capacity set out in s. 4(1) of the Health Care Consent Act, 1996, S.O. 1996, c.2, Sched. A, as amended (“HCCA”); and
(2) Whether the Board made errors of fact and/or mixed fact and law in applying the test for capacity based on the evidence before it.
[3] GB alleges that the evidence before the Board showed that he had the ability to appreciate the consequences of his treatment decision and that he had decided not to receive antipsychotic medications because he concluded their side effects outweighed any therapeutic benefits.
Standard of Review
[4] GB’s appeal is brought as of right pursuant to section 80 of the HCCA which permits an appeal from a decision of the Board on a question of law or fact or both.
[5] On the appeal, the court may exercise all the powers of the Board; substitute its opinion for that of a health practitioner, an evaluator, a substitute decision-maker or the Board; or refer the matter back to the Board, with directions, for a rehearing in whole or in part.
[6] On a statutory appeal from an administrative tribunal, pure questions of law are reviewed on a correctness standard, and on mixed questions of fact and law, in which there is no extricable error of law, the standard of review is palpable and overriding error: see Canada (Minister of Citizenship and Immigration) v. Vavilov, 2019 SCC 65 at paras. 36-37.
[7] As noted in A.S. v Sum, 2021 ONSC 4296, at paras. 7 and 8, the Board is entitled to “some considerable deference with respect to its assessment of the credibility and reliability of the evidence it received…because the Board was in the unique position of being able to hear from the witnesses and assess credibility in a way that a paper record, on appeal, does not afford. However, “[t]he requirement of deference must not sterilize such an appeal mechanism to the point that it changes the nature of the decision-making process the legislature intended to put in place” Vavilov, at para. 36. On this appeal, the court adopts the approach taken by the court in A.S. v. Sum, to keep this “guiding principle in mind”.
[8] The court also adopts the following statement of the standard of review to be applied on questions of mixed fact and law as set out in BL v. Ptyyck, 2021 ONCA 67, at para. 22:
…The Board’s application of the statutory test for capacity to the evidence to determine whether a person is capable is a question of mixed fact and law, reviewable on the deferential standard of palpable and overriding error, absent an extricable question of law in the Board’s analysis: [citations omitted]
[9] The events leading to this appeal are briefly summarized as follows:
(i) GB was found not criminally responsible on account of a mental disorder in connection with charges of arson causing damage to property on January 4, 2021, following which, the Ontario Review Board (the “ORB”) ordered GB’s detention in hospital. GB is currently a patient at St. Joseph’s Healthcare Hamilton – West 5th Campus (“SJHC”);
(ii) On September 30, 2021, Dr. Shariati found GB incapable with respect to consenting to antipsychotic medication to treat his delusional disorder, persecutory type;
(iii) GB applied to the Board to review Dr. Shariati’s finding of incapacity;
(iv) Dr. Shariati and GB testified at the Board hearing. GB was represented by experienced legal counsel. Dr. Shariati represented himself. Dr. Joseph Ferencz, GB’s attending physician, also attended;
(v) The Board found GB capable with respect to the first branch of the two-part test for capacity to consent to treatment found under subsection 4 (1) of the HCCA and determined that GB was able to understand the information relevant to a decision with respect to the treatments proposed i.e., GB was able to him to take in, retain and process the objective information;
(vi) However, with respect to the second branch of the two-part test, the Board concluded that there was “sufficient clear, cogent, and compelling evidence to meet the standard of proof that, as a result of a psychotic mental condition, GB lacked the capacity to appreciate his condition in the reasonably foreseeable consequences of a decision or lack of a decision with respect to antipsychotics” (Reasons, p.24); and
(vii) On November 1, 2021, GB appealed the Decision and now seeks an order quashing the Decision and a finding by this court that GB is capable; or, in the alternative, an order remitting the matter back to the Board for a new hearing, subject to such directions as this court deems proper.
The Decision
[10] In the Reasons, the Board noted that GB was a 35-year-old single man with a high school education and some university. He completed an apprenticeship program to become an electrician and, at times, had been employed at ski resorts and as a paid electrical apprentice. At the time of the hearing, GB was unemployed and supported by ODSP.
[11] The Board noted that GB was under the supervision of the ORB following an index offence, namely, arson damage to property contrary to section 434 of the Criminal Code of Canada, RSC 1985, c. C-46 (“CCC”) which occurred on October 16, 2020, and for which GB was found not criminally responsible (“NCR”) on January 4, 2021. GB was admitted to SJHC with a diagnosis of delusional disorder, persecutory type.
The Board Hearing
[12] The Board hearing took place over 2 days: October 13 and October 29, 2021. The Board heard the oral testimony of Dr. Shariati and GB and received three exhibits: Exhibit 1: the documentary brief of Dr. Shariati; Exhibit 2: photocopies of pages taken from the Journal of Clinical Pharmacology; and Exhibit 3: photocopies of two pages taken from WebMD.
[13] Exhibit 1 was comprised of Forms signed pursuant to the Mental Health Act, R.S.O. 1990, c. M.7, as amended, (“MHA”) and the HCCA; the CCB Summary signed by Dr. Shariati on October 12, 2021, setting out Dr. Shariati’s finding of incapacity, proposed treatment plan, information given to GB and an explanation for Dr. Shariati’s finding of incapacity; Progress Notes of Dr. Courtright; Progress Notes of H. Moulden, psychologist; Plans of Care of N. Wilz, RN, and J. Forbes, RPN; and Administrator’s Report to the Ontario Review Board dated February 5, 2021 (the “ORB Report”), filed in advance of the ORB hearing.
[14] Under the heading “Personal Background”, the CCB Summary referred the reader to the ORB Report.
The ORB Report
[15] The ORB Report contains details of the arson committed by GB (the index offence), and the criminal proceedings that ensued, together with a family and social history of GB compiled from GB and family members while GB was at SJHC. The ORB Report sets out GB’s psychiatric history and his earlier in-patient admissions and included GB’s (then) diagnosis, medications, capacity issues and his clinical course while at SJHC, and concluded with a Clinical Risk Summary and Disposition Recommendations. Attached to the ORB Report was a Psychological Risk Assessment dated January 28, 2021, which assessed GB’s risk from the perspective of the risk that GB posed “to recidivate violently”.
[16] On the first day of the hearing, counsel for GB objected to the inclusion in evidence of the ORB Report on the basis that it was not relevant and was prejudicial. In the alternative, counsel for GB submitted that he should be permitted to make submissions on the weight to be given to the ORB Report.
[17] In response to GB’s objections, Dr. Shariati submitted that the ORB Report was included to provide history and context for GB’s background; to explain how GB’s mental illness led to his being found NCR and subject to the ORB. Dr. Shariati left it to the discretion of the Board whether to exclude all or part of the ORB Report.
[18] The Board determined that the ORB Report was not a document “generally objected to at a CCB hearing” and agreed with Dr. Shariati that the ORB Report provided a history and context for the matter and was, therefore, relevant. However, the Board invited GB’s counsel to make submissions as to the weight to be given to the ORB Report, which he chose not to make at that time.
Other Evidence Before the Board
[19] No objection was raised to the Board accepting into evidence the other documents that formed part of Exhibit 1.
[20] In the CCB Summary itself (i.e., without reference to the ORB report), Dr. Shariati refers to GB’s history with delusional disorder and his numerous interactions with various mental health providers. It also references the reason for the ORB detention order, namely the arson, and GB’s delusion that he is “on the run from the mob” and is “being pursued by a gang” and GB’s incorrect belief that the goal of the treatment team is to use antipsychotic medication to make GB forget about those [real] concerns.
[21] The CCB Summary states that GB actively believes that he is being pursued by a gang and is not able to acknowledge or appreciate that this worry is based on a delusion; also, that GB does not appreciate the chronic, active and pervasive nature of his delusional disorder and its impact on himself and others.
[22] In the Progress Notes prepared by Dr. Courtright, she documents that GB expressed a paranoid ideation that he was subject to threats by the Hells Angels who may want to put him through a “meat grinder” and that a co-patient on GB’s unit is also involved with the Hells Angels.
[23] The Progress Notes prepared by Heather Moulden note that GB reported that he suffers from PTSD from his past experiences with the Hells Angels and that he faces an ongoing threat from that organization. The notes state that GB minimized “the index offences [the arson] and of the possible impact his actions would have had on his family”. The Progress Notes also document that GB disagrees that his beliefs about the Hells Angels are delusional in nature; that he has no intention of taking antipsychotic agents; and disagrees with his psychiatrist’s opinion respecting his medication needs.
[24] The Nursing Assessment prepared by N. Wilz notes that GB referred to the antipsychotic medication Haldol as “poison”, and that he does not want to take medication but wishes, instead, to receive CBT (cognitive behaviour therapy) from which, he believes, he would benefit. These notes include a heading “Risks” under which are listed Violence, Harm to others; Fire risk; risk factors for suicide: hopelessness, depressed mood, and anxiety.
Oral Evidence
(a) Dr. Shariati
[25] In his testimony at the Board hearing, Dr. Shariati stated that GB suffers from a severe and long-standing psychotic disorder and was a patient pursuant to the ORB detention order. He testified that GB has not received appropriate treatment and that GB denies that he experiences delusions.
[26] Dr. Shariati testified that in his opinion, GB does not have the ability to appreciate the consequences of his illness and does not appreciate the benefits antipsychotic treatment can provide, nor the consequences of not receiving treatment. In cross-examination, Dr. Shariati acknowledged that GB had not undergone any CBT and explained why CBT would not be an appropriate alternative treatment.
(b) GB
[27] GB also testified at the hearing, He stated that he was able to understand the reasonably foreseeable consequences of antipsychotic medication because he had been on them for two weeks and had suffered serious side effects - including “suicidal thoughts, feeling vapid and empty, impotence, and restlessness” with no therapeutic benefits.
[28] In his evidence in chief and in cross-examination, GB was asked whether he understood that he had a mental health condition. In chief, DB responded that he did have “delusional, persecutory symptoms, which basically means that I, I struggle to understand what is safe and what is not safe”.
The Decision
(i) Identification of the applicable law
[29] At p. 3 of the Reasons, the Board correctly states that the onus of proof on any review of incapacity under the HCCA rests with the physician, on a balance of probabilities, and that the Board must be satisfied “on the basis of cogent and compelling evidence that the physician’s onus has been discharged” and that hearsay evidence may be considered but carefully weighed.
[30] At. p. 4 of the Reasons, the Board correctly states that GB is presumed to be capable to consent to treatment and reproduces the two-part test for capacity to treatment found in section 4 (1) of the HCCA:
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.
[31] The Board applied the test for capacity set out in the seminal case of Starson v. Swayze, [2003] SCC 32, at p. 78 (“Starson”). It found that GB was able to understand information relevant to a decision with respect to the treatments proposed and the first branch of the two-part capacity test was met. No appeal is advanced from that finding.
[32] With respect to the second branch of the test, the Board correctly stated out the second branch of the test, set out in Neto v. Klukach, [2004] O.J. No. 394:
The second branch assesses the ability to evaluate, not just understand, information. The patient must have an ability to appreciate the relevant information as it relates to him or her.
(ii) Review of the Evidence
[33] In the Reasons, the Board reviewed the evidence and its analysis of the evidence to the second part of the test under s. 4(1).
[34] Pages 5 to 24 of the Reasons, summarized in part below, contain the Board’s review and analysis of the evidence.
[35] The Board considered the evidence put forth by Dr. Shariati that GB suffered from delusional disorder which manifested itself in persecutory delusions.
[36] The Board noted GB’s history of psychiatric admissions, many of which related to GB’s long-standing delusional beliefs concerning threats posed to him by the Hells Angels and/or a “Mafia biker mob”. The Board noted that GB had had legal difficulties and had posed a risk to himself and others in the past as a result of his delusions (Reasons, at pp.7, 8).
[37] The Board considered Dr. Shariati’s evidence that:
(a) a reasonably foreseeable consequence of taking the antipsychotic treatment was that the manifestations of GB’s mental condition would improve whereas the reasonably foreseeable consequences of being untreated was that his delusional disorder was unlikely to improve and might worsen, and was more likely to become treatment resistant;
(b) although GB had taken antipsychotic medication at times, he did not stay on that medication for longer than two weeks and never reached a therapeutic dose and, for that reason, GB was unable to appreciate the benefit of this medication.
(c) GB was not able to appreciate the foreseeable risks and benefit of the treatment because he was not able to acknowledge or appreciate that his worries about being pursued by a gang were delusional in nature (Reasons, at p. 8);
(d) GB was reported to have disagreed with his diagnosis and that his core symptom was paranoid delusions and, instead, attributed his thoughts and behaviours to PTSD, something fundamentally different from delusional disorder.
[38] The Board summarizes the testimony of Dr. Shariati at p. 12 of the Reasons:
The testimony of the doctor was that GB had a severe longstanding psychotic mental disorder and he was presently under a detention order. The doctor said that GB was not treated at the time of the hearing with the appropriate dose of antipsychotic medication. The doctor said GB denied delusions and that GB did not appreciate the benefits of treatment and did not appreciate the consequences of no treatment.
[39] The Board considered the opinion of Dr. Courtright who:
(a) reported that GB expressed concerns that Haldol (and antipsychotic) would affect his thinking and would cause impotence;
(b) noted that GB reported having been poisoned with antipsychotic medication and asked that the doctors “give up on their antipsychotic hypothesis”;
(c) noted that when she advised GB that he required treatment with antipsychotic medication and that psychosis was the underlying source of his anxiety and fear, as opposed to PTSD, GB became frustrated and disengaged; and
(d) was of the opinion of that GB had “very poor insight into his mental illness and did not conceive of himself as suffering from delusions or an underlying psychotic disorder, but rather PTSD.” (Reasons, at p. 9)
[40] The Board considered the psychologist’s report note in which:
(a) GB was noted to be seeking to access CBT for PTSD that he believed he suffered as a result of his past experiences with the Hells Angels from whom he faced an ongoing threat; and
(b) GB is noted to have delusional beliefs that he was “overdosed” on psychiatric medications and put into a coma for several days to weeks and was in litigation with the hospital, who now wished to have GB medicated so that he would not follow through with his lawsuit (Reasons, at p. 10).
[41] The Board noted that, according to the psychologist,
“the active nature of GB’s delusional belief system, coupled with his lack of insight, would impede his ability to fully engage in and benefit from psychological interventions at the time [and]…that providing CBT for PTSD would be counterproductive, as such treatment would likely serve to reinforce rather than address his delusional beliefs” (Reasons, at ps. 10, 11)
[42] The Board considered the nursing assessments of September 16 and October 8, 2021, in which GB identified Haldol as “poison”; expressed his belief that he needed CBT; and reiterated his delusional beliefs that the Hells Angels were after him and had wanted him dead for the previous seven years and that if he left the hospital grounds, he would be killed.
[43] The Board considered GB’s evidence denying that he had received any benefit from the antipsychotic treatment he had been given, noting only negative side effects; that when GB was asked to describe one delusion, he responded that there were multiple attempts on his life and strangers at his house and a gun pulled on him, which caused him anxiety; that, although that GB believed that CBT would help him, he was not sure what CBT was, but was sure that it would not work together with antipsychotic treatment; and the medical research and data on the use of antipsychotics was scarce and biased and suggested that delusional disorder was highly resistant to medication alone.
[44] The Board noted that, when questioned by his counsel, GB acknowledged that he had a mental condition, which he described as “delusional and persecutory”. When asked to describe his symptoms, GB responded that “he struggled to understand what was safe and what was not safe”.
[45] GB repeated this answer when he was questioned by Dr. Shariati, and further stated that he had experienced traumatic events, which caused anxiety. When Dr. Shariati asked GB if they had discussed that GB’s most prominent anxiety was that a member of the Hells Angels pulled a gun on him, GB responded that he was not sure who pulled a gun on him. (Reasons, at p. 13 14).
[46] The Board noted that when Dr. Shariati asked GB whether he agreed with the description of events in the past and that his beliefs about being pursued by the Hells Angels were delusions, GB responded that he continued to struggle with what was and what was not safe that he had never disagreed with his diagnosis of delusional disorder. However, when GB was asked whether he recalled telling the doctor that people were aware there was a “hit” on him by the Hells Angels, GB replied that he had never said that (Reasons, at pp. 15-16).
(iii) Evidentiary Findings and Application of the second branch of the test
[47] The Board accepted Dr. Shariati’s evidence under the second branch of the test that GB was incapable, which was supported by other psychiatrists such as Dr. Courtright and the psychologist who assessed GB.
[48] The Board accepted the evidence of Dr. Shariati that GB had been given information about his psychosis and the risks/benefits of treatment with antipsychotics and found it to be clear from GB’s evidence that GB had not considered or acknowledged the potential benefit of treatment with antipsychotic medication.
[49] The Board considered the testimony of GB in which he acknowledged that he had been diagnosed with delusional disorder, and had never disagreed with that diagnosis, to be inconsistent with the documentation of the doctor where it was reported that GB had denied that he experienced delusions.
[50] The Board noted that while GB acknowledged that his mental condition was labelled as delusional disorder, GB was not able to acknowledge the manifestations of the mental condition – the delusions -- which were described in the evidence of the doctor and had been a very long-standing duration.
[51] The Board accepted the evidence of the doctor and of GB, that GB believed that he suffered from anxiety and PTSD; that GB wanted CBT, a treatment for PTSD, which was contraindicated for GB, although it could be considered when used together with antipsychotics. The Board concluded that GB was not able “to appreciate that CBT for his psychotic mental condition required that it be in association with treatment with antipsychotics at a therapeutic dose and for therapeutic length of time” (Reasons, p. 23).
[52] The Board did not accept GB’s evidence on his reported side effects when he received antipsychotics, accepting the other evidence that the reported side effects were not normally observed with such treatment, and that there was no evidence that GB’s suicidal thoughts were caused by treatment with antipsychotics as opposed to being a manifestation of his mental condition.
[53] The Board concluded that it could give GB’s evidence little weight and that parts of his testimony lacked credibility as being inconsistent with reports of the treatment team. For example, the Board noted that while “GB’s delusions centred around the Hells Angels for many years, GB was not able to describe a specific delusion when asked.” (Reasons at p. 23, 24).
(iv) Conclusions
[54] The Board found that GB lacked the ability to appreciate that he experienced the manifestations of a psychotic mental condition and, as a result, was unable to apply the relevant information about the proposed treatment with antipsychotics to his circumstances; because GB could not appreciate that he had a psychotic condition, he was not able to weigh out the pros and cons of treatment. The Board found that GB was unable to appreciate the reasonably foreseeable consequences of a decision or lack of decision with respect to the treatment with antipsychotics proposed for his psychotic condition. (Reasons, at p. 21).
[55] The Board found that the doctor met his onus and that when the evidence was considered as a whole there was “sufficient clear, cogent, and compelling evidence…that, as a result of a psychotic mental condition, GB lacked the capacity to appreciate his condition and the reasonably foreseeable consequences of a decision or lack of a decision with respect the antipsychotics.” (at p. 24).
Analysis
[56] While not raised in his factum, in oral submissions on this appeal, GB submitted was that it was an error in law for the Board to have admitted the ORB Report into evidence and that the Board’s decision was thereby tainted and ought not to stand. GB put forth no case to support these submissions.
[57] GB submitted that the ORB Report contained irrelevant and prejudicial information, creating the risk that the Board would consider the ORB Report and improperly “conflate” the issue before it: whether GB had capacity to consent to the proposed anti-psychotic treatment with the improper consideration of whether taking the proposed treatment would be in the GB’s best interests in that it might lead to the end of the detention order.
[58] Dr. Shariati disputes GB’s submissions and submits that it is usual and commonplace for such reports to be admitted in evidence on capacity hearings for the purpose of providing background information; he references Heinekamp v. Livermore, 2010 ONSC 358, a case in which the Administrator’s Report (i.e., the ORB Report) was admitted by the Board.
[59] In this case, the transcript of the Board hearing records that counsel for GB objected to the ORB Report being entered into evidence but, as an alternative to its exclusion, proposed that he be permitted to make submissions as to the weight it should be given. The Board invited such submissions.
[60] Based on the foregoing passage from the transcript and the caselaw referenced by Dr. Shariati, I accept his submissions that the admission into evidence of the ORB Report was neither unusual, nor constituted an error in law.
[61] I next consider whether the Board made improper use of the ORB Report.
[62] GB and Dr. Shariati agree that Starson makes it clear that “[A] patient who is capable has the right to refuse treatment, even if that treatment is, from a medical perspective, in his or her best interest” (at para.19). Similarly, it would be an error to use the ORB report for the purpose of considering whether GB’s best interests would be served by his taking the antipsychotic medication.
[63] The Board was alive to this issue, as evidenced in the transcript of the second day of the hearing (pdf p. 52 -53), when Dr. Shariati asked GB about discussions he had had about the types of factors that might lead to GB obtaining a community discharge. Counsel for GB objected to that question and the Board determined that the Board did not have to “get into that area”.
[64] The Reasons show that the Board referenced the factual history in the ORB Report for context to evaluate the evidence before it, including GB’s evidence. For example, the Board noted that GB had been asked about the arson and the reason for his detention but did not link these to his mental condition. However, nothing in the Reasons can support a finding that the Board used the ORB Report for an improper purpose or, in particular, that the Board considered GB’s bests interests in its assessment of his mental capacity.
[65] Throughout the Reasons, referenced above, the Board correctly referenced the proper two-part test for capacity under s. 4(1) of the HCCA. I conclude that the Board did not err in law in applying either part.
- Did the Board make errors of mixed fact and law in applying the test for capacity?
[66] As referenced above, no appeal is taken from the Board’s finding that the doctor had not met his onus to establish incapacity under the first branch of the test.
[67] As to the second branch, the Reasons set out, in detail, the evidence upon which the Board found that the doctor had satisfied his onus. The Reasons make clear that the Board considered all of the evidence before it, and made findings of credibility, as it was permitted and obligated to do, and then applied the correct legal test to its factual findings.
[68] In evaluating GB’s evidence, the Board was entitled to assess his credibility and a reviewing court should “not interfere lightly with credibility assessments made by the Board”: see A.S. v. Sum, 2021 ONSC 4296, at paras. 42-43.
[69] The lengthy Reasons explain, in detail, the basis for the Board’s factual findings and its assessment of credibility.
[70] The Board found that GB lacked credibility, noting, in part, that GB was unable to link the index offence and the reason for his ORB detention to his medical condition. Similarly, while his delusions centred around the Hells Angels, GB was unable to describe a specific delusion when asked (Reasons at pp. 23-24).
[71] It was open to the Board to prefer the evidence of Dr. Shariati, which the Board found was supported by the other medical evidence and records, over the evidence of GB, whose evidence was contradictory and not supported by the medical records and other evidence put forth by the doctor.
[72] I find no basis to interfere with the Board’s credibility assessments.
[73] The Reasons demonstrate that the Board understood the evidence and made findings of credibility and fact that were open to it on the record. I find no palpable and overriding errors in the Board’s factual findings, nor in its application of the law to those findings.
Disposition
[74] For the reasons set out above, GB’s appeal is dismissed.
L. Sheard J.
Released: May 31, 2022
G.B. v. Shariati, 2022 ONSC 3230
COURT FILE NO. CV-21-00077420-0000
ONTARIO
SUPERIOR COURT OF JUSTICE
AND IN THE MATTER OF AN appeal from a decision of the Consent and Capacity Board, pursuant to the Health Care Consent Act, 1996, S.O. 1996, c.2, Schedule A, as amended and pursuant to the Mental Health Act, R.S.O. 1990, c. M.7, as amended
BETWEEN:
G.B.
- and -
Dr. Khashayar Shariati
REASONS FOR JUDGMENT
L. Sheard J.
Released: May 31, 2022
[^1]: When referring to page numbers in the Reasons, the pages used are those found at the top right-hand corner of the Record and not the page numbers found at the bottom right-hand corner.