Licence Appeal Tribunal File Number: 15620/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 Section 47(1) of the Act.
Between:
Nicola Bousquet
Appellant
And
Registrar of Motor Vehicles
Respondent
DECISION
ADJUDICATOR: Peter Savage, M.D.
APPEARANCES:
For the Appellant: Nicola Bousquet, Appellant
For the Respondent: Ian Sookram, Agent for Registrar
HEARD: March 1, 2024
OVERVIEW
1Nicola Bousquet (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 treating health care provider that the appellant suffers from a medical condition that may affect her ability to drive 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 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 alcohol withdrawal seizure, 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 denies that she suffers from alcohol withdrawal seizure and deny that she suffers from a medical condition which interferes with her ability to drive 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 safely.
7To resolve that issue, I will address the following questions:
i. Does the appellant suffer from alcohol withdrawal seizures?
ii. If so, is this likely to significantly interfere with her ability to drive a motor vehicle 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 not 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 safely and I set aside the Registrar's decision to suspend the appellant's driver's licence.
ANALYSIS
Focus of Hearing
10The Registrar clarified the appellant's licence is suspended based on the alleged condition of alcohol withdrawal seizure and while the Registrar believes there is a relationship to substance use, the Registrar concedes that substance use is not a cause of the licence suspension nor part of the focus of this hearing.
Does the appellant suffer from alcohol withdrawal seizures?
11The evidence presented at the hearing does not establish that the appellant suffers from a medical condition, namely alcohol withdrawal seizures.
12The Registrar's position is supported by medical reports completed by Dr. Katrenne Monkman and Dr. Brian Walk.
13Dr. Katrenne Monkman, an internal medicine specialist, submitted an unsolicited medical condition report on January 2, 2024 indicating that the appellant suffered an alcohol withdrawal seizure two weeks prior to her admission to hospital. The diagnosis was made based on the appellant's statements at the time of admission.
14Dr. Brian Walk submitted a Substance Use Assessment form dated January 25, 2024. In that form, Dr. Walk states there was an alcohol withdrawal seizure less than three months ago and notes that the provoking factor has been stabilized and been corrected.
15The Registrar testifies that a Loss of Consciousness and Seizure questionnaire was not given to the appellant and that form may have had useful information in determining the possibility of an alcohol withdrawal seizure.
16The appellant denies that she suffers from alcohol withdrawal seizures.
17The appellant drew attention to her notice of appeal. In that document, she wrote "... At the time I was questioned by the medical practitioner I was unaware that a withdrawal symptom of alcohol is a condition known as alcohol tremor. I experienced this quite severely and thought it may have been a seizure. To stress this point, the possibility of me having a single seizure during my withdrawal was my determination and not that of a medical practitioner..."
18The appellant testified she has never had a seizure and there is no history of seizures in her family.
19The appellant states she was under stress in the six months leading up to her hospitalization in December 2023. The stress was related to an abusive relationship and led to her drinking alcohol. She drank at home alone and hid her drinking from friends and family.
20A few weeks prior to her hospitalization, she decided to stop drinking alcohol. She stopped abruptly and, in about 24 hours, she noticed severe shaking in her arms and shoulder and neck. She did not lose consciousness nor was she incontinent. This is what she later described as a seizure.
21The appellant researched her condition, educated herself and determined that she would need help to withdraw from alcohol. She presented herself to hospital and was admitted in order to have medical assistance in detoxification. She experienced the same sort of shaking and tremor while withdrawing from alcohol in hospital.
22When questioned about the need for four days in hospital, the appellant admitted she had suffered so much stress that she had some suicidal ideation and that led to a longer period of observation and support from hospital staff.
23The appellant testified she was discharged from hospital on no medications, has been alcohol-free and has been free from shaking and tremors since her discharge.
24The appellant testified she has become more knowledgeable about alcohol and its dangers. She believes she went through alcohol withdrawal syndrome and not an alcohol withdrawal seizure. Her position is that the word "seizure" was introduced by herself due to her own ignorance of the term and that the medical reports of seizure have been the result of her choice of words. Further, the appellant testified that neither Dr. Monkman nor Dr. Walk ever reviewed or questioned her as to the exact events that had occurred and had just accepted her use of the word "seizure."
25I am faced with conflicting positions. The Registrar's position is that both Dr. Monkman and Dr. Walk have stated there was an alcohol withdrawal seizure. The appellant maintains the diagnosis was made based on her misuse of the word seizure. Dr. Monkman wrote, "the appellant reported a seizure two weeks ago". I have no information how Dr. Walk came to his diagnosis, but I have the appellant's testimony stating neither physician asked about the details of her "seizure".
26I am concerned that the Registrar did not ask for the Loss of Consciousness and Seizure questionnaire to be completed by the appellant. It was open to the Registrar to do so. There may have been useful information gathered by completion of this form and this lack of inquiry makes me question the Registrar's position that there was a seizure.
27The appellant argues that the word "seizure" was a word she used inappropriately. It was the word she used to describe shaking and tremors in her upper extremities. She submits that she had no tremor in her lower extremities, no convulsions, no incontinence and no loss of consciousness. The appellant's position is that she had alcohol withdrawal syndrome but not an alcohol withdrawal seizure.
28I accept the fact that both doctors have made the diagnosis of alcohol withdrawal seizure but I prefer the evidence given in the appellant's testimony and accept how the word "seizure" was misused by the appellant and was most likely misunderstood by the practitioners. I accept the appellant's argument that she suffered alcohol withdrawal symptoms but not an alcohol withdrawal seizure.
29I find that the Registrar has not established on a balance of probabilities that the appellant suffers from an alcohol withdrawal seizure.
30As the Registrar failed to establish the alleged medical condition, there's no need to proceed with the next issue, whether the alleged medical condition is likely to significantly interfere with ability to drive. The appellant's appeal is successful.
Conclusion
31I find that the Registrar has not discharged the onus of establishing on a balance of probabilities that the appellant suffers from a medical condition, namely alcohol withdrawal seizure, that is likely to significantly interfere with their ability to drive a motor vehicle safely.
ORDER
32For the reasons set out above, pursuant to subsection 50(2) of the Act, I set aside the Registrar's decision to suspend the appellant's driver's licence.
Peter Savage M.D Adjudicator
Released: March 4, 2024