Licence Tribunal
Appeal d'appel en Tribunal matière de permis
FILE: 7324/MED
CASE NAME: 7324 v. Registrar of Motor Vehicles
Appeal under Section 50(1) of the Highway Traffic Act, R.S.O. 1990, c. H.8, from a Decision of the Registrar of Motor Vehicles Pursuant to Section 47(1) of that Act - to Appeal a Suspended Licence
Applicant
Applicant
-and-
Registrar of Motor Vehicles
Respondent
REASONS FOR DECISION AND ORDER
ADJUDICATOR: David W. Hurst, M.D., Member or Vice-Chair
APPEARANCES:
For the Applicants: self-represented, the Applicant’s husband, witness
For the Respondent: Kyle Biel, Agent
Heard in location/by teleconference: April 19, 2012
DECISION AND REASONS
This is an appeal to the Licence Appeal Tribunal by the Applicant respecting a decision of the Registrar of Motor Vehicles (the “Registrar”) pursuant to section 47(1) of the Highway Traffic Act, R.S.O. 1990, c. H.8 (the “Act”).
FACTS
Mr. Biel opened the case for the Ministry with a Medical Condition Report dated December 10th, 2011 and signed by Dr. A.Z. Under a list of common medical conditions was ticked the box for alcohol dependence. There were no other details.
December 22nd, 2011 the M.T.O. wrote to the Applicant that they had received a report indicating that she has a condition that affects her ability to drive safely. She has alcohol dependence. She was instructed to take this letter to her treating physician, and request the following information to be sent to the Medical Review Section:
1Completion of the enclosed Substance Abuse Assessment Form by your treating physician.
2If your physician confirms a diagnosis of alcohol dependence, the Ministry will require information confirming that you have remained abstinent from alcohol for a period of one year. Clinical explanation must be provided for the results of any biochemical markers that are outside the normal lab range.
Mr. Biel then displayed a copy of the Substance Abuse Form that had been sent to the Applicant but their records show that it had not been dealt with nor returned.
January 16th, 2012 a report was sent to the M.T.O. by Dr. G.T.F. A synopsis of this report is as follows:
The doctor had been the Applicant’s family physician since June of 1973. It was noted that the Applicant had a tendency to enjoy drinking, becoming a problem at one point.
She was referred to a psychiatrist and was treated for depression and alcohol abuse. She seemed to have been cured of this addiction. Her last drink had been three years previously. At Christmas time she became depressed again and stopped visiting her psychiatrist. She recalled the death of her father a year before and with Christmas approaching started to drink to overcome her gloom. Her husband became concerned. She was seen at a regional health centre on December 9th, 2011. The emergency room physician decided that her driver’s licence should be suspended. The doctor stated that records of her blood work and liver enzymes done on office visits were always within normal limits over the year. She was retested on December 30th, 2011 and the tests were normal. There was no indication of any drug use of any kind and no evidence of alcohol in her blood. (The M.T.O. has received none of these reports).
The doctor explained that the Applicant had learned her lesson and would not use alcohol in the present or in the future. She was described as a rational, logical person with good family support. She needed her licence in order to take care of her grandchildren. A section of his letter stated “I believe that her driver’s licence should be reinstated”.
Mr. Biel’s next entry was a consultation report from a psychiatrist; Dr. S.P. A distillation of this report describes the doctor’s consultation with the Applicant in the inpatient psychiatry unit. She had been held on a Form One (detention). The problem noted was that of alcohol intoxication, alcohol abuse disorder. Gambling addiction (bingo), and shopping expeditions. The letter said there were plans for the Applicant to go to the Community Concurrent Disorders Program. Plans were made for a family meeting involving a social worker. The doctor advised her to remain in hospital with the idea of a family meeting. This psychiatrist expressed approval of the plans for ongoing assistance with the Applicant. But the doctor noted manipulative behaviour on the part of the Applicant pertaining to her husband visiting the hospital. (The details of this are not clear). The doctor’s prognosis was guarded but the doctor was quite in favour of plans for management by the Concurrent Disorders Program in the community.
Mr. Biel then entered a consultation note regarding the Applicant from Dr. R.P. another psychiatrist, dated December 12, 2011.
Scanning of this medical report reveals that the Applicant had been brought to the emergency department of this regional hospital where she was expressing some suicidal ideation. She was intoxicated.
The letter noted that the Applicant had been drinking off and on for quite some time. She had not required any hospitalization with respect to her alcohol abuse other than three years ago when she was admitted to the neighbouring community hospital under the care of Dr. J. (psychiatrist). She had continued to see Dr. J. on a fairly regular basis until about four months previously, (autumn 2011). The Applicant was noted to be taking Celexa 20mg per day. She was not referred to any addiction program.
Regarding this current hospitalization it was noted that she was increasingly stressed with the upcoming Christmas events leading to drink. Her serum alcohol level on December 8th was 61. She was looking to get some help regarding her drinking habits. A meeting was to be arranged shortly. A review of her mental status included mention of her improper attire, her cooperation, and there was no acute distress. There was no objective evidence of any anxiety, agitation, irritability, paranoia, suicidal or homicidal ideation. She was described as pleasant with normal speech flow, volume and content. She was well oriented in all three spheres. Her attention, concentration, memory of recent events and her motor skills were adequate. It was worth noting that she appeared to have fair insight and judgment into her present condition. She remained in hospital.
Impression/recommendations: the Applicant was described as a 58 year old woman admitted to psychiatry with a history of alcohol intoxication, depression, and anxiety.
Mr. Biel’s next entry dated December 30th, 2011 disclosed routine blood analyses which were normal but with no reference to the important liver biochemical markers.
December 22nd 2011 the M.T.O. wrote to the Applicant mentioning these reports regarding her condition of alcohol dependence. Her licence was suspended.
Again the form letter asked for completion of the enclosed Substance Abuse Assessment Form and asked that they needed confirmation that the Applicant was abstinent from alcohol for one year.
The next entry was a blood screen report dated December 30th, 2011. This report disclosed no findings of habituating drugs; ethyl alcohol was not detected.
The next entry from the Agent was dated 2011/08/06. This report showed alkaline phosphatase, SGOT, SGPT & GGTP all in the normal range and these were the important biochemical markers regarding liver function. The second sheet dated 2010/01/07 revealed a normal alkaline phosphatase and also included normal readings for SGOT, SGPT & GGTP.
The final laboratory report in this grouping was dated 2011/12/30. This sheet disclosed a normal alkaline phosphatase, SGOT, SGPT, & GGTP. (All liver function tests).
Attention was then drawn to a report of the Medical Advisory Committee (of the M.T.O.) that the Applicant should remain suspended and instructions indicated that they needed to reconsider after an assessment from a physician specializing in addictions medicine. The report would confirm successful completion of a recommended treatment program, a 12 month period of abstinence and interpretation of supportive biochemical markers (MCV, GGT, AST & ALT). It was noted that if the addiction physician’s report was supportive, and confirmed that requirements were met, the noted period of abstinence could be reduced.
The MAC reasons were: December 2011 an account of alcohol dependence. A note by the admitting psychiatrist of suicideation, was intoxicated having had more to drink in the previous 3 – 4 days. The alcohol level was noted at 61. The family doctor (Dr.F.) said that the driver had had a problem with drinking but was supposedly cured of addiction. The Applicant agreed to connect with a concurrent disorders program but was unwilling to consider recommended treatment inpatient rehab. It was noted that Dr. F. did not indicate the need for the Applicant to proceed with a follow up concurrent disorders program. It was also noted in Dr. F.’s report that it was barely one month post-discharge following serious intoxication. Given diagnosis, considerable intoxication, relapse with psychiatric complications there was need for formal treatment of substance use disorder and one year of abstinence for consideration of reinstatement.
March 12, 2012 the M.T.O. again wrote to the Applicant indicating they must have confirmation that the Applicant had remained abstinent from alcohol for a period of one year and they requested up to date biochemical markers (MCV, GGT, AST & ALT).
Mr. Biel presented a certified copy of the Applicant’s driving record stating only the suspension for medical reasons dated December 31, 2011.
Mr. Biel then appended a copy of the CCMTA Medical Standards for Drivers dated August 2011 with emphasis on section 13.2 – alcohol dependence and alcohol withdrawal seizures.
THE APPLICANT’S CASE
She described the events of the Christmas season of December/11 having lingering depression over the loss of her father at that time a year earlier. There was a shortage of money and to help with her depression she began to drink seriously. She does not usually keep much alcohol (wine) at home. She confined herself to her bedroom for days, with no food. She slept well, got through possibly three to four bottles of wine. She mentioned her severe embarrassment about this interval and at that time her husband, very concerned, called the hospital and was told to notify the police for her transport to the regional health centre by ambulance. At that point she described herself as “sick of this life”. She described her two wonderful grandchildren, a very important feature of her life in these days of retirement, and observed that her birthday was to occur tomorrow following this hearing. She stated that she had consumed no alcohol since this trip to the hospital in December 2011 and before that had not had a drink for three years. She stated that she would not drink again.
With questioning from the Tribunal she described herself as only a random social drinker in her earlier years and at the age 30 had become a regular drinker. She described her health as good except for the fact that she had been found to be suffering from hypothyroidism. This was the essence of her presentation.
Mr. Biel questioned her again to confirm that she had been abstinent for three years and elicited the fact that some years before, a trip to a community medical centre was caused by alcohol abuse. It also emerged at this point that she had seen Dr. S.J. (psychiatrist) for depression and that there had been as many as three days of significant drinking with recurring vomiting. She saw this psychiatrist in December/11 who prescribed Celexa for her regarding depression.
Mr. Biel reviewed her three day drinking episode confined to the bedroom when she had enough wine to keep going, drinking a bottle a day with no food and that when her husband went into action she was drunk. She recalled that she was encouraged by her medical advisors to join the community disorders program. (This apparently has not happened). The Applicant stated that she had been seeing her family doctor again. The matter of the uncompleted Substance Abuse Form was reviewed. While there appears to have been some confusion about this, she was told by her doctor’s office that the form had been completed and sent to the Ministry. Mr. Biel observed that this has never been received. The Applicant admitted to her problems with alcohol, gambling (bingo), and apparently excessive shopping.
Regarding community health programs, nothing has occurred and the Applicant is confident that she can handle things herself.
In review of her thyroid problems she stated that the diagnosis had been made or at least reviewed about four months ago. Apparently the Applicant had been using time expired medication but is now on Synthroid. She notes to have made quite a significant improvement in her all round performance and outlook.
THE APPLICANT’S WITNESS (HUSBAND)
He gave a succinct statement of the events leading up to Christmas of 2011. She withdrew to the bedroom with an ample supply of red wine and naturally he reacted by summoning the police. He noted that there were some problems regarding the family as to how things had proceeded at the regional medical centre. He noted that his wife never drove when she was drinking and had an excellent driving record with no offences. He noted that his wife had had no alcohol since December 8th, 2011.
Mr. Biel questioned the witness to review the drinking at that time and also to inquire about the Applicant’s comment “sick of life”. Her husband stated with confidence that she was not suicidal.
MR. BIEL, AGENT, SUMMARY
He indicated that the proceedings today were clearly matters of concern to the M.T.O. with no personal axe to grind. He reviewed the criteria spelled out in the Highway Traffic Act section 47(1) and underlined that in this case there was an alcohol dependence report listed in the initial Medical Condition Report. He underlined the Ministry’s ever present needs for medical details regarding the Applicant and in particular the completion of the highly detailed Substance Abuse Form which so far has not been presented to the M.T.O. He noted that the Applicant’s family doctor concurs that she is addicted but felt that she has had a very significant learning experience. Even so, Mr. Biel pointed to the previous episode at a community hospital two years previously involving alcohol abuse. Mr. Biel underlined again that by HTA 340/94 section 14(b), the Applicant must not be addicted to alcohol or medications. He observed this history of at least two visits to the emergency rooms for alcohol addiction going back several years. He referred to the Applicant’s comments indicating a suicidal ideation, and the description of ill-advised gambling and shopping sprees. He noted the plans for family meetings but there have been no reports. He drew attention to the events today which indicate that the Applicant has an alcohol dependence problem. Mr. Biel noted the absence of any current psychiatric reports and the fact that a completed Alcohol Assessment Form is missing. He noted the request for an organized rehabilitation program by the MAC and nothing has been done.
He said the 12 months period of complete abstinence is reasonable, and noted that while the testimony today indicates that the Applicant has been abstinent for four months, the M.T.O. has no medical confirmation to prove this. He also noted there are no significant updates on the important biochemical markers.
Mr. Biel also noted that the Applicant’s family doctor (Dr.F.) had more questions while providing few answers and that she must be encouraged to provide the M.T.O. with a medical update. Until the M.T.O. receives this information this suspension must be confirmed.
THE APPLICANT’S SUMMARY:
She is not drinking and will never do so again and referred to her urgent need for licencing in order to be able to help her daughter and her grandchildren.
ISSUES
Should the decision of the Registrar to suspend the Applicant’s licence be confirmed, modified or set aside?
LAW
O. Reg. 340/94, Section 14 states:
(1) An applicant for or a holder of a driver’s licence must not,
(a) suffer from any mental, emotional, nervous or physical condition or disability likely to significantly interfere with his or her ability to drive a motor vehicle of the applicable class safely; or
(b) be addicted to the use of alcohol or a drug to an extent likely to significantly interfere with his or her ability to drive a motor vehicle safely.
(2) In determining whether an applicant for or a holder of a driver’s licence of any class meets the qualifications described in subsection (1), the Minister,
(a) may take into consideration the relevant medical standards for applicants or holders of that class of driver’s licence set out in the CCMTA Medical Standards for Drivers; and
(b) may require the applicant or holder to provide evidence satisfactory to the Minister that he or she is able to drive a motor vehicle of the applicable class safely, including,
(i) any reports of examinations under section 15, and
(ii) any additional medical information.
(3) Despite clause (2) (a) and unless otherwise provided in this Regulation, if there is a difference between a medical standard set out in the CCMTA Medical Standards for Drivers and a medical standard set out in this Regulation, the Minister shall take into consideration the standard set out in this Regulation instead of the standard set out in the CCMTA Medical Standards for Drivers.
(4) In this section, the CCMTA Medical Standards for Drivers means the document entitled CCMTA Medical Standards for Drivers, published by the Canadian Council of Motor Transport Administrators and dated March 2009, as it may be amended from time to time, that is available on the Internet through the website of the Canadian Council of Motor Transport Administrators.
Section 47(1) states:
Subject to section 47.1, the Registrar may suspend or cancel,
(b) a driver’s licence; …
on the grounds of,
(d) misconduct for which the holder is responsible, directly or indirectly, related to the operation or driving of a motor vehicle;
(e) conviction of the holder for an offence referred to in subsection 210(1) or (2);
(f) the Registrar having reason to believe, having regard to the safety record of the holder or of a person related to the holder, and any other information that the Registrar considers relevant, that the holder will not operate a commercial motor vehicle safely or in accordance with this Act, the regulations and other laws relating to highway safety; or
(g) any other sufficient reason not referred to in clause (d), (e) or (f).
Section 50 of the Act states:
50 (1) Every person aggrieved by a decision of the Minister made under subsection 32(5) for which there is a right of appeal pursuant to a regulation made under clause 32 (14) (n) or a decision of the Registrar under section 17 or 47 may appeal the decision to the Tribunal.
(2) The Tribunal may confirm, modify or set aside the decision of the Minister or the Registrar.
APPLICATION OF THE LAW TO FACTS
The Tribunal today has heard a clear presentation of the Applicant’s dependency problems.
She has been a serious drinker going back several years but in fairness it is important to note she has achieved lengthy periods of sobriety. Unfortunately this has never been clearly demonstrated to the M.T.O. and biochemical markers which have been reported are seriously in need of updating. It has also been made clear today by Mr. Biel that the M.T.O. can not act responsibly on this matter of suspension due to the inadequate medical documentation. Despite the Applicant’s alcohol abuse for years, her health remains intact. It is noteworthy that the discovery of the serious thyroid gland problem has been dealt with admirably. This has gone a long way to improve the Applicant’s outlook on life.
The Applicant may not fully understand that she suffers from an obsessive compulsive disorder manifested here by abuse of alcohol, excessive gambling, and also problems with excessive shopping sprees. Such a disorder is quite amenable to skilled care by her family doctor and psychiatrists. Some of this has been accomplished but updated medical reports are essential to assist the M.T.O. with their deliberations.
At this time the Applicant has been abstinent for four months which is an excellent beginning on the 12 month interval. This four month abstinence has not been documented with the M.T.O. and it would be very helpful to her case if this could be done by her physicians retroactively.
She has a very caring and supportive husband and has gone a long way to stabilize the family during this difficult interval.
The Applicant has a serious problem with alcohol dependence and now knows the way to go with medical help. She should do well.
DECISION
Upon the application by the Applicant to appeal the decision dated December 22, 2011 of the Registrar to suspend her driver’s licence pursuant to Section 47(1) of the Act, and having considered the evidence filed with the Tribunal, and the submissions of the Registrar and of the Applicant;
IT IS THE DECISION OF THE TRIBUNAL pursuant to the authority vested in it under section 50(2) of the Act that the decision of the Registrar be confirmed.
LICENCE APPEAL TRIBUNAL
___________________
David W. Hurst, M.D, Presiding Member
RELEASED: April 30, 2012