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
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 the Act to suspend driving privileges.
Between:
Thomas Jones
Appellant
and
Registrar of Motor Vehicles
Respondent
DECISION AND ORDER
Panel: Erica Weinberg, M.D., Member
Stephen Scharbach, Member
Appearances:
For the Appellant: Thomas Jones, Self-represented
Respondent: Sanjay Kapur, Agent
Overview
1The appellant appeals a decision by the Registrar of Motor Vehicles (“Registrar”) to suspend his class G driver’s licence on medical grounds.
2According to the Registrar, the available medical information indicates that the appellant suffers from a psychiatric condition – major depressive disorder - that affects his ability to drive safely. The appellant’s licence should remain suspended until a physician confirms a 6-month period of emotional and mental stability from the date of his last admission to a hospital in early August 2020. At that point the Registrar will assess whether reinstatement is appropriate.
3According to the appellant, he experienced an episode of his condition that required hospitalization in March 2020 and his licence was appropriately suspended. However, since then, he had been effectively treated and does not currently experience symptoms that affect his ability to safely drive. He was again hospitalized in early August 2020 primarily to change medications in a monitored setting. According to the appellant, his treating psychiatrist has confirmed that she has no concerns about his ability to safely drive. He requests that this Tribunal set aside the suspension.
ISSUE
4Does the appellant suffer from a psychiatric condition likely to significantly interfere with his ability drive safely?
DECISION
5The appellant has a psychiatric condition that in the past has significantly interfered with his ability to safely drive. However, medical information from the appellant’s psychiatrist indicates that since his hospitalization in March 2020, he has been effectively treated and has returned to his baseline mood and function. At present, his condition does not significantly interfere with his ability to drive safely and the Registrar’s decision to suspend the appellant’s licence is set aside.
THE LAW
6The Registrar has the authority under s. 47(1) of the Highway Traffic Act (the “Act”) and s.14(1) of Ontario Regulation 340/94 (“Regulation”) to suspend or cancel a driver’s licence if the driver suffers from any physical or mental condition likely to significantly interfere with the driver’s ability to operate a motor vehicle safely.
7Information about a driver’s physical or mental condition is often provided to the Registrar by health care practitioners who are required by the Act to report to the Registrar the names and clinical condition of any person who, “… in the opinion of such medical practitioner is suffering from a condition that may make it dangerous for such person to operate a motor vehicle.”
8A person whose licence is suspended on medical grounds may appeal the suspension to this Tribunal and, following a hearing, the Tribunal may confirm, modify, or set aside the decision of the Registrar.
9In determining whether a driver suffers from a condition that may disqualify him/her for a driver’s licence, the Regulation allows the Registrar to consider the medical standards set out in the Canadian Council of Motor Transport Administrators Medical Standards for Drivers (“CCMTA Standards”).
10The CCMTA Standards have been developed and published in order to establish consistent medical standards for assessing driving eligibility. While they are relevant and may be considered, the CCMTA Standards are not binding on either the Registrar or the Tribunal.
11Chapter 14 of the CCMTA Standards deals with eligibility for licencing of those who suffer from psychiatric disorders including major depressive disorder. Section 14.6.1 of the Standards states that drivers who suffer from that condition are eligible for a licence if:
the condition is stable
the driver has sufficient insight to stop driving if the condition becomes acute
the functional abilities necessary for driving are not impaired
a treating physician supports a return to driving, for drivers who have stopped driving due to a psychiatric disorder
the conditions for maintaining a licence are met.
12That section also states that given the nature of psychiatric disorders, assessment of driving eligibility must rely primarily on the clinical judgement of health care professionals involved in the driver’s treatment.
EVIDENCE AND ANALYSIS
(a) Registrar’s Decision to Suspend
13In a letter dated March 6, 2020, the Registrar informed the appellant that his driver’s licence was being suspended because the Ministry of Transportation (“Ministry”) had received a medical report indicating that he had a psychiatric condition that affected his ability to safely drive.
14That was based on a medical condition report dated March 3, 2020 submitted to the Ministry by an emergency room physician who assessed the appellant prior to his admission to a hospital. The physician indicated that the appellant was suffering from a psychiatric illness - major depressive disorder - that may make it unsafe for him to drive.
15In its March 6, 2020 letter, the Registrar informed the appellant that once his condition improved, he would need to arrange for a Mental Health Assessment Form to be completed by a physician and submitted to the Registrar. Once submitted, the assessment results would be reviewed against the CCMTA Standards and a decision would be made about whether his licence could be reinstated.
16The Mental Health Assessment Form was completed on May 11, 20201 by Dr. A., a psychiatrist who has been involved in the appellant’s care since August 2019.
17Dr. A. stated that the appellant was admitted to a hospital in March 2020 “…due to major depressive disorder with suicidal attempt in his car,” but stated that he responded well to treatment both on an in-patient and out-patient basis and has reported no symptoms since his discharge. She reported that the appellant had no difficulties in judgement, cognition or attention to memory. Dr A. stated that she did not currently have any acute safety concerns but, given the relapse in the last year, he was at increased risk for another episode and as such will likely remain on medications and under her care long term.
18The Registrar reviewed Dr. A.’s report and responded to the appellant in a letter dated August 26, 2020. The appellant was told that his licence would remain suspended and that for reinstatement to be considered, the Registrar would require confirmation by a physician of a 6-month of period of mental and emotional stability.
19On September 9, 2020, about six months after the appellant’s hospitalization in March 2020, the Registrar received a second report from Dr A. who stated that the appellant has been stable over the last six months and returned to his base line mood and function. She did not have any concerns about his level of alertness or executive function and stated that there have been no expressed suicidal thoughts or gestures since the March 2020 episode.
20Dr A. also reported that the appellant was admitted to a hospital in early August 2020 after experiencing some mood decline. According to Dr A., the main purpose for the admission was “… to assess safety, prevent rapid decline and for medication changes to be made in a monitored setting because he was not able to see me for a sooner appointment”. She stated that he demonstrated good judgment and insight in reporting his symptoms quickly and clearly to family members and attending at the emergency department at the hospital when unable to reach her.
21According to Dr A., she had seen the appellant once since his discharge in August and had no acute safety concerns. The medication changes made in the hospital were effective and well tolerated. The appellant appeared to have returned to his normal base line function. Dr A. stated that she had no concerns at that point over his level of alertness, executive function or safety pertaining to suicidal gestures.
22The Registrar reviewed Dr A.’s report and responded in a letter dated September 22, 2020. The appellant was told that his driver’s licence would remain suspended but would be reviewed for reinstatement once the Registrar received confirmation from his physician of a 6-month period of mental and emotional stability starting from his last hospital admission in August 2020.
23According to submissions made on behalf of the Registrar at the hearing, the Registrar originally required a 6-month period of mental and emotional stability starting from the date of the appellant’s hospitalization in March, 2020. However, after learning that the appellant had again been hospitalized in August 2020, the Registrar concluded that the appellant had suffered a relapse of his condition and required a 6-month period of stability starting from his August 2020 hospitalization.
(b) Appellant’s Position
24The appellant’s position is that while the initial decision to suspend his licence in March 2020 was reasonable given the medical condition report submitted to the Registrar at that point, his condition is now stable and no longer significantly interferes with his ability to drive safely.
25He testified that he was hospitalized in March 2020 after he took sleeping pills in a suicide attempt after parking his car in a parking lot. He was found wandering around the parking lot by a passerby and was led back to his car. An ambulance was called, and he was hospitalized. According to the appellant, although he was in his car when the ambulance arrived, he had no intention of driving or using his car to harm himself or others.
26With respect to the August 2020 hospitalization, the appellant testified that he had been prescribed lithium and other medications that were being monitored by Dr A. By early August 2020 after finding out from his family physician that his kidney function had deteriorated, he and his spouse became concerned about the long-term side effects of lithium and wanted to explore replacing it with another medication. The appellant stated that he had a pre-arranged appointment with Dr A. in a week or so but was unable to speak with her sooner. He therefore went to the hospital emergency room to have a physician assess his continued use of lithium.
27According to the appellant, when checking into the emergency room, his spouse mentioned his previous suicide attempt in March 2020 and he was admitted to the hospital – not because he had any current intention to self-harm, but to have the changes in his medication closely monitored in a hospital setting.
28According to the appellant, his mood has been stable since the March 2020 hospitalization and he has no intention to harm himself. He stated that neither his spouse nor Dr. A. have any current concerns about his ability to drive safely. The appellant stated that he is followed frequently by Dr. A., his family physician and when needed by a social worker.
(c) Decision
29Under s. 50(2) of the Act, the Tribunal may confirm, modify or set aside a decision of the Register made under s. 47 of the Act. In this case we set aside the Registrar’s decision to suspend the appellant’s driver’s licence.
30The Registrar’s original decision to suspend that appellant’s licence in March 2020 was reasonable given the medical condition report that was then submitted. The Registrar required a Mental Heath Assessment before considering reinstatement. Dr A.’s May 2020 assessment provided more detail concerning the appellant’s disorder, his treatment and his current condition. After reviewing the assessment, the Registrar decided to maintain the suspension but would review it once the appellant had a confirmed 6-month period of mental and emotional stability.
31Dr. A. provided her September 9, 2020 report six months after the appellant’s March 2020 hospitalization. She stated that over the past 6-month period the appellant had been stable and returned to his baseline mood and function and there have been no expressed suicidal thoughts or gestures.
32However, she also mentioned the appellant’s admission to a hospital in early August 2020. The Registrar regarded that hospitalization as a relapse of the appellant’s condition and therefore required an additional 6-month period of mental and emotional stability starting from early August 2020.
33However, after considering Dr A.’s September 9, 2020 report and the appellant’s testimony, our conclusion is that the main reason for the August 2020 hospitalization was for medication changes to be made in a monitored setting, to assess safety, and prevent rapid decline. Dr. A. reported that the medication changes were well tolerated and she “…did not have concerns over the appellant’s level of alertness, executive function, or safety pertaining to suicidal or parasuicidal gestures”.
34In our view, the suspension of the appellant’s driver’s licence should now be set aside. That appears to be consistent with the CCMTA Standards which state that drivers with the appellant’s condition are eligible for a licence if:
the condition is stable,
the driver has insight to stop driving if the condition becomes acute,
the functional abilities necessary for driving are not impaired and,
a treating physician supports a return to driving.
35The CCMTA Standards also state that given the nature of psychiatric disorders, assessment of driving eligibility must rely primarily on the clinical judgement of health care professionals involved in the driver’s treatment. In this case, the appellant’s treating psychiatrist has indicated that the appellant’s condition has been stable since March 2020 and the primary reason for the August hospitalisation was to change medications in a monitored setting. She presently does not have any concerns about the appellant’s executive function, level of alertness or safety relating to “suicide or parasuicidal gestures”. We therefore conclude that the appellant is not presently suffering from a condition that significantly affects his ability to drive safely.
ORDER
36Pursuant to s. 50 (2) of the Highway Traffic Act, the decision of the Registrar to suspend the appellant’s driver’s licence is set aside.
LICENCE APPEAL TRIBUNAL
_______________________
Erica Weinberg, M.D. Member
_______________________
Stephen Scharbach, Member
Released: December 4, 2020