Licence Appeal Tribunal
Appeal d'appel en Tribunal matière de permis
FILE: 10262/MED
CASE NAME: 10262 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
10262 Appellant
-and-
Registrar of Motor Vehicles Respondent
REASONS FOR DECISION AND ORDER
ADJUDICATOR: Kevin Flynn, M.D., Member
APPEARANCES:
For the Appellant: Self-represented
For the Respondent: Kyle M Biel, Agent
Heard by teleconference: July 7, 2016
REASONS FOR DECISION AND ORDER
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
An unsolicited Medical Condition Report was completed on April 24, 2016 by Dr. U., a psychiatrist, in compliance with section 203 of the Act. This was based on examination the same date. The patient was aware of the report.
The condition reported was:
Mental or Emotional Illness-Unstable
Dr. U elaborated by stating:
He reported suicidal ideation involving killing himself in a car accident but came to the hospital instead. Mildly depressed. Loss of status after deficits from multiple car accidents. Willing to get help.
The Registrar informed the Appellant on April 25, 2016 that his driving privilege was suspended under section 47(1) of the Act.
The Appellant was requested to take the letter of suspension to his physician, specialist or nurse practitioner when his condition improved and have a Mental Health Assessment form completed and forwarded to the Medical Review Section.
The Mental Health Assessment was completed in May 2016 by a nurse practitioner, Ms. V, who became involved on or about the same date.
The assessment is summarized as follows:
- Primary mental illness: Situation Stress/Crisis and Chronic Pain less than 3 months
- Current status: Stable with ongoing symptoms, mild
- Current symptoms: Suicide attempt (within the past year)
- No impairment of cognition, attention or memory and no judgment difficulties
- No substance dependence, misuse or abuse
- Adherent to recommended treatment and no pattern of non-adherence
- Under medical supervision monthly, by a nurse practitioner
- Has appropriate insight on impact on ability to drive
- Does not require independent functional assessment
On June 2, 2016, the Registrar informed the Appellant that his driver's licence would remain under suspension.
He was requested to have the following information forwarded to the Medical Review Section when his symptoms have improved:
- Confirmation of a three month period of mental and emotional stability
- Improvement of his condition with confirmation that symptoms are being successfully treated and/or resolved.
Evidence by the Appellant
The Appellant, age 38, is a non-practising professional who suffered a brain injury in a traffic accident in British Columbia ("B.C.") in 2009. He was then involved in four traffic accidents between 2009 and 2014 in which he sustained injuries with concussion and chronic pain.
He returned to Ontario with his wife and two children in March, 2016.
He was prescribed Cymbalta, 30 mg daily, in B.C. which he brought with him to Ontario and obtained a renewal from a walk-in clinic.
He was on "medical marijuana" for pain while in B.C. and continued to obtain this by mail after his move to Ontario. He uses alcohol only on social occasions. He had financial difficulties and found that he was not able to provide for his family.
On the morning of April 24, 2016, he had a dispute with his wife and he took his car keys and drove onto the highway hoping that he would be in an accident with another vehicle, in order to hide an attempted suicide. He stated that if he died in an accident his wife would receive benefits.
He changed his mind and drove to a local hospital. He was seen there by an Emergency Room ("E.R.") physician who contacted a psychiatrist, Dr. U., at a secondary level hospital. The psychiatrist received relevant information by video from the E.R. doctor and interviewed the patient.
Dr. U. questioned him and advised him that he could drive home as she found that he was not a danger to himself or others, but she told him that his licence to drive would be suspended.
She completed the Medical Condition Report without seeing him physically.
He was referred for a follow-up to a nurse practitioner, Ms. V.
He was also taking another anti-depressant, Effexor, which he discontinued along with Cymbalta on advice from the nurse practitioner, Ms. V. who wanted a "wash-out" of all medications. His wife is aware that he is not on anti-depressant medication now. She has also met with the nurse practitioner on two occasions.
He reviewed his coping mechanisms with Ms. V. and communication with his wife has improved. His wife does not work and they have two small children. He has also been accepted as a patient by a local family physician and he attends a pain clinic in Toronto.
He states that he is a diligent driver and although he had transient suicidal ideation, he did not make an actual attempt and sought medical help.
ISSUES
Should the decision of the Registrar to suspend the Appellant's licence be confirmed, modified or set aside?
In particular:
Does the Appellant 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.
(2) The Tribunal may confirm, modify or set aside the decision of the Minister or the Registrar.
APPLICATION OF THE LAW TO FACTS
Mr. Biel stated that the Respondent relied on the following:
The Registrar was authorized to suspend the driving privilege under section 47(1) upon receiving a Medical Condition Report from a physician in compliance with section 203 of the Act. The report stated that the Appellant had suicidal ideation, about causing a motor vehicle collision, while suffering from an unstable mental or emotional illness.
According to the Appellant's evidence, the physician gave permission to the Appellant to drive his car home.
The Ministry responded quickly and suspended the Appellant's driving privilege and requested confirmation by his physician, that his condition has remained stable for a period of three months.
Ontario Regulation 340/94 (14) (a) states that a driver must not suffer from a mental or emotional condition likely to significantly interfere with his ability to drive a motor vehicle safely.
The Canadian Council of Motor Transport Administrators, CCMTA, Guidelline 14.6.1 states that:
All drivers are eligible for a licence if the condition is stable, has sufficient insight to stop driving if the condition becomes acute; the functional abilities necessary for driving are not impaired and the treating physician supports a return to driving.
The Mental Health Assessment in May 2016, did not state how long the condition remained stable and does not state support for reinstatement of the Appellant's driving privilege.
The treatment plan for the Appellant is ongoing and there is no medical evidence that the condition has been successfully treated or resolved.
The Appellant stated that the psychiatrist, Dr. U. deemed him well enough to drive his car home, in spite of reporting him as unsafe to the Ministry. He acknowledged that he had suicidal ideation, but did not have a plan to carry it out.
On the Mental Health Assessment, Ms V. stated that his condition was stable and he suggests that she forgot to state for how long he was stable.
He states that he is improving and maintaining his stability as well as starting with a new family physician.
He suggests that the CCMTA Guideline does not state a three month period of stability before reinstatement can be considered.
He stated that he tried to go through an Administrative Review but was unable to make contact.
He also submitted that the nurse practitioner supports reinstatement even though she has not stated this in writing.
The Tribunal has carefully considered the evidence and submissions. The Tribunal finds that the Registrar was justified in issuing a suspension of the Appellant's driving privilege upon receipt of a Medical Condition Report of suicidal ideation while driving under unstable emotional stress.
However, the Appellant changed his mind and sought medical help. A psychiatrist spoke to him and decided that he was not a danger to himself or others and allowed him to drive his car home.
The Appellant has a background of concussion with injuries sustained in a number of motor vehicle incidents in another province. While there, he was prescribed antidepressants and "medical marijuana" for pain. He returned to Ontario where he found himself without a physician and in financial difficulties. This led to stress with his wife and in desperation, he took his car on the highway and thought of orchestrating a collision that would benefit his wife and family.
He displayed insight into his problem by seeking medical help and has benefitted from the support provided monthly by a nurse practitioner until locating with a family physician.
The Mental Health Assessment completed in May 2016, by the nurse practitioner checked "suicide attempt" but the Tribunal finds that an attempt has not been made, although suicidal ideation did take place. She noted that the condition is mild in nature and stable, even though she did not note the duration of stability. She stated that the Appellant has no impairment of cognition, attention or memory and has no difficulties with judgment. He is adherent to treatment and has appropriate insight into his functional ability to drive. His level of depression is described as mild.
The Tribunal finds that the CCMTA Guideline 14.6.1 has been met by the Appellant and the three month stability period requested by the Registrar, commencing April 24, 2016, is almost completed.
Weighing the evidence on a balance of probabilities, the Tribunal finds the Appellant is not suffering from a condition which is likely to significantly interfere with his ability to drive a motor vehicle safely.
DECISION
Upon the application by the Appellant to appeal the decision effective May 5, 2016 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 be set aside.
LICENCE APPEAL TRIBUNAL
Kevin Flynn, M.D., Member
Released: July 22, 2016