Kristine Gilliland v. Registrar of Motor Vehicles, 2024 CanLII 74751

Licence Appeal Tribunal File Number: 15975/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:

Kristine Gilliland

Appellant

and

Registrar of Motor Vehicles

Respondent

DECISION

ADJUDICATOR: Dr. Isla McPherson, Member

APPEARANCES:

For the Appellant: Kristine Gilliland, Appellant

For the Respondent: Sharon Nelson, Agent

Held by teleconference: July 4, 2024

OVERVIEW

1Kristine Gilliland (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 an unsolicited Medical Condition Report stating that the appellant suffers from a medical condition that may affect her ability to drive a motor vehicle 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 a mental health condition, 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 agrees that she suffers from a mental health condition but denies that her mental health condition 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 a mental health condition?

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

PROCEDURAL MATTERS

10The appellant did not attend the hearing at its onset. The Tribunal reached out to the appellant through several channels of communication, and after 30 minutes was able to reach the appellant, and she subsequently joined the hearing. The appellant was provided an opportunity to request an adjournment and the parties indicated they were prepared to proceed as planned.

ANALYSIS

Does the appellant suffer from a mental health condition?

11The evidence presented at the hearing establishes that the appellant suffers from a medical condition, namely a mental health condition.

12The Registrar’s position is supported by:

i. a Medical Condition Report dated, June 21, 2021, from Dr. Y.

ii. a Mental Health Disorder Form dated July 21, 2023, from Dr. Y.

13The Medical Condition Report dated June 21, 2021, from the appellant’s family physician, Dr. Y, supports the Registrar’s position that the appellant suffers from a mental health condition. Dr. Y has checked the box “Other” on the MCR list of medical conditions and written a description of the concern as, “loss of sensation leg, tunnel vision”. Dr. Y additionally provided a narrative that the appellant has a history of anxiety and panic attacks but is being referred to a neurologist to investigate for other causes of her symptoms.

14Following the receipt of the MCR the Registrar suspended the appellant’s licence due to a Mental Health Condition, Visual Impairment and Musculoskeletal Condition/Motor Function Ability Impairment. The Registrar requested a completed Mental Health Disorder Form, Vision Report Form and Musculoskeletal Form/Motor Function Ability Impairment Form. The appellant submitted a Vision Report Form dated June 20, 2023, the Mental Health Disorder Form dated July 21, 2023, and later the Musculoskeletal Form/Motor Function Ability Impairment Form with a date of December 11, 2023. Following the receipt of the requested vision and musculoskeletal forms, the suspension was lifted for the medical conditions of vision impairment and a musculoskeletal condition. However, the suspension remained for a mental health condition.

15The Mental Health Disorder Form was completed by Dr. Y on July 21, 2023, two years after the suspension, and further supports the Registrar’s position that the appellant suffers from a mental health condition. Dr. Y has indicated on this form that the appellant has diagnoses of Major Depressive Disorder and Anxiety Disorder.

16Following the receipt of the Mental Health Disorder Form the Registrar continued the suspension of the appellant’s licence and requested a completed functional driving assessment before considering reinstatement.

17The appellant does not dispute that she suffers from mental health concerns. She testified that she has lived with mental health concerns for over 30 years when she was diagnosed with depression and anxiety at the age of 23. She testified that she additionally suffered from a panic attack in 2021 that was the event that led to the MCR being submitted.

18The medical evidence before the Tribunal comprises two medical forms completed by the appellant’s family physician that confirm two mental health conditions and the appellant agrees that she has both mental health conditions.

19The medical evidence in this case is clear and the diagnoses are 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 a mental health condition.

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

20I 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.

21The Registrar’s position is supported by:

i. The Mental Health Disorder Form completed July 21, 2023, by Dr. Y.

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

22The Registrar supports their position that the appellant’s medical condition is likely to interfere with her ability to drive and their request that a functional driving assessment be completed by relying on the Mental Health Disorder Form. On this Form Dr. Y has checked “yes” to the question of whether the appellant requires an independent functional assessment.

23The Registrar also relies on the CCMTA Standards Chapter 14, 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. The Registrar takes note that there is no medical evidence submitted stating that a physician supports a return to driving and as a functional driving assessment has been requested by Dr. Y, this brings into question whether the appellant has the functional abilities necessary to drive.

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 are not bound by them.

25The appellant argues that although she continues to have depression and anxiety, her symptoms are stable, and she has not had a panic attack since 2021. She testified that she had a panic attack while driving that resulted in experiencing symptoms of tunnel vision and weakness in her legs. She was under considerable stress at the time with her spouse’s health concerns and job loss as well as caring for an elderly family member. She testified she reported the concern to Dr. Y, her family doctor for 4 years, and was referred for neurological consultation to assess for multiple sclerosis in 2021/22. She testified that she had an MRI of her brain and was told there were no concerns or new diagnoses. The appellant reported that in 2021 she was also referred to a psychiatrist at her own request to clarify her diagnosis of depression. She testified she wanted clarity on the condition as she had been diagnosed 30 years earlier. She testified that she had one meeting with a psychiatrist and described that the psychiatrist advised Dr. Y to submit the MCR. She testified no treatment recommendations or follow up were provided by the psychiatrist and she has not seen any other mental health professional since 2021.

26The appellant testified that she has never had any accidents related to driving due to her mental health concerns nor been admitted to hospital for her mental health. Under cross-examination, she was questioned about the events that led to the suspension. She testified that the event she suffered that led to the suspension was unforeseen and occurred without warning while driving. She experienced both tunnel vision and weakness in her legs, which required her to pull over as she was unable to drive safely.

27The appellant testified about the hardships she has experienced attempting to complete the requested functional driving assessment, including financial barriers and accessibility. She testified the closest assessment centre to her residence is currently not taking appointments until the fall 2024 due to limited staffing. She testified she requires a driver’s licence as she is the primary support for the 6 other people in her household that she supports. The appellant testified she has had her husband drive her over the past three years while her licence is suspended.

28Under cross-examination she testified that she sees Dr. Y every 3-6 months for her mental health concerns. It was brought to her attention that Dr. Y documented in the medical submissions that when she completed the Mental Disorder Form in July 2023 Dr. Y had seen the patient less than once per year, “..the patient was last seen April 2022 (was phone call) has not been seen since then…”. The appellant clarified the frequency of seeing Dr. Y was less than every 3-6 months but was not sure of the frequency. The appellant testified she takes citalopram 40 mg daily since the panic attack in 2021 and that this is prescribed by Dr. Y. She testified she has not stopped the medication since it was started in 2021 nor missed any doses. The Registrar questioned how she was refilling her medication as she was seeing Dr. Y. rarely and questioned the appellant on her duration of her current prescription. The appellant testified that her current prescription reads that she has a 90-day supply of medication with one refill and at this time has no follow up appointment booked with Dr. Y.

29Under cross-examination the appellant was questioned about other supports that she has for her mental health condition. She testified she does not see a counselor or other mental health allied health professional. She had the single appointment with her psychiatrist in 2021 and otherwise Dr. Y is the sole provider of any health care including mental health.

30Under cross-examination, the appellant was questioned whether she had attempted to gather more updated medical evidence in support of her case. The appellant testified that she attended an appointment with Dr. Y on June 25, 2024, the week prior to the hearing. She testified that at this appointment she had discussed with Dr. Y and both her mental health conditions and her driver’s licence suspension. The appellant testified that Dr. Y reiterated the recommendation from the psychiatrist involved in her care to have her driver’s licence suspended. No further medical evidence was submitted following this appointment.

31I have considered the appellant’s position that she had an isolated panic attack while driving, and her mental health symptoms have since been treated and are stable. However, I also acknowledge that the only medical evidence on file that addresses the appellant’s mental health condition is the Mental Health Disorder Form where the appellant’s family physician of several years has clearly indicated their recommendation for a functional driving assessment bringing into question the appellant’s functional ability to drive. I appreciate that when experiencing symptoms of tunnel vision and weak legs the ability to operate a motor vehicle may be impaired. I can also appreciate that panic attacks can strike without warning with no clear trigger making it impossible to plan ahead for and avoid while driving.

32I further note that the appellant described being under considerable stress due to family circumstances at home at the time of the panic attack in 2021. I also acknowledge that during the hearing she testified to being under considerable ongoing stress at the time of the hearing due being the sole provider for 6 people living in her household, suggesting similar environmental stressors that led to the initial concerns. I also acknowledge that psychiatric disorders including the conditions the appellant suffers from are chronic and subject to relapse.

33I further acknowledge that the appellant has testified that her family physician is the sole provider of her psychiatric care and therefore would be the healthcare provider positioned to provide an assessment on the appellant’s mental health status. In addition, I take note that the appellant testified the psychiatrist she had seen had advised Dr. Y to complete the MCR. Thus, it appears the only two physicians involved in the appellant’s mental health care have concerns about her driving.

34In addition, I take note that this Mental Health Form is 1 year old at this time, and that as per the Case Conference Report and Order the appellant intended to gather further medical evidence to support her case at an appointment with Dr. Y on June 25, 2024. While the appellant testified that she attended this appointment and discussed both her mental health condition and her driver’s licence suspension with Dr. Y at this appointment, I note that the appellant submitted no further medical information in support of either stability of her mental health over the past year nor any recommendation that a functional assessment was no longer required nor that she was fit to return to driving. This complete absence of updated medical information despite the opportunity to gather this information and the importance of this information being discussed at the case conference all suggest that Dr. Y continues to stand by her recommendation for a functional driving assessment as indicated in the Mental Health Disorder Form.

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. My review of the evidence shows that the conditions recommended for relicensing outlined in the CCMTA Standards have not been met.

36I acknowledge the burden that the lack of a driver’s licence is having on the appellant. However, I find the medical evidence is clear and persuasive.

37As 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

38I 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

39For 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.