An 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 to suspend a licence pursuant to Section 47(1) of the Act.
Between:
Maxine Carlisle
Appellant
-and-
Registrar of Motor Vehicles
Respondent
DECISION AND ORDER
ADJUDICATOR:
Dr. Dimitri Louvish, M.D., Member
Kevin Lundy, Member
APPEARANCES:
For the Appellant:
Maxine Carlisle, Self-Represented
For the Respondent:
Stephen Grootenboer, Agent
Heard by teleconference:
July 11, 2022
Background
1By letter dated April 21, 2022, the Registrar of Motor Vehicles (the ‘Respondent’) advised Maxine Carlisle (the ‘Appellant’) that her driver’s licence was being suspended for medical reasons. This decision was made after the Respondent received an unsolicited medical condition report, dated April 20, 2022, from a physician indicating an uncontrolled substance use disorder for alcohol.
2In its letter, the Respondent asked the Appellant to submit additional information to its medical review team. Specifically, the Respondent sought confirmation of a diagnosis of severe alcohol use disorder, completion of a Substance Use Assessment form and confirmation that the Appellant has abstained from alcohol for a one year period. The Respondent also advised the Appellant that this period may be reduced to six months if the Appellant’s healthcare practitioner confirmed that she had successfully completed an alcohol treatment program.
Issue
3The issue to be determined is whether the Appellant’s medical condition, if any, is likely to significantly interfere with her ability to drive a motor vehicle safely.
Result
4For the reasons set out below, we confirm the Respondent’s decision.
Law
5Subsection 47(1) of the Highway Traffic Act (the ‘HTA’) authorizes the Respondent to suspend or cancel a driver’s licence for any of the grounds listed in paragraphs (d), (e), (f) or (g) of that section. Paragraph (g) states that a licence may be suspended for “any other sufficient reason not referred to in clause (d), (e) or (f).”
6To that end, paragraph (a) of subsection 14(1) of O. Reg. 340/94 (the ‘Regulation’) provides that the licence may be suspended if the driver suffers from a medical condition that is likely to significantly interfere with his or her ability to drive safely:
- (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…
14Subsection 14(2)(a) of the Regulation permits the Minister of Transportation (the ‘Minister’) to consider the Canadian Council of Motor Transport Administrators Medical Standards for Drivers (the ‘CCMTA Standards’) when determining whether the requirements of subsection 14(1) have been met. Similarly, although the Licence Appeal Tribunal (the ‘Tribunal’) is not bound by the CCMTA Standards, it may consider these guidelines in its analysis. In the present case, the Registrar relied upon the CCMTA Standards with respect to alcohol use disorder.
15Under subsection 14(2)(b) of the Regulation, the Minister may also require a driver to provide satisfactory evidence that he or she is able to drive safely. The Tribunal may consider whether a driver has complied with such a request.
16The Respondent bears the burden of demonstrating the ground for suspending the licence on a balance of probabilities. Pursuant to subsection 50(2) of the HTA, following the hearing, the Tribunal may confirm, modify or set aside the decision of the Respondent.
Evidence and Analysis
17The Appellant is a family physician who resides alone in a rural area outside Kenora, Ontario. She relies upon her vehicle to drive to her place of employment in Kenora, located approximately twenty kilometers from her residence. Before her licence was suspended, she also drove to other locations through her participation in the Ontario Physician Locum Program to assist medically underserviced communities across the province, particularly in northern Ontario.
18She candidly acknowledged that she is a weekend binge drinker and explained that she typically purchased sufficient alcohol at the end of the week to last until Saturday and ceased drinking by Sunday to ensure that the effects of the alcohol had worn off by the start of the following work week. She estimated that during these binge drinking episodes, she regularly consumed either a bottle of wine or twenty-five ounces of liquor over the course of an evening, but consistently abstained from any consumption during the week when she is at work or during any period when she may be called into work. She emphatically denied ever operating a vehicle in a state of intoxication or withdrawal.
19On May 12, 2022, the Appellant’s family physician sent the completed Substance Use Assessment form to the Respondent, stating a diagnosis of severe alcohol use disorder. However, in the same form, the doctor confirmed that the Appellant had completed a rehabilitation program and remained abstinent from alcohol for a period of less than six months. She stated in the completed Substance Use Assessment that she did not have a concern with the Appellant’s ability to drive. As a result, the Respondent advised the Appellant in a letter dated May 18, 2022 that her licence would be eligible for reinstatement upon confirmation of six months abstinence from alcohol, pursuant to subsection 15.6.3 of the CCMTA Standards.
20The Appellant has been able to abstain from the consumption of alcohol for lengthy periods in the past, including durations of ninety days at one point and six weeks on another occasion. She readily acknowledged that on the weekends, she drinks to excess and agreed with her doctor’s diagnosis that her substance use disorder is severe. She emphasized however that she never operates a motor vehicle during these binge episodes and that her situation is distinct from that of a driver who may experience a seizure without warning. By contrast, she noted that she can regulate the effects of her disorder by choosing when not to consume alcohol. She also denied any psychological preoccupation with alcohol, does not plan her week around obtaining it or think about it during the work week.
21She relies on being able to drive her own car since she otherwise cannot obtain regular transportation either to or from her clinic or to purchase groceries and other necessities. Her family resides primarily in Winnipeg and Ottawa and she has no friends upon whom she could reasonably rely to drive her to work when she is on call or at the late hours that her occupation often requires, let alone long distance locum commutes. As of June 1, 2022, she took a leave of absence from her employment both as a hospitalist and family physician. Consequently, as of the date of the hearing, she has no income. Her resulting financial circumstances has led to significant anxiety as she now faces the possibility of bankruptcy. While her ability to work has not been restricted by the College of Physicians and Surgeons of Ontario, she prefers to meet with her patients in person. She also acknowledged that she needs to focus on her substance use disorder. She noted that she is otherwise in good health.
22Since her driver’s licence was suspended, the Appellant has discontinued her weekly binge drinking. She also attended residential treatment for her alcohol use disorder at the Sister Margaret Smith Centre (‘S.M.S.C.’) in Thunder Bay and remained abstinent for ninety days following completion of the program on December 10, 2021. After a brief relapse related to depression, she remained abstinent for another six to eight weeks.
23The program at S.M.S.C. was in-patient and included intensive programs through the mornings and afternoons as well as most of the evenings seven days a week for approximately thirty-five to forty days. While she finished the program, she did not request a discharge summary that may have described her performance or progress in the program. The subsequent out-patient follow-up component involves once a week consultation with a counsellor. While the counsellor has been off for the past two weeks, she has connected with a substitute via internet.
24In addition to seeing the counsellor on a weekly basis, the Appellant also checks in with a friend every night telephone to confirm that she is being responsible with respect to alcohol. She attends the Caduceus Group online on a weekly basis and has an account with Smart Recovery. She plans to enroll in the Physician Health Program by the end of the summer. This is an abstinence based program with counselling for physicians that will monitor her progress going forward. She has an appointment with a psychiatrist in August 2022.
25Unfortunately, the Appellant experienced four more recent relapses in the past eight weeks, specifically two days in June 2022 and two days in July 2022, all on weekends. She last drank alcohol during the weekend immediately preceding the hearing as she was feeling suicidal over her inability to drive. She described these recent incidents as the result of situational crises over the suspension of her licence. She explained that she contacted EMS on Friday when she experienced these thoughts. She was held overnight and released after being assessed by a psychiatrist who diagnosed her as not acutely suicidal.
26She reported these relapses to her counsellor and was advised that such setbacks are part of the process and should be expected. Nonetheless, she acknowledged that she is dealing with numerous stressors, both professionally and financially, all of which are exacerbated by her geographical isolation and lack of social interaction. She has been prescribed a number anti-depressant medications since April 2022 for mood disorder.
27The Appellant expressed a commitment to remaining abstinent and can call a counsellor or colleague if she experiences an urge to drink. She stated that her mental health is stable but acknowledged that she has good days and bad days and is attempting to address one hurdle at a time to deal with the “vicissitudes of life.” She noted that she does not engage in active self-harm and that her recent relapses each lasted no longer than two to three days.
28The Respondent cited its concerns regarding uncontrolled alcohol use disorder. It argued that the Appellant’s medical condition will significantly interfere with her ability to safely operate a vehicle. The Respondent reaffirmed its position that the Appellant must demonstrate stability in the form of six months of abstinence before it will consider licence reinstatement. It maintained that in light of the evidence, insufficient time has elapsed to consider lifting the Appellant’s licence suspension.
29Ultimately, this appeal raises two issues that must be addressed:
a. Does the Appellant have a medical condition; and,
b. Will that condition significantly interfere with her ability to drive safely?
Does the Appellant have a medical condition?
30At the hearing, the Tribunal received evidence regarding an unsolicited medical report confirming the Appellant’s alcohol use disorder. At certain times during the hearing, the Appellant acknowledged the seriousness of her condition. At other times, she appeared to rely upon the efficacy of her past practice of limiting her consumption to the end of the week to avoid driving under the influence of alcohol. When asked what she would do if called into work before the effects of her consumption had dissipated, she responded that she simply would not drive.
31The Appellant should be commended for attending residential treatment and trying to make positive changes in her life. There is an abundance of evidence that the Appellant does have a condition. The Appellant’s admission that she suffers from alcohol use disorder and the fact that she is trying to maintain her sobriety supports a finding that she has a medical condition capable of satisfying the first element of the test. While we do not dispute the significant challenges she has experienced as a result of depression and other stress factors, her alcohol use disorder remains outstanding and unresolved.
Is this condition likely to significantly interfere with her ability to drive safely?
32The Appellant maintains that she does not drink and drive and has never been charged for any HTA infractions related to substance use. She took the position that other than a few recent relapses, she has discontinued her prior pattern of weekend binge drinking. Furthermore, she has attended in patient treatment and has arranged several supports including follow up treatment by a psychiatrist.
33We are concerned that the Appellant has been unable to maintain prolonged periods of abstinence without relapse and that her progress is hampered by multiple stressors and depression. Although the imminent intervention of a psychiatrist may assist in the long term management of the Appellant’s disorder, the comparatively short periods of sobriety to date and the lack of any present solutions to related stress factors are not sufficient to satisfy us that she has her disorder under control.
34The Appellant provided the Respondent with a medical opinion that confirms her condition will not interfere with her ability to drive a motor vehicle safely. However, we find that the evidence demonstrates on the balance of probabilities that the Appellant still suffers from an uncontrolled substance use disorder for alcohol.
35The absence of any infractions on her driving record relating to substance abuse is commendable; however, this is not determinative on whether her medical condition is likely or unlikely to significantly interfere with her ability to drive safely.
Conclusion
36We find that the Appellant suffers from a condition of alcohol use disorder. While she is commended for her recent efforts, she has not abstained from alcohol long enough to provide any reassurance to us that her alcohol use disorder is under control or fully resolved. While we accept that she has insight into her condition and is committed to addressing her substance use disorder, the evidence strongly indicates that she is presently closer to the beginning of that process rather than at its resolution.
37Finally, although the Appellant acknowledged that she has a severe disorder, at times during the hearing, she minimized the severity of the problem by repeatedly suggesting that her substance use disorder could be managed simply as a matter of scheduling as she has done in the past and that, provided that she remains in her residence while binge drinking, there is no safety concern. In light of her multiple relapses after leaving S.M.S.C., her plan to rely upon remote consultations may not be sufficient to lessen the temptation to consume alcohol. In addition, steps to address the interplay between alcohol abuse and other mental health issues appeared more prospective than resolved as of the date of the hearing.
38Ultimately, we find that the Appellant has not been able to demonstrate a sufficient period of abstinence to provide confidence that her substance use disorder is under control.
39Along with the HTA, the Respondent relied on section 15.6 of the CCMTA Standards which provides the guidelines for assessment. We agree that the medical standards are clearly established in this guideline and their application in this case are prudent. The Appellant has failed to meet the guideline and presents with an addiction that is neither resolved nor currently being addressed.
40The dangers of the impact of alcohol use on highway safety are well known and we take judicial notice of it. Based on a careful consideration of all the evidence before us, we are satisfied on a balance of probabilities that the Appellant’s medical condition is likely to significantly interfere with her ability to drive a motor vehicle safely. Therefore, the Respondent’s decision is confirmed.
WE ORDER AS FOLLOWS:
41For the reasons set out above, pursuant to subsection 50(2) of the HTA, the Registrar’s decision to suspend the Appellant’s driver licence is confirmed.
LICENCE APPEAL TRIBUNAL
_____________________________
Dr. Dimitri Louvish, M.D., Member
____________________________
Kevin Lundy, Member
Released: July 20th, 2022