Licence Appeal Tribunal File Number: 15001/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:

Matthew Adams

Appellant

and

Registrar of Motor Vehicles

Respondent

DECISION

PANEL:

Dimitri Louvish, M.D., Member Avril A. Farlam, Vice-Chair

APPEARANCES:

For the Appellant:

Christopher Marlatt, Appellant’s Case Worker

For the Respondent:

Stephen Grootenboer, Representative

HEARD: July 20, 2023

OVERVIEW

1Matthew Adams (the “appellant”) appeals the decision of the Registrar 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 from a physician that the appellant suffers from substance use disorder and psychiatric illness.

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, namely substance use disorder and psychiatric illness, that is likely to significantly interfere with his ability to drive safely.

4The appellant appeals the suspension under s. 50(1) of the Act. The appellant does not deny that he suffers from a mental health condition. In his Notice of Appeal the appellant states “…we are not and have not disputed the fact that Matthew has a mental Health Condition”. The appellant does deny in his Notice of Appeal his mental health condition interferes with his ability to operate a motor vehicle safely. The appellant also states in his Notice of Appeal that:

A. The appellant has been “targeted in a systemically discriminatory fashion by the Ministry’s polices on Medical Condition Reporting”. The appellant submits that he did not have care and control of a motor vehicle at any point that day, knows he should not drive a motor vehicle if and when he experiences significant stress or while in the midst of a mental health crisis.

B. The appellant is an “…exemplary driver with an impeccable driving record.”

C. The burden of proof is on the Registrar.

5In support of his position, the appellant attached to his Notice of Appeal some news articles and the Tribunal’s decision in Melanson v. Registrar of Motor Vehicles, 2023 CanLII 13045 (ON LAT) which set aside the Registrar’s decision to suspend another driver’s licence.

ISSUES

6The issue in dispute is whether the appellant suffers from medical conditions, namely substance use disorder and psychiatric illness, that are likely to significantly interfere with his ability to drive a motor vehicle safely.

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

i. Does the appellant suffer from substance use disorder and/or psychiatric illness?

ii. If so, are these likely to significantly interfere with his ability to drive a motor vehicle safely?

ANALYSIS

The appellant suffers from substance use disorder and psychiatric illness

8The evidence presented at the hearing establishes that the appellant suffers from medical conditions, namely, substance use disorder and psychiatric illness.

9In his Notice of Appeal the appellant does not deny that he suffers from a mental health condition.

10In addition, the medical records filed by the Registrar dating back to 2018 clearly establish that the appellant suffers from psychiatric illness. In April 2018 the appellant was diagnosed with unstable mental or emotional illness by Dr. Michaela Beder, his psychiatrist. At that time Dr. Beder noted that he was “speeding while unwell”, indicating that the appellant was driving at the time. The appellant’s physician Dr. Morgan Kwiatkoski, in his report dated June 26, 2018 diagnosed the appellant with bipolar disorder including anxiety and depressive symptoms and prescribed medication for this condition. After initially suspending the appellant’s driver’s licence, it was reinstated based on Dr. Kwiatkoski’s opinion that the appellant had been mentally and emotionally stable for three months.

11Dr. Katharine Charlton, staff psychiatrist at St. Michael’s hospital sent a medical condition report to the Registrar dated January 28, 2023 in which she diagnosed the appellant with substance use disorder, specifically alcohol and cannabis, and psychiatric illness, specifically bipolar disorder. Dr. Charlton testified at the hearing that although she was not the appellant’s treating psychiatrist and did not examine him, she was concerned that it was not clear from the hospital records whether a report had been sent to the Registrar so she sent in the report herself. Dr. Charlton testified that before doing so, she had reviewed the records made by the hospital emergency department physician and the admitting psychiatrist Dr. Saloma, both of whom had expressed concerns about the appellant’s driving. Dr. Charlton also expressed the concerns in the appellant’s hospital records about his chronic use of alcohol and cannabis combined with active mania and that the appellant does not recognize that his substance use is worsening his mania.

12Dr. Charlton testified that prior to his admission to hospital on January 26, 2023, the appellant had not been taking his medication for months, had lit fires in the streets, gone into an apartment that he did not live in several times, thrown an object at the police, and hears voices. Dr. Charlton confirmed that the appellant was admitted to the hospital for treatment on January 26, 2023 and was not discharged until February 14, 2023.

13On discharge from the hospital, the appellant was advised to regularly see his family doctor, get his monthly injection of medication, take his prescribed medication and to attend an addiction service. These medical recommendations are consistent with the appellant’s diagnoses of substance use disorder and psychiatric illness made while he was in hospitalized in January and February 2023.

14The evidence is clear that the Registrar has established on a balance of probabilities that the appellant suffers from both substance use disorder and psychiatric illness.

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

15We are satisfied that the appellant’s medical conditions, specifically substance use disorder and psychiatric illness are likely to significantly interfere with his ability to drive safely.

16Dr. Charlton testified that the records made by a hospital emergency department physician and the admitting psychiatrist Dr. Saloma showed that both of these physicians expressed concerns about the appellant’s driving. Dr. Charlton also expressed the concerns in the appellant’s hospital records about his chronic use of alcohol and cannabis combined with active mania and that the appellant does not recognize that his substance use is worsening his mania.

17The actions of the appellant which led to his hospitalization in January, 2023, as documented in the hospital records according to the testimony of Dr. Charlton, show that the appellant was not able or willing to control his actions at that time. The appellant had not been taking his medication for months, had lit fires in the streets, gone into an apartment that he did not live in several times, and thrown an object at the police.

18The Registrar relies on the Canadian Council of Motor Transport Administrators Medical Standards for Drivers (the “CCMTA Standards”) and argues 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 us. The Registrar relies on chapters 14.6.1 and 15.6.3.

19The CCMTA Standards recommend that a driver who has been diagnosed with the psychiatric disorder be considered eligible for a driver’s licence if the condition is stable, the driver has sufficient insight to stop driving if the condition becomes acute, the functional abilities necessary for driving are not impaired, a treating physician supports a return to driving for drivers who have stopped driving due to a psychiatric disorder, and conditions for maintaining a licence are met.

20The CCMTA Standards recommend that a driver who has been diagnosed with alcohol use disorder can be considered eligible for a driver’s licence if they have abstained from the use of the substance for 12 months. It is recommended that earlier re-licensing may be considered upon favourable recommendation from an addictions specialist or treating physician recognized by the licensing authority, and the successful completion of a drug rehabilitation program.

21Although we are not bound by the CCMTA Standards, we find them to be reasonable and we are persuaded in this case that we should follow the Standards because the considerations set out are important to ensure that drivers do not present a safety risk to themselves or others while driving.

22The appellant has a history of psychiatric illness and was hospitalized less than six months ago for this and substance use disorder. We share the concerns expressed by Dr. Charlton about the appellant’s documented chronic use of alcohol and cannabis combined with active mania and that the appellant does not recognize that his substance use is worsening his mania. At this time there is no evidence that any treating physician currently supports a return to driving. There is no report from a physician specializing in mental health or other mental health specialist confirming appellant’s condition is stable. In our view, re-licencing at this time is not appropriate because the appellant likely presents a safety risk to themselves or others while driving.

23Further, the use of alcohol and cannabis affects the functions necessary for driving including reaction times, visual acuity, judgement and insight, alertness, and motor co-ordination. It 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 or cannabis, determine never to drive when intoxicated, their assessment of their ability to drive will likely be affected by having consumed alcohol or cannabis.

24Although the appellant testified that he is now taking his prescribed medication and getting his monthly injections, is not using any substances, is seeing his family doctor regularly, the Registrar’s position that the appellant’s substance use disorder and psychiatric illness makes him unsafe to drive is supported by Dr. Charlton’s testimony, report and the views of two other hospital physicians as reflected in the hospital records, as well as the CCMTA Standards.

25The appellant testified that he is now seeing his family doctor regularly and there is no barrier to him asking his family doctor for a report but put forward no medical evidence at the hearing other than the testimony of Dr. Charlton who was summonsed to the hearing by the appellant.

26Instead, the appellant submits that the appellant has been “targeted in a systemically discriminatory fashion by the Ministry’s polices on Medical Condition Reporting”. The appellant submits that he did not have care and control of a motor vehicle at any point that day and knows he should not drive a motor vehicle if and when he experiences significant stress or while in the midst of a mental health crisis. The appellant says he is an “…exemplary driver with an impeccable driving record.” The burden of proof is on the Registrar. The appellant also suggested in closing submissions that Dr. Charlton’s testimony and report are of no import because she should have examined the appellant before completing her medical condition report.

27We are not persuaded by any of these submissions. There is no evidence that the appellant has been targeted in a “systemically discriminatory fashion” as suggested. Pursuant to s. 203(1) of the Highway Traffic Act, R.S.O. 1990, c. H.8, all medical practitioners are required to report any person 16 years of age or older who is suffering from a condition that may make it dangerous for the person to drive. It is not relevant whether the person who is the subject matter of the report has been driving that day or not, or whether they have a record of other driving offences or not, or whether their medical condition is physical, mental or emotional.

28We find on the basis of the medical evidence provided that the Registrar has met the burden of proof in this case.

29We find Dr. Charlton’s report and testimony credible and give it great weight. Dr. Charlton is an experienced medical specialist who reviewed the appellant’s records, including those made by two other physicians, one of whom is also a mental health specialist, and was satisfied with the medical information provided to her by her resident, and the extensive medical documentation in the hospital records to the extent that she signed the report herself to make sure a report had been submitted in accordance with the law. Dr. Charlton did not need to examine the appellant herself in order to make the report in these circumstances.

30While the appellant may wish to highlight what he sees as a systemic problem, a hearing before the Tribunal is not the appropriate forum. We make decisions based on the law and the facts as established by the evidence before us. The news articles submitted by the appellant with his Notice of Appeal are not relevant evidence in this appeal. The Tribunal decision cited by the appellant is not binding on us and is specific to its facts.

31Based on the evidence before us as set out above, we are satisfied that the appellant’s medical conditions are likely to significantly interfere with his ability to drive safely.

Conclusion

32We find that the appellant suffers from medical conditions, namely substance use disorder and psychiatric illness that are likely to significantly interfere with his ability to drive a motor vehicle safely.

ORDER

33For the reasons set out above, and pursuant to subsection 50(2) of the Act, we confirm the Registrar’s decision to suspend the appellant’s driver’s licence.