Carson Brett v. Registrar of Motor Vehicles, 2022 CanLII 8659

Tribunals Ontario Licence Appeal Tribunal

Tribunaux décisionnels Ontario Tribunal d'appel en matière de permis

Date: 2022-02-01

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 a licence.

Between:

Carson Brett Appellant

and

Registrar of Motor Vehicles Respondent

DECISION AND ORDER

Panel: Evelyn Spence, LL.B. and Peter Savage, M.D.

Appearances:

For the Appellant: Carson Brett, Self-represented

For the Respondent: Stephen Grootenboer, Agent

Place and date of hearing:

By teleconference January 21, 2022

REASONS FOR DECISION AND ORDER:

A. Overview

1The appellant, Carson Brett, has type 1 diabetes and is insulin-dependent. On the evening of November 16, 2021, he was cooking dinner at home when he became distracted by a phone call. The distraction caused him to err when administering his insulin, which resulted in him suffering an episode of severe hypoglycemia and loss of consciousness. He was taken to hospital by ambulance, where his blood sugar levels were stabilized. He was discharged later that evening.

2As a result of this event, the Ministry of Transportation received a medical condition report (“MCR”) from the appellant’s treating ER physician indicating that the appellant had suffered a sudden incapacitation requiring the intervention of a third party. Thereafter, the Registrar of Motor Vehicles (the “registrar”) suspended the appellant’s Class G driver’s licence under section 47(1) of the Highway Traffic Act (the “Act”).

3The appellant appeals the suspension pursuant to section 50(1) of the Act. He maintains that his medical condition is controlled and is not likely to significantly interfere with his ability to drive a vehicle safely. The respondent, on the other hand, relies on the Canadian Council of Motor Transport Administrators Medical Standards for Drivers (the “CCMTA Standards”) guideline and submits that the appellant’s licence should remain suspended for a period of six months, during which period the appellant would be expected to confirm he has not experienced any severe hypoglycemic reactions and his condition has remained stable.

B. ISSUE AND RESULT:

4The issue to be determined in this appeal is whether the appellant’s reported medical condition of severe hypoglycemia is likely to significantly interfere with his ability to drive a motor vehicle safely.

5Upon consideration of the evidence and for the reasons that follow, we find the registrar has not met its burden of establishing that the appellant’s medical condition is likely to significantly interfere with his ability to drive a vehicle safely. We therefore set aside the registrar’s decision to suspend the appellant’s licence for medical reasons.

C. LAW:

6Section 31 of the Act sets out purpose of driver’s licences. Of note, s. 31(a) emphasizes that persons who demonstrate that they are likely to drive safely have the privilege of driving in Ontario.

7Section 203 of the Act requires all physicians in the Province of Ontario to report to the registrar the name, address and clinical condition of any person sixteen years of age or over who is suffering from a medical condition that may make it dangerous for the person to operate a motor vehicle safely.

8The registrar has the power under subsection 47(1) of the Act to suspend or cancel a driver’s licence for a “sufficient reason”. Subsection 14(1)(a) of Ontario Regulation 340/94 (the “Regulation”) under the Act states 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.

9Section 14(2)(a) of the Regulation allows the registrar to consider the CCMTA Standards when determining whether the requirements of subsection 14(1) are met. Similarly, the Tribunal may take the CCMTA Standards into consideration, although they are not binding requirements.

10The registrar has the burden to establish, on a balance of probabilities, the grounds for suspending the appellant’s licence, which is that his medical condition is likely to significantly interfere with his ability to drive a motor vehicle safely.

11Following a hearing, the Tribunal may, under s. 50(2) of the Act, confirm, modify or set aside the decision or order of the registrar.

D. EVIDENCE AND ANALYSIS:

12The initial question we must decide is whether the appellant suffers from a medical condition; namely, severe hypoglycemia. If we determine that he does, we must then determine whether that medical condition is likely to significantly interfere with his ability to drive a motor vehicle safely. That analysis follows.

Does the appellant suffer from a medical condition?

13According to section 7.1 within Chapter 7 of the CCMTA Standards, anyone who requires treatment with insulin is at risk of hypoglycemia.

14Hypoglycemia may occur for a number of reasons, including reduced food intake, unusual level of physical exertion, and alteration of insulin dose. Relatedly, “severe hypoglycemia” is defined within the chapter as “hypoglycemia that requires outside intervention to abort, or that produces an alteration in level of consciousness or loss of consciousness. The altered or reduced level of consciousness prevents a person experiencing severe hypoglycemia from taking appropriate action.”

15All of the evidence filed with the Tribunal, including the medical reports and the appellant’s own oral testimony, supports that the appellant is an insulin-dependent diabetic and that on November 16, 2021, he suffered an episode of severe hypoglycemia requiring outside intervention. The appellant testified that he has been living with type 1 diabetes for the past four and a half years and he does not disagree with the physicians’ medical assessments or deny that he became incapacitated due to severe hypoglycemia on the date in question.

16Based on the above, we are satisfied that the appellant suffers, or recently did suffer, an event of severe hypoglycemia.

Is the appellant’s condition likely to significantly interfere with his ability to drive a motor vehicle safely?

17The evidence in this matter is clear that the appellant’s severe hypoglycemia episode on November 16, 2021 was caused by an isolated and avoidable error on the part of the appellant. It does not, in our view, indicate a lack of glycemic control or the potential for further hypoglycemic events that would put the driving public at risk.

18Particularly, in explaining the events leading up to his hospitalization, the appellant acknowledged the error he made, accepted responsibility for the error, and indicated a clear understanding of how the error happened and how it could have been prevented. In his oral testimony, Mr. Brett demonstrated a solid understanding of his diabetes, as well as excellent knowledge of his insulin pump and its workings. He referred to, and very articulately explained, the blood glucose assessment and progress readings for the month prior and immediately following his severe hypoglycemia event (the “BG reports”).

19The appellant is followed by an endocrinologist and a family physician, both of whom he sees regularly. He reported that his endocrinologist has been pleased with his results but that her feedback is generally that his blood glucose levels are on the higher end of where she would like to see them. The appellant admitted that because he tends to guard against hypoglycemic episodes, such as the one he experienced on November 16, his blood glucose readings often reflect levels on the higher side. The BG reports filed with the Tribunal support this, and demonstrate that the appellant usually experiences hyperglycemic (or high blood glucose) patterns, and not hypoglycemic (low blood glucose) patterns.

20The Diabetes Assessment form, which the appellant’s family physician completed and submitted at the request of the registrar on December 7, 2021, specifies, among other things, that the appellant:

a) demonstrates good knowledge of his diabetes and its management, and monitoring and assessment indicate effective blood glucose (“BG”) control;

b) has A1C results consistent with his BG logs;

c) had not experienced any episodes of hypoglycemia unawareness in the previous three months and had not had more than one reported episode of hypoglycemia unawareness in the past 12 months;

d) had not had more than one reported episode of severe hypoglycemia requiring outside intervention in the previous six months;

e) had regained adequate glycemic control; and

f) has “well controlled type 1 diabetes, on insulin pump, good continuous BG readings in past month. Administered insulin while preparing to eat dinner but was distracted by phone call. Was aware of hypoglycemia and tried to correct with oral sugar but lost consciousness. Paramedics called by partner. Treated in ER and released.”

21Additionally, we are satisfied that the appellant is responsible in his operation of a motor vehicle, and he expressed a clear understanding of the impacts that could result if he suffered a hypoglycemic event while driving. He testified that he has, on a number of occasions, handed over his keys to others when his blood glucose levels were low, and he provided a recent example where he refused to drive when his sugar levels were hovering at the 5.2 mmol/L mark. He always makes sure his vehicle is equipped with quick-fix sugar replacements, which he keeps readily available in his glove box and centre console.

22The registrar, in relying upon section 7.6.4 of the CCMTA Standards, maintains that, before the appellant’s licence can be reinstated, it requires confirmation that the appellant has not experienced any severe hypoglycemic reactions and that his condition has remained stable for a period of six months.

23As noted above, the Tribunal is entitled to take the CCMTA Standards into consideration but is not bound by them. Based on the evidence before us, we believe the likelihood that the appellant will experience another episode of hypoglycemia in the next four months is extremely unlikely, such that the additional waiting period is not necessary in these circumstances.

24The appellant has a very solid understanding of his condition and its proper management. In his four and a half years of living with diabetes, the appellant has never had a previous severe hypoglycemic spell and we find that the BG reports generally demonstrate excellent control over his blood glucose levels. The appellant’s episode of severe hypoglycemia was the result of a significant but rare and avoidable mistake on his part and does not, on balance, represent a concern that he is unable to drive a motor vehicle safely.

E. ORDER:

25For the reasons set out above, and pursuant to subsection 50(2) of the Act, the registrar’s decision to suspend the appellant’s driver’s licence for medical reasons is set aside.