Licence Tribunal
Appeal d'appel en Tribunal matière de permis
FILE: 10292/MED
CASE NAME: 10292 v. Minister of Transportation
Appeal under Section 50(1) of the Highway Traffic Act, R.S.O. 1990, c. H.8, from a Decision of the Minister of Transportation pursuant to Section 32(5)(b)(i) - to Change the Class or Classes of Motor Vehicles in Respect of which the Licence was Issued
10292 Appellant
-and-
Minister of Transportation Respondent
REASONS FOR DECISION AND ORDER
ADJUDICATOR: David Borenstein, M.D., Member
APPEARANCES:
For the Appellant: Self-represented
For the Respondent: Kyle Biel, Agent
Heard by teleconference: July 18, 2016
DECISION AND REASONS
This is an appeal to the Licence Appeal Tribunal (the "Tribunal") by the Appellant respecting a decision of the Minister of Transportation (the "Respondent") pursuant to Section 32(5)(b)(i) of the Highway Traffic Act, R.S.O. 1990, c. H.8 (the "Act").
FACTS
The Appellant had a commercial licence (Class B), with a reported history of diabetes.
He had been updating the Ministry of Transportation (MTO) on a regular basis as to his diabetes stability. His physician's update on October 13, 2015 noted, in the section on general health, that the Appellant had cardiovascular disease. On November 30, 2015 the MTO wrote the Appellant requesting a Commercial Driver's Cardiovascular Assessment by the end of January 2016.
On January 11, 2016, his family physician, Dr. M.B., submitted a general medical assessment. It stated that he has an "aortic valve replacement 8/15. On Coumadin. Now stable. NY Class I. Echo pending". The form for Commercial Cardiovascular Assessment was also completed and noted the following information:
- A history of heart disease and arrhythmia
- A past surgical treatment of aortic stenosis in August 2015
- A history of atrial fibrillation
- A CHADS2 score of 3
- A history of tachyarrythmia
- A history of congestive heart failure (CHF) with inotropic support in hospital for CHF
- A history of cardiomyopathy
- A functional status of NYHA II with sight limitation of physical activity
- A left ejection fraction (LVEF) of 35-50% (specifically 40%) via echocardiogram.
- An overall excellent prognosis.
His list of medications documented on November 3, 2015 was as follows: Lasix, Coversy, Insulin, Warfarin, Metoprolol, Spiriva, Lipitor, Metformin, Amiodarone, Aspirin and Aligng.
The Appellant confirmed this list at the hearing. The MTO chose not to read through the various surgical, medical and procedural notes; however, both parties agreed that the Tribunal would consider all submitted reports in rendering a decision.
The MTO reviewed the information in the reports and wrote to the Appellant, on February 17, 2016 indicating that he no longer met the standard for a commercial licence and was to be downgraded to a class "G" licence.
The Appellant and his wife each testified that he went to the hospital in May 2015 for leg swelling and was found to need surgery. He received medical treatment for about a week until his surgery and has since been well. He feels great. A cardiologist follows him annually. He currently drives a van transporting children, but would like to drive a school bus. He doesn't understand why he can have one licence, but not another and feels there is a big difference between driving a bus and commercial tractor-trailer. In submissions, he stated that he feels it is unfair that the use of inotropic drugs in the hospital, forever precludes him from having a commercial licence in the future.
Registrar's Submissions:
The Registrar submitted that they are very much concerned about the use of inotropic drugs as reported in the cardiovascular condition report. The Canadian Council of Motor Transport Administration (CCMTA) guidelines in section 3.6.42 state commercial drivers must be NYHA (New York Heat Association Heart Function Classification) class I or II, have a LVEF of > 35% and not be receiving intermittent inotropes. Section 14.6 of the Canadian Medical Associations (CMA) Driver's Guide - Determining Medical Fitness to Operate Motor Vehicles states that patients receiving intermittent outpatient or home inotropes should be disqualified from licensure. The MTO must adhere to the standards supported by the two major professional organizations.
ISSUES
Should the decision of the Respondent to change the class or class of motor vehicles in respect of which the licence is issued in accordance with the result of the examination be varied, modified or set aside?
Does the Appellant suffer from a physical condition or disability to an extent that he should no longer be entitled to exercise the privilege of a Class B licence?
LAW
The relevant statutory provisions state as follows.
Section 32(5)(b)(i):
- No person shall drive a motor vehicle on a highway unless the motor vehicle is within a class of motor vehicles in respect of which the person holds a driver's licence issued to him or her under this Act.
(5) The Minister may require an applicant for a driver's licence or an endorsement or a person who holds a driver's licence to submit to the examinations that are authorized by the regulations at the times and places required by the Minister and to meet other prescribed requirements, and the Minister may,
(b) in the case of a person who holds a driver's licence,
(i) impose the conditions authorized by the regulations, remove any conditions or endorsements or change the class or classes of driver's licence held by the person, in accordance with the results of the examinations and other prescribed requirements, or
Further, 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.
APPLICATION OF THE LAW TO FACTS
The CCMTA and CMA standards state that a driver cannot be receiving intermittent or outpatient treatment with an inotropic drug if they are to have a commercial driver's licence. Inotropes are medications that have a direct effect on the strength of contraction of the heart muscle. And thus their use indicates a condition that requires direct medical intervention on how the heart functions. If their effectiveness failed during the operation of a commercial vehicle, the result could be devastating.
The MTO argues the Appellant must meet the appropriate standards, while the Appellant argues that he only received this class of treatment in hospital during a bridge time from symptom onset until surgery, and is since stable. The Registrar did not dispute this point, and seemed to be under the same impression that the Appellant was only on this type of medication in hospital. However, all documentation supports that the Appellant is taking daily Amiodarone for his atrial fibrillation. He used a different name for this drug when reading his medication list to the Tribunal, but upon reviewing the trade name of all his medications, it is apparent he is taking this inotropic drug on a daily basis for heart rhythm control, thus the Appellant does not meet the safety standards for a commercial licence as set out by the two leading guidelines in this province. The standards are reasonable and well documented by two well-recognized professional organizations to ensure the safety of both the commercial driver and others on the road.
In conclusion, the Tribunal finds that the Appellant does suffer from a physical condition likely to significantly interfere with his ability to drive a motor vehicle of the applicable class safely.
DECISION
Upon the application by the Appellant to appeal the decision dated February 17, 2016 of the Respondent to change the class or classes of motor vehicle in respect of which the licence was issued pursuant to Section 32(5)(b)(i) of the Act, and having considered the evidence filed with the Tribunal, and the submissions of the Respondent 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 Respondent be confirmed.
LICENCE APPEAL TRIBUNAL
David Borenstein, M.D., Member
Released: July 27, 2016