Licence Appeal Tribunal File Number: 15755/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:

Gavin Goodchild

Appellant

and

Registrar of Motor Vehicles

Respondent

DECISION

PANEL:

Dr. Isla McPherson, Member Dr. David To, Member

APPEARANCES:

For the Appellant:

Gavin Goodchild, Appellant

For the Respondent:

Sharon Nelson, Representative

HEARD: April 23, 2024

OVERVIEW

1Gavin Goodchild (the “appellant”) appeals from the November 23, 2023 decision of the Registrar of Motor Vehicles (“Registrar”) to suspend their Class GM 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 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 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 seizure due to alcohol withdrawal, 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. The appellant acknowledges that he suffers from seizure due to alcohol withdrawal but denies that this condition interferes with his ability to drive safely.

5Pursuant to subsection 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 safely.

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

i. Does the appellant suffer from seizures due to alcohol withdrawal?

ii. If so, is this likely to significantly interfere with his 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.

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

PROCEDURAL ISSUES

11During the hearing, the Registrar raised other medical conditions in suspending the appellant’s licence.

12After clarification, the Registrar agreed that the appellant’s driving licence is only currently suspended due to the sole condition listed on the Registrar’s letter dated April 16, 2024; “seizure due to alcohol withdrawal”.

ANALYSIS

Does the appellant suffer from seizures due to alcohol withdrawal?

13The evidence presented at the hearing establishes that the appellant suffers from seizures due to alcohol withdrawal.

14This is supported by medical reports completed by several physicians.

15On November 21, 2023, Dr. B, an emergency room physician, completed a Medical Condition Report (“MCR”) stating that the appellant suffers from seizures, from a cause not yet diagnosed.

16Further, Emergency Room Visit Notes by Dr. B, also dated November 21, 2023 (“Dr. B Notes”), state that they had treated the appellant in the emergency room for seizures on that same day. The note also states that, “chart review shows that in 2016 [the appellant] was also seen for a seizure and appears to be possibly alcohol withdrawal and he had a shoulder dislocation at that time.”

17On the same day on November 21, 2023, another set of Emergency Room Visit Notes, by Dr. S (“Dr. S Notes”), states that the appellant developed a seizure in the emergency room and “does have indeed history of seizure with alcohol in the past”.

18On February 15, 2024, Dr. A, the appellant’s family physician, completed a Seizures and Loss of Consciousness report, stating that the appellant had experienced a seizure due to alcohol withdrawal less than 3 months ago.

19On April 11, 2024, Dr. A completed another report, titled Substance Use Assessment, which reiterated that the appellant had experienced a seizure related to alcohol withdrawal between three and six months ago.

20The appellant acknowledges that he suffered or suffers from seizures due to alcohol withdrawal and does not dispute this.

21We find that the Registrar has established on a balance of probabilities that the appellant suffers from seizures due to alcohol withdrawal.

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

22We find that the Registrar has 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.

23The Registrar submits that the appellant’s seizures due to alcohol withdrawal can lead to sudden impairment of driving ability and presents a safety risk to other road users. The Registrar submits that in order to consider reinstatement of the appellant’s driver licence, they require confirmation that the appellant has remained seizure free and abstinent from alcohol for a period of one year. The Registrar also submits that this period may be reduced to six months if the appellant’s healthcare practitioner confirms they have successfully completed an alcohol treatment program and supports reinstatement of their driving privilege.

24The Registrar relies on the Canadian Council of Motor Transport Administrators Medical Standards for Drivers [February 2021] (the “CCMTA Standards”).

25Paragraph 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. The Registrar relies on the CCMTA Standards, in particular Chapters 17.6.3 (Alcohol Withdrawal Seizures) and 15.6.3 (Substance Use Disorder). Chapter 17.6.3 provides that all drivers with alcohol withdrawal seizures are eligible for a licence if:

i. The treating physician has confirmed that the cause of the seizure was alcohol withdrawal (i.e., the driver is not epileptic)

ii. They have undergone addiction treatment and have received a favourable report from an addiction counsellor;

iii. And the criteria for licence reinstatement are met in accordance with the Substance Use Disorder Standard (see 15.6.3).

26Chapter 15.6.3 provides that all drivers suffering from alcohol use disorder may be eligible for a licence if they meet the criteria for remission and/or have abstained for twelve months. It also states that earlier relicensing may be considered upon favourable recommendation from an addiction specialist and/or treatment physician recognized by the licensing authority, and the successful completion of a drug rehabilitation program. The Registrar indicated that it is requiring a minimum of six months of abstinence.

27The CCMTA Standards indicate that seizures, such as the type of seizure the appellant is reported to have suffered, cause an episodic impairment of the functions necessary for driving and a driver cannot compensate. Thus, experiencing a seizure would significantly interfere with a driver’s ability to drive safely and present a risk to the driver and other road users.

28The CCMTA Standards also indicate that seizures must be controlled as a prerequisite to driving and the purpose of a seizure-free period for a provoked seizure is to establish the likelihood that the provoking factor has been successfully treated or stabilized.

29The Registrar further relies on two forms completed by the appellant’s family physician, Dr. A: the submitted Seizure and Loss of Consciousness Form dated February 15, 2024 and the Substance Use Assessment Form dated April 11, 2024. On both forms Dr. A has checked the box confirming that the appellant has a substance use disorder. The Registrar also notes that on both forms, Dr. A has checked a box indicating that the appellant has abstained from alcohol for less than 6 months.

30The Registrar also relies on the medical records in the Dr. S Notes and Dr. B Notes. Both physicians report a prior history of an alcohol withdrawal seizure. According to the submitted records, the emergency room physician was only aware that the appellant had a previous seizure because the concern was raised to the physician by the appellant’s wife, “Wife said similar episode a few years ago”.

31In the hospital records relied upon by the Registrar, Dr. S. describes that a referral to a neurologist for consideration of further investigations and treatment with anti-seizure medication is warranted.

32In his testimony, the appellant submits that his seizures due to alcohol withdrawal do not impact his ability to drive safely.

33The appellant confirmed that he has been contacted by a neurologist’s office and has an appointment scheduled for 6 weeks from the date of the hearing. The appellant testified that he plans to attend the appointment but does not feel it is necessary prior to having his licence reinstated.

34The appellant spoke in detail about his efforts to quit alcohol. He explained he had been drinking approximately 10 to 12 beers per week for about 14 years. However, he decided to engage in a challenge to stop drinking alcohol for a month in February 2023. The appellant explained that this resulted in significant health and lifestyle improvements. Therefore, he decided to abstain from alcohol starting from February 2023, and was abstinent from alcohol until November 2023.

35The appellant detailed that on November 19, 2023, he attended a social event to watch a football game with friends. He consumed eight beers and tried a Percocet pill given to him by a friend because he was having some hip pain.

36He stated that on the following day, he felt dizzy and nauseous. On November 21, 2023, he felt confused and had vertigo, so was brought to the hospital for assessment. He felt better after treatment at the hospital and returned home. He explained that the seizure occurred only while he was at the hospital; the seizure was neither spontaneous nor recurring. He stated that he acted responsibly by seeking medical help.

37The appellant testified that the episode in which he had a shoulder dislocation in 2016 was not a seizure. He stated that after a hot day at work, he was dehydrated and had lost consciousness, fell, and thus dislocated his shoulder. He states he was not advised by the physicians at the hospital in 2016 that he had a seizure.

38The appellant provided a note from his family physician, Dr. A, dated March 20, 2024, stating “Mr. Goodchild is fit to drive. I have no concerns”.

39Further, the appellant relied on a Substance Use Assessment report, also completed by Dr. A on April 11, 2024, which states “I support the patient’s driving privileges. It was a one time event and he does not need a drug treatment program.” Dr. A has additionally checked Yes to the box asking if this was the appellant’s first seizure on the Substance Use Assessment Form. We take note that Dr. A is of the understanding that this is the appellant’s first seizure, when the November 2023 hospital records indicate that there was a prior alcohol withdrawal seizure as described.

40The appellant reasoned that because his family physician is supportive of him driving, he has not consumed any alcohol since November 2023, and he is now a “non-drinker”, attending the alcohol treatment program as requested by the Registrar would be redundant.

41The appellant further states that on or about February 22, 2024, he contacted the Registrar by telephone, and states he was advised by a representative of the Registrar that an alcohol treatment program was not applicable in his case, and he only required his physician to write a note that he is fit to drive. The Registrar does not have written documentation of this phone call.

42The appellant testified about his regret over his alcohol consumption on November 19, 2023, and detailed the subsequent impact of the suspension of his driver’s licence since that time on his livelihood.

43The appellant also stated that since the seizure in November 2023, he has had no desire or cravings to consume any alcohol. He testified he has felt much healthier and motivated to make positive changes in his life since abstaining from alcohol.

44The appellant outlined the steps taken to maintain sobriety, that he no longer socializes with his “drinking buddies” and has started exercising. His wife has also abstained from alcohol and is a support. While reporting he has lost quite a few friends he does not feel that a limited social network is a risk to his abstinence. We find that the appellant was forthcoming in his testimony and is motivated to make positive changes in his life.

45The Tribunal, however, must consider whether the appellant’s seizures due to alcohol withdrawal are likely to significantly interfere with the appellant’s ability to drive a motor vehicle safely.

46Although not bound by the CCMTA Standards, the Tribunal may consider them when making the 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, we are persuaded to apply the CCMTA Standards here. Our review of the evidence shows that the conditions recommended for relicensing outlined in the CCMTA Standards have not been met.

47Standard 17.6.3 describes the criteria for reinstatement following alcohol withdrawal seizures. We note that none of the eligibility criteria have been met. It has been established that the appellant has suffered an alcohol withdrawal seizure. We think it is prudent for the appellant to attend his upcoming neurologist appointment and address the question of whether antiseizure medication is required, prior to considering reinstatement of the appellant’s driver’s licence. Further, we acknowledge that the appellant has not undergone addiction treatment nor received a favorable report from an addiction counselor. While we acknowledge Dr. A’s medical report, we take note that they are not an addiction counsellor nor specialized in addiction medicine and appear to not be relying on full information in making their assessment.

48With respect to Standard 15.6.3, the appellant has not been abstinent from alcohol for 12 months by his own testimony. The appellant has additionally not met the criteria for earlier relicensing as he has not completed a treatment program. As licensed physicians in Ontario, and as authorized by s.16 of the Statutory Powers Procedure Act, R.S.O. 1990, c. S.22, we acknowledge that alcohol withdrawal seizures occur predominantly in patients with a long history of heavy alcohol use. The appellant has confirmed this longstanding pattern of behaviour, testifying he has been drinking regularly over the past 14 years. We also note that substance use disorders are chronic, relapsing disorders that often require long term pharmacological and psychosocial interventions. For these reasons, we agree with the CCMTA Standard that requires a treatment program be completed to consider early reinstatement and find it reasonable and prudent for road safety in the context of alcohol withdrawal seizures, as the appellant would experience sudden incapacitation with no ability to compensate if a seizure were to occur.

49We acknowledge the appellant’s position that he does not have a medical condition that will affect his ability to drive safely and acknowledge his testimony that he has abstained from alcohol for five months. Despite this period of sobriety, Dr. A. documented the presence of a substance use disorder in a report dated less than two weeks prior to the hearing. While we acknowledge that Dr. A. supports the appellant’s return to driving, this recommendation is based on this seizure being an isolated event, which is contradicted by other medical records. We give weight to Dr. M.’s medical opinion that a neurologist consultation is warranted to determine if further investigations or antiseizure medication is required and this appointment will not take place until June 6, 2024.

50Additionally, we acknowledge the important role of driver insight and judgment in maintaining road safety. Although the appellant has expressed remorse over the events on November 19, 2023, we are concerned about the appellant’s decision to take a narcotic provided by friend recreationally while concurrently drinking heavily. This demonstrates limited insight into the risks associated with substance use.

51Although the appellant is taking steps to remain abstinent, he is at substantial risk of relapse at this early stage. As described in the CCMTA Standards, a “drug rehabilitation program”, in this case, such as an alcohol treatment program, can help prevent relapses and thus prevent associated seizures from alcohol withdrawal.

52We recognize that a seizure due to alcohol withdrawal following cessation of alcohol consumption is variable – it can occur within a few hours to days after stopping drinking, with minimal to no warning, and accordingly can cause disastrous consequences to road users.

53We accept the Registrar’s submissions that, considering road safety, it is reasonable to require further time until reinstatement of the appellant’s driver’s licence, and completion of an alcohol treatment program.

54We are satisfied on a balance of probabilities that the appellant’s medical condition is likely to significantly interfere with his ability to drive safely.

Conclusion

55We find that the Registrar has discharged the onus of establishing on a balance of probabilities that the appellant suffers from a medical condition, namely seizures from alcohol withdrawal, that is likely to significantly interfere with his ability to drive a motor vehicle safely.

ORDER

56For 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.