Date: 2018-10-19

Appeal under subsection 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 47(1) of the Act to suspend a Driver’s Licence

Between:

P.M.

Appellant

and

Registrar of Motor Vehicles

Respondent

DECISION AND ORDER

Panel: Constantine Petrou, M.D., Member

Stephen Scharbach, Member

Appearances:

For the Appellant: P.M., Self-Represented

For the Respondent: Kiel Biel, Agent

Place and Date of Hearing: Teleconference

October 5, 2018

REASONS FOR DECISION AND ORDER:

A. Overview

1This is an appeal from a decision of the Registrar of Motor Vehicles (“Registrar”), to suspend the appellant’s driver’s licence on medical grounds.

2The suspension was imposed after the Registrar received two medical condition reports submitted by physicians that indicated that on May 10, 2018, the appellant experienced a “ventricular tachycardia arrest” – stoppage of the heart due to an abnormally irregular rapid heartbeat – which caused him to suddenly lose consciousness. He was hospitalised for over three weeks and an implantable cardioverter defibrillator (“ICD”) was implanted to assist heart function.

3In a letter dated June 4, 2018, the Registrar informed the appellant that his driver’s licence would be suspended because of his medical condition. The Registrar stated that reinstatement will be considered once the Registrar receives confirmation that;

• the ICD has not delivered any shock or anti-tachycardia pacing therapy

• a period of at least 6 months has elapsed since the last episode of ventricular tachycardia or ventricular fibrillation.

4The appellant appealed the Registrar’s decision on August 9, 2018. He also provided the Registrar with additional information, including medical information, and requested that his licence be reinstated immediately.

5In a letter dated August 29, 2018, the Registrar informed the appellant that the new information was reviewed but the decision to suspend and the conditions for reinstatement remained unchanged.

6The appellant’s position is that he experienced a fainting spell for 30 seconds and spontaneously recovered within minutes. He says that his loss of consciousness was due to a high heart rate and was not a cardiac arrest.

7In his view, the episode was the result of early rising (he is non-functioning in the morning due to hypoglycemia, chronic fatigue, headaches and chemical sensitivities), and excessive caffeine – he had several cups of coffee together with headache pills containing caffeine.

8He states that he fully recovered within 30 minutes and was active immediately upon admission to the hospital. He states that he remained active in the hospital for three weeks waiting for the ICD to be implanted, and there have been no fainting spells since.

9According to the appellant, a six-month driving suspension is excessive and unwarranted in his circumstances. He essentially states that he does not suffer from a medical condition likely to make it unsafe for him to drive. He asks this Tribunal to set aside the Registrar’s decision and re-instate his licence.

B. ISSUE

10Does the appellant now suffer from a medical condition likely to significantly interfere with his ability to drive a motor vehicle safely?

C. DECISION

11The evidence establishes that the appellant suffers from the condition of ventricular tachycardia (“VT”) with underlying cardiomyopathy. That condition caused him to suddenly lose consciousness and is likely to significantly interfere with his ability to drive safely.

12We confirm the Registrar’s decision of June 4, 2018 to suspend the appellant’s licence until the Registrar receives and reviews medical information confirming that the ICD has not delivered any shock or anti-tachycardia pacing therapy and a period of at least 6 months has elapsed since the last episode of VT or ventricular fibrillation.

D. THE LAW

13The Registrar has the power under s. 47(1) of the Highway Traffic Act, R.S.O. 1990, c. H.8 (“Act”) to suspend or cancel a driver’s licence on various grounds including any “…physical condition or disability likely to significantly interfere with his or her ability to operate a motor vehicle…safely” (Ontario Regulation 340/90 (“Regulation”), s. 14(1)(a).

14Medical suspensions are often based on reports provided to the Registrar by physicians. The Act requires medical practitioners to report any driver to the Registrar who, in the practitioner’s opinion. “…is suffering from a condition that may make it dangerous for the person to operate a motor vehicle.” (Act, s. 203).

15The Regulation also permits the Minister of Transportation to require a driver to provide satisfactory medical evidence of his or her ability to drive safely (Regulation, s. 14(2)(b)).

16In assessing whether an individual suffers from a medical condition that may disqualify him/her from driving, s. 14(2)(a) of the Regulation allows the Minister to consider the medical standards set out in the Canadian Council of Motor Transport Administrator’s Medical Standards for Drivers (“CCMTA Standards”).

17Those standards were developed in consultation with the medical community and they are published to establish consistent medical standards for assessing driving eligibility.

18Section 3.6.31 of the CCMTA Standards is particularly relevant to this case. That standard addresses driving eligibility of non-commercial drivers who, like the appellant, have had an ICD implanted as a secondary prophylaxis (after experiencing an initial episode) for VT with an impaired level of consciousness.

19Section 3.6.31 states such drivers will be eligible for licencing if;

…it has been six months or more since their last episode of sustained symptomatic ventricular tachycardia or syncope [loss of consciousness] judged to be likely due to VT or cardiac arrest…

20Any person aggrieved by a decision of the Minister under s. 47 of the Act to suspend a licence on medical grounds may appeal that decision to this Tribunal.

21On an appeal, the Registrar has the burden of establishing, on a balance of probabilities, that appropriate grounds for suspension exist.

22Following a hearing, the Tribunal may confirm, modify or set aside the decision or order of the Registrar (Act, s. 50(2)).

E. Analysis

(a) The Appellant’s Condition

23On May 10, 2018, the appellant experienced a sudden loss of consciousness while at a restaurant. Emergency personnel were called and he was taken to the local hospital and initially treated in the intensive care unit. He was later transferred from that hospital to a cardiac unit at the Kingston General Hospital and was discharged about three weeks after the episode after an ICD was implanted.

24The appellant states that his loss of consciousness was due to a high heart rate as a result of him rising too early and consuming excessive caffeine. He denies that he suffered a cardiac arrest. He is aware that he has an underling nonischemic cardiomyopathy (decreased heart function) condition and testified that he did not understand that condition or its health implications.

25The appellant’s opinion about the cause of his loss of consciousness is not supported by any medical evidence. The medical evidence establishes that the appellant experienced a sudden loss of consciousness due to cardiac arrest caused by VT and that he has an underlying condition of nonischemic cardiomyopathy. That evidence can be summarised as follows:

(i) Consult/History/Progress notes from Peterborough Regional Health Centre (“PRHC”) written by Dr. H.

The appellant was admitted to PRHC on May 10 and was discharged on May 18, 2018. According to progress notes dictated by Dr. H. on May 10, the appellant has” … a previous history of nonischemic cardiomyopathy as well as nonsustained ventricular tachycardia” and “He had a ventricular tachycardia arrest today”, and will be admitted to the intensive care unit.

According to Dr. H., “EKGs from the event demonstrate fairly clear ventricular tachycardia”.

Dr. H’s diagnosis is stated (in part) to be “ventricular tachycardia arrest, successfully resuscitated May 2018.”

(ii) Discharge Summary from PRHC written by Dr. D.

Dr. D. dictated her discharge summary on May 18, 2018, the day the appellant was transferred to the Kingston General Hospital (“KGH”).

She states in her summary that the appellant “suffered a brief, hemodynamically significant VT arrest”. Dr. D stated that the appellant lost consciousness and she therefore submitted a medical condition report to the Ministry of Transportation and informed the appellant that he will have a “six month driving restriction”.

(iii) Medical Condition Report Submitted by Dr. D

Dr. D submitted a medical condition report dated May 17, 2018. The report states that the appellant suffers from heart disease and experienced a “VT arrest”.

(iv) Medical Condition Report Submitted by Dr. L

The appellant was admitted to the Kingston General Hospital on May 18 and was discharged on May 30, 2018 after an ICD was implanted.

Dr. L., a physician at KGH who was involved in the appellant’s care, submitted a medical condition report to the Registrar dated May 30, 2018. In that report Dr. L. stated that the appellant had heart disease and experienced a VT arrest on May 10. Dr. L’s report states, “Per CCS guidelines, no driving X6 mo from date of event. Now has ICD”.

(v) Discharge Plan Provided to the Appellant by KGH.

After an ICD was implanted on May 29, 2018, the appellant was discharged from KGH on May 30, 2018. He was provided with a discharge plan which contains a section entitled “Diagnosis Details”. The information contained in that section confirms the diagnosis rendered by the three physicians above. It states that the appellant “…is known for ventricular tachycardia (diagnosed in 2017 on EST and Holter)… On May 10th he presented at Peterborough hospital with VT arrest for which he only required CPR briefly…”

26All of the available medical information is consistent and it establishes on a balance of probabilities that the appellant has the condition of ventricular tachycardia with an underlying condition of nonischemic cardiomyopathy and that condition caused a sudden cardiac arrest on May 10, 2018.

(b) Is the Appellant’s Condition Likely to interfere with his Ability to Drive Safely?

27The appellant has experienced one event where he suddenly lost consciousness due to his condition.

28The appellant testified that he was in a restaurant, felt ill and went to the washroom. While standing in the washroom he lost consciousness, fell backwards, and hit his head. The appellant stated that he lost consciousness quickly and apparently before he could sit down or summon help. He testified that he was not sure that he could have pulled over if that had occurred while he was driving.

29Clearly, a condition that can lead to sudden loss of consciousness significantly interferes with a person’s ability to drive safely. A similar episode while driving could easily lead to a collision and places both the appellant and other users of the road at risk of injury or death.

(c) Registrar’s Decision is Consistent with CCMTA Standards

30The Registrar’s June 4, 2018 decision to suspend and impose conditions for reinstatement is consistent with the CCMTA Standards.

31Those standards express eligibility requirement for drivers with various types of medical conditions, including heart conditions.

32There are several eligibility standards that apply to various types of heart conditions. The standard that applies in the appellant’s case is contained in section 3.6.31 which is entitled – ICD Implanted as secondary Prophylaxis for VF or VT – Non-Commercial Drivers.

33That standard to drivers who, like the appellant, are non-commercial drivers who have had an ICD implanted as a secondary prophylactic for VT and who have experienced an impaired level of consciousness.

34The standard states that such drivers will be eligible for licencing if,

it has been six months or more since their last episode of sustained symptomatic VT or syncope [loss of consciousness] judged to be likely due to VT or cardiac arrest.

35The Registrar’s conditions for consideration of reinstatement expressed in his letters of June 5 and August 29, 2018 are squarely in line with CCMTA standard 3.6.31.

36The appellant argues that standard is meant for general application and should be applied flexibly in light of an individual’s particular circumstances. He states that in his case a six-month suspension is excessive because he recovered quickly, has had no further episodes of loss of consciousness, is very physically active, and he is confident that he can drive safely.

37Despite those positive factors we conclude that the Registrar’s decision in this case was correct. The standard is stated to apply in the appellant’s specific circumstances – he has ventricular tachycardia, he has experienced an episode involving loss of consciousness, and he has had an ICD implanted to protect against a further episode. In addition, the medical information indicates that the appellant has an underlying non-ischemic cardiomyopathy. We see no reason to depart from the applicable CCMTA standard in this case.

38Given that the appellant’s condition can lead to a sudden loss of consciousness, we agree that requiring a six-month symptom free period before consideration of reinstatement is appropriate and in the public interest.

DECISION

39Under s. 50(2) of the Highway Traffic Act, the Tribunal may confirm, modify or set aside a decision of the Registrar made under s. 47 of the Act.

40The Registrar’s decision, contained in his letter of June 4, 2018, is confirmed.