Bryan Watson v. Registrar of Motor Vehicles, 2023 CanLII 62919

Licence Appeal Tribunal File Number: 14828/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 Registrar of Motor Vehicles to suspend a licence pursuant to Section 47(1) of the Act.

Between:

Bryan Watson

Appellant

and

Registrar of Motor Vehicles

Respondent

DECISION

PANEL: Constantine Petrou, M.D., Member Avril A. Farlam, Vice-Chair

APPEARANCES:

For the Appellant: Bryan Watson, Self-represented Marie Watson, Wife for support George Tooke, Friend witness

For the Respondent: Stephen Grootenboer, Representative

Heard by Teleconference: June 15, 2023

OVERVIEW

1Bryan Watson (the "appellant") appealed the decision of the Registrar effective February 23, 2023 to suspend his 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 dated February 9, 2023 from Dr. Moore that the appellant suffers from cognitive impairment, Miege's syndrome Parkinson's, Parkinson's related dementia, possible vascular dementia and neurological disease.

2Section 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.

3The Registrar takes the position that the appellant suffers from a medical condition of cognitive impairment and/or Parkinson's which are likely to significantly interfere with his ability to drive safely.

4The appellant appeals the suspension under s. 50(1) of the Act. He denies that he has a medical condition, namely cognitive impairment and/or Parkinson's and denies that these interfere with his ability to drive safely.

5Having considered all the evidence, and for the reasons which follow, we confirm the Registrar's decision to suspend the appellant's driver's licence.

ISSUES

6The issue in dispute is whether the appellant suffers from medical conditions namely cognitive impairment and/or Parkinson's, that are likely to significantly interfere with his ability to drive a motor vehicle safely.

[7] To resolve that issue, we will address the following questions: i. Does the appellant suffer from cognitive impairment and/or Parkinson's? ii. If so, is this likely to significantly interfere with his ability to drive a motor vehicle safely?

ANALYSIS

The appellant has cognitive impairment and Parkinson's

8The evidence presented at the hearing supports the Registrar's allegation that the appellant suffers from a medical condition, namely cognitive impairment and/or Parkinson's disease.

9The Registrar's position is supported by the February 9, 2023 and May 31, 2023 medical reports of Dr. Moore, and the May 24, 2023 report of Dr. Taabazuing.

10Dr. Moore, the appellant's family physician, in her February 9, 2023 report diagnosed the appellant with cognitive impairment, Miege's syndrome Parkinson's, Parkinson's related dementia, possible vascular dementia and neurological disease. This report was sent to the Ministry of Transportation by Dr. Moore as required under s. 203 of the Act.

11Dr. Moore in her May 31, 2023 report stated that the appellant's Meige syndrome and Parkinson's disease appear stable but, as outlined by Dr. Taabazuing, there remain concerns about his cognition. Dr. Moore confirmed that Dr. Taabazuing has been following the appellant since October 2022 and last saw him March 1, 2023 at which time cognitive testing resulted in a diagnosis of likely mixed dementia (Parkinson's disease associated dementia plus vascular dementia) and he was referred to a facility for a formal driving assessment ("FDA") as he wanted to resume driving. Dr. Moore confirmed that the appellant does not want to attend the FDA due to cost. Dr. Moore concluded that while the appellant's physical health has improved he is currently unable to ascertain the appellant's fitness to drive from a cognitive standpoint without the additional information that a FDA would provide.

12Dr. Taabazuing, an associate professor in geriatric medicine at a medical school, wrote a report dated May 24, 2023 at the request of the appellant in which she confirmed that, after assessment, she diagnosed the appellant with probable mixed dementia (Parkinson's disease associated dementia in combination with vascular dementia) based on testing she had done. Dr. Taabazuing concluded that she is not confident to make a decision about his safety to drive without an objective driving assessment, has discussed this with the appellant and his wife and has made a referral to a FDA facility.

13The appellant denies that he has cognitive impairment, and/or Parkinson's disease, Miege's syndrome Parkinson's, Parkinson's related dementia, possible vascular dementia and neurological disease.

14However, the appellant and his wife Marie Watson both testified that he takes four pills a day for Parkinson's disease and has done so for the last four years. The appellant testified that he takes a total of some 15 medications every day and receives regular Botox injections from Dr. Jog, a neurologist, to treat distortion in his face which he understands from Dr. Jog results from his Meiges syndrome. The appellant testified that Dr. Jog has diagnosed him with Meiges syndrome three or four years ago.

15Although the appellant testified that Dr. Jog told him Dr. Jog does not know why his driver's licence has been taken away because the appellant is in better shape than Dr. Jog is, the appellant did not submit any report completed and signed by any physician, including Dr. Jog. The appellant did submit a written report purporting to be authored by Dr. Jog which the Registrar found, after investigation, had been completed and signed by the appellant himself. There are indications in Dr. Jog's purported report that it was not written by a physician. No diagnosis is provided. Dr. Jog's practitioner information is described as "CLINICAL, Neurological". The comment purportedly from Dr. Jog is "I have no idea why Mr. Watsons Driver Licence was Revocked. His Parkinsons Disease is hardly noticeable at best. I can see no reason for suspension..." We find it unlikely that a physician would describe a medical condition as "hardly noticeable", fail to provide a diagnosis where the form requires a diagnosis to be made, and then later in the same report, refer to the appellant having Parkinsons Disease. We give this purported report no weight. Even if the purported report was written by Dr. Jog, which we find is unlikely, we prefer the more recent May 2023 reports of Drs. Moore and Taabazuing.

16The appellant, Mrs. Watson and George Tooke, a close friend, all testified that they do not believe that the appellant has any cognitive impairment and/or Parkinson's disease. The appellant and Mr. Tooke both testified that they know other people that have Parkinson's disease and that the appellant does not appear to have those symptoms. Both Mrs. Watson and Mr. Tooke testified that they do not have any medical training.

17We prefer the evidence of Drs. Moore and Taabazuing over that of the appellant, Mrs. Watson and Mr. Tooke. These physicians, one of whom is a geriatric specialist, have both had an opportunity to assess the appellant and to provide their diagnosis. Their opinions are supported by the fact that the appellant has for some years taken medication for Parkinson's and treatment for Miege's syndrome by the appellant's own admission.

18The testimony of the appellant, Mrs. Watson and Mr. Toole do not persuade us that that Drs. Moore and Taabazuing are in error in their assessments and diagnosis. The appellant has provided no written medical evidence in support of his belief that he has been improperly diagnosed.

19We find that the Registrar has established on a balance of probabilities that the appellant has cognitive impairment, Miege's syndrome Parkinson's, Parkinson's related dementia, possible vascular dementia and neurological disease.

The appellant's medical condition is likely to significantly interfere with his ability to drive safely

20We are satisfied that the appellant's medical condition is likely to significantly interfere with his ability to drive safely.

21Both Drs. Moore and Taabazuing have indicated that the appellant should complete an FDA.

22The Registrar relies on the Canadian Council of Motor Transport Administrators Medical Standards for Drivers (the "CCMTA Standards"), particularly s. 6.6.1 and 12.6.1 in support of its submission that the licence suspension should be confirmed by the Tribunal. Section 14(2)(a) of the Regulation allows the Registrar 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 on the Tribunal.

23The CCMTA Standards suggest that judgement and insight are important for driving, and that neurological disorders such as Parkinson's disease may impair driving performance by impairing motor, visual and cognitive functioning and suggest that FDA is an appropriate means of assessing the effects of cognitive limitations upon driving.

24Section 6.6.1 of the CCMTA Standards provides that a driver who has been diagnosed with cognitive impairment may be considered eligible for a driver's licence if, where required, an FDA shows the condition does not affect ability to drive.

25Section 12.6.1 of the CCMTA Standards provides that a driver who has been diagnosed with Parkinson's disease may be considered eligible for a driver's licence if they have sufficient range of motion, strength and coordination to perform the functions necessary for driving, cognitive functions necessary for driving are not impaired, pain and any drugs used to treat the condition to not impair the functional abilities necessary for driving and where required, and a road test or FDA indicates the driver is able to compensate for any loss of functional ability necessary for driving.

26In this particular case, although we are not bound by the CCMTA Standards, we find the requirement for an FDA to be reasonable and consistent with the opinions of Drs. Moore and Taabazuing, both of whom recommended that the appellant's ability to drive be assessed in an FDA. Cognitive impairment and Parkinson's disease are neurological medical conditions that can affect the functions necessary for driving including reaction times, judgement and insight, alertness, and motor co-ordination.

27Neither of the appellant's physicians are supportive of the appellant's ability to drive safely absent an FDA according to their reports.

28Although the appellant, Mrs. Watson and Mr. Tooke all testified that the appellant has the cognitive ability to safely drive and drives a scooter now despite his medical condition of cognitive impairment and Parkinson's disease, the Registrar's position that the appellant's medical condition, namely cognitive impairment, Miege's syndrome Parkinson's, Parkinson's related dementia, possible vascular dementia and neurological disease makes him unsafe to drive without the further information that would result from an FDA.

29The Registrar's submission is supported by Drs. Moore and Taabazuing, as well as the CCMTA Standards. We agree with the Registrar's submissions.

30We are satisfied that the appellant's medical condition is likely to significantly interfere with his ability to drive safely.

Conclusion(s)

31We find that the appellant suffers from a medical condition, namely cognitive impairment and/or Parkinson's, that is likely to significantly interfere with his ability to drive a motor vehicle safely.

ORDER

32For 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.

LICENCE APPEAL TRIBUNAL

__________________________

Dr. Constantine Petrou Adjudicator

__________________________

Avril A. Farlam Vice-Chair