Licence Appeal Tribunal

Safety, Licensing Appeals and Standards Tribunals Ontario

Tribunal d’appel en matière de permis

Tribunaux de la sécurité, des appels en matière de permis et des normes Ontario

Date: 2018-09-05

Appeal under section 47(1)(b) of the Highway Traffic Act, R.S.O. 1990, c. H.8, from a decision of the Registrar of Motor Vehicles to suspend a driver’s licence for medical reasons.

Between:

A.P. Appellant

and

Registrar of Motor Vehicles Respondent

DECISION AND ORDER

Panel: Dimitri Louvish M.D., Member Luisa Ritacca, Member

APPEARANCES: For the Appellant: Self-represented For the Respondent: Sonia De Santis, Agent for the Respondent

Place and dates of hearing: by teleconference August 3, 2018

REASONS FOR DECISION AND ORDER:

A. Overview

1This is an appeal from a decision of the Registrar of Motor Vehicles to suspend the appellant’s licence to drive, effective April 26, 2018. The appellant is a 24-year old female, who has type 1 diabetes. She has lived with her condition for over 18 years. She has been driving since she was 16 years old. On April 23, 2018, the appellant had a hypoglycemic episode while in a grocery store, which resulted in her briefly losing consciousness. Emergency Medical Services (EMS) was called to respond.

2The Registrar made his original decision to suspend the appellant’s licence following the receipt of a medical condition report from an Emergency Room doctor, who reported the appellant’s episode of apparent hypoglycemic and loss of consciousness.

3The appellant filed her Notice of Appeal on July 4, 2018. In her reasons for appeal, the appellant stated that she strongly disagreed with the Registrar’s decision to continue to suspend her license for an extended period of time, despite confirmation from her endocrinologist and diabetes care specialist that her condition is stable and that she is fit to drive. The appellant further stated that she has had no additional severe hypoglycemic reactions since the episode in April.

4For the reasons that follow, we find that the appellant’s medical condition of diabetes is not likely to significantly interfere with her ability to drive safely.

5The Registrar’s suspension is therefore set aside.

ISSUES:

6The appellant acknowledged that she suffers from type 1 diabetes and that an episode of hypoglycemia played a part in her losing consciousness in a grocery store on April 23, 2018. As such, the only issue for the panel to determine was as follows:

a. Is the appellant’s medical condition of diabetes likely to significantly interfere with her ability to drive safely?

THE LAW:

7The Registrar has the power under s. 47(1) of the Highway Traffic Act (the “HTA”) to suspend or cancel a driver’s licence for any of the specified grounds listed in paragraphs (d) through (f) of that subsection, which involve misconduct and criminal behaviour. Subsection (g) provides that the Registrar may suspend or cancel a driver’s licence for “any other sufficient reason not referred to in clauses (d), (e), or (f)”.

8It is open to the Registrar to conclude that subsection 47(1)(g) is engaged where the driver suffers from a medical condition or disability likely to significantly interfere with his or her ability to drive safely.

9Subsection 14(1) of O. Reg. 340/94 (the “Regulation”) under the HTA 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;

10Pursuant to s. 14(2)(a) of the Regulation, in determining whether subsection 14(1) is triggered, the Minister of Transportation may consider the CCMTA Medical Standards for Drivers, which are published by the Canadian Council of Motor Transport Administrators. Similarly, this panel may take the CCMTA Medical Standards for Drivers into consideration, although they are not binding requirements.

11The Registrar has the burden to establish the ground for suspending the licence on a balance of probabilities.

12Pursuant to section 50(2) of the HTA, following a hearing, this panel may confirm, modify or set aside the decision or order of the Registrar.

EVIDENCE AND ANALYSIS:

13The appellant is a 24 year old female, who suffers from type 1 diabetes. She has been living with the disease since childhood. She is a recent graduate and is currently employed as a communications consultant. She lives approximately 35 to 40 minutes away from her place of employment. Until her licence was suspended, the appellant used her vehicle to travel to and from work. At present, she is relying on her boyfriend and family members to take her to work.

14Based on her testimony, it is clear that the appellant has good insight into managing her disease. At present she wears a personal constant glucose monitoring device (GMD). She acknowledged that she was not wearing her GMD at the time of the incident because she was just sorting out her insurance coverage for the device.

15The appellant testified that she tests her glucose levels upon waking up in the morning, has a juice box and then gets ready for work. She eats breakfast and checks her glucose again before heading out to work in her car. She carries a juice box and granola bar with her at all times and tries not to skip meals.

16The appellant is under the regular care of an endocrinologist, whom she sees yearly, and a nurse practitioner who works within the diabetic clinic every three months.

17At the Registrar’s request, the appellant delivered two Medical Condition Reports completed by her endocrinologist, dated May 16, 2018 for Syncope/Loss of Consciousness and Diabetes. In both Reports, the endocrinologist confirmed that the appellant has an awareness of early symptoms of hypoglycemia. In a letter accompanying the reports, the endocrinologist also confirmed that the appellant “understands the caution that needs to be taken with driving”.

18The appellant also filed a letter from her family physician dated May 16, 2018. In it, her family physician confirmed that the appellant is careful about her blood sugars while driving; that she checks her level both before and after driving and that she will not drive if the glucose level is less than 5. Further, he confirms that she has had no previous episode of loss of consciousness related to her diabetes and there is nothing to suggest hypoglycemia unawareness.

19The appellant acknowledged that on the evening of April 23, 2018, she briefly lost consciousness while grocery shopping after work. The appellant testified that she had skipped lunch that day and that upon feeling the early symptoms of hypoglycemia, she drank her juice and granola bar. She also took a can of ginger ale from the store. She had no intention of leaving until she felt better. She believes she was likely unconscious for 10 to 15 seconds. She was conscious by the time the EMS arrived on scene.

20The appellant assumed that she had a drop in her glucose level that caused her to briefly lose consciousness, but it does not appear that her glucose levels were checked either at the grocery store or at the hospital.

21The appellant was treated with fluids at the hospital prior to being released. It does not appear that she required any specific medical intervention to assist her with her glucose.

22Based on the evidence before it, the panel was satisfied that the appellant does suffer from type 1 diabetes and that on April 23, 2018 she had an incident of hypoglycemia, which played a part in her episode at the grocery store.

23The respondent took the panel through the CCMTA Standards for Drivers as they relate to persons with diabetes. Chapter 7, section 7.6.4 provides in part that where a non-commercial driver has had an episode of “severe hypoglycemia”, there should be evidence of no further severe hypoglycemic episodes while awake or asleep for six months prior to issuing (or in this case reinstating) a license.

24The respondent argued that the appellant had an episode of “severe hypoglycemia” in the grocery store on April 23, 2018. It was the respondent’s position that the episode was “severe” because the appellant required intervention from the third party, EMS, even though she was not given anything by the EMS or the hospital to treat her glucose level.

25The panel does not accept the respondent’s position with regard to the hypoglycemic episode. The appellant lost consciousness for 10-15 seconds and was awake and alert at the time the EMS arrived. She did not require any significant medical intervention. The appellant testified that she wanted to go to the hospital because she was still feeling shaky, but once there, she was not provided with anything other than intravenous fluids.

26Even if the panel were to accept that the appellant suffered a “severe hypoglycemic” episode in April, we do not accept that in this case it is necessary for the appellant to demonstrate that she has had no further severe hypoglycemic episodes within the last six months. The CCMTA Standards are not binding on this panel and in the circumstances the panel finds that the six-month time period is excessive.

27The evidence shows that the appellant has taken significant steps to manage her diabetes and that her health care providers believe that she has her disease well under control. The appellant’s attention to her diet, her awareness of the early warning signs of hypoglycemia and her commitment to use a glucose monitoring device at all times shows remarkable insight into the management of her disease.

28The panel finds that the appellant’s physical condition is not likely to significantly interfere with her ability to drive a motor vehicle safely.

Conclusion

29For the reasons set out above, pursuant to subsection 50(2) of the HTA, the Registrar’s decision to suspend the appellant’s driver’s license is set aside.