Tribunals Ontario
Licence Appeal Tribunal
Tribunaux décisionnels Ontario Tribunal d'appel en matière de permis
Date: 2021-03-18
Appeal under section 50(1) 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 under subsection 47(1) of the Act
Between:
Hina Shams Appellant
and
Registrar of Motor Vehicles Respondent
DECISION AND ORDER
Adjudicators: Dr. Peter Savage, Member; Colin Osterberg, Member
Appearances: For the Appellant: Hina Shams, Self Represented For the Respondent: Kyle Biel, Agent
Heard by Teleconference: February 26, 2021
REASONS FOR DECISION AND ORDER
A. OVERVIEW:
1On January 22, 2021, the Registrar suspended the appellant’s Class G licence under s. 47(1) of the Highway Traffic Act, R.S.O. 1990, c. H.8 (the “HTA”), after receiving a report from a treating physician that the appellant suffers from schizophrenia or other psychotic condition that is likely to significantly interfere with her ability to drive safely. The appellant appeals the suspension and asks the Tribunal to reinstate her licence.
2Having considered all of the evidence and for the reasons that follow, we confirm the Registrar’s decision to suspend the appellant’s driver’s licence for medical reasons.
B. ISSUES:
3The issue in this appeal is whether the appellant suffers from a medical condition, specifically schizophrenia or other psychotic disorder, which is likely to significantly interfere with her ability to drive a vehicle safely.
4To answer that issue, we will address the following questions:
a. Does the appellant suffer from a medical condition?
b. If the appellant suffers from a medical condition, is it likely to significantly interfere with her ability to drive a vehicle safely?
C. LAW:
5Under the HTA the Registrar is responsible for ensuring that drivers are medically fit to drive vehicles on the highway. In this case, the Registrar acted pursuant to s. 47(1) of the HTA and s. 14(1)(a) of O. Reg. 340/94 under the HTA (the “Regulation”).
6Under s. 14(2)(b) of the Regulation, the Registrar may require a driver to provide satisfactory evidence that he or she is able to drive safely.
7A person whose licence is suspended under these provisions may appeal the suspension to the Tribunal under s. 50(1) of the HTA.
8On appeal, the Registrar has the burden of establishing, on a balance of probabilities, that the appellant’s ability to drive safely is significantly affected by a medical condition.
9Following a hearing, the Tribunal may, under s. 50(2) of the HTA, confirm, modify or set aside the decision or order of the Registrar.
D. EVIDENCE AND ANALYSIS:
a. Does the appellant suffer from a medical condition?
10The Registrar alleges that the appellant has schizophrenia or other psychotic disorder based on the reports of two psychiatrists, Dr. Suzanne Archie and Dr. Natasja Menezes.
11The appellant denies that she has schizophrenia or other psychotic disorder. She asserts that she has stress-related problems and points to reports from Dr. Stephanie Wu, a family physician who assessed the appellant on two occasions at the Locke Street Walk-in Clinic in Hamilton.
12The medical evidence presented at the hearing supports the conclusion that the appellant suffers from schizophrenia or other psychotic disorder. This diagnosis was made by two of the appellant’s treating psychiatrists, Dr. Archie and Dr. Menezes. While Dr. Wu’s initial diagnosis was situational stress, that was based on an incomplete medical history. Dr. Wu did not maintain that diagnosis when she assessed the appellant a second time, after reviewing a report of Dr. Menezes.
13On January 13, 2020, Dr. Archie completed a Medical Condition Report in which Dr. Archie stated that the appellant has or appears to have a condition or disorder, namely schizophrenia or other psychotic disorder.
14According to the appellant, Dr. Menezes, psychiatrist, had been seeing the appellant as a patient since August 2019. On January 28, 2020, Dr. Menezes completed a Mental Health Assessment. Dr. Menezes stated that the appellant’s primary mental illness at that time was schizophrenia or other psychotic disorder with the most recent episode having its onset between six months and twelve months previously. Dr. Menezes said in that Assessment that the symptoms were ongoing and severe and included symptoms of delusions.
15On August 18, 2020, Dr. Stephanie Wu, a family physician at the Locke Street Walk-in Clinic in Hamilton saw the appellant for the first time. Dr. Wu assessed the appellant based on the history provided by the appellant only and diagnosed situation stress/crisis of six to twelve months onset. Dr. Wu stated that the appellant’s condition was stable and that she had no current symptoms. The appellant was not taking medications at that time.
16On November 18, 2020, Dr. Menezes reported that the appellant had formerly been followed for psychosis but had not been seen since February 2020. Dr. Menezes had a recent report from a concerned family member about active delusions, erratic driving and the appellant reporting to family thoughts of killing herself while driving.
17On January 19, 2021, Dr. Menezes completed a Mental Health Disorder form. On the form, Dr. Menezes stated that the appellant’s primary mental illness is schizophrenia or other psychotic disorder and that the onset of the appellant’s most recent illness episode was less than three months. Dr. Menezes indicated that the appellant’s condition was improving with on-going mild symptoms including anxiety and delusions. Dr. Menezes reported that in the past the appellant had a pattern of non-adherence to treatment and follow-up but was likely to comply now.
18In her January 19, 2021, report, Dr. Menezes stated that the appellant had been unwell and dropped out of care. She stated that with her recent admission to hospital, for the first time the appellant was more consistently treated, with expected and observed improvement. Ongoing improvement was expected.
19On February 23, 2021, Dr. Wu assessed the appellant and reported that she was mentally stable based on the assessment and review of a Mental Health Disorder form filled out by her psychiatrist. Dr. Wu reported that it was her understanding that the appellant had been improving since starting treatment based on the psychiatric report but that Dr. Wu had no information or records regarding her initial license suspension or any hospital admission other that what she was told by the appellant. Therefore Dr. Wu stated she was unable to comment on mental stability over the past six months.
20At the hearing, the appellant denied suffering from schizophrenia or other psychotic disorder. She believes that her condition is stress related. However, the appellant agreed that she feels better when taking the anti-psychotic medication prescribed by Dr. Menezes. The appellant submitted no medical evidence which disputes Dr. Menezes’ and Dr. Archies’ diagnosis of schizophrenia or other psychotic disorder.
21Based on the above, we find on a balance of probabilities that the appellant suffers from schizophrenia or other psychotic disorder. Dr. Archie and Dr. Menezes were in the best position to assess the appellant’s medical condition and there was no medical evidence presented at the hearing which causes the Tribunal to doubt those assessments.
b. If the appellant suffers from a medical condition, is it likely to significantly interfere with her ability to drive a vehicle safely?
22The Registrar has the burden of establishing that the appellant’s medical condition is likely to significantly interfere with her ability to drive a motor vehicle safely. We find that the Registrar has met that burden.
23Dr. Menezes, in her January 28, 2020, described the appellant’s symptoms as severe and that those symptoms consisted of delusions. There were no difficulties in cognition, attention or memory but the appellant did have difficulties with judgement according to Dr. Menezes. The appellant was prescribed medication at that time and was to remain under monthly medical supervision. Dr. Menezes indicated that the appellant did not have appropriate insight or understanding of her medical condition and their impacts on her functional ability to drive.
24According to the appellant, she stopped taking her medications after one month and stopped seeing Dr. Menezes in March 2020. She acknowledged that, she started seeing Dr. Menezes in August 2019 and was placed on medications at that time. She stopped receiving treatment after that and ended up in the hospital in January 2020. After she stopped seeing Dr. Menezes in March 2020, the appellant stopped taking medications on her own initiative.
25The appellant received no treatment from March 2020 until December 2020 when she was involuntarily admitted to hospital. As noted above, the appellant’s family reported in November that the appellant was suffering from delusions and may be suicidal, indicating that she might try and kill herself while driving. The appellant said that some members of her family arranged to have her admitted to hospital involuntarily in December 2020. At hospital, the appellant says that she initially refused to take medication as she did not agree with Dr. Menezes’ diagnosis. She eventually agreed to take the anti-psychotic medications at hospital because that was the only way she would be released. While we acknowledge that the family’s report to Dr. Menezes constitutes “double hearsay”, we accept it. It comes to the Tribunal via Dr. Menezes’ report, which we consider to be reliable. The appellant acknowledges that her family took steps to have her admitted, which corroborates the evidence in part.
26The appellant says that, since she was released from hospital she has been under a community treatment order and that, if that order was not in place she would not be taking any medication as she does not believe that she requires it or that she has a psychotic disorder.
27The appellant says that she is safe to drive and that she is no safer driving when taking medication than she is when not taking medication. The appellant said that she wants to be allowed to drive again and expressed the firm intention to stop taking medication as soon as the community treatment order expires. That order has a six-month term and the appellant intends to stop seeing Dr. Menezes at that time. The appellant is afraid that Dr. Menezes will take away her licence again if she continues to see her after the community treatment order expires.
28The Registrar made the following submissions with respect to how the appellant’s condition affects the appellant’s ability to drive:
the appellant’s condition is not yet stable and has not been stable for the past six months. The respondent argues that a period of stability is required;
the appellant’s condition includes delusions which are ongoing, and which may impact her ability to drive safely;
the appellant has been hospitalized involuntarily twice in the last year, which is an indication of the severity her condition when not under treatment;
the appellant has a pattern of non-adherence to treatment recommendations of her doctors including medication and follow-up;
the appellant has past issues with poor judgement as well as lack of insight into her condition and the effect her condition might have on her driving;
the appellant’s family has expressed concern recently that the appellant was thinking of killing herself while driving;
six months of proven stability is the minimum required pursuant to the ministry’s policy when a driver has had two periods of hospitalization in a one-year period;
there has been no physician who has stated that the appellant’s driver’s licence should be re-instated.
29The evidence supports the Registrar’s submissions. We find, on a balance of probabilities, that the appellant’s medical condition of schizophrenia or other psychotic disorder is likely to significantly interfere with her ability to drive a vehicle safely. A review of the evidence and the appellant’s submissions shows that she has a significant mental health issue and that she lacks insight with respect to her condition and its impact on her ability to drive safely. The appellant made it clear that she intends to stop taking her medication as soon as she is no longer subject to the community treatment order and that she is eager to be allowed to drive. Previously, when she stopped taking medication, she relapsed and began having suicidal thoughts, including committing suicide while driving. Given that she is not stable, the appellant is likely to constitute a risk to herself and others if she is permitted to drive.
E. ORDER:
30For the reasons set out above, pursuant to subsection 50(2) of the HTA, we confirm the Registrar’s decision to suspend the appellant’s driver’s licence for medical reasons.
LICENCE APPEAL TRIBUNAL
Colin Osterberg, Member
Dr. Peter Savage, Member
Released: March 18, 2021