Licence Tribunal
Appeal d'appel en
Tribunal matière de permis
DATE:
2014-09-03
FILE:
9001/MED
CASE NAME:
9001 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
Appellant
Appellant
-and-
Registrar of Motor Vehicles
Respondent
REASONS FOR DECISION AND ORDER
ADJUDICATOR:
David W. Hurst, M.D., Member
APPEARANCES:
For the Appellant:
Self-represented
For the Respondent:
Kyle Biel, Agent,
Heard by teleconference:
August 26, 2014
DECISION AND REASONS
This is an appeal to the Licence Appeal Tribunal (the “Tribunal”) by the Appellant 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
Representing the Registrar, Mr. Biel told the Tribunal that the Ministry of Transportation ( “M.T.O.”) received a Medical Condition Report with the” tick” boxes marked, as follows, for both “seizure(s) – cerebral?”, and “seizure(s) – alcohol related?” The document was dated October 16, 2013 and signed by Dr. C.
On October 22, 2013, the M.T.O. wrote to the Appellant stating they had received a report indicating that he had a condition that affects his ability to drive safely.
The reported condition was listed as:
- Seizure
- Seizure(s) – alcohol related
The Registrar of Motor Vehicles had decided to suspend the Appellant’s driving privilege under Section 47(i) of the Act.
For reinstatement, the Ministry said they required the following:
- If your physician confirms a diagnosis of alcohol dependence and/or that you have experienced an alcohol withdrawal – related seizure, the Ministry will require confirmation that you have remained seizure free and abstinent from alcohol for a period of one year. This period may be reduced to six months if your physician confirms that you have successfully completed an alcohol treatment program and is supportive of your driving privilege.
- The enclosed form(s) completed in full and all questions answered.
Mr. Biel then entered an M.T.O. form regarding epilepsy and seizures, signed and completed by Dr. P.K. on August 15, 2014. The Appellant’s primary medical condition was stated as alcohol withdrawal seizure which had occurred more than 6 – 12 months previously. It was a Grand Mal Seizure. There had been no previous seizures.
Reviewing this detailed questionnaire, pertinent observations are as follows:
- An EEG showed no epileptiform activity
- Alcohol withdrawal was noted
- There was no diagnosis of substance dependence
- There is a diagnosis of substance abuse
- The Appellant has since abstained from alcohol use for five months
- The Appellant has not completed a supervised treatment program and is not attending counselling for addiction treatment
- The Appellant has been intermittently attending some AA meetings
- Recent biochemical markers show the MCV and ALT as normal
- The Appellant is taking no prescribed medication
- The Appellant has appropriate insight into his medical condition on his functional ability to drive
An additional note stated that exacerbating life events have been dealt with and the Appellant is now abstinent from alcohol.
Mr. Biel then entered a completed Substance Abuse Assessment Form signed on May 15, 2014 by Dr. P.K. The doctor’s written note stated that the Appellant is currently abstinent from alcohol. Laboratory work has all been normalized. It also noted that a CT of the head and an EEG were normal and he supported the reinstatement of his patient’s driving privilege.
On scanning this very searching document, it was noted that laboratory work (MCV & ALT) were both in the normal range. GGT and AST were not done. The history of alcohol use indicated the Appellant’s first use of alcohol at 19 years of age. Regular use began at 30 years of age. Intoxication occurred at 20. Use of alcohol was daily. Alcohol consumed on each occasion was 2 – 6 beers. Most recent use was January of 2014 and the date of reduction or abstinence was January 2014. An alcohol withdrawal seizure occurred 12 – 72 hours after significantly reducing alcohol consumption.
An alcohol use disorders identification test gave the Appellant a score of 5 owing to the fact someone in his immediate group had demonstrated concern about his drinking, with a suggestion to cut down.
The LEEDS dependence questionnaire gave him an excellent score.
With this document there was an attached imaging report indicating a normal MRI study of the head.
The next entry by the Agent was a short note dated May 13, 2014 and signed by Dr. D.K. He said:
The Appellant has been seizure free since I have known him and has endeavoured to reduce or eliminate all his alcohol consumption. His blood work indicates that his acute alcoholic hepatitis has resolved. His blood work has normalized. I cannot comment on his likelihood for recidivism to alcohol abuse but am happy with his progress thus far.
The Agent then filed an EEG study dated November 30th, 2013. This was a normal tracing.
Further laboratory work was noted regarding this Appellant on April 7th, 2014 and it was noted that the bilirubin, alkaline phosphate and ALT were all in the normal range (liver function tests).
On June 18th, 2014, the M.T.O. wrote to the Appellant indicating that they had reviewed the subsequent reports filed on his behalf and it had been determined that his driving privilege should remain under suspension.
For reinstatement, the Ministry requested:
- Confirmation that you have remained seizure free and abstinent from alcohol for a period of one year. This period may be reduced to six months if your physician confirms that you have successfully completed an alcohol treatment program and is supportive of your driving privilege.
- The results of recent biochemical markers (MCV, GGT, AST & ALT) with a clinical explanation for any levels outside the normal laboratory range.
Mr Biel then presented a certified copy of the Appellant’s driving record which included the following:
Driving with more than 80 mgs alcohol in blood. Offence date 2011/05/31
11/07/14 suspended until October 17, 2011 blood/alcohol content in excess of .08, CCC
13/11/01 suspended for medical reasons
Current demerit points – zero
The Agent then filed an extract from the Canadian Council of Motor Transport Administrators. Mr. Biel addressed section 15.6.3 on page 230, which standard states:
All drivers eligible for a licence if:
- Meets the criteria for remission and/or has abstained from the substance for 12 months
- Earlier re-licencing may be considered upon favourable recommendations from an addiction specialist and/or treatment physician recognized by the licencing authority and the successful completion of a drug rehabilitation program.
THE APPELLANT’S SUBMISSION
The Appellant described the occurrence of this solitary seizure in mid October 2013 at a time in his life when things were not going well.
He described this as an interval when his father had died. Shortly thereafter, he was evicted from his lodgings as the landlord had stopped paying on the mortgage and a sheriff’s order forced him to leave. He was divorced and began to eat very poorly (his mother observed the inadequacy of his meals) and then his girlfriend left him. Then he had to endure the difficulties of arranging for his son to move west for schooling.
He admitted that he had been drinking beer. On a good day at work he would have two beers on coming home and on a bad day it would amount to 6 or 8 beers. There had been many bad days.
He works as a machine operator and left one job because there was no sign of advancement, because he lacked higher qualifications. He said that alcohol had not interfered with work.
He then quit his job to take time to sort out his problems and succeeded, acquiring a new home, letting him visit his son under his divorce agreement. Stress had subsided to nil. In essence, he developed a new life with a new job but on October 16, 2013 he went to work and “blacked out”. This resulted in him waking up in hospital. The people there told him he had suffered a seizure. He had never experienced this before. The blood tests, which were not reported at the hearing, he described as all normal.
The Appellant had started reducing his alcohol consumption for about a month before this seizure. Going from a routine of 8 – 10 bottles a day down to 2 – 6 bottles. He informed the Tribunal that he has been totally abstinent from alcohol since January 2014.
The Appellant said he was happy at his new position with a new company and of course there have been no further seizures.
He lamented that in his apartment building, two tenants have had strokes and were given their driver’s licences back in three months, his stepfather underwent recent heart surgery and also has been re-licensed in three months. He indicated that he was being unfairly singled out.
Mr. Biel questioned him further and learned that indeed the Appellant’s doctors advised him to abstain, which he has done since January 2014. The Agent felt that there was a need for supportive blood work reports for the interval in hospital in mid October 2013. Mr. Biel observed that the April 2014 blood reports are the only tests that the M.T.O. has reported on file regarding the Appellant’s liver. The Appellant replied that blood tests were done almost daily when he was seeing Dr. K. (gastroenterologist) and the doctor had told him to abstain. The Appellant said all the blood tests were normal.
The Tribunal also learned that the Appellant had been treated at a regional addiction centre and they discharged him for reasons that he does not understand. Details about the Appellant’s consumption of beer immediately prior to this seizure showed that he had consumed 6 beers one day before the seizure which was less than his normal day of 8 – 10 beers. The Appellant said that he was not abstinent after the seizure but began to reduce his intake. His last ingestion of alcohol was January 2014.
The Appellant said no treatment had been prescribed for his acute alcoholic hepatitis. He also volunteered that he had been going to the AA organization meetings in May 2014 but with his new job he has no time for that.
The Tribunal also learned that the Appellant only sees his family doctor (Dr. P.K.) at random and he receives no management of the alcohol problem. He did state that Dr. P.K. is aware of his difficulties.
Mr. Biel summarized the position of the Registrar. Upon receipt of the Medical Condition Report mentioning an alcohol related seizure, possibly due to withdrawal, the Registrar acted correctly with this suspension in that the Appellant must not be addicted to alcohol lest it interfere with safe driving. In essence, he was consuming too much. Mr. Biel said the guidelines of the Act. must apply and there must be a well-documented period of 12 months of abstinence of alcohol. Only 5 months have been achieved. The Agent felt that a proper treatment program is in order and could well be orchestrated by Dr. P. K., the Appellant’s own physician.
The Agent also noted that Dr. D.K. (gastroenterologist) said in his comments – “I cannot comment on his likelihood for recidivism to alcohol abuse but am happy with his progress thus far”.
For all of these reasons, Mr. Biel submitted that the position of the Ministry be confirmed.
ISSUES
Should the decision of the Registrar to suspend the Appellant’s licence be confirmed, modified or set aside?
In particular:
Is the Appellant addicted to the use of alcohol or a drug to an extent 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.
(2) The Tribunal may confirm, modify or set aside the decision of the Minister or the Registrar.
APPLICATION OF THE LAW TO FACTS
The Registrar had no alternative but to suspend the Appellant’s driving privilege on receipt of Medical Condition Report saying he suffered a seizure very likely caused by alcohol withdrawal.
Documentation is somewhat scanty and in fact the epilepsy survey and the Substance Abuse Assessment reports show that a good score has been obtained but it is significant to note that his doctors told him it was time to cut back.
In the Appellant’s own narrative, the Tribunal has learned that he has been using alcohol (beer), consuming, on a regular basis, almost daily of 6 – 10 bottles of beer. This is abuse, to say the least.
The occurrence of a seizure with only a moderate reduction in his intake is likely a very strong signal that he has an abuse and/or addiction problem.
While the Appellant deserves great credit for having already been abstinent for five months, as indicated by the Act and in the CCMTA document, a one year period of abstinence is needed to delineate whether the Appellant has regained control.
The Appellant has shown real insight into the difficulties he has and how to solve them.
The Ministry’s CCMTA guidelines suggest a minimum of one year abstinence before a driver should be re-licensed. The Tribunal can find no good reason why the guideline should not be followed in this case. The occurrence of a seizure after a modest reduction in his daily consumption of alcohol is an alarming event. The Appellant should demonstrate with adequate medical documentation that he has been abstinent for 12 months and in this remaining interval he is well advised to undergo considerable therapy, preferably under the guidance of his family doctor who knows him well.
Weighing the evidence on a balance of probabilities, the Tribunal finds the Appellant is 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 Appellant to appeal the decision effective October 22nd, 2013 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 Appellant;
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 by confirmed.
LICENCE APPEAL TRIBUNAL
David W. Hurst, M.D., Member
Released: September 03, 2014