Kathryn Lord v. Registrar of Motor Vehicles, 2024 CanLII 126336

Licence Appeal Tribunal File Number: 16397/MED

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:

Kathryn Lord

Appellant

and

Registrar of Motor Vehicles

Respondent

DECISION

ADJUDICATOR: Dr. Isla McPherson, Member

APPEARANCES:

For the Appellant: Kathryn Lord, Appellant

For the Respondent: Ian Sookram, Agent

Held by teleconference: December 3, 2024

OVERVIEW

1Kathryn Lord (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 Mental Health Disorder Form stating that the appellant suffers from a medical condition that may affect her ability to drive a motor vehicle of the applicable class safely.

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. Section 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 Registrar 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 his licence under s. 47(1)(g) of the Act.

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

5Pursuant to section 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 and for the reasons that follow, 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 and I confirm the Registrar’s decision to suspend the appellant’s driver’s licence.

ANALYSIS

Does the appellant suffer from a mental health condition?

10The evidence presented at the hearing establishes that the appellant suffers from a medical condition, namely a mental health condition.

11The Registrar’s position is supported by:

i. a Mental Health Disorder Form dated October 10, 2024, from Dr. P;

ii. a Mental Health Disorder Form dated August 16, 2023, from Dr. P;

iii. a Substance Use Assessment Form dated May 1, 2023, from Dr. P;

iv. Hospital admission notes from April 2023 and July 2023.

12The Mental Health Disorder Form completed by the appellant’s family physician Dr. P dated October 10, 2024, supports the Registrar’s suspension of the appellant’s licence due to a mental health condition. Dr. P answered the question on the form asking what the patient’s primary mental illness is with checking off three conditions listed. Dr. P added a narrative comment that there are concerns with mood and mental health and suicidal ideation requiring several hospitalizations. Dr. P has also documented that the appellant’s most recent illness episode occurred less than last three months ago and listed three current symptoms.

13Upon receipt of this Mental Health Disorder Form the Registrar suspended the appellant’s driver’s licence effective October 25, 2024.

14The Registrar’s position is supported by documentation of mental health conditions from a medical suspension in 2023. Dr. P completed a Substance Use Assessment Form dated May 1, 2023, and a Mental Health Disorder Form dated August 16, 2023, that both documented the presence of mental health concerns. At the time of submitting these forms, Dr. P had attached hospital admission notes from April and July 2023.

15The appellant testified she agrees that she has been diagnosed with mental health conditions, but she is in remission and does not have any symptoms that would interfere with her ability to drive.

16The medical evidence before the Tribunal comprises multiple medical forms that have consistently documented over the past two years that the appellant has been diagnosed with mental health conditions and the appellant does not dispute these diagnoses.

17The medical evidence in this case is clear and the presence of mental health conditions is not under dispute. Based on the information available, I find that the Registrar has established on a balance of probabilities that the appellant suffers from mental health conditions.

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

18I find that the Registrar has proven on a balance of probabilities that the appellant’s medical condition is likely to significantly interfere with her ability to drive a motor vehicle safely.

19The Registrar argues that that the appellant’s mental health conditions can and will interfere with her ability to drive and they therefore require confirmation of a six-month period of mental and emotional stability, confirmation of adherence with the recommended treatment regimen and/or having insight into the condition, confirmation that the condition being successfully treated or resolved, confirmation that there has been an improvement in emotional control, and that there are no longer symptoms of sedation before considering reinstatement. The Registrar’s position is supported by:

i. The Mental Health Disorder Form completed October 10, 2024, by Dr. P;

ii. The Canadian Council of Motor Transport Administrators Medical Standards for Drivers [February 2021] (the “CCMTA Standards”).

20The Registrar relies on the CCMTA Standards Chapter 14 along with internal policies at the Registrar of Motor Vehicles. Chapter 14 of the Standards documents that psychiatric disorders can result in either a persistent or episodic impairment of the functions necessary for driving. The Registrar relies on Standard 14.6.1. This Standard indicates a driver is eligible for a 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, and a treating physician supports a return to driving. In addition to this Standard, the Registrar relies on their internal policies when they require confirmation of six months of mental and emotional stability before considering reinstatement of the appellant’s driver’s licence.

21Section 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 but are not bound by them.

22The Registrar testified that a six-month period of stability is required due to multiple concerning responses from Dr. P. The Registrar testified that Dr. P reported: the appellant’s most recent illness episode was less than three months ago; the appellant has severe ongoing symptoms; the appellant is taking medication that results in side effects of sedation or psychomotor slowing to an extent that may impair her ability to safely operate a motor vehicle; the appellant is currently not under medical supervision from a regulated health practitioner; and Dr. P has written a narrative comment that there are concerns with the appellant’s mood and mental health with suicidal ideation that has required several hospitalizations. Furthermore, there is no support from a physician to reinstate the appellant’s driver’s licence.

23The appellant argued that she has not seen Dr. P for almost a year and as a result he has submitted inaccurate information. The appellant submits that her licence should be reinstated for the following reasons: her mental health conditions are stable enough that she has been taken off all medication and discharged from psychiatric care; she has stopped all psychiatric medications and therefore does not have sedation or psychomotor slowing; she is currently under the care of a psychiatrist Dr. P referred her to; and Dr. P has acknowledged that she has insight, is adherent with a treatment regimen and does not require a functional driving assessment. The appellant also relies on a supportive letter from social worker, Mr. O, that indicates the appellant has shown stability in her life for more than six months, is not currently medicated for her mental health conditions and is not experiencing any negative effects of being off her medication. The appellant further argued that her initial referral to the Registrar was not due to mental health concerns. I take note that the Registrar’s submissions document that the initial Medical Condition Report that had prompted the first suspension and subsequently the monitoring of her ongoing mental health was due to alcohol use disorder.

24The appellant testified she was shocked that Dr. P had reported her latest acute illness was less than three months ago when she had not been admitted to hospital since April 2024. Although she reported she had been in the Emergency Department (ED) in June 2024 with mental health symptoms, she did not require admission, which the appellant reported was Dr. P’s criteria for assessing an acute illness episode. Under cross examination the appellant testified she had five hospital admissions for mental health concerns in 2023, and two hospital admissions in 2024 along with the ED visit mentioned in June 2024. One admission to hospital in 2023 reported by the appellant was due to discontinuing a medication which resulted in an escalation of symptoms requiring hospitalization, but the symptoms stabilized upon reintroduction of the medication.

25The appellant was questioned regarding the duration of time she had been taking psychiatric medications and she reported she had been prescribed psychiatric medications to be used as needed since 2018 and began taking psychiatric medications daily in 2022.

26Under cross-examination the appellant was questioned regarding her treating physicians. She reported Dr. P has been her family doctor for three to four years. Regarding psychiatric care, the appellant testified she had a psychiatrist in her hometown but requested a referral when she moved in February 2024. The appellant testified she saw a new psychiatrist, Dr. M, in July 2024 who took her off all four of her psychiatric medications and then discharged her from his care in September 2024. The appellant was questioned whether Dr. M was aware she had been in the Emergency Department one month earlier in June 2024, had a hospital admission in April 2023, or was aware she had a hospital admission in 2023 as a result of discontinuing one medication. The appellant responded that she believes Dr. M was aware of this history. The appellant testified she asked Dr. P for a referral for a new psychiatrist in either August or September 2024 and then saw Dr. R in October 2024, and has seen him several times. She reported that Dr. R has diagnosed her with a new mental health diagnosis, and she has recently started a new psychiatric medication.

27The appellant was questioned whether she had approached Dr. P regarding the inaccuracies she noted in his report. The appellant testified she had expressed her concerns at Dr. P’s office and asked for a letter in support of reinstating her licence that confirmed a longer period of stability. The appellant testified she was told that Dr. P was going to stand by what he had documented on the Mental Health Disorder Form and the appellant could return in January 2025 for a letter of support, but he would not write one until that time. The appellant was asked if she had requested a letter of support from either of the psychiatrists she has seen in the past two months, but she reported she had not.

28There are multiple inconsistencies and contradictions between the appellant’s testimony and letter of support from Mr. O and the medical evidence from Dr. P. From the appellant’s testimony, her longest healthcare provider is Dr. P, having been her doctor for three to four years and he has been a prescriber of her psychiatric medications. I note Dr. P is copied on the submitted hospital admission notes as well as the doctor who has referred the appellant for psychiatric care and thus would receive the psychiatric progress notes. As such, I reason that Dr. P is positioned to have a comprehensive understanding of the appellant’s mental health concerns. While I appreciate the importance of Mr. O’s provision of counseling and the support he has provided to the appellant, I note that he followed the appellant for her mental health for less time, is not copied on her hospital admission records, does not refer for psychiatric care, does not have the training or authority to prescribe nor monitor the use of psychiatric medications, and is not a regulated healthcare professional. For these reasons, I assign more weight to the medical evidence provided by Dr. P.

29With respect to the appellant’s testimony regarding her psychiatric care, I find it a little surprising that a new psychiatrist, Dr. M, would discontinue all four long-term psychiatric medications one month after a visit the ED and three months after an admission to hospital for mental health symptoms, and then promptly discharge the appellant from their care without monitoring for relapse. This is concerning given that the appellant testified she had an admission to hospital one year prior for escalating mental health symptoms after she was taken off one medication. Secondly, I find it very odd that the appellant would ask for a referral to a new psychiatrist while either still seeing or very recently being discharged from another psychiatrist’s care. Lastly, I reason that as Dr. M had found the appellant stable enough to come off all medications and be discharged from psychiatric care, Dr. M would have been in a position to write a very supportive letter, and I therefore find it odd that the appellant did not request a letter of support from this physician, nor was one requested from Dr. R who she reports she has seen recently. Furthermore, this testimony contradicts the statement from Dr. P that the appellant is not under the care of a regulated healthcare professional.

30The inconsistencies and contraindications continue with respect to whether medications are being taken and if the side effects are significant. Dr. P has reported that the appellant is taking medication that results in side effects of sedation or psychomotor slowing to an extent that may impair her ability to safely operate a motor vehicle. The appellant testified she was taken off all medication as of two months ago and then restarted on a different medication. If Dr. P referred the appellant to her current psychiatrist as she has testified, it reasonably follows that he would receive the psychiatric consult notes as this is the accepted medical practice to send a consultation note to the referring physician, and thus Dr. P would be aware of any medications the appellant is or is not taking, which gives weight to the medical evidence provided by Dr. P.

31The CCMTA standards highlight a period of stability prior to considering reinstatement. I appreciate that Dr. P’s medical evidence has documented an acute illness episode less than three months earlier with severe ongoing symptoms. This is considerably short of the six-month time frame requested by the Registrar. I further note that there is a shorter period of stability in the appellant’s testimony regarding her prescribed medications. Furthermore, the appellant has testified to having had seven hospital admissions and an ED visit for mental health concerns in less than two years, which does not suggest any longer-term stability preceding the most recent acute illness episode.

32I appreciate that the appellant has been successful in an appeal before the Tribunal in 2023 for her mental health conditions. Importantly, I note differences in Dr. P’s documentation on the Mental Health Disorder Forms submitted for each appeal, including symptom presence and severity. On the Form dated August 16, 2023, Dr. P had reported that the appellant’s symptoms were resolved and checked a box indicating there were no ongoing symptoms, whereas on the Form dated October 10, 2024, Dr. P reported the appellant was experiencing severe symptoms and confirmed three different symptoms were currently present.

33I acknowledge the appellant’s argument that she was not initially suspended due to mental health concerns. However, the situation before the Tribunal is that while she may not have been suspended due to mental health concerns initially, now that the suspension is in place, there is no supportive letter from Dr. P nor any physician to reinstate her licence, despite the appellant requesting a letter of support and reportedly receiving care from two different psychiatrists recently. Based on my review of the medical evidence from Dr. P, there is support for the driver’s licence suspension due to mental health concerns. With the multiple inconsistencies and contradictions in the evidence and difficulty following the logical sequence of healthcare provision, the absence of any support from a physician is given weight in this decision.

34I appreciate the hardships that the appellant is undergoing with the loss of her driver’s licence but given the medical evidence and the individual merits of this case, I believe a period of stability is reasonable and prudent for road safety.

35Although this Tribunal is not bound by the CCMTA Standards, they can be considered when making the decision for the reason that 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.

36As such, for the reasons cited, I 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

37I find that the Registrar has discharged the onus of establishing on a balance of probabilities that the appellant suffers from a medical condition, namely a mental health condition, and that condition is likely to significantly interfere with her ability to drive a motor vehicle safely.

ORDER

38For the reasons set out above, pursuant to subsection 50(2) of the Act, I confirm the Registrar’s decision to suspend the appellant’s driver’s licence.