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: 2020-05-13

Appeal under subsection 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 – Suspension of a Licence for Medical Reasons

Between:

Justin Secord Appellant

And

Registrar of Motor Vehicles Respondent

DECISION AND ORDER

Panel: Dr. Dimitri Louvish, Member Ted Crljenica, Vice Chair

Appearances: For the Appellant: Justin Secord For the Respondent: Sonia DeSantis, Agent

Heard by Teleconference: April 30, 2020

REASONS FOR DECISION AND ORDER

A. OVERVIEW

1This is an appeal from a decision of the respondent, the Registrar of Motor Vehicles, to suspend the appellant’s class G driver’s licence as a result of a hypoglycemic seizure. The appellant was notified of the suspension by letter from the respondent dated January 13, 2020.

2For the reasons that follow the Tribunal confirms the decision by the Registrar to suspend and maintain the suspension of the appellant’s class G driver’s licence in regard to his condition of diabetes. The Tribunal sets aside the Registrar’s request for information in regard to a psychiatric condition.

B. LAW

3The respondent has the power under s. 32(5)(b) of the HTA to suspend a licence in accordance with requirements prescribed in the regulations.

4Subsection 14(1)(a) of O. Reg. 340/94 enacted under the HTA requires that a holder of a driver’s licence must not 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.

5Section 14(2)(a) of the O. Reg. 340/94 allows the respondent to consider the CCMTA Standards when determining whether the requirements of s. 14(1) are met. Similarly, the Tribunal may take the CCMTA Standards¹ into consideration. However, the CCMTA standards are not binding on the respondent or on this Tribunal.

6The Registrar has the burden of establishing on a balance of probabilities the ground or grounds to suspend a driver’s licence.

7Pursuant to section 50(2) of the HTA, after a hearing the tribunal may confirm, modify or set aside the decision or order of the respondent to reinstate a licence.

C. ISSUE

8The legal issue for the tribunal to determine is whether the appellant suffers from a medical condition that is likely to significantly interfere with his ability to drive safely pursuant to section 14 (1)(a) of O. Reg. 340/94.

D. THE EVIDENCE

9The appellant suffers from type 1 diabetes. His diabetes has been controlled through the use of insulin injections. He is being followed by an endocrinologist at a Diabetes Education Centre and to a lesser extent by his family physician.

10The appellant also suffers from depression. Since April or May 2020, he had been taking sertraline, an antidepressant medication. In January 2020 his family physician increased the dosage of sertraline. On January 8, 2020, a few hours after he took the higher dosage for the first time, the appellant suffered a seizure while sleeping. An ambulance was called and the appellant was transported to a hospital emergency department. His blood glucose level was very low, measuring 2.3 mmol/L. He was treated with glucagon and released later that day.

11He immediately stopped taking sertraline and was prescribed another antidepressant medication. He has not had a seizure since January 8, 2020.

12As required by the Act, the emergency physician filed a Medical Condition Report with the respondent. On January 13, 2020 the respondent wrote to the appellant advising him that his licence is being suspended as a result of his diabetes. As directed by the January 13, 2020 letter from the respondent, the appellant attended with his family doctor to have forms received from the respondent completed. On January 23, 2020, the doctor completed the respondent’s Epilepsy and Seizure Form and Diabetes Assessment Form. According to the appellant’s doctor, the appellant:

a. Exhibits adequate glucose control by monitoring and assessment;

b. Has an adequate understanding of diabetes and the close relationship between insulin, oral medication, diet and exercise;

c. Is generally compliant with respect to diet, self-monitoring attendance at the doctor’s office, lifestyle, and exercise/rest.

d. Is aware of the early symptoms of hypoglycemia; and

e. Had an A1C reading of greater than 12%. The date of the reading was not set out in the form.

13By letter dated February 21, 2020, the respondent advised the appellant that the Ministry reviewed the information received from the appellant’s doctor and that in order to have his licence reinstated the appellant’s treating doctor or specialist must provide the Registrar with:

a. Confirmation that he has not experienced any further hypoglycemic reactions and that his condition has remained stable for a period of six months;

b. Confirmation that he continues to have stable glycemic control;

c. The result of a repeat A1C analysis and confirmation that it is congruent with his blood logs, and

d. Confirmation that he has not had any other seizures in the past six months.

14In response, the appellant’s family doctor provided the respondent with a letter dated March 3, 2020. In that letter she stated that the appellant is diabetic and suffers from depression; that his hypoglycemic reaction/seizure may have been a result of the interaction between insulin and sertraline; that the appellant has discontinued sertraline and has not had a recurrent seizure; and that prior to the January 8, 2020, the appellant had not had a seizure for over five years. The doctor’s conclusion was that the “precipitating event” for the seizure has been corrected and that the appellant’s “driving risk has returned to his baseline”.

15By letter dated April 17, 2020, the registrar wrote to the appellant advising that the information requested by its letter of February 21, 2020 has not been provided. It appears that the registrar was not satisfied with the doctor’s letter of March 3, 2020 and requested the same information requested in the February 21, 2020 letter. In addition, for the first time, the registrar also noted that a psychiatric condition has been reported to the registrar and enclosed a Mental Health Assessment form to be completed by the appellant’s treating physician and returned.

16During the April 30, 2020 hearing the respondent’s agent was asked the basis of the Registrar’s request for information regarding a psychiatric condition. She advised that this request arose from the reference in the doctor’s letter of March 3, 2020 to the appellant’s depression. When asked if the respondent has information that the appellant’s depression has or is likely to interfere with the appellant’s ability to safely drive a motor vehicle, she responded that it does not.

17In his testimony the appellant advised that his primary diabetes treatment is provided by an endocrinologist working out of a Diabetes Education Centre. His last attendance at the Education Centre was in November 2019. It was in regard to that attendance that the hemoglobin A1C blood test result referred to in paragraph 12 (e), above indicated a value of greater than 12%. The therapeutic target is for A1C to be in the ≤ 7% range. The A1C test is a marker that correlates with mean blood glucose readings over the previous three months.

18A nurse practitioner at the Education Centre instructed the appellant to change the proportion of insulin he takes by one unit for every 10 grams of carbohydrates. He had been taking one unit for every 15 grams of carbohydrates. The appellant testified that he has been compliant with these instructions.

19The appellant testified that according to his continuous blood sugar monitoring device his blood glucose readings on the day prior to the hearing were 12.4 mmol/L in the morning and 11.1 at lunchtime. On the previous day the morning reading was 20.1mmol/L and the lunchtime reading was 23.1.

20According to the appellant he does not consume alcohol or recreational drugs.

E. ANALYSIS

21In the materials filed with his appeal the appellant included information regarding drug interactions. According to that material there is a moderately significant risk that using sertraline and insulin can result in hypoglycemia. This is consistent with the opinion of the appellant’s family doctor in her letter of March 3, 2020. It is also consistent with the appellant having experienced hypoglycemia the very day he took his first increased dose of sertraline.

22We find it probable that that the appellant’s seizure on January 8, 2020 was caused by hypoglycemia brought about by the interaction between his insulin medication and the higher dose of sertraline. We also accept the appellant’s evidence that he no longer takes sertraline and that he has not had a seizure since that time.

23However, the evidence also discloses that the appellant’s most recent A1C reading (from November 2019) was greater than 12%. The A1C is a blood test that reflects glucose levels over the previous three months. A reading of greater than 12% is very high and indicative that the appellant’s diabetes is not adequately managed. We accept his testimony that he was advised to increase the daily insulin dose in relation to carbohydrate intake and that he has been following that advice. However, despite this, his blood glucose levels in the two days prior to this hearing were high, reaching 23.1 mmol/L.

24Thus, we find that the appellant’s does not exhibit stable glycemic control. As such the information requested by the respondent in its letter of February 21, 2020 is reasonable. For this reason, we confirm the respondent’s decision to maintain the suspension of the appellant’s driver’s licence on the basis of his diabetic condition.

25As for the respondent’s request that the appellant’s doctor complete and submit to the respondent a Mental Health Assessment form in regard to the appellant’s depression, we find that there is no basis for this request. Pursuant to subsection 14(1)(a) of O. Reg. 340/94 a holder of a driver’s licence must not 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. There is no evidence or any indication whatsoever that the appellant’s depression has or will impact his ability to drive safely. It appears that the registrar’s Medical Review Section reacted to the mention in the doctor’s letter of March 3, 2020 of the appellant suffering from depression without considering the registrar’s statutory and regulatory mandate.

G. CONCLUSION

26Pursuant to subsection 50(2) of the Highway Traffic Act we confirm the Registrar’s decision pursuant to its letters of February 21, 2020 and April 17, 2020, to maintain the suspension of the appellant’s class G driver’s licence on the basis of the having inadequate glycemic (blood sugar level) control due to his diabetes type 1 that may interfere with his ability to safely operate a motor vehicle.

27Pursuant to subsection 50(2) of the Highway Traffic Act we set aside the Registrar’s decision pursuant to its letter of April 17, 2020 to require the appellant to provide the Ministry with information requested in that letter in regard to his condition of depression.

Footnotes

1. 1Canadian Council of Motor Vehicle Administrators, Determining Driver Fitness in Canada.