Licence Appeal Tribunal File Number: 15296/MED

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:

Lisa Morrow

Appellant

And

Registrar of Motor Vehicles

Respondent

DECISION

ADJUDICATOR:

Dr. Dimitri Louvish, Member Rebecca Hines, Member

APPEARANCES:

For the Appellant:

Lisa Morrow, Appellant

For the Respondent:

Ian Sookram, Program Advisor

Heard by Teleconference:

November 3, 2023

OVERVIEW

1Lisa Morrow (the “appellant”) appeals from the decision of the Registrar of Motor Vehicles (“Registrar”) to suspend her Class G licence on July 31, 2023, under s. 47(1) of the Highway Traffic Act, R.S.O. 1990, c. H.8 (the “Act”) after the Registrar received an unsolicited report from a treating healthcare provider that the appellant suffers from a medical condition that may affect her safety to drive.

2The Registrar (the “respondent”) has the authority under s. 47(1)(g) of the Act to suspend or cancel a driver’s licence for any sufficient reason. Section 14(1)(a) of O. Reg. 340/94 under the Act (the “Regulation”) 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 their ability to safely drive a motor vehicle of the applicable class safely. Under s. 14(2)(b) of the Regulation, the Minister of Transportation (“MTO”) may require a driver to provide satisfactory evidence that they are able to drive safely.

3The respondent takes the position that the appellant suffers from a medical condition, namely diabetes, that is likely to significantly interfere with her ability to drive safely and that this provides sufficient reason to suspend their licence under s. 47(1)(g) of the Act.

4The appellant appeals the suspension under s. 50(1) of the Act. She acknowledges that she suffers from diabetes, however, denies that this medical condition will interfere with her ability to drive safely.

5Pursuant to section 50(2) of the Act, after a hearing the Tribunal may confirm, modify, or set aside the decision or order of the respondent.

ISSUES:

6The issue in this appeal is whether the appellant suffers from a medical condition that is likely to significantly interfere with her ability to drive a motor vehicle safely.

7To resolve that issue, we will address the following questions:

1. Does the appellant suffer from diabetes?

2. If so, is this likely to significantly interfere with their ability to drive a motor vehicle safely?

8The respondent bears the burden of proving on a balance of probabilities that the answer to each of the above questions is “yes.”

RESULT

9Having considered all the evidence and submissions and for the reasons that follow, we find that the respondent has satisfied its burden to establish that the appellant suffers from diabetes which is likely to significantly interfere with her ability to drive a motor vehicle safely and we confirm the respondent’s decision to suspend her driver’s licence.

ANALYSIS

Does the appellant suffer from diabetes?

10It is undisputed that the appellant is a person living with type 1 diabetes. Since both parties agree that she has been diagnosed with this condition, we find that the appellant does suffer from diabetes and our analysis will focus on whether this condition interferes with her ability to drive a motor vehicle safely.

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

11We find that the respondent has proven 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.

12On July 27, 2023, the appellant was involved in an accident when she drove her vehicle off the road into a ditch after experiencing a hypoglycemic episode and was taken to the hospital. On the same date, Dr. Pitcher, emergency physician submitted an unsolicited Medical Condition Report (“MCR”) to the MTO supporting that the appellant had hypoglycemia requiring intervention of a third party or producing loss of consciousness and that this condition would consequently affect her ability to drive safely.

13In response to the report, the MTO sent the appellant a letter dated July 31, 2023, confirming that her licence had been suspended due to diabetes and substance use disorder. The letter advised the appellant to take the letter to her physician, specialist, or nurse practitioner when the condition improves and have them complete both a Substance Use Assessment form and Diabetes Assessment form and submit it to the Driver Medical Review Office.

14On August 25, 2023, the appellant submitted the requested forms completed by Denise Lorbetskie, nurse practitioner. The Substance Use Assessment form noted that the appellant does not have a substance abuse disorder, rarely drinks alcohol and that the incident in question was related to low blood sugar. The Diabetes Assessment Form indicated that the appellant has good knowledge of her condition and that the assessment indicates effective blood glucose control. Further, that the appellant’s insulin pump had been upgraded which has improved monitoring and control of blood sugars.

15The MTO responded by letter dated September 18, 2023, advising the appellant that her licence remained suspended because of the severe hypoglycemia episode. It requested that she submit confirmation to the Driver Medical Review Office that she has not experienced any severe hypoglycemic reactions and that her condition has remained stable for a period of six months. It also advised her that a recently conducted A1C result must also be provided with confirmation that the level is congruent with her blood logs and that stable glycemic control has been re-established.

16The appellant submitted a letter from Ms. Lorbetskie, nurse practitioner, dated October 4, 2023, to MTO which confirmed that she was under a new continuous monitoring system since August 16, 2023, with a Medtronic pump upgrade. Further, she has been attending and compliant with the diabetes education centre since July 28, 2023, and had not had any severe hypoglycemic events since July 27, 2023. Further, Ms. Lorbetskie’s letter confirmed that the appellant’s A1C level was 7.9 mmol/L and a 7-day blood log noted her result was 10.6 mmol/L. She also submitted various blood logs which confirm same.

17The respondent submits that due to the significance of the incident in July 2023, it requires that the appellant’s condition be stable for a period of six months before it can consider reinstatement of her licence. In this case, the respondent asserts that extra safety precaution of another three months is necessary. The respondent relies on Chapter 7 of the Canadian Council of Motor Transport Administrators Medical Standards for Drivers (“CCMTA Standards”), which highlights the dangers that hypoglycemic unawareness could cause while driving and outlines the requirements for considering licence reinstatement. This would include a period of stability with regular blood sugar monitoring and documentation as well as blood tests. The respondent maintains that these conditions have not been met.

18The appellant argues that her diabetes is currently under control, is stable and will not interfere with her ability to drive safely. She submits the incident in July 2023 was an isolated incident. Further, she maintains that she started using a new insulin pump with better monitoring including a special sensor which adjusts and corrects every 5 minutes. Further, she has lowered her A1C level from 8.1 mmol/L to 7.9 and she now has a stable glycemic standard.

19We agree with the respondent. Although we are not bound by the CCMTA Standards, they may be applied by this Tribunal. The CCMTA Standards state that hypoglycemic unawareness can significantly impair the sensory, motor and cognitive functions required for driving and severe hypoglycemia can lead to unconsciousness. These conditions can render it unsafe for a person to drive a motor vehicle.

20In this case, it has been a little over three months since the appellant experienced a severe hypoglycemic episode which led to her driving her vehicle off the road and into a ditch. We find this time frame of stability is short of the 6-month period recommended by the CCMTA Standards. While we acknowledge that the appellant has taken steps to manage and control her diabetes, we agree with the respondent that in this case an extra safety precaution is reasonable.

21Based on the evidence before us, we find on a balance of probabilities that the appellant has diabetes that is likely to significantly interfere with her ability to drive safely.

Conclusion

22We find that the Registrar has discharged the onus of establishing on a balance of probabilities that the appellant suffers from a medical condition that is likely to significantly interfere with her ability to drive a motor vehicle safely.

ORDER

23For the reasons set out above, pursuant to subsection 50(2) of the Highway Traffic Act, we confirm the Registrar’s decision to suspend the appellant’s driver’s licence.

Dr. Dimitri Louvish Adjudicator

Rebecca Hines Adjudicator