Licence Appeal Tribunal File Number: 16338/MED

In the matter of an appeal under subsection 50(1) of the Highway Traffic Act, R.S.O. 1990, c. H.8 (the “Act”), from a decision of the Registrar of Motor Vehicles to suspend a licence pursuant to subsection 47(1) of the Act.

Between:

Danielle Patenaude

Appellant

and

Registrar of Motor Vehicles

Respondent

DECISION

ADJUDICATOR:

Dr. David To

APPEARANCES:

For the Appellant:

Danielle Patenaude, Self-Represented

For the Respondent:

Stephen Grootenboer, Representative

HEARD:

November 18, 2024

OVERVIEW

1Danielle Patenaude (the “appellant”) appeals from the decision of the Registrar of Motor Vehicles (“Registrar”) to suspend her 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 a medical condition that may affect her safety to drive.

2The Registrar has the authority under s. 47(1)(g) of the Act to suspend or cancel a driver’s licence for any sufficient reason. Paragraph 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 mental, emotional, nervous or physical condition or disability likely to significantly interfere with their ability to safely drive a motor vehicle of the applicable class safely. Under s. 14(2)(b) of the Regulation, the Minister of Transportation may require a driver to provide satisfactory evidence that they are able to drive safely.

3The Registrar takes the position that the appellant suffers from a medical condition, namely a mental health condition, that is likely to significantly interfere with her ability to drive safely and that this provides sufficient reason to suspend her licence under s. 47(1)(g) of the Act.

4The appellant appeals the suspension under s. 50(1) of the Act. She acknowledges that she suffers from a mental health condition but denies that this condition interferes with her ability to drive a motor vehicle of the applicable class safely.

5Pursuant to s. 50(2) of the Act, after a hearing the Tribunal may confirm, modify, or set aside the decision or order of the Registrar.

ISSUES

6The 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 of the applicable class safely.

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

i. Does the appellant suffer from a mental health condition?

ii. If so, is this likely to significantly interfere with her ability to drive a motor vehicle of the applicable class safely?

8The Registrar bears the burden of proving on a balance of probabilities that the answer to each of the above questions is “yes.”

RESULT

9Having considered all the evidence and submissions, I find that the Registrar has satisfied its burden to establish that the appellant suffers from a medical condition that is likely to significantly interfere with her ability to drive a motor vehicle of the applicable class safely.

10I confirm the Registrar’s decision to suspend the appellant’s driver’s licence.

PROCEDURAL ISSUES

11The appellant submitted that the Tribunal should not consider the October 29, 2024 report sent to the Registrar from Dr. A due to Dr. A’s alleged breach of the appellant’s privacy. This is because the appellant advised Dr. A that she transferred her care to a different physician and that Dr. A was no longer her current physician and thus should not have sent the report.

12Although I recognize that the appellant has found a new physician to continue her care and did not consent to Dr. A sending a report to the Registrar, all physicians in Ontario, including Dr. A, have a duty to report individuals who appear to have certain medical conditions.

13Subsection 203(1) of the Act explains that prescribed persons (which includes physicians) shall report to the Registrar individuals who have or appear to have a prescribed medical condition. Subsection 14.1(3) of the Regulation lists the prescribed medical conditions that prescribed persons shall report, which include psychiatric illness which currently involve acute psychosis or severe abnormalities of perception. Similarly, s. 203(2) of the Act permits discretionary reports where a prescribed person may report to the Registrar if they believe that an individual has a medical condition that may make it dangerous for the person to operate a motor vehicle. Subsection 203(3) states that these discretionary reports prevail over any duty of confidentiality or rule of professional conduct.

14Therefore, I find that because Dr. A had concerns regarding the appellant’s acute psychosis and on the appellant’s safety to drive, Dr. A’s reporting was not a breach of confidentiality or of the appellant’s privacy, but rather it was Dr. A’s duty to make the report – Dr. A did not have a choice to make the report. As such, I have taken Dr. A’s October 29, 2024 report into consideration as evidence.

ANALYSIS

Does the appellant suffer from a mental health condition?

15The evidence presented at the hearing establishes that the appellant suffers from a medical condition.

16This was not in dispute in this appeal.

17The Registrar’s position is supported by a November 4, 2024 medical report completed by Dr. B, a psychiatrist. This Mental Health Disorder report notes that the appellant has an anxiety disorder and “schizophrenia or other psychotic disorder.”

18The appellant acknowledges that she has those medical conditions.

19I find that the Registrar has established on a balance of probabilities that the appellant suffers from a mental health condition.

Is the appellant’s medical condition likely to significantly interfere with her ability to drive a motor vehicle safely?

20I find that the Registrar has proven on a balance of probabilities that the appellant’s mental health condition is likely to significantly interfere with her ability to drive a motor vehicle of the applicable class safely.

21Based on the evidence available, several factors make the appellant currently unsafe to drive.

22The appellant’s current physician, Dr. B, acknowledged that the appellant has ongoing symptoms related to schizophrenia, specifically hallucinations.

23Although Dr. B noted that the appellant is adherent to her treatment, is under monthly medical supervision, and has appropriate insight on her medical condition and the impacts on her ability to drive, I am concerned that Dr. B indicated that the appellant has difficulties with judgment, which is an important aspect of safe driving. Dr. B also indicated that the most recent illness episode was less than three months ago.

24I have also considered the reports from the appellant’s former psychiatrist, Dr. A, as additional evidence to support that the appellant is currently unsafe to drive.

25A Medical Condition Report, completed by Dr. A, dated July 29, 2024, notes the physician’s concern that the appellant had an acute episode of schizophrenia and was not adherent to treatment at that time. In the report, Dr. A wrote that there had been no safety issues with driving but advised that the appellant undergo a driving assessment.

26Dr. A. provided a subsequent letter dated October 29, 2024 explaining that the appellant had frequently missed her appointments without rescheduling, and that Dr. A’s medical opinion was that the appellant was not safe to drive because her symptoms are poorly controlled, including paranoid delusions, auditory hallucinations, disorganized behaviour, response to internal stimuli and having “virtually no insight into her condition”. Dr. A also noted that collateral information indicated that the appellant was most likely not taking her medications or that they were ineffective.

27Although I still considered Dr. A’s opinion in this appeal as Dr. A had been treating the appellant for a period of approximately one year, I put less weight on the sections of this report that relied on collateral information from other sources. The appellant provided evidence that the collateral information which Dr. A considered came from an individual who had been abusing the appellant and that the individual falsely reported that the appellant’s mental health was unstable as a means to harm the appellant. Further, the appellant testified that she believed Dr. A ignored the personal and social difficulties that she was facing and gave recommendations that only worsened the abuse. I accept the appellant’s testimony on this.

28While the appellant testified that she is safe to drive and has some insight into her illness, I prefer the medical reports by both her current physician Dr. B and former physician Dr. A, because both physicians assessed and treated the appellant over a period and provided a more objective perspective. The appellant testified that she knows that she is safe to drive when she has adequate sleep and is not stressed. When she does not feel well, she would take the bus or walk and then arrange an urgent appointment with her medical team. She testified she already has monthly appointments arranged and attends groups for therapy. In addition, she explained that she has been consistently adherent to her medications since 2021 and takes them in the evening because she understands the medications’ sedative effect, so in the past she waited until the morning to drive when she was no longer sedated.

29The appellant testified that in the past, stress caused her to experience symptoms of schizophrenia – the major stressor was related to her social circumstances in her former city. She testified that since relocating to a new city and moving into a new apartment this month, she has had significantly reduced stress, and as such would be safe to drive.

30As a licensed physician in Ontario, and as authorized by s.16 of the Statutory Powers Procedure Act, R.S.O. 1990, c. S.22, I understand that symptoms of schizophrenia including acute psychosis are often exacerbated by psychological stress, among other causes. Following a period of active phase symptoms such as acute psychosis, there can be periods of residual symptoms, where there may be few and diminished symptoms. Although the improvements to the appellant’s symptoms are a recent change and she is likely not experiencing acute psychosis currently, her most recent illness episode was less than three months ago and further follow-up with her physician would be helpful to ensure that treatment is optimized to reduce the chance of relapse. I recognize that the appellant’s positive changes in her life are likely to improve her mental health in the future.

31The Registrar submits that the appellant’s mental health condition is likely to significantly interfere with the appellant’s ability to drive safely. The Registrar submits that to consider reinstatement, they require confirmation that the appellant’s mental health is stable for more than three months and improvement in her symptoms and judgment, among other requirements.

32The Registrar relies on the Canadian Council of Motor Transport Administrators Medical Standards for Drivers [February 2021] (the “CCMTA Standards”). Paragraph 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 Registrar relies on Chapter 14.6.1 (Psychiatric Disorder).

33Although not bound by the CCMTA Standards, the Tribunal may consider them when making its decision. These Standards are the result of a lengthy and intensive process to provide medical standards based on the best evidence available and with a focus on functional ability to drive rather than exclusively on medical diagnoses. While each appeal including this one must be judged on its own merits, I am persuaded to apply the CCMTA Standards here. My review of the evidence shows that the conditions recommended for licensing outlined in the CCMTA Standards have not been met.

34Standard 14.6.1 describes the criteria for licence eligibility for drivers with a psychiatric disorder. Based on the evidence, it is unlikely that the appellant’s mental health condition has been stable for a sufficient period based on Dr. B’s November 4, 2024 report which indicates the most recent illness episode was less than three months ago. Further, there is no explicit indication in this report that Dr. B supports the appellant’s return to driving, considering that Dr. B still indicated concerns with judgment. Similarly, Dr. A had concerns about the appellant’s safety to drive based on their August 26, 2024 appointment.

35Between the differing opinions in Dr. A’s report based on their August 26, 2024 appointment and Dr. B’s report dated November 4, 2024, I find Dr. B’s report is more compelling on the findings that the appellant does have insight into her ability to drive safely as well as not requiring a functional assessment, because Dr. B’s is more recent and likely the appellant has had an improvement in her symptoms over the past months.

36Therefore, the appellant currently only meets some, but not all the conditions recommended for licensing in the CCMTA Standards for psychiatric disorders.

37I do commend the appellant’s goals to seek employment. The appellant explained the importance of a driver’s licence for this and to attend medical appointments. However, based on the Act, I am only able to consider whether the appellant’s medical condition is likely to significantly interfere with her ability to drive safely.

38I accept the Registrar’s submissions that, considering road safety, it is reasonable to require further medical documentation from the appellant.

39I am satisfied on a balance of probabilities that the appellant’s medical condition is likely to significantly interfere with her ability to drive safely.

Conclusion

40I find that the Registrar has discharged the onus of establishing on a balance of probabilities that the appellant suffers from a medical condition that is likely to significantly interfere with her ability to drive a motor vehicle of the applicable class safely.

ORDER

41For the reasons set out above, pursuant to s. 50(2) of the Act, I confirm the Registrar’s decision to suspend the appellant’s driver’s licence.