Licence Appeal Tribunal
Appeal under subsection 50(1) of the Highway Traffic Act, R.S.O. 1990, c. H. 8, (HTA) from a decision of the Minister of Transportation to suspend the driving privileges of the appellant under subsection 47(1) of the HTA
Between:
DB Applicant
and
Registrar of Motor Vehicles Respondent
DECISION and ORDER
Panel: Dr. Isla McPherson, Member Patricia Conway, Member
APPEARANCES: For the Appellant: DB, self represented For the Respondent: Kyle Biel, agent
Court Reporter: Gabriel Lavoie
Place and date of hearing: By Teleconference, October 21, 2019
OVERVIEW
1The appellant is appealing to the Licence Appeal Tribunal (Tribunal) from an order of the Registrar made in September 2016 suspending the appellant’s driving privileges under s. 47(1) of the Highway Traffic Act, R.S.O. 1990, c. H.8. (the “HTA) This order was made after the Registrar received an unsolicited Medical Condition Report from the appellant’s physician pursuant to s. 203 of the HTA stating that the appellant suffered from a mental disorder that might significantly interfere with their ability to drive safely. Specifically, the appellant had been diagnosed with schizophrenia and had ceased to take prescribed medications.
2The appellant began this appeal on April 13, 2019.1 The hearing was originally scheduled for July 3, 2019. It has been adjourned several times to allow the appellant to find a psychiatrist and obtain an up to date medical health assessment report. That report dated August 28, 2019 was received by the Tribunal on September 4, 2019.
Preliminary Issue
3The appellant requested that the Tribunal make a confidentiality order with respect to the decision. The Tribunal considered the intensely personal and potentially prejudicial nature of the matters under consideration and made the order requested. We determined that the intensely private and personal nature of the matters in issue here are such that the appellant’s desire to avoid disclosure and the lack of any public interest in these matters outweighs the desirability of adhering to the principle that the record be available to the public. Specifically, we order that the identity of the appellant not be disclosed and have therefore ensured that his request for anonymity is respected in these reasons.by referring to him and to his doctors and the treating facilities so that they are not identifiable. .
Issues for determination
4a. Does the appellant suffer from schizophrenia?
b. If he does, does the schizophrenia significantly interfere with his ability to drive safely?
The Law
5Section 47(1) of the HTA provides:” subject to section 47.1, the Registrar may, by order, suspend or cancel….(b) a driver’s licence…on grounds of …(g) any other sufficient reason not referred to in clause (d), (e) or (f).”
6Section 14 of Ontario Regulation 340/94 under the HTA provides that the holder of a driver’s licence must not:
(1) suffer from any mental, emotional, nervous, or physical condition or disability likely to significantly interfere with his or her ability to drive ... safely.
EVIDENCE AND ANALYSIS
Issue a: Does the appellant suffer from schizophrenia?
7The appellant informed the hearing that he was diagnosed with schizophrenia by a Dr. M. at Christmas of 2004. He reported feeling relieved when given the diagnosis because it “explained things I was thinking”. The appellant declined to elaborate on the circumstances that led to the diagnosis. He appeared to admit or accept the diagnosis during the hearing.
8The appellant testified that he had another psychiatric assessment in 2007 and that the examining physician made the same diagnosis. The appellant has not tendered in evidence any report from Dr. M nor from the 2007 physician. The appellant stated that after the diagnosis at Christmas of 2004, Dr. M. prescribed medications to control the agitation and anxiety caused by the condition. Although the appellant was not absolutely certain of the names of the drugs, he believed these were Ciprolex and Zeldox. The appellant testified that he stayed on the medication for several years.
9The appellant’s family physician, Dr. S., submitted an unsolicited Medical Condition Report (MCR) to the Registrar in September 2016 indicating that the appellant suffered from schizophrenia and had stopped taking his medication. This led the Registrar to suspend the appellant’s licence.
10In July 2017 Dr. S. sent another report to the Registrar stating the appellant suffered from schizophrenia and was not taking his medication. On that form Dr. S. checked the box stating that the appellant was suffering from psychosis.
11The completed mental health assessment report (MHA) submitted to the Registrar by the appellant’s psychiatrist dated August 22, 2019 indicates that the appellant has a diagnosis of schizophrenia. The appellant testified at the hearing that he had seen Dr. U several times and that he had a two-week period of hospitalization in July of 2019. The appellant did not understand why the admission to hospital was made. He stated that he thought it was because the appellant asked Dr. U. to cap his pen during one of their sessions. The appellant requested this because he was concerned about ink evaporating into the air from the open pen.
12The appellant’s testimony at the hearing questioned the reports of Dr. S. and Dr. U. The appellant stated that he believed that both doctors were influenced by his mother. There was no evidence offered to support this belief, nor any explanation of why he believed it.
13Thus, the evidence before the Tribunal includes three medical submissions by two different physicians completed over the course of three years, all consistently documenting the diagnosis of schizophrenia. The Tribunal has also heard from the appellant that there have been two earlier diagnoses of schizophrenia made by two other physicians treating him. The appellant has provided no evidence from a physician to contradict that diagnosis and has offered no substantive evidence to support the allegation that Dr. S. and Dr. U. are biased against him or that such bias has led to a misdiagnosis.
14Having considered the evidence before us, we are satisfied that the Registrar has proven on a balance of probabilities that the appellant suffers from schizophrenia.
Issue b: Is the appellant’s mental condition likely to significantly interfere with their[^2] ability to drive safely?
15The CCMTA Driving Standards (“Standards”) acknowledge that a diagnosis of schizophrenia does not necessarily preclude a person’s ability to drive safely. However, the Standards warn that without appropriate medical treatments which may include medications, an individual may suffer from psychotic symptoms such as delusions or hallucinations as well as disorganized or illogical thoughts and behaviours. Active psychotic symptoms, being outside the control of the person experiencing them, are incompatible with safe driving. The Standards state that the medical condition, schizophrenia, must be under control and the person afflicted with the condition must have insight into the effect the condition might have on driving, and must be compliant with recommended treatment, including prescribed medications.
16Dr. S’s September 2016 MCR to the Registrar reported that the appellant was not taking his prescribed medications. In 2017, Dr. S. sent his second report noting that the appellant was still not taking the medications, and that the appellant was experiencing psychosis. Dr. U’s MHA states that the appellant has ongoing moderate symptoms that included delusions and paranoid beliefs as well as other symptoms including agitation, aggression and poor impulse control. At the hearing, the appellant testified that Dr. U. prescribed venlafaxine but that he only had enough left to last another 15 days. Asked what he intended to do, the appellant responded that he was not sure he would continue taking it. The appellant said that he was not concerned about what would happen if he went off the medication. The appellant also stated that he had lost trust in Dr. U. and would no longer return to see him. The appellant hoped to find another physician but had not made an appointment to see any physician or other medical caregiver.
17This evidence indicates that the appellant does not understand, or does not believe, that compliance with his prescribed pharmaceutical regime is necessary to enable him to maintain mental stability and manage his psychotic symptoms. If these psychotic symptoms are not being managed, we have grave concerns that the appellant cannot drive safely.
18Further, the evidence in Dr. S.’s MCR, states that the appellant has no insight into how his condition might affect his ability to drive safely. The appellant testified that he wanted a driver’s licence for purposes of identification only and had no intention of driving. Mr. Biel, the Registrar’s agent at the hearing, noted that there are other forms of identification available to the appellant. The Tribunal’s view is that the appellant’s intentions are not relevant to the issue before it.
19The appellant testified that he did not understand what Dr. U. was referring to in his MHA when he described the appellant as aggressive or as impulsive. The Tribunal finds that this lack of self-awareness demonstrates that the appellant does not recognize the extent to which his judgment, reasoning and decision-making are impaired by his mental condition when he is not compliant with the medication regime prescribed by Dr. S. or Dr. U. These executive functions, judgment, reasoning and decision-making, are key to safe driving.
20The Standards, while not binding on the Tribunal, corroborate our concerns. Standard 14.6.1, dealing with psychiatric disorders including schizophrenia, states that the deficits displayed by a schizophrenic whose condition is not controlled by appropriate medications include impairment of the executive functions detailed above: judgment, reasoning and decision-making. The presence of these impairments in the appellant’s executive functions convinces us that the appellant’s ability to drive safely would be significantly impaired by his mental condition while he continues to not to take his medications and has no insight into the importance of compliance.
DECISION AND ORDER
21The Tribunal therefore confirms the order of the Registrar suspending the appellant’s driver’s licence.
LICENCE APPEAL TRIBUNAL
Dr. Isla McPherson, Chair
Patricia Conway, member
Released: December 04, 2019