Licence Tribunal
Appeal d'appel en
Tribunal matière de permis
FILE: 8412/MED
CASE NAME: 8412 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 Suspend a Licence
Applicant Applicant
-and-
Registrar of Motor Vehicles Respondent
REASONS FOR DECISION AND ORDER
ADJUDICATOR: Kevin Flynn, M.D., Member
APPEARANCES:
For the Applicant: Self-represented
For the Respondent: Russell McKnight, Agent
Heard in Toronto: November 27, 2013
DECISION AND REASONS
This is an appeal to the Licence Appeal Tribunal (the “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
The Respondent’s Case
On September 9, 2013, an Emergency Room physician, Dr. L. completed a Medical Condition Report in compliance with section 203 of the Act, based on examination the same date.
Seizure(s)-Cerebral
Absence/Partial Seizure and Loss of Consciousness
The Registrar informed the Applicant by letter on September 12, 2013 that it has been decided to suspend her driving privilege under section 47(1) of the Act.
In order to be considered for reinstatement she was requested to take the letter of suspension to her physician or specialist when her condition improves and to have the enclosed Epilepsy and Seizures Form completed and forwarded to the Ministry.
The Applicant’s neurologist, Dr. B., completed the form on September 23, 2013.
Primary medical condition: Seizures
Latest seizure: 1-3 years ago
Type of seizure: Simple Partial (no impairment in level of consciousness)
Secondary Generalized
Was this the first seizure? Yes
Was the previous seizure different than the current type of seizure? Yes
Simples/Complex Partial to Generalized Tonic Clonic (Grand Mal)
Has the patient had an EEG within last 12 months? Yes
Did the EEG show signs of epileptiform activity? Yes
Has the patient had an imaging test within the last 12 months? No
What was the etiology of the seizure? Idiopathic/IUnknown
Is the patient taking any prescribed medication (for any condition)? Yes
Has anti-seizure medication been prescribed? Yes
Are the seizures prevented by the current medication? Yes
Is the patient compliant with recommended treatment regimen (i.e. no significant pattern of misuse of medication or missed appointments)? Yes
Does the patient have appropriate insight of her medical condition and the impact on their functional ability to drive? Yes
Has the provoking factor stabilized, resolved or been corrected? Yes
Has the patient had surgery to prevent further seizures? No
Additional Comments:
There have been no further secondary generalized seizures.
Very brief aurae still occur
The Registrar informed the Applicant on October 24, 2013 that following review of the report received, it had been decided that the suspension of her driving privilege should continue.
In order to be considered for reinstatement she must provide confirmation that she has remained seizure free for a period of six months; if seizures continue, confirmation that the pattern has remained consistent for a period of one year.
She was informed that she may appeal the suspension to the Licence Appeal Tribunal.
The Applicant’s Case
The Applicant informed the Tribunal that she had one seizure on June 5, 2011. Her physician at that time informed her that her licence to drive would be suspended for one year and she did not drive for twelve months. However the Tribunal was advised that a Medical Condition Report was not completed as required by section 203 and no record of suspension appears on the driver’s record for that period.
She has been on anti-seizure medication since that time, namely Keppra 1000 mg three times daily and lamotrigine 50 mg twice daily.
The lamotrigine was reduced by 25 mg once a month under supervision by her neurologist, Dr. B. starting four days before she was seen in the Emergency Room on September 8, 2013. She stated that she had a migraine attack, felt cold, had rapid breathing and went to the E.R. hoping that her neurologist would see her there as it was on a weekend. She believed that she was having an anxiety attack and after examination she was given Ativan, a mild anxiolytic which relieved her symptoms, and was sent home. She denied loss of consciousness.
She consulted Dr. B. who decided that the reduction of lamotrigine would occur on a much reduced regimen. She stated that this was the first time she had experienced anything like this and she attributes the symptoms to both the reduced dosage and also to a stressful work load. She has also been attending a psychiatrist since late September 2013 to assist with stress management and has been taking citalopram, an anti-depressant.
She informed the Tribunal that her menstrual cycle may have been an additional factor.
She has also been concerned that because she is soon to be married there may be implications regarding future pregnancies.
She has been a patient of Dr. B. for two years and also has been attending the Seizure Disorder Clinic at a Toronto teaching hospital where her medication regimen was approved.
In her Reasons for Appeal the Applicant stated that she did not lose awareness or loss of consciousness on the day of her attendance at the E.R. and was able to express herself coherently. She denies that she had a seizure on that date.
Her neurologist Dr. B. reviewed her Reasons for Appeal and added a handwritten note on October 29, 2013:
I fully agree with this description and feel this event was not a seizure.
On November 18, 2013, Dr. B. wrote to the Registrar:
This patient was diagnosed with a seizure disorder in July 2011. She presented with a generalized seizure. She was found to have frequent very brief seizure aurae. At times having difficulty understanding what was being said and at times difficulty expressing herself.
She is presently being treated with Keppra 1000 mg 3 times daily, lamotrigine 50 mg twice daily which is being very slowly reduced and discontinued and citalopram 20 mg daily.
She is also followed at a seizure disorder clinic.
She has had no further generalized seizures since the episode of July 2011 and has had no further episodes of loss of awareness.
She did come to the hospital with a panic attack on September 8, 2013. She is now seeing Dr. S. in treatment of a generalized anxiety disorder with an occasional panic attack.
At this time she is compliant with her medications and considering that she has no periods of interruption of her stream of consciousness, her return to driving should be reconsidered.
ISSUES
Should the decision of the Registrar to suspend the Applicant’s licence be confirmed, modified or set aside?
In particular: Does the Applicant suffer from a mental, emotional, nervous or physical disability likely to significantly interfere with her ability to drive a motor vehicle safely?
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.
Section 47(1) of the Act gives the Registrar the power to suspend or cancel a driver’s licence on the ground(s) set out in section 14 (1) of the Regulation set out above.
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 Respondent relies on section 47(1) of the Highway Traffic Act that authorizes suspension of driving privilege upon receipt from a physician in compliance with section 203 of the Act, of a Medical Condition Report of Absence or Partial Seizure with loss of consciousness.
The Applicant’s neurologist reports that very brief aurae still occur, but no further secondary seizures.
The Canadian Council of Motor Transport Administrators (CCMTA) section 17.6.8 applies to non-commercial drivers who have epilepsy with simple partial seizures.
The Standard for eligibility:
Six months since the last seizure OR
The driver is experiencing seizures but the seizure pattern has been consistent for at least one year and therefore no seizure-free waiting period required
Favourable assessment from the treating physician or neurologist
No impairment in level of consciousness or cognition
No head or eye deviation with seizures
The conditions for maintaining a licence are met
The Applicant relies on the lack of medical evidence to support a diagnosis that she had a seizure or loss of consciousness on September 8, 2013. Her neurologist has stated that the event reported was not a seizure; that she has not had a seizure since July 2011 and that she is compliant with her treatment.
He supports reinstatement of driving privilege.
Weighing the evidence on a balance of probabilities, the Tribunal finds the Applicant is not suffering from a condition which is likely to significantly interfere with her ability to operate a motor vehicle safely.
Furthermore the Tribunal finds that the pattern of seizures has been consistent for in excess of two years and therefore no seizure free waiting period is required.
DECISION
Upon the application by the Applicant to appeal the decision effective September 22, 2013, 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 set aside.
LICENCE APPEAL TRIBUNAL
Dr. Kevin Flynn, M.D., Presiding Member
Released: December 6, 2013