Licence Appeal Tribunal File Number: 15342/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:

Carter Quinlan

Appellant

and

Registrar of Motor Vehicles

Respondent

DECISION

ADJUDICATOR: Dr. Erica Weinberg

APPEARANCES:

For the Appellant: Carter Quinlan, Self-Represented

For the Respondent: Stephen Grootenboer, Representative

HEARD by teleconference: November 24, 2023

OVERVIEW

1Carter Quinlan (the “appellant”) appeals from the decision of the Registrar of Motor Vehicles (“Registrar” or “respondent”) to suspend their Class G licence under s. 47(1) of the Highway Traffic Act, R.S.O. 1990, c. H.8 (the “Act”) after the Registrar received a report from a treating health care provider that the appellant suffers from a medical condition that may affect their safety to drive.

2The Registrar 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 may require a driver to provide satisfactory evidence that they are able to drive safely.

3The Registrar takes the position that the appellant suffers from two medical conditions, namely alcohol use disorder and seizure due to alcohol withdrawal, that are likely to significantly interfere with their 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. They acknowledge that they had one seizure due to alcohol withdrawal, deny that they suffer from alcohol use disorder and deny that they suffer from any medical condition which interferes with their 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 Registrar.

ISSUES

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

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

i. Does the appellant suffer from seizure due to alcohol withdrawal (alcohol withdrawal seizure)?

ii. Does the appellant suffer from alcohol use disorder?

iii. If so, are either or both likely to significantly interfere with their ability to drive a motor vehicle safely?

8The Registrar 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, I find that the Registrar has satisfied its burden to establish that the appellant suffers from medical conditions that are likely to significantly interfere with their ability to drive a motor vehicle safely and I confirm the Registrar’s decision to suspend the appellant’s driver’s licence.

ANALYSIS

Does the appellant suffer from seizure due to alcohol withdrawal?

10The evidence presented at the hearing establishes, on a balance of probabilities, that the appellant suffers from a medical condition, namely seizure due to alcohol withdrawal.

11The Registrar’s position is supported by medical reports completed by Drs. J., C. and G.

12In the September 12, 2023 Medical Condition Report, neurologist, Dr. J., indicated that the appellant suffered sudden incapacitation due to seizure from alcohol/drug withdrawal.

13In a September 12, 2023 neurology clinic note, authored by resident Dr. C., on behalf of Dr. J., Dr. C. indicated that the appellant suffered two witnessed episodes suggestive of seizure (July 1, 2023 and August 26, 2023) and that both of these seizures were provoked by significant alcohol consumption. I further note from the clinic note that: both of these events were witnessed; the witness(es) reported the appellant lost consciousness; all four of the appellant’s limbs shook during the episodes; the episodes lasted 1-1.5 minutes; and the appellant was transported to local hospitals by EMS following the episodes. I acknowledge that some of this evidence is hearsay evidence and recognize that despite having the discretion to admit hearsay evidence, tribunals must be cautious in doing so given that hearsay evidence can be inherently unreliable. However, in this case I accept the hearsay evidence. The appellant testified that both episodes were witnessed by the same or similar friends who they were with while consuming alcohol and on the day of the episodes. Moreover, the appellant was present at the neurology consultation and the appellant made no objection to this hearsay evidence.

14In an October 5, 2023 completed substance use assessment form, the appellant’s family physician, Dr. G., indicated that: the appellant experienced a seizure within the last 12 months; the seizure was related to the use of alcohol or other substances; the seizure was due to alcohol withdrawal; the last seizure was less than three months ago; and the last seizure was in August 2023.

15The appellant does not deny he suffered two episodes of loss of consciousness, those being on July 1, 2023 and August 26, 2023. They further acknowledge that both episodes in question occurred a number of hours following the consumption of a significant amount of beer the previous evening(s)/early morning and that they felt a sensation of tension prior to losing consciousness on both occasions. The appellant acknowledged at the hearing that the episode on August 26, 2023 was an alcohol-related seizure, However, the appellant denies that their episode on July 1, 2023 was a seizure. The appellant relies on the fact that there is no convincing evidence that they suffered a seizure on July 1, 2023, including: that the emergency room (“ER”) physician at the hospital they attended on that occasion did not indicate to them that they had suffered a seizure; the physician indicated that they had too much to drink in a short period of time; there were no test results consistent with a seizure; they were told to go home and sleep off the previous night’s alcohol consumption; and there is nothing wrong with their head as both the CT scan of their brain on August 28, 2023 and the neurological exam performed on September 12, 2023 were normal. As a licenced and duly qualified physician practicing in Ontario, I know that neither a normal CT head nor a normal neurological exam rule out the diagnosis of seizure. I take notice of this fact pursuant to s. 16(b) of the Statutory Powers Procedure Act, R.S.O. 1990, c. S.22. Furthermore, I note that no hospital records were submitted as evidence from the appellant’s July 1, 2023 ER visit.

16I find that the Registrar has established on a balance of probabilities that the appellant suffers from seizure due to alcohol withdrawal.

Does the appellant suffer from alcohol use disorder?

17The evidence presented at the hearing establishes, on a balance of probabilities, that the appellant suffers from a medical condition, namely alcohol use disorder.

18The Registrar’s position is supported by a medical report completed by Dr. G.

19In the completed substance use assessment form, Dr. G. indicated that the appellant has moderate substance use disorder to alcohol (alcohol use disorder).

20I also take note from Dr. C.’s letter that the appellant “states that he does not regularly drink alcohol but does have some binging tendencies” and that prior to the appellant’s episode on August 26, 2023, “he states that he drank at least 18 units of alcohol” and prior to the episode on July 1, 2023, the appellant “also drank a considerable amount of alcohol but struggled to quantify it”.

21The appellant argues that they do not suffer from alcohol use disorder, do not have a drinking problem, nor a problem with alcohol. They further argue that at their appointment with Dr. G., Dr. G. did not ask them appropriate questions regarding their drinking, rather Dr. G. relied only on estimates from their weekend consumption of alcohol. The appellant denies drinking alcohol during the week, however, they testified that they may consume large quantities of beer on ‘special occasions’, perhaps two weekends per month. Although they stated that they do not count the number of beers they drink, the appellant estimated that on a Friday night they might consume 10-15 beers.

22I prefer the evidence of Dr. G. over that of the appellant and find, on a balance of probabilities, that the appellant suffers from alcohol use disorder. Dr. G. is qualified to make such a diagnosis and determine whether the appellant suffers from that condition. Furthermore, according to the appellant, Dr. G. recommended counselling as a treatment for their alcohol use. Dr. G. was in a position to determine that the appellant suffers from alcohol use disorder and I accept the diagnosis.

23I assign less weight to the appellant’s self-assessment that they do not suffer from alcohol use disorder. The appellant did not submit any medical evidence to dispute Dr. G.’s diagnosis. I prefer Dr. G.’s objective, medically supported assessment over the appellant’s subjective self-assessment.

24I find that the Registrar has established on a balance of probabilities that the appellant suffers from alcohol use disorder.

Are either or both of the appellant’s medical conditions likely to significantly interfere with their ability to drive a motor vehicle safely?

25I find that the Registrar has proven on a balance of probabilities that the appellant’s medical conditions of seizure due to alcohol withdrawal and alcohol use disorder individually or combined, are likely to significantly interfere with their ability to drive a motor vehicle safely.

26The Registrar’s representative argues that sudden incapacitation due to seizure due to alcohol withdrawal can and will significantly interfere with a driver’s ability to drive safely and presents a safety risk to other road users. They further argue that in order to consider reinstatement of the appellant’s driver’s licence they require confirmation that the appellant has remained seizure free and abstinent from alcohol for a period of one year. This period may be reduced to six months if the appellant’s healthcare practitioner confirms they have successfully completed an alcohol treatment program and is supportive of their driving privilege.

27Section 14(2)(a) of the Regulation allows the Registrar to consider the Canadian Council of Motor Transport Administrators Medical Standards for Drivers [February 2021] (the “CCMTA Standards”), when determining whether the requirements of s. 14(1) are met. The Tribunal may take the CCMTA Standards into consideration, although they are not binding on the Tribunal.

28The Registrar relies on the CCMTA Standards, in particular Chapters 17.6.3 (Alcohol Withdrawal Seizures) and 15.6.3 (Substance Use Disorder) plus internal policies at the Ministry of Transportation. Chapter 17.6.3 provides that all drivers are eligible for a licence if: the treating physician has confirmed that the cause of the seizure was alcohol withdrawal (i.e., the driver is not epileptic); they have undergone addiction treatment and have received a favourable report from an addiction counsellor; and the criteria for licence reinstatement are met in accordance with the Substance Use Disorder Standard (see 15.6.3). Chapter 15.6.3 provides that all drivers suffering from Alcohol Use Disorder may be eligible for a licence if they meet the criteria for remission and/or have abstained for twelve months. It also states that earlier re-licencing may be considered upon favourable recommendation from an addiction specialist and/or treating physician recognized by the licensing authority, and the successful completion of a drug rehabilitation program.

29The appellant argues that they do not suffer from a medical condition that significantly affects their ability to drive safely. The appellant testified that: there is nothing medically wrong with them; all the medical tests were normal; they do not have epilepsy; their alcohol withdrawal seizure on August 26, 2023 was a fluke; Dr. S., the ER physician at the hospital they attended on August 26, 2023, told them there were no concerns; the information from Drs. C. and J. scared them and made them realize that they should not be drinking alcohol; they are now attending substance use counselling with Ms. P., as recommended by Dr. G (first session October 31, 2023; second session November 28, 2023); Dr. G. also told them that they should not be drinking alcohol; and they began abstaining from alcohol shortly after the August 26, 2023 episode.

30Furthermore, the appellant testified that they have never driven under the influence of alcohol. I take note of the fact that the appellant’s Extended Driver Record Search for Criminal Code Convictions shows no evidence of any alcohol-related infractions.

31While the CCMTA Standards are well-reasoned and provide assistance, every case must be considered on its own facts.

32Although I am not bound by the CCMTA Standards, I find them to be reasonable. Seizures, such as the type of seizure the appellant suffered, cause a sudden impairment of cognitive, motor or sensory functions, or a loss of consciousness. As these seizures cause an episodic impairment of the functions necessary for driving, a driver cannot compensate. The use of alcohol affects the functions necessary for driving including reaction times, visual acuity, judgement and insight, alertness and motor co-ordination. The use of alcohol impairs a driver’s judgment and behaviour towards others, including in determining whether they are fit to drive or not. Although a person may, when not under the influence of alcohol, determine never to drive when intoxicated, their assessment of their ability to drive will likely be affected by having consumed alcohol. Furthermore, as in the appellant’s case, the use of alcohol can also lead to other health issues or concerns, such as alcohol withdrawal seizures.

33There are discrepancies between the appellant’s testimony and the medical evidence regarding the August 26, 2023 ER visit. The appellant could not provide any plausible explanation for these discrepancies. It is clear from the written evidence, that ER physician, Dr. S.: was considering the appellant’s episode to have been a seizure; used the word ‘seizure’ while conversing with the appellant; and asked the appellant to undergo a CT brain that day, which the appellant refused. I also take note that: Dr. S. indicated that the appellant denied any previous episode similar to the August 26, 2023 episode; Dr. S.’s referral to the urgent neurology clinic was regarding “query seizure”; the ER Discharge eNotification states, “The reason for the visit was seizure”; and under ‘Clinical Information’ in the CT brain scan report it states, “ …seizure 1 minute, not yet diagnosed…no prior concerns, seizure early am…”. I prefer the written evidence over the appellant’s recollection of the August 26, 2023 ER events.

34Given the evidence, I am persuaded to apply the CCMTA Standards for both medical conditions.

35I acknowledge that, when considering earlier re-licensing of a driver’s licence for alcohol use disorder, Chapter 15.6.3 of the CCMTA Standards does not state a specific time period required for remission. In addition, I acknowledge that the appellant testified that they have been abstinent from alcohol for a little less than three months but note that Dr. G., in the October 5, 2023 completed substance use assessment form, indicated that they did not have knowledge that the appellant was abstinent from alcohol. I also commend the appellant for beginning substance use counselling and I acknowledge the impact the lack of a driver’s licence is having/may have on their schooling and/or apprenticeship.

36However, in the circumstances of this case, I find that three months is too early for early reinstatement of the appellant’s driver’s licence for alcohol use disorder. In addition to not yet having completed their substance use counselling, the appellant has no favourable recommendation from any treating healthcare professional for early reinstatement of their driver’s licence. In fact, the appellant stated that Dr. G. would not provide a favourable recommendation prior to six months. I find the appellant falls short of the criteria set out in the CCMTA Standards for earlier re-licensing. In addition, I find, on a balance of probabilities, that the appellant’s actions following their first episode on July 1, 2023, demonstrate a lack of judgement. The appellant testified they were told by the ER physician that the episode was related to their heavy/rapid consumption of alcohol. However, the appellant indicated they did not alter their alcohol consumption pattern after the July 1, 2023 episode because they: did not think this would happen again; the August 26, 2023 episode was a fluke; did not and do not believe they have anything wrong with them; and see no concerns regarding their alcohol consumption. Furthermore, I find that the appellant currently lacks sufficient insight into their condition of alcohol use disorder. The appellant still denies or cannot accept that, on a balance of probabilities, they suffer from alcohol use disorder. Insight is an important consideration when considering safety to drive. I accept the respondent’s submission that further time and medical information should be submitted is reasonable keeping in mind public road safety.

37Taking into consideration the evidence and submissions regarding the appellant’s medical condition of seizure due to alcohol withdrawal, I find on a balance of probabilities that the appellant suffered two seizures due to alcohol withdrawal, those being on July 1, 2023 and August 26, 2023. It is clear from Dr. C.’s September 12, 2023 report, that Drs. C. and J. had access to at least some of the appellant’s medical records from the July 1, 2023 episode. Drs. C. and J. would have taken the July 1, 2023 medical information into consideration when making their decision that they believe that both of the episodes were seizures and that both of these seizures were provoked by alcohol consumption. Furthermore, they indicated that these episodes did not need any other specific examinations like an EEG or MRI. Based on my knowledge, I know that this means that Drs. C. and J. were confident with their diagnosis that the appellant’s seizures were due to alcohol withdrawal and the appellant did not need further testing to rule out a seizure disorder or epilepsy.

38I acknowledge that the appellant has not had a seizure in the past three months but note that the appellant falls short of the criteria set out in Chapter 17.6.3 of the CCMTA Standards. The appellant has just begun their substance use counselling, has no report from their counsellor and as previously mentioned, falls short of the criteria set on in Chapter 15.6.3 of the CCMTA.

39In addition, I find that the appellant lacks sufficient understanding or insight into the medical condition of seizure due to alcohol withdrawal as it relates to themselves. As previously stated, the appellant indicates that there is nothing medically wrong with them, all the medical tests were normal, their alcohol withdrawal seizure on August 26, 2023 was a fluke and they do not suffer from alcohol use disorder.

40Furthermore, I know that the time period for a seizure due to alcohol withdrawal to occur following cessation of alcohol consumption is variable. This type of episodic seizure can occur within a few hours of stopping drinking or can take up to 72 hours to start. Had either of the appellant’s seizures due to alcohol withdrawal, with its accompanying sudden loss of consciousness, started later and while they were driving, the consequences of the seizure could have been catastrophic for both the appellant and other road users. I accept the respondent’s submission that further time and medical information should be submitted is reasonable keeping in mind public road safety.

41I am satisfied on a balance of probabilities that the appellant’s medical conditions individually or combined are likely to significantly interfere with their ability to drive safely.

Conclusion

42I find that the Registrar has discharged the onus of establishing on a balance of probabilities that the appellant suffers from the medical conditions of seizure due to alcohol withdrawal and alcohol use disorder, that are likely, individually or combined, to significantly interfere with their ability to drive a motor vehicle safely.

ORDER

43For the reasons set out above, pursuant to subsection 50(2) of the Act, I confirm the Registrar’s decision to suspend the appellant’s driver’s licence.

Released: December 6, 2023

LICENCE APPEAL TRIBUNAL

__________________________

Erica Weinberg

Adjudicator