Licence Appeal Tribunal File Number: 15299/MED

In the matter of an appeal under subsection 50(1) of the Highway Traffic Act, R.S.O. 1990, c. H.8 (the “Act”), from a decision of the Registrar of Motor Vehicles to suspend a licence pursuant to Section 47(1) of the Act.

Between:

Larry Gaule

Appellant

And

Registrar of Motor Vehicles

Respondent

DECISION AND ORDER

ADJUDICATORS: Dr. Isla McPherson, Member Jeffrey Campbell, Vice-Chair

APPEARANCES:

For the Appellant: Larry Gaule, Appellant

For the Respondent: Stephen Grootenboer, Agent

Held by teleconference: November 8, 2023

REASONS FOR DECISION AND ORDER

OVERVIEW

1Larry Gaule, the appellant, appeals the decision of the respondent Registrar of Motor Vehicles (the “Registrar”) to suspend the appellant’s driver’s licence. The Registrar advised the appellant of the suspension of the licence by way of letter dated September 6, 2023.

2The Registrar takes the position that the appellant is suffering from a medical condition, namely seizures, that is likely to significantly interfere with his ability to drive a motor vehicle safely.

3The Registrar has the authority under s.47(1) of the Act to suspend a person’s driver’s licence. 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 physical condition or disability likely to significantly interfere with his or her ability to safely drive a motor vehicle of the applicable class. Under s. 14(2)(b) of the Regulation, the Minister may require a driver to provide satisfactory evidence that he or she is able to drive safely.

4The appellant appeals the suspension under s. 50(1) of the Act.

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 Registrar.

ISSUES

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

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

a. Does the appellant suffer from medical condition, namely seizures?

b. If the appellant does suffer from the above condition, is that condition likely to significantly interfere with his ability to drive a motor vehicle of applicable class safely?

RESULT

8For the reasons set out below, pursuant to subsection 50(2) of the Act, we confirm the Registrar decision to suspend the appellant’s driver’s licence.

ANALYSIS

The appellant suffers from a medical condition

9The evidence presented at the hearing establishes that the appellant suffers from a medical condition, namely seizures.

10In support of its allegation that the appellant suffers from the medical condition, the Registrar relies on a Medical Condition Report (“MCR”) dated August 29, 2023 by treating neurologist Dr. Kyle Goldberger. In that report, under the heading of Seizures, Dr. Goldberger advised that the appellant suffers from epilepsy.

11The evidence and the testimony of the appellant demonstrate the following:

c. On May 10, 2023, the appellant experienced the first documented syncopal episode while at work in Grimsby, Ontario. He attended at West Lincoln Memorial Hospital ER where he underwent investigations including a CT of his head and chest, EKG and bloodwork including cardiac enzymes. Results of the investigation were unremarkable, and he was discharged home.

d. On June 20, 2023, the appellant experienced a second documented episode of loss of consciousness while in Newmarket, Ontario. He attended Southlake Regional Health Centre where he received another CT of his head and was referred for an echocardiogram. Results of the investigations were unremarkable. It was at Southlake that the appellant came under the care of Dr. Goldberger.

e. On August 21, 2023, while visiting Ireland, the appellant experienced the third documented episode of loss of consciousness and was admitted to University Hospital Waterford. He was discharged on August 23, 2023. The hospital records reveal that the appellant was “brought in by ambulance after witnessed event [loss of consciousness] followed by tonic-clonic seizure”. The records also advise that the appellant “was reviewed by neurology who agreed with probable diagnosis of generalized seizures – likely epilepsy however, will need eeg to confirm”. The appellant was started on an antiepileptic medication to treat seizures and advised not to drive for 12 months. Upon discharge, the hospital noted the appellant should undergo “an eeg in Canada on return and continued follow-up as scheduled with neurologist there”

f. On August 29, 2023, the appellant attended an appointment with Dr. Goldberger at Southlake Regional Health Centre. Dr. Goldberger ordered the EEG and an MRI and placed the appellant on the antiepileptic drug, Keppra, 500 mg twice daily, to address the seizures that the appellant was experiencing. It was following this meeting that Dr. Goldberger submitted the MCR to the Ministry of Transportation with his diagnosis of epilepsy.

g. On October 24, 2023, the appellant attended a follow-up appointment with Dr. Goldberger. Dr. Goldberger noted, “Last seizure: Aug 2023. Ongoing auras 1-2/week”. The appellant testified that Dr. Goldberger suggested increasing the Keppra prescription to 750 mg twice daily in order to treat the auras he was experiencing. The appellant declined, advising that he could not tolerate the side effects of the antiepileptic.

12As auras can be the earliest sign of seizure activity for people with epilepsy, the appellant not implementing the neurologist’s suggestion to increase the anti-epileptic drug to treat the auras is concerning that seizure control has not been established.

13We find that the above medical evidence supports the Registrar's position. That and the appellant's admissions lead us to conclude that the appellant suffers from seizures. The appellant attended hospital on three occasions, May 10, 2023, June 20, 2023, and August 21, 2023, after experiencing episodes of loss of, or altered, consciousness, and was diagnosed as having suffered seizures on all three occasions. We accept those diagnoses since they were made by doctors qualified to make them and the appellant has presented no medical evidence to suggest those diagnoses were incorrect.

The appellant’s medical condition of seizures is likely to significantly Interfere with his ability to drive a motor vehicle safely

14We find that appellant’s condition of seizures is likely to significantly interfere with his ability to drive a motor vehicle safely.

15The appellant has experienced three seizures since May 2023. The evidence also establishes that he continues to experience auras one to two times per week.

16The respondent relies upon the records of the West Lincoln Memorial Hospital, Southlake Regional Health Centre, the discharge report of the University Hospital Waterford, the MCR dated August 29 2023 and the progress report of Dr. Goldberger dated October 24 2023.

17The Registrar relies on the Canadian Council of Motor Transport Administrators Standard (“CCMTA Standard”) 17.6.6, which states that non-commercial drivers are eligible for a licence if it has been six months since the seizure occurred with or without medication. The CCMTA Standard states that the six-month waiting period can be reduced to no less than three months on a neurologist’s recommendation if rationale is provided.

18The Tribunal is entitled to take the CCMTA Standards into consideration but is not bound by them. The overriding consideration in this appeal is whether the Registrar has proven, on a balance of probabilities, that the appellant’s condition is likely to significantly interfere with his ability to drive a motor vehicle of the applicable class safely. While the CCMTA Standards are well-reasoned and helpful, every case must be considered on its own facts.

19The appellant submits that he does not believe that his seizures are caused by epilepsy, but rather are the result of trauma tracing back to a work accident in January 2022. We do note, however, that the treating neurologist at University Hospital Waterford advised that the appellant’s seizures are “likely epilepsy”, the MCR lists epilepsy under the category of Seizures and Dr. Goldberger’s note of October 24, 2023 states a diagnosis of focal epilepsy. No submitted medical evidence disputes the diagnosis of epilepsy and neither the neurologist in Ireland, nor Dr. Goldberger has offered the theory that the appellant’s seizures are related to trauma. Also, the cause of the seizures is not in dispute in this matter, but, rather, whether the seizures will significantly interfere with his ability to drive a vehicle safely.

20The appellant also submits that the MRIs, CTs and EEG which he has undergone have not revealed any abnormalities. This, however, is not uncommon in seizure diagnoses. We do note that the cause of the appellant’s seizure continues to be investigated, and he is scheduled to undergo a sleep deprived EEG in the near future.

21We are also alive to the fact that, while there have been no reported seizures since August, 2023, the appellant continues to experience auras at least once per week. Dr. Goldberger recommended increasing the appellant’s Keppra prescription in order to help reduce the auras, but this was declined by the appellant.

22The appellant testified that he had raised his concerns regarding the suspension of his driver’s licence with Dr. Goldberger at his latest appointment on October 24, 2023 and Dr. Goldberger did not extend support for reinstatement of his driver’s licence at this appointment.

Conclusion

23We conclude that, as the appellant’s seizures continue to be investigated and the dose of Keppra is being adjusted to address ongoing auras, that he has yet to reach a state of general stability with respect to his seizures. Further, as no neurologist has recommended a reduction of the appellants licence suspension, the CCMTA Standard of a six-month suspension is reasonable in this case.

24The appellant’s three seizures were accompanied by loss of consciousness. We conclude that an episode of this sudden and episodic nature, while driving, is likely to significantly interfere with the appellant’s ability to drive a motor vehicle safely.

ORDER

25For the reasons set out above, pursuant to subsection 50(2) of the Act, we confirm the Registrar’s decision to suspend the appellant’s driver’s licence.

Dr. Isla McPherson, Member

Jeffery Campbell, Vice Chair