Licence Tribunal
Appeal d'appel en Tribunal matière de permis
FILE: 8577/MED
CASE NAME: 8577 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: Sonia De Santis, Agent
Heard in Toronto: February 19, 2014
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 Evidence
On January 14, 2014, an unsolicited Medical Condition Report based on an examination the same date, was completed by an Emergency Room physician, Dr. B. in compliance with section 203 of the Act.
The condition reported was:
Alcohol Dependence
Mental or Emotional Illness – Unstable
Patient acutely depressed. Was driving while intoxicated and actively looking for a suicide option (while driving).
The Registrar informed the Applicant by letter dated January 17, 2014 that his driving privilege was suspended under section 47(1) of the Act.
In order to be considered for reinstatement he was requested to take the letter of suspension to his treating physician and to have a Mental Health Assessment form completed and returned. He was also requested to have a Substance Abuse Assessment completed and returned.
Dr. Y., the Applicant’s family physician since April 2012, completed the Mental Health Assessment on January 24, 2014.
Primary mental illness: Depression/Dysthymia; Situation Stress/Crisis
Onset: less than 3 months
Current status: Stable with ongoing mild symptoms; stable for less than 3 months.
No difficulties in cognition, attention or memory or judgement.
No admission to hospital in the last 12 months due to psychiatric illness and no substance dependence or abuse
Taking prescribed medication with no sedation, impairment, slurred or double vision.
No ECT treatment
Compliant with recommend treatment by physician.on a monthly basis
Has appropriate insight of his medical condition and the impact on his ability to drive
Has not been referred for independent driving assessment
Is not a danger to himself or others and has no reason to limit his ability to drive a motor vehicle.
In response to the above assessment, on January 24, 2014, the Registrar requested confirmation of a three month period of psychiatric stability.
On February 18, 2014, Dr. Y. completed a Substance Abuse Assessment which was submitted by the Applicant to the Tribunal at the commencement of proceedings.
By consent, the Assessment was submitted by Ms. De Santis to the Medical Review section during a short recess.
Upon resuming the hearing, Ms. De Santis conveyed the Respondent’s response to the Applicant and the Tribunal and the hearing continued.
The Substance Abuse Assessment stated:
Health History: Psychiatric disorder; Chronic Depression.
Celiac disease
Chronic dysthymia with on and off major depression episode; this may in fact be induced by hypothyroidism.
Physical assessment and laboratory evaluation:
Thyroid profile: TSH: 18.01 (normal range 0.5 top 5.0) on January 14, 2014
(emphasis by Tribunal)
Ethanol: less than 2 mmol/L (Range 0-17)
Remainder of laboratory results performed at hospital on January 14, 2014 were normal.
Physical examination: normal
Age of first use of alcohol: 13; Age of first regular use: 15
First intoxication: 18; Frequency: 3 to 4 per week
On each occasion: 2 to 3 drinks.
Date of reduction or abstinence: January 24, 2014
Longest period of abstinence in past 3 years: 4 weeks.
Current medication: Thyroxine 50 mcg daily (emphasis by Tribunal)
Alcohol Use Disorders Identification Test: Score =4 out of possible 46
Diagnosis: Misuse
Recommendations for treatment: Treatment of hypothyroidism.
The Tribunal and the Applicant were advised by Ms. De Santis that the Registrar’s position was that alcohol was not an issue in the proceedings
The Applicant was again informed by the Registrar that he was required to submit confirmation of a three month period of psychiatric stability.
The Applicant’s Evidence
The Applicant stated that on Friday, January 10, 2014, he was dismissed without cause from his position as Chief Operating Officer of a private company where he held that office for three years.
He became depressed with concern for the future support of his wife and four children age 14 months to 7 years. On Monday, January 13, 2014, he was advised by his financial advisor to file for personal bankruptcy. Having reached his lowest point of depression he had a few drinks with a friend between 8:30 p.m and 11:30 p.m. and on his way home he started to drive too fast and at one point found himself thinking of driving into a wall.
The following day, January 14, 2014, he saw his family physician and described his feelings of the previous day. The doctor arranged for the Applicant’s wife to pick him up and take him to the Emergency Room where he was seen by the physician, Dr. B. who ordered some laboratory tests and then completed the Medical Condition Report. The doctor told him that his thyroid stimulating hormone test was extremely high indicating very low thyroid activity.
The Applicant informed the Tribunal that he had been on thyroid medication for a number of years but had discontinued to take his medication two years ago, partly because he travelled a lot in business and also because he did not feel any different when he stopped the medication.
He saw his family physician, Dr. Y. on January 15, 2014. He was unable to inform the Tribunal if a Discharge Summary was sent to Dr. Y. by the hospital.
His thyroid condition has been stabilised by Dr. Y. since January 14, 2014 and he sees the doctor for psychotherapy once a week for chronic anxiety and lack of energy.
He stated that he has not been on anti-depressant medication and has not had suicidal ideation in the past.
Regarding the request by the Registrar for confirmation of a three month period of psychiatric stability, the Applicant stated that he was not aware that the Ministry is not allowed to obtain copies of medical records from either the hospital or his physician.
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 his 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.
The Respondent relies on:
A Medical Condition Report filed on January 14, 2014 by a physician in compliance with Section 203 of the Act reporting depression with suicidal ideation.
Section 47(1)(g) of the Act authorised the Registrar to issue a suspension of the Applicant’s driving privilege.
Ontario Regulation 340/94 (14) authorised the Registrar to continue the suspension until the Applicant submits confirmation that his psychiatric condition has remained stable for a period of three months.
The onus is on the Applicant to show that he does not suffer from a medical condition that would significantly interfere with his ability to operate a motor vehicle safely.
The Canadian Council of Motor Transport Administrators (CCMTA), under Chapter: 14 defines suicidal ideation
Suicidal ideation is defined as having thoughts of suicide or taking action to end one’s own life, irrespective of whether the thoughts include a plan to commit suicide, Studies indicate that more than 90% of all suicides are associated with psychiatric disorders.
14.3 states: The consistency of findings supports a general conclusion that drivers with
Psychiatric conditions are at increased risk of adverse driving outcomes.
14.4 states: Suicidal ideation is an important consideration regarding drivers with psychiatric disorders because of the risk of traffic suicide.
14.6.1 Guidelines for assessment of Psychiatric disorder:
All drivers eligible for a licence if:
the condition is stable
the driver has sufficient insight to stop driving if condition becomes acute
the functional abilities necessary for driving are not impaired
a treating physician supports a return to driving for drivers who have stopped driving due to a psychiatric condition, and
the conditions for maintaining a licence are met.
The Applicant submits that this was an acute event not likely to recur and was associated with hypothyroidism, acute depressive reaction and misuse of alcohol.
He took steps immediately to reach out for help and he has been compliant with following up with the family physician on a regular basis for counselling and psychotherapy.
His family physician has recommended re-instatement.
APPLICATION OF THE LAW TO FACTS
The Tribunal finds that the Respondent was justified in issuing a suspension of driving privilege upon receipt of a report by a physician in compliance with section 203 of the Act, of depression accompanied by thoughts of self harm.
The Tribunal finds that there is sound medical evidence that the cause of the depression has been established as being due to hypothyroidism caused by discontinuing his thyroid replacement hormone without medical authorisation. This condition was aggravated by reactive depression associated with sudden loss of employment and misuse of alcohol
The Tribunal finds that the Applicant no longer has thoughts of self harm and is under the care of a family physician who has been in a psychotherapeutic relationship and has recommended that his driving privilege be reinstated.
The Tribunal finds that CCMTA Standard 14.6 conditions for reinstatement described above have been met.
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 his ability to operate a motor vehicle safely.
DECISION
Upon the application by the Applicant to appeal the decision effective January 27, 2014 of the Registrar to suspend his 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
Kevin Flynn, M.D., Member
Released: February 26, 2014