Licence Appeal Tribunal File Number: 15581/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:

Sheryl Veerasammy

Appellant

And

Registrar of Motor Vehicles

Respondent

DECISION

ADJUDICATOR:

Peter Savage M.D,

Kailey Minnings M.D.

APPEARANCES:

For the Appellant:

Sheryl Veerasammy, Appellant

For the Respondent:

Stephen Grootenboer, Representative

HEARD: March 19, 2024

OVERVIEW

1Sheryl Veerasammy (the “appellant”) appeals from the decision of the Registrar of Motor Vehicles (“Registrar”) to suspend their 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 their 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. 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 seizures, that is likely to significantly interfere with their ability to drive safely and that this provides sufficient reason to suspend their licence under s. 47(1)(g) of the Act.

4The appellant appeals the suspension under s. 50(1) of the Act. They deny that they suffer from seizures and deny that they suffer from a medical condition which interferes with their 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 their ability to drive a motor vehicle safely.

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

i. Does the appellant suffer from seizures?

ii. If so, is this likely to significantly interfere with their 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, we 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 their ability to drive a motor vehicle safely and we confirm the Registrar’s decision to suspend the appellant’s driver’s licence.

ANALYSIs

Does the appellant suffer from seizures?

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

11The Registrar’s position is supported by medical reports completed by Dr. Ferahani and Dr. Bhaskar.

12Dr. Ferahani, a neurologist, reports the appellant suffers from focal seizures in her unsolicited medical condition report of December 12, 2023.

13In her narrative letter of February 22 2024 Dr. Bhaskar, also a neurologist, describes the appellant having episodes of déjà vu and losing time as early as 2022 and states, “… there was a suspicion that these could be focal dyscognitive seizures”.

14The appellant testified both of their neurologists felt these episodes of déjà vu and losing time were temporal lobe seizures. The appellant testified that Dr. Ferahani prescribed anti-seizure medication.

15The appellant denies that they suffer from seizures.

16The appellant does not believe that they have had episodes of seizures but, argues these episodes were caused by hormonal changes during pregnancy and breastfeeding. They emphasize their normal EEGs, and while they acknowledge their abnormal MRI of the brain showing multiple cavernomas, their position is that the lack of growth of the cavernomas on serial MRIs supports their position that they do not pose a risk of seizures.

17The cavernomas are structural defects in the appellant’s brain. (We note this fact relying on s. 16 of the Statutory Powers Procedure Act). The cavernomas are not the reason the appellants license was suspended, however the appellant acknowledged they were present, while noting their size had been stable. The neurologist, Dr. Bhaskar, mentioned them in her narrative report. She stated cavernomas can have association with seizures, especially if there is any bleeding around them.

18The appellant testifies that in their opinion they have never had a seizure and further that there is no family history of seizures.

19We acknowledge the appellant’s position with respect to the stability of EEG’s and MRI's, as well as own view that they have not had seizures. We prefer the evidence provided by two neurologists that the appellant has had seizures, as well as the fact that anti seizure medication was prescribed by Dr. Ferahani.

20We find that the Registrar has established on a balance of probabilities that the appellant suffers from seizures.

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

21We find that the Registrar has proven on a balance of probabilities that the appellant’s medical condition is likely to significantly interfere with their ability to drive a motor vehicle safely.

22The Registrar argues that seizures interfere with the appellant’s ability to drive safely in that sudden loss of consciousness or unawareness could have catastrophic effects to the appellant or to other users of the road if they were to occur while the appellant was driving a motor vehicle.

23The Registrar relies on the Canadian Council of Motor Transport Administrators Medical Standards for Drivers [February 2021] (the “CCMTA Standards”). The Registrar relies on section 17.6.8 of the CCMTA Standards.

24Section 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 is not bound by them.

25The CCMTA Standards recommend that a driver who has been diagnosed with simple partial seizures be considered eligible for a licence if it has been six months since the last seizure or there is a favorable assessment from the treating physician or neurologist. It further states there should be no impairment in the level of consciousness or cognition and no head or eye deviation with seizures.

26The Registrar points out the seizure-free period in this case is unknown. The appellant testifies their episodes stopped in February 2022 when they stopped breastfeeding, while Dr. Bashkar writes the spells stopped in April 2023.

27The Registrar notes there is no endorsement to drive from any of the appellant’s physicians. On the contrary, Dr. Ferahani completed the report to the Registrar at the first opportunity (two months after the appellant obtained her G2 license). Further the appellant testified Dr. Ferahani declined to complete their licensing paperwork at a follow up appointment on March 11, 2024 and made arrangements for an appointment in June of 2024 to reconsider re: licensing and competition of the paperwork, including the seizure and loss of consciousness questionnaire.

28The Registrar points out these seizures are cognitive in nature with no prodrome (early signs or symptoms) and may suddenly occur without warning, thus interfering with vehicle safety should one occur while driving.

29The Registrar points out that the appellant has been prescribed medication to prevent seizures, but that the appellant has not taken the medication.

30The appellant argues that the seizures do not impact their ability to drive safely.

31The appellant argues that the episodes the neurologists are concerned about are not seizures, but spells brought on by hormonal changes while she was pregnant and breastfeeding.

32The appellant argues the anti-seizure medications have side effects, that they do not need them, and that when they tried one anti-seizure medication in the past, they could not tolerate the side effects.

33The appellant argues the neurologists misinterpreted her description of the episodes and that once they had made up their minds they would not reconsider.

34We find that CCMTA Standard 17.6.8 is reasonable and that the conditions for licensing set out in that standard are not met. We give significant weight to the fact that two neurologists have worked up and treated the appellant for seizures. It concerns us that the length of time since the last seizure is unknown. We find Dr. Ferahani’s decision to wait till the June 2024 appointment before further assessing ability to drive safely seems to be very reasonable. We are also concerned that the appellant has not taken the prescribed medication to prevent seizures, as this may increase the risk of future seizures. While we understand that the presence of cavernomas is not the cause for the appellant’s license suspension, as physicians we understand that cavernomas may lead to seizures even in the absence of interval growth (this could be due to micro bleeds or mass effect) and take notice of that fact pursuant to s. 16 of the Statutory Powers Procedure Act.

35We are satisfied on a balance of probabilities that the appellant’s medical condition is likely to significantly interfere with their ability to drive safely.

Conclusion

36We find that the Registrar has discharged the onus of proving on a balance of probabilities that the appellant suffers from a medical condition, namely seizures, that is likely to significantly interfere with their ability to drive a motor vehicle safely.

ORDER

37For the reasons set out above, pursuant to subsection 50(2) of the Act, we confirm the Registrar’s decision to suspend the appellant’s driver’s licence.

Released: March 27, 2024

________________

Peter Savage M.D.

Adjudicator

_________________

Kailie Minnings M.D.

Adjudicator