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Amanda Pearson, who was born male, paid out-of-pocket for her surgery. She took her case to the Health Services Appeal and Review Board when OHIP refused her claim. Earlier this month, the board ruled against her appeal for funding, leaving the Human Rights Tribunal as her last option.

Michelle Siu/The Globe and Mail

More than five months after Ontario's Health Minister said work was being done to end the bottleneck for transgender people seeking publicly funded sex-reassignment surgeries, the waiting list at the only hospital in the province that can approve them has swelled to more than 1,000.

The Adult Gender Identity Clinic at Toronto's Centre for Addiction and Mental Health is telling new clients they can expect to wait "24 months at minimum" for an appointment, a spokeswomen for the hospital said. As of Tuesday, there were 1,064 clients in line, up from 680 in mid-April, when the issue was first reported by The Globe and Mail.

As the line for approvals continues to grow, one transgender woman is planning to take her fight for funding to the Ontario Human Rights Tribunal, the latest in a series of legal moves aimed at putting pressure on the province to change the rules and increase the number of places that can approve clients for surgery.

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Amanda Pearson spent roughly $20,000 of her own money to have genital surgery in the United States. It's a procedure covered by the Ontario Health Insurance Plan, but only with the approval of the CAMH clinic.

Unwilling to wait, Ms. Pearson paid out-of-pocket, then took her case to the Health Services Appeal and Review Board when OHIP refused her claim. Earlier this month, the board ruled against her appeal for funding, leaving the Human Rights Tribunal as her last option.

"The wait-and-hope approach to the government making change isn't working," said Ms. Pearson, who last month legally changed her name from Bobbie, the latest step in her years-long effort to live life as a woman.

"I really believe the current government is on the wrong side of history here," said the 57-year-old, who has returned to school to get a degree in psychology.

In a separate case, an Ottawa resident has filed a Charter challenge to the OHIP regulation, which designates the hospital as the sole site allowed to approve sex-reassignment surgery candidates for OHIP coverage, after having his claim for surgery rejected by the same appeal body.

Health Minister Eric Hoskins said in April he had asked ministry staff to look into how to improve access, telling The Globe, "I suspect in the near future we should have some further suggestions and actions by the ministry which will address the issue of wait times and the single site."

CAMH chief executive Catherine Zahn has said the regulation should "absolutely" be scrapped. "Why would a restriction like that be placed on an assessment that, given the right professionals, could take place in any number of venues?" she said earlier this year.

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Asked for an update, the Health Minister's office indicated Tuesday that work is continuing.

"Minister Hoskins has asked the ministry to look at options to reduce wait times, improve access and look at the support we provide and the mechanism through which we provide that support," a spokesman for his office said in an e-mail. "This is an issue of importance to our government and we look forward to sharing the details of our plan soon."

CAMH says it has added a social worker to help shorten waits and support clients since the surge in referrals for surgery approval began to grow. It also has developed proposals with community partners for expansion of assessment and treatment, but has not received approval for those plans, a hospital spokeswoman said in an e-mail.

Susan Ursel, the lawyer representing Ms. Pearson, said there is no reason why the government can't allow professionals other than those at CAMH to give approval for surgery, noting outside assessments are already used by the clinic.

"It is not necessary for CAMH to be the gatekeeper," she said.

Ms. Ursel said she expects Ms. Pearson's case to go before the Human Rights Tribunal in the coming months.

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