Date: 2023-07-13

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 driver’s license under subsection 47(1) of the Act.

Between:

Vuong Hong

Appellant

and

Registrar of Motor Vehicles

Respondent

DECISION AND ORDER

ADJUDICATOR: Dr. Peter Savage, Member

APPEARANCES

For the Appellant: Vuong Hong, Self-represented

For the Respondent: Stephen Grootenboer, Agent

Heard by Teleconference: July 13, 2023

REASONS FOR DECISION AND ORDER

A. Overview

1On June 2, 2023, the Registrar of Motor Vehicles (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 “HTA”), for medical reasons. The appellant appeals the suspension.

2The Registrar alleges that the appellant has insulin dependent diabetes and has suffered from both hypoglycemic unawareness and severe hypoglycemia with loss of consciousness and that these conditions require that his licence be suspended. The appellant disagrees with the Registrar’s decision and has appealed that decision to the Licence Appeal Tribunal (the “Tribunal”).

3Having considered all the evidence and for the reasons that follow, I confirm the Registrar’s decision to suspend the appellant’s Class G driver’s licence.

B. Issue

4The issue in this appeal is whether the appellant suffers from a medical condition which is likely to significantly interfere with his ability to drive a motor vehicle safely.

5To resolve that issue, I will address the following questions:

1. Does the appellant suffer from a medical condition, namely episodes of hypoglycemic unawareness and severe hypoglycemia?

2. Are these conditions likely to interfere with his ability to drive a motor vehicle safely?

C. The Law

6The Registrar has the authority under s. 47(1)(g) of the HTA to suspend or cancel a driver’s licence on the ground that the driver suffers from a medical condition or addiction likely to significantly interfere with his or her ability to drive safely.

7Section 14(1)(a) of O. Reg. 340/94 under the HTA requires 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.”

8Section 203(1) of the HTA requires medical professionals to report prescribed medical conditions to the Registrar, while s. 203(2) gives medical professionals the discretion to report medical conditions that they believe might make it dangerous for a person to drive.

9Section 14(2)(a) of O. Reg. 340/94 allows the Registrar to consider the Canadian Council of Motor Transport Administrators (“CCMTA”) Medical Standards for Drivers when determining whether the requirements of s. 14(1) are met. The CCMTA Standards are not binding on the Registrar or on this Tribunal.

10The Registrar has the burden of establishing on a balance of probabilities that one or more grounds for suspending a driver’s licence has been made out.

11Pursuant to section 50(2) of the HTA, after a hearing the Tribunal may confirm, modify or set aside the decision or order of the Registrar.

D. Evidence and Analysis

a. Does the appellant suffer from hypoglycemic unawareness and severe hypoglycemia?

12In an unsolicited medical report, the appellant was diagnosed with severe hypoglycemia by Dr. Anna Goulding, an internist who treated the appellant while hospitalized in May 2023. The diagnosis was confirmed by Dr Toan Di Nhan, the appellant’s family doctor in the June 30, 2023 diabetic condition report.

13The appellant does not dispute the diagnosis of hypoglycemia unawareness and severe hypoglycemia but, in his view, these conditions were brought on by COVID-19 and not related to his diabetic management. He admits to two periods of unconsciousness requiring hospital treatment but argues this was related COVID-19.

14The appellant’s position is not supported in the medical reports where both physicians diagnose episodes of severe hypoglycemia in the presence of COVID-19 but not caused by COVID-19. I am satisfied that the appellant suffers from diabetes which has caused the conditions of hypoglycemic unawareness and severe hypoglycemia requiring medical intervention and hospitalization.

b. Is the appellant’s medical condition of hypoglycemic unawareness and severe hypoglycemia likely to interfere with his ability to drive a motor vehicle?

15The Registrar has the burden of establishing that the appellant’s substance use disorder and alcohol withdrawal seizure are likely to significantly interfere with his ability to drive a motor vehicle of the applicable class safely.

16The Registrar drew my attention to the CCMTA Standards referring me to the portions of those standards that highlight the dangers that hypoglycemic unawareness could cause while driving and outlining the requirements for considering licence reinstatement. This would include a period of stability with regular blood sugar monitoring and documentation as well as a confirmatory HGA1C blood test. The Registrar maintains that these conditions have not been met.

17The Registrar relies on the appellant’s testimony as evidence that his medical condition is likely to significantly interfere with his ability to operate a car safely. Specifically, the appellant testified he had a Libra (2) glucose monitor and was using it on May 22 and 23, 2023 and, even though the alarm sounded, the appellant was not able to take action to avoid a severe hypoglycemic reaction.

18Further, the appellant testified his Libra (2) glucose monitor’s alarm goes off once or twice every month, indicating hypoglycemia. The appellant testified his blood sugar is around 3.6 mmol/L when the alarm goes off. The respondent points out that this blood sugar level is already quite low and may not give the appellant time to correct the hypoglycemia.

19The Registrar argues not enough time has passed to be assured that the appellant will be free of further episodes of hypoglycemia.

20The Registrar appreciates the testimony the witness Mr. Anderson (discussed below), but points out the fact that Mr. Anderson admits that he has no medical training or expertise.

Appellant’s Evidence

21The appellant testified he has managed his diabetes for 15 years and has never had episodes like this before.

22The appellant was initially unsure of the timing of events leading to his hospitalization but, after referring to a calendar and discussion with his witness, he confirmed he had an episode of diabetic unawareness leading to unconsciousness on May 22, 2023. His wife was unable to bring him to consciousness and called 911 and he was taken to hospital. The appellant testified that prior to going unconscious, his glucose monitor alarm sounded but he was not able to take action to prevent the event. He testified that he knew he was unwell and had reduced his rapid acting insulin earlier in the day but that had not prevented the hypoglycemia. In hospital he was treated, his blood sugar level stabilized and he was diagnosed with COVID-19. He was released from hospital at 5:00 a.m. on May 23, 2023 but had to return to hospital the same day via ambulance as he had another severe hypoglycemic reaction, leading again to unconsciousness and requiring medical intervention. He was kept in hospital until May 26, 2023.

23The appellant draws my attention to his doctor’s discharge statement where she indicates he has a continuous glucose monitor, has been discharged with glucagon, and has been advised on the use of carbohydrates to combat hypoglycemia. She notes he has excellent knowledge around his diabetic condition and believes him to be safe.

24The appellant argues COVID-19 was the issue that caused the severe hypoglycemic reactions and not his diabetes.

25The appellant’s witness Mr. Christian Anderson testified that the appellant is a good worker and that staff at his work site are aware of his diabetes and support him in good diabetic management. He noted that he has arranged help in organizing transportation to and from work. Mr Anderson has never noticed the appellant having any hypoglycemic spells while at work.

26The appellant testified he has a family doctor and an endocrinologist who help him monitor his diabetes.

27The appellant also relies on his clean driving record and denies ever having a hypoglycemic episode while driving.

Analysis

28The CCMTA Standards state that hypoglycemic unawareness can significantly impair the sensory, motor and cognitive functions required for driving and severe hypoglycemia can lead to unconsciousness. All of these circumstances can and will render it unsafe for a person to drive a motor vehicle.

29A period of only 6 weeks has passed since these two episodes of severe hypoglycemia and this time frame of stability is far short of the 6-month period recommended by the CCMTA.

30The appellant has an excellent driving record and has access to his family doctor and an endocrinologist although neither of these physicians has stated that, in their opinion, his licence should be reinstated.

31The hypoglycemia event in May occurred at a time the appellant was suffering from COVID-19 and, as I explain below, I have no doubt that COVID-19 may have been a contributing factor to the development of hypoglycemia.

32Pursuant to s. 16(b) of the Statutory Powers Procedure Act, this Tribunal may take notice of any generally recognized scientific fact, information or opinions that are within its scientific knowledge. As a licenced medical doctor in the province of Ontario, I have found all types of infections can affect insulin-dependent diabetics, sometimes raising blood sugar levels and sometimes causing sugar levels to drop when patients are not eating as well. Diabetic patients must learn to control their sugar levels at all times and, in this particular case, the appellant did not control his blood sugar level in spite of the glucose monitor’s alarm alerting him to a low sugar level. On this point, I am concerned that in spite of the alarms sounded by the appellant’s glucose monitor, the appellant was not able to react and correct the hypoglycemia

33Further, I am concerned that the appellant downplays the seriousness of these episodes and instead links them to COVID-19. While he blames COVID-19 for these episodes, any viral infection can have a similar effect and he must have the skills to deal with such episodes in the future.

34I find that the Registrar has established on a balance of probabilities that the appellant’s medical conditions of hypoglycemic unawareness and severe hypoglycemia are likely to significantly interfere with his ability to drive a motor vehicle. I agree with the Registrar that the CCMTA Standards are important guidelines, and I accept and apply them in this case.

35I heard the Registrar’s argument noting the seriousness of this condition and asking for a longer period of time of stability and I agree with this position. I heard the evidence from the discharging doctor that the appellant had good understanding of the condition and was safe. I find this statement likely reflected the doctor’s opinion that the appellant was safe to go home and did not reflect an opinion that the appellant was safe to drive.

36I am persuaded by the evidence presented at this hearing that the Registrar has satisfied the onus on it to prove that the appellant suffers from a medical condition which is likely to significantly interfere with his ability to drive a motor vehicle safely.

E. Order

37For the reasons set out above, pursuant to subsection 50(2) of the HTA, I confirm the Registrar’s decision to suspend the appellant’s Class G License.