Licence Appeal Tribunal File Number: 14771/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:
Sarah E. Connell
Appellant
and
Registrar of Motor Vehicles
Registrar
DECISION AND ORDER
ADJUDICATORS: Dr. Isla McPherson, Member Jeffery Campbell, Vice-Chair
APPEARANCES:
For the Appellant: Sarah E. Connell, Appellant
For the Registrar: Ian Sookram, Agent
Held by teleconference: June 5, 2023
REASONS FOR DECISION AND ORDER
A. Overview
1Sarah E. Connell (the “Appellant”) appeals the decision of the Registrar of Motor Vehicles (the “Registrar””) to suspend her driver’s 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 physician that the appellant suffers from a medical condition which makes it unsafe for her to drive.
2In response to a Medical Condition Report (“MCR”) dated July 15, 2022, completed by ER physician, Dr. Catharine Sellens (“Dr. Sellens”), the Registrar suspended the Appellant’s Class G licence under s. 47(1) of the Highway Traffic Act, R.S.O. 1990, c. H.8 (the “Act”), for medical reasons, specifically seizure. The Appellant was notified of the suspension by letter dated July 25, 2022.
3The Registrar later received a Seizures and Loss of Consciousness form dated August 5, 2022 (“Seizures Form”) completed by Nurse Practitioner Rose Patterson which stated that the Appellant’s seizure was related to the use of alcohol and that the Appellant was “currently working on sobriety and that she “reports 3 [weeks] sobriety today”.
4The Registrar, by letter dated August 10, 2022, revised the Appellant’s condition to “seizure due to alcohol withdrawal”.
5The 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 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.
6The Registrar takes the position that the Appellant suffers from a medical condition, namely alcohol use disorder and seizure due to alcohol withdrawal, that is likely to significantly interfere with her ability to drive safely and that her licence should remain suspended.
7The Appellant appeals the suspension under s. 50(1) of the Act. She denies that she suffers from alcohol use disorder or seizure due to alcohol withdrawal and denies that she suffers from a medical condition which interferes with her ability to drive safely.
8Pursuant 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. Having considered all the evidence and for the reasons that follow, we confirm the Registrar’s decision to suspend the Appellant’s driver’s licence.
B. Issue
9The 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.
10To resolve that issue, we will address the following questions:
Does the Appellant suffer from medical conditions, namely seizure due to alcohol withdrawal and/or substance use disorder – alcohol?
If the Appellant does suffer from one or both of the above conditions, is that condition likely to significantly interfere with her ability to drive a motor vehicle safely?
11For the reasons set out below, we find that the Appellant does suffer the above stated medical conditions and that those conditions are likely to significantly interfere with her ability to operate a motor vehicle safely. We, therefore, confirm the Registrar’s decision to suspend the Appellant’s licence.
C. Evidence and Analysis
a. Does the Appellant suffer from seizure due to alcohol withdrawal and substance use disorder – alcohol?
i. Substance Use Disorder - Alcohol
12We find that the Appellant does suffer from Substance Use Disorder – Alcohol.
Evidence of the Registrar
13In support of its allegation that the Appellant suffers both from seizure due to alcohol withdrawal and substance use disorder – alcohol, the Registrar relies on MCRs dated July 15, 2022 and February 16, 2023, the Seizure Form dated August 5, 2022, and a Substance Use Assessment (“Substance Form”) dated September 16, 2022 completed by Dr Shayna Henry.
14In the Seizure Form dated August 5, 2022, Nurse Practitioner Rose Patterson documented severe substance use disorder due to alcohol and advised that a treatment program had not been completed.
15In the Substance Form dated September 16, 2022, Dr. Shayna Henry noted mild substance use disorder due to alcohol and also advised that there was no completion of a supervised treatment program.
16Family doctor, Dr Ow, noted in the MCR dated February 16, 2023 that “the [Appellant] as a history of alcohol use disorder and alcohol withdrawal seizures” and that the Appellant “likely has not been alcohol abstinent for the minimum 6 months required by the Ministry.”
Testimony of the Appellant
17The Appellant testified that, previously, her drinking habit was to consume two bottles of wine every few weeks, when she would go through depressive episodes. She had been abstinent from alcohol since July 2022. The Appellant testified that she attended counselling regarding her alcohol use from September to December 2022 but discontinued that counseling due to a lack of funds. She also testified that she attends Alcoholics Anonymous three times a week and has an AA sponsor.
18Regarding the MCR of February 16, 2023 in which Dr. Ow stated that she could not support “reinstatement of her driving privileges at this time and she likely has not been alcohol abstinent for the minimum 6 months required by the Ministry.”, The Appellant advised that she had a medical emergency two days before in which she overdosed on prescription medication. There was no alcohol involved.
Conclusion
19While we are sympathetic to the Appellant’s testimony, she did not provide any documentary evidence with respect to her counselling, her AA involvement or the reasons for her medical emergency on February 14, 2023. The Registrar, however, did submit the Seizure Form, the Substance Form and the MCR, all of which attest to the Appellant’s use of alcohol. We are satisfied that the Registrar has proven that the Appellant suffers from the medical condition of substance use disorder as the Registrar presented ample evidence that she does.
ii Seizure due to Alcohol Withdrawal
20We find that the Appellant does suffer from Seizure due to Alcohol Withdrawal.
Evidence of the Registrar
21The Registrar relies upon the MCR by Dr. Sellens, dated July 15, 2022 which states that the Appellant had a seizure which was the “3rd seizure but 1st time @ hospital.”
22In the Seizure Form dated August 5, 2022, Nurse Practitioner Patterson confirmed a “Provoked seizure with no structural brain abnormality” and “Substance Use Related Seizure”. The completed form also confirmed that this was not the patient’s first seizure.
23In the Substance Form dated September 16, 2022, Dr. Henry commented, “patient had an event in July that was probably a seizure (?related to alcohol) but we cannot confirm whether it was a true seizure”.
24In the MCR dated February 2, 2023, Dr. Ow observed, “Patient has a history of alcohol use disorder and alcohol withdrawal seizures.”
Testimony of the Appellant
25With respect to the episode that prompted the MCR of July 15, 2022, the Appellant testified that she “passed out” while in her mother’s car at a drive thru and her mother drove her to the hospital. She testified that she believes that the episode may have been due to syncope because she had an eating disorder and at that time she weighed only 87 lbs. She advised that she had 3 similar episodes but only went to the hospital for one of those.
26The Appellant testified that she had been referred to an epilepsy clinic and followed up with a neurologist on November 2, 2022 who ordered further investigations and an MRI which took place in May 2023. She has not yet received the results of the MRI.
Conclusion
27When weighing the testimony of the Appellant and the Registrar’s several medical submissions, we find the timely and numerous medical submissions persuasive. We find the submissions of a nurse practitioner and 3 physicians who have documented the presence of alcohol withdrawal seizures compelling. On the balance of probabilities, we find the Appellant likely suffers from Seizure due to alcohol withdrawal.
b. Is the Appellant’s medical conditions of seizure due to alcohol withdrawal likely to significantly interfere with her ability to drive a vehicle safely?
28We find that the Appellant’s medical conditions are likely to interfere with her ability to drive a vehicle safely.
Position of the Registrar
29The Registrar has the burden of establishing that the Appellant’s medical conditions are likely to significantly interfere with her ability to drive a motor vehicle of the applicable class safely. We find that the Registrar has satisfied this burden.
30In deciding whether to suspend a driver’s licence, s. 14(2)(a) of Regulation 340/94 (Drivers’ Licences) under the Act allows the Registrar to take into account the CCMTA Medical Standards for Drivers (CCMTA Standards). Similarly, the 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 at least one of the Appellant’s disorders is likely to significantly interfere with her ability to drive a motor vehicle safely. While the CCMTA Standards are well-reasoned and helpful, every case must be considered on its own facts.
31With respect to substance use disorder, the CCMTA Standard 15.1 outlines how alcohol has sedative effects and can affect functions necessary for driving including reduced reaction times, blurred or double vision, altered depth perception, reduced judgment and insight, blunted alertness and reduced motor co-ordination.
32The Registrar relies on the CCMTA Standards, chapter 15.6.3 which prescribes the eligibility requirements for those who drive with the medical condition of substance use disorders. As per that section, prior to the reinstatement of the Appellant’s licence, the Registrar requires that the Appellant meets the criteria for remission and/or has abstained from the substance from 12 months.
33Regarding seizures, CCMTA Standard 17.1 documents the risks when driving as sudden impairment of cognitive, motor or sensory functions or a loss of consciousness.
34The Registrar relies on the CCMTA Standards, chapter 17.6.3 which prescribes the eligibility requirements for those who drive with the medical condition of alcohol withdrawal seizures. As per that section, prior to the reinstatement of the Appellant’s licence, the Registrar requires that the Appellant meets the criteria for licence reinstatement in accordance with the criteria in the aforementioned chapter 15.6.3.
Testimony of the Appellant
35The Appellant testified that she has a clear driving record and does not pose a danger to anyone. She advised that having her licence reinstated would not only help her financially and assist her in attending her AA meetings, but also would help with her mental health.
Conclusion
36We find that the effects of the substance use disorder and seizure due to alcohol withdrawal can be significant and that they both, individually and taken together, are matters of significant concern with respect to the ability of sufferers to drive safely.
37Having concluded that the Appellant does suffer from the medical conditions of substance use disorder - alcohol, and seizures due to alcohol withdrawal, and, having no objective evidence with respect to the Appellant’s ability to drive safely, we find the recommendations of the CCMTA to be reasonable and accept them.
38While we commend the Appellant for her efforts in addressing her alcohol use, based on the evidence before us, we are satisfied that the Registrar has discharged its burden of establishing that the Appellant has conditions that are likely to significantly interfere with her ability to drive a vehicle safely.
E. Order
39For the reasons set out above, pursuant to subsection 50(2) of the HTA, we confirm the Registrar’s decision to suspend the Appellant’s Class G Licence.
LICENCE APPEAL TRIBUNAL
___________________________
Dr. Isla McPherson, Member
Jeffery Campbell, Vice Chair
Released: June 9, 2023