Licence Appeal Tribunal File Number: 16358/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:
Wayne Huber Appellant
and
Registrar of Motor Vehicles Respondent
DECISION
ADJUDICATOR: Dr. David To
APPEARANCES:
For the Appellant: Wayne Huber, Self-represented
For the Respondent: Ian Sookram, Representative
HEARD: December 2, 2024
OVERVIEW
1Wayne Huber (the "appellant") appeals from the decision of the Registrar of Motor Vehicles ("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 treating physician that the appellant suffers from a medical condition that may affect his 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 severe hypoglycemia, that is likely to significantly interfere with his ability to drive safely and that this provides sufficient reason to suspend his licence under s. 47(1)(g) of the Act.
4The appellant appeals the suspension under s. 50(1) of the Act.
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 his 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 severe hypoglycemia?
ii. If so, is this likely to significantly interfere with his ability to drive a motor vehicle of the applicable class safely?
RESULT
8For the reasons set out below, I find that the Registrar has not satisfied its burden to establish that the appellant suffers from a medical condition that is likely to significantly interfere with his ability to drive a motor vehicle safely.
9I set aside the Registrar's decision to suspend the appellant's driver's licence.
ANALYSIS
Does the appellant suffer from severe hypoglycemia?
10The evidence presented at the hearing establishes that the appellant suffers from a medical condition, namely severe hypoglycemia.
11The Registrar's position is supported by a Medical Condition Report completed by Dr. Guay dated August 31, 2024. This report noted the appellant had hypoglycemia requiring intervention of a third party or producing loss of consciousness.
12The appellant acknowledges that he had an episode of severe hypoglycemia requiring treatment.
13I find that the Registrar has established on a balance of probabilities that the appellant suffers from severe hypoglycemia.
Is the appellant's medical condition likely to significantly interfere with his ability to drive a motor vehicle safely?
14I find that the Registrar has not proven on a balance of probabilities that the appellant's medical condition is likely to significantly interfere with his ability to drive a motor vehicle safely.
15The Registrar submits that severe hypoglycemia interferes with the appellant's ability to drive safely.
16The Registrar relies on the Canadian Council of Motor Transport Administrators Medical Standards for Drivers [February 2021] (the "CCMTA Standards"), which state that severe hypoglycemia causes an altered level of consciousness, preventing a person experiencing this from taking appropriate action, and therefore would be a danger to road safety. It explains that treatment with insulin increases the risk of hypoglycemia (low blood glucose).
17Paragraph 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.
18CCMTA Standard 7.6.4 recommends that a driver, who has been diagnosed with severe hypoglycemia and who is not a commercial driver, be considered eligible for a licence if there have been no further episodes of severe hypoglycemia within the past 6 months and conditions for maintaining a licence are met. It also provides that earlier re-licensing can be considered if an appropriate specialist indicates that glycemic control (blood glucose) has been re-established.
19The Registrar's position is that they seek confirmation from the appellant's physician of a 6-month period without severe hypoglycemia and stable glycemic control. Because the appellant's episode of severe hypoglycemia occurred only three months ago on August 31, 2024, the Registrar submits that sufficient time has not yet elapsed.
20The appellant submits that earlier re-licensing should be considered based on his adequate control of his medical condition. Based on the reasons below, I agree with the appellant's position.
21The appellant testified that he was diagnosed with Type 2 diabetes mellitus last year and started taking oral medications at that time. In May 2024, because his A1C (a measure of average blood glucose) was too high, his physician advised that he start a daily long-acting insulin injection. He explains he was on the same initial dose of insulin from May 2024 to August 2024 and felt well on it.
22The appellant used a continuous glucose monitoring device called Freestyle Libre, which is applied as a patch to his arm. He testified that over the four months he was taking insulin, there was only two instances at night when he was asleep when the device sent him an alarm that his blood glucose was low – below 4 mmol/L. When this happened, he would eat a chocolate bar to increase his blood glucose. He explained he never experienced nor did his device advise of any low blood glucose readings during the daytime.
23On approximately August 30, 2024, the appellant stated that his Freestyle Libre patch fell off his arm. He explained that day he was physically active and had consumed a few beers, but ate less food than usual before going to sleep. In the morning, he felt lightheaded and weak, and went to the emergency department to seek help. After treatment for his symptoms, which the medical report stated was due to hypoglycemia, the appellant stated he felt well.
24The appellant explained that since August 30, 2024, he was advised by physicians to stop insulin, as his blood glucose control was adequate and that stopping the insulin would reduce the risk of hypoglycemic episodes. Further, the appellant has been taking metformin (an oral medication for diabetes) twice daily without having to take any other diabetes medications.
25The appellant's physician, Dr. Currie, completed an initial Diabetes Assessment dated September 30, 2024. This report stated that the appellant was off insulin, his diabetes was treated with oral medications, his A1C was 5.9% with adequate glycemic control, and the A1C results were consistent with the patient's blood glucose logs. A subsequent report by Dr. Currie dated November 19, 2024 reiterated that the appellant was still on oral medications and not insulin.
26As 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 draw on generally recognized information within my specialized knowledge to take notice that the appellant's most recent A1C in November 2024 of 6.0%, while only taking metformin for the preceding two and a half months, demonstrates good control of his blood glucose. The A1C test measures the average blood glucose levels over the past three months, with the A1C target for most adults with diabetes being less than 7.0%. I also take notice that metformin does not cause significant hypoglycemia.
27As a physician, I take notice that alcohol consumption while using insulin can lead to hypoglycemia, because the liver metabolizes the alcohol instead of maintaining steady blood glucose levels. The appellant acknowledged that he made a mistake and should have eaten more food that evening. He recognized the importance of food intake if he consumes alcohol in the future. Further, Dr. Currie's report dated September 24, 2024 advised that the appellant did not have any substance use concerns. Considering that the appellant is no longer taking insulin, I find that this interaction with alcohol consumption is unlikely to recur.
28The Tribunal is entitled to take the CCMTA Standards into consideration but is not bound by them. I agree that uncontrolled episodes of severe hypoglycemia present a significant risk to safe driving and respect the CCMTA recommendations. However, while the CCMTA Standards are well-reasoned and provide assistance, every case must be considered on its own facts.
29Although 6 months have not elapsed since the appellant's episode of severe hypoglycemia, I find that it is unlikely that the appellant's current medical condition would significantly interfere with his ability to drive safely.
30First, the appellant no longer requires insulin because he has good glycemic control, likely owing to his efforts to improve his lifestyle and his adherence to metformin. I found that the appellant was forthright and credible regarding these efforts. The appellant testified that he has been taking many steps to improve his health. He is working with a dietitian and has implemented dietary choices to improve his blood glucose control. He also testified he lost 20 pounds of weight over the past several months, which I recognize also improves his blood glucose. The appellant has a good understanding of his diabetes and has taken steps to implement his healthcare team's recommendations. I also recognize that the appellant being advised to stop insulin under his physician's guidance significantly reduces the risk of future episodes of hypoglycemia. The fact that the appellant continued to use the Freestyle Libre device for a month after stopping insulin without any further hypoglycemia recorded further supports the appellant's position.
31Second, CCMTA Standard 7.6.4 recommends that earlier relicensing than 6 months can be considered if an appropriate specialist indicates that glycemic control has been re-established. In this case, Dr. Currie, a specialist in family medicine, indicated in their September 30, 2024 report that the appellant regained adequate glycemic control while on oral medications for diabetes. Based on the appellant's management of his diabetes and insight into his condition, I agree that earlier relicensing is appropriate.
32Based on the above reasons, I am not satisfied on a balance of probabilities that the appellant's medical condition is likely to significantly interfere with his ability to drive a Class G vehicle safely.
CONCLUSION
33I find that the Registrar has not discharged the onus of establishing on a balance of probabilities that the appellant's medical condition, namely severe hypoglycemia, is likely to significantly interfere with his ability to drive a motor vehicle of the applicable class safely.
ORDER
34For the reasons set out above, pursuant to s. 50(2) of the Act, I set aside the Registrar's decision to suspend the appellant's driver's licence.
Released: December 9, 2024
Dr David To Adjudicator