File Number: 11676/MED
Appeal under subsection 50(1) of the Highway Traffic Act (the HTA), R.S.O. 1990, c. H.8, from a Decision of the Registrar of Motor Vehicles pursuant to section 47(1) of the HTA to Suspend a Driver’s Licence
Between:
L.T.
Appellant
and
Registrar of Motor Vehicles
Respondent
DECISION AND ORDER
Panel: Dimitri Louvish, M.D., Member Harriet Lewis, Member
Appearances:
For the Appellant: L.T., Appellant
For the Respondent: Sonia De Santis, Agent
Place and Date of Hearing: By Teleconference November 14, 2018
REASONS FOR DECISION AND ORDER
A. OVERVIEW:
1The appellant L.T. is a 42-year-old mother of three teenage children. She has been successfully treated for narcolepsy since March 2017 but for approximately sixteen months did not have a formal diagnosis of the condition.
2In July 2018, she was tested at a Sleep Laboratory and formally diagnosed as having narcolepsy with cataplexy by Dr. K.W.
3On August 16, 2018, Dr. K.W. provided a Medical Condition Report to the Registrar of Motor Vehicles (“the Registrar”). As a result, on August 20, 2018, the Registrar wrote to L.T. to advise her that her licence was being suspended effective August 30, 2018 because of narcolepsy. The Registrar’s letter stated that prior to reinstatement L.T. would have to provide confirmation from her treating physician, specialist or nurse practitioner that she has not experienced an episode of cataplexy or a daytime sleep attack for 12 months or more.
4On August 20, 2018, L.T. filed her notice of appeal of that suspension. Since the incident of August 16, she has had an adjustment to her medication regime and has had no episodes of narcolepsy or cataplexy.
5For the reasons that follow, we are modifying the decision of the Registrar to provide that the period of freedom from cataplexy or daytime sleep attacks prior to reinstatement will be reduced from 12 or more months, to 6 months.
B. ISSUES:
6The issue in this appeal is whether the appellant suffers from any mental, emotional, nervous or physical condition or disability likely to significantly interfere with her ability to drive a motor vehicle safely.
C. EVIDENCE:
7The appellant lives in a semi-rural area and uses her passenger vehicle to ferry her children to their school and part-time jobs. She also uses her car for her employment as a Youth Worker with a public social service agency. She runs youth groups in which she teaches skills for independent living. She is currently on medical leave as her position requires a driver’s licence.
8Approximately three and a half years ago L.T. noticed symptoms of fatigue, daytime drowsiness, and sleep paralysis, as well as occasional droopiness in the muscles of her face and weakness and buckling in one of her legs. On the rare occasions when she felt drowsy while driving, she pulled over until the drowsiness passed. The facial drooping and leg buckling were embarrassing to her as they occurred at work, but were momentary and did not impair her driving. She reported her symptoms to her family physician who referred her to a neurologist for a CT scan and MRI. Following those tests, she was prescribed Medafinil and after two weeks on that drug, her symptoms subsided substantially. She no longer had symptoms of narcolepsy although she continued to have the occasional facial and leg issues which are symptoms of cataplexy.
9In April 2018, L.T.’s family physician retired and his practice was assumed by Dr. D.D. who began overseeing L.T.’s health. Thereafter, in July 2018 L.T. attended a Sleep Lab and was assessed and formally diagnosed as having narcolepsy with cataplexy by Dr. K.W. who reported it to the MTO.
10Following her formal diagnosis, L.T.’s medication was changed to Venlafaxine, 150 mg once a day, and since that adjustment, she has not experienced symptoms of narcolepsy or catalepsy.
[11 Her treatment continues to be overseen on a monthly basis by Dr. D.D. In addition, to her daily Venaxofline, she maintains a strict lifestyle involving regular hours of sleep, exercise and a proper diet. She has no other medical conditions.
12On November 9, 2018, Dr. D.D. provided a letter confirming L.T.’s diagnosis and treatment. Included in that letter is his opinion that L.T. “is well treated and is fit for driving.”
13On November 13, 2018, the Registrar issued a further letter to L.T. acknowledging the November 9 report but confirming the requirement of 12 months absence of episodes of cataplexy and confirmation that L.T. continues not to experience any daytime sleep attacks.
14The Registrar’s agent reviewed the appellant’s history and explained the background and content of the CCMTA, including guidelines relevant to narcolepsy and cataplexy. She confirmed that the Registrar is relying on s.18.6.2 of those guidelines which indicate a symptom free period of 12 months.
D. THE LAW:
15The Registrar has the power under s. 47(1) of the Act to suspend or cancel a driver’s licence for any sufficient reason.
16In this case, the applicable reason is found in Ontario Regulation 340/94 under the HTA which 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.
17In determining whether a person meets the standard set by s.14(1) the Minister may, under s.14(2)(b) of the Regulation, require him or her to provide satisfactory evidence that he or she is able to drive a motor vehicle of the applicable class safely. That evidence may include any reports of examinations that the Minister has required the person to submit to pursuant to s.15 of the Regulation.
18Paragraph 14(2)(a) of the Regulation allows the Minister to consider the Canadian Council of Motor Transport Administrators Medical Standards for Drivers (the “CCMTA Standards”) when determining whether the requirements of s.14 (1) are met.
19The Tribunal may take the CCMTA Standards into consideration although they are not binding requirements. In this case, the respondent referred the Tribunal to s. 18.6.2 of the CCMTA; which, as noted above, recommends a twelve-month period free of narcolepsy and cataplexy.
20The jurisdiction of the Tribunal is set out in s. 50(2) of the HTA and allows the Tribunal to confirm, modify or set aside the decision or order of the Minister.
F. ANALYSIS:
21The medical evidence in this case has confirmed that the L.T. has responded well to medication. She has not experienced a daytime sleep attack for over 3 years. The change from Medafinil to Venlafaxine, has addressed the cataplexy symptoms and she has had no incidents since the medication change 4 months ago.
22L.T.’s answers to our questions were open and straightforward and we find her credible. She was the instigator of her treatment for narcolepsy in 2017 and for cataplexy some months later. Dr. D.D. continues to monitor her on a monthly basis and he has also provided a positive assessment of her ability to operate a motor vehicle safely.
F. CONCLUSION
23For the reasons set out above, pursuant to subsection 50(2) of the HTA, we are modifying the Registrar’s decision to reduce the period in which the appellant must provide confirmation that she has been free of episodes of cataplexy or daytime sleep attacks from 12 months to 6 months.
LICENCE APPEAL TRIBUNAL
________________________
Dimitri Louvish M.D., Member
_________________________
Harriet Lewis, Member
Released: November 23, 2018