Amandeep Rama v. Minister of Transportation, 2023 CanLII 40110

Licence Appeal Tribunal File Number: 14812/MED

In the matter of an appeal under subsection 50(1) of the Highway Traffic Act, R.S.O. 1990, c. H.8, from a decision of the Minister of Transportation to change the class of a driver’s licence under s. 32(5)(b)(i) of the Act.

Between:

Amandeep Rama

Appellant

and

Minister of Transportation

Respondent

DECISION

ADJUDICATOR:

Dr. Erica Weinberg, Member

APPEARANCES:

For the Appellant:

Amandeep Rama, Self-Represented

For the Respondent:

Ian Sookram, Representative

HEARD by Teleconference: May 4, 2023

OVERVIEW

1Amandeep Rama, the appellant, appeals the decision of the Minister of Transportation (the “Minister”, the “Ministry”), to downgrade his Class A driver’s licence under s. 32(5)(b)(i) of the Highway Traffic Act, R.S.O. 1990, c. H.8 (the “Act”), effective March 27, 2023.

2Following the receipt of an unsolicited Medical Condition Report dated September 12, 2022, the Registrar of Motor Vehicles (the “Registrar”) suspended the appellant’s driver’s licence, effective September 22, 2023. The Medical Condition Report was sent to the Ministry as required under s. 203 of the Act.

3In this case, the Registrar acted pursuant to s. 47(1) of the Act and s. 14(1)(a) of O. Reg. 340/94 under the Act (the “Regulation”). Section 14(1)(a) of 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 his or her ability to drive a motor vehicle of the applicable class safely.

4Under s. 14(2)(b) of the Regulation, the Registrar or Minister may require a driver to provide satisfactory evidence that he or she is able to drive safely.

5Following the receipt and review of medical documentation, including a Seizures and Loss of Consciousness form (“Ministry form”), the appellant’s Class G driver’s licence was reinstated on March 27, 2023.

6Under the Act, the Minister is responsible for ensuring that commercial drivers are medically fit to drive commercial vehicles on the highway. Section 32(5)(b)(i) of the Act states that the Minister may impose the conditions authorized by the regulations, remove any conditions or endorsements or change the class or classes of driver’s licence held by the person, in accordance with the results of the examinations and other prescribed requirements.

7The Minister takes the position that the appellant no longer meets the Canadian Council of Motor Transport Administrators Medical Standards for Drivers [February 2021] (the “CCMTA Standards”) for a commercial driver’s licence due to the medical condition of syncope.

8The appellant appeals the downgrade of his Class A driver’s licence under s. 50(1) of the Act. He denies that his medical condition interferes with ability to drive a commercial vehicle safely.

9Following a hearing, the Tribunal may, under s. 50(2) of the Act, confirm, modify or set aside the decision or order of the Minister.

10Having considered all of the evidence, and for the reasons which follow, I find that the Minister has not met the burden of establishing that the appellant’s medical condition is likely to significantly interfere with his ability to drive a commercial vehicle safely. Therefore, I set aside the decision of the Minister to change the class of the appellant’s driver’s licence.

ISSUES

11The issue in dispute is whether the appellant suffers from a medical condition, namely syncope, that is likely to significantly interfere with his ability to drive a commercial vehicle safely.

12To resolve that issue, I will address the following questions:

i. Does the appellant suffer from syncope?

ii. Is the appellant’s medical condition, if any, likely to significantly interfere with his ability to drive a commercial Class A vehicle safely?

ANALYSIS

Does the appellant suffer from syncope?

13I find that the evidence presented at the hearing supports that the appellant suffers from syncope.

14The Minister’s position that the appellant has the medical condition of syncope is supported by the reports of the appellant’s primary care physician, cardiologist and neurologist.

15On September 12, 2022 the appellant went to the hospital after experiencing a witnessed episode. The emergency room physician indicated on the Medical Condition Report that the appellant suffered an episode of Sudden Incapacitation and checked off both seizure and syncope.

16Over the subsequent months, the appellant underwent numerous cardiac (heart) and neurological (brain) investigations, and had consultations with both a cardiologist, Dr. C. and a neurologist, Dr. D.

17In the summary of the cardiology consultation note dated December 20, 2022, Dr. C. indicated that in September 2022, the appellant had an episode of syncope/presyncope. In Dr. D.’s neurology follow-up note dated March 21, 2023, she indicated that the investigations did not show evidence for epilepsy, and the appellant’s September 2022 episode itself was not strongly in favour of seizures and was more in favour of syncope.

18The appellant does not deny that on September 12, 2022 he experienced an episode which, in his Notice of Appeal, he described as a quick blackout.

19I find that the Minister has established on a balance of probabilities that the appellant has the medical condition of syncope.

Is the appellant’s medical condition, if any, likely to significantly interfere with his ability to drive a commercial Class A vehicle safely?

20On appeal, the Minister has the burden of establishing, on a balance of probabilities, that the appellant’s medical condition is likely to significantly interfere with his ability to drive a vehicle of the applicable class safely. I find that the Minister has not met that burden.

21I find on a balance of probabilities that the appellant’s medical condition of syncope is not likely to significantly interfere with his ability to drive a commercial Class A vehicle safely.

22The appellant is a long-haul cross-border truck driver who typically drives 7-8 hours per day on days he works. On trips that involve longer distances, he stays and sleeps overnight prior to returning to Canada. Normally he takes the majority of his eating provisions with him when he travels.

23The appellant’s trucking trip leading up to his syncopal episode on September 12, 2022 was unusually long (14-16 hours). He stated that he: had significant mechanical issues/trouble with his own truck; left his personal belongings (including food and water) in his own truck; had to drive a temporary truck; did not consume food and only had a coffee to drink while trucking; had very limited sleep (2-3 hours); and returned home around noon (12 p.m.) on September 12, 2022. The appellant did not consume food once home as he was attending a friend’s barbecue later that day. The appellant stated that at the barbecue, while sitting on outside stairs, he felt very sleepy and woke up immediately after his friends poured liquid on his face. Dr. C.’s note states that the appellant “started to feel slightly dizzy when sitting on the stairs and then may have briefly passed out or became severely presyncopal”. Dr. D.’s description of the episode was that the appellant “was feeling sleep-deprived and was unresponsive for a few seconds”.

24The appellant argues that his commercial driver’s licence should be reinstated. He relies on the facts that: he followed through with all the medical investigations asked of him; none of the investigations showed any abnormality of significance; no physician prescribed any medication as a treatment for his September 2022 episode; nearly seven months have passed with no further episode; and his treating physicians support the reinstatement of his commercial driver’s licence.

25The Minister relies on the CCMTA Standards and argues that the appellant should be episode free for at least one year before his Class A driver’s licence is reinstated. Section 14(2)(a) of the Regulation allows the Registrar or Minister to consider 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 requirements.

26The respondent’s representative referred to Chapter 19.6.10 of the CCMTA Standards (Single or recurrent unexplained, single or recurrent atypical vasovagal, or recurrent typical vasovagal syncope – Commercial drivers) which indicates that commercial drivers are eligible for a licence if it has been at least 12 months since the last episode of syncope and the conditions for maintaining a licence are met. He emphasized that the appellant’s treating neurologist checked off “atypical vasovagal syncope” on the March 2023 Ministry form.

27I acknowledge that commercial drivers, such as the appellant, often drive under more adverse conditions and drive longer distances than drivers of non-commercial vehicles. Furthermore, should a crash occur, the consequences are much more likely to be serious given the gross weight of the vehicle involved.

28I also acknowledge that the appellant’s syncopal episode in September 2022 occurred from a seated position, and thus, according to the CCMTA Standards and Dr. D.’s completed Ministry form, the appellant had an episode of atypical vasovagal syncope.

29However, I am drawn to other aspects of the completed Ministry form. Dr. D. indicated that the appellant’s primary medical condition was syncope/loss of consciousness and hand wrote “unresponsiveness likely due to falling [a]sleep. In medical terms, “likely” means on the balance of probabilities. In addition, Dr. D. answered affirmatively to the question, “Has the condition or underlying cause been successfully treated or resolved?”, and in her March 2023 note stated that she is of the opinion that the appellant “can go back to driving as before”.

30Furthermore, I am drawn to Dr. C.’s December 2022 note. Dr. C., a trained cardiologist, states he is of the opinion that the cause of the appellant’s syncope/severe presyncope was “environmental”, i.e., being related to the appellant’s poor oral intake and lack of sleep for nearly 24 hours. In addition, Dr. C. states that “from a cardiac perspective all of his investigations have been normal…I do not believe that his event was related to any type of cardiac pathology or cardiac arrhythmias”. Moreover, Dr. C. states, “From a cardiac point of view I do not believe there is any concern with regards to reinstating his licence”. It is clear from Dr. C.’s report that he was aware that the appellant is a commercial truck driver.

31By letter dated April 20, 2023 the Minister requested that the appellant get confirmation from his treating physician, specialist or nurse practitioner whether his syncopal event on September 12, 2022 was atypical vasovagal syncope or syncope with a reversible cause, (e.g., sleep).

32I am of the opinion that Dr. R., the appellant’s primary care physician, fulfilled the Minister’s April 20, 2023 request for more information by indicating in a narrative letter that the appellant had a “syncope episode in September 2022 due to lack of sleep and fasting”. Yet, on April 26, 2023, the Minister requested that Dr. D., confirm whether the appellant has the diagnosis of syncope or atypical syncope.

33Furthermore, I am of the opinion that every case should be considered on its own merits. I am satisfied I have done so in this case. It is clear from the appellant’s testimony and the written evidence before me that the events leading to the appellant’s syncopal episode in September 2022 (i.e., extended driving time, limited oral intake and little sleep) were exceptional. I am satisfied from the appellant’s testimony that he now has sufficient insight into the necessity of good oral intake and sleep hygiene, at all times. The appellant’s treating physicians, including two specialists, are supportive of the reinstatement of the appellant’s commercial licence. Dr. D., the appellant’s treating neurologist, is of the opinion that the appellant’s September 2022 episode was not strongly in favour of seizures and was more in favour of syncope. Dr. C., the appellant’s treating cardiologist, does not believe that the appellant’s episode was related to any type of cardiac pathology or cardiac arrhythmia.

34Based on the above, I find, on a balance of probabilities, that the appellant’s medical condition is not likely to significantly interfere with his ability to drive a commercial vehicle safely.

Conclusion

35After a careful consideration of the totality of the evidence before me, and based on the above, I find that the Minister has not discharged the onus of establishing on a balance of probabilities that the appellant’s medical condition is likely to significantly interfere with his ability to drive a commercial vehicle safely.

ORDER

36For the reasons set out above, pursuant to subsection 50(2) of the Act, I set aside the Minister’s decision to change the class of the appellant’s driver’s licence.