Licence Appeal Tribunal File Number: 15931MED

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:

John Omoruan

Appellant

and

Registrar of Motor Vehicles

Respondent

DECISION

ADJUDICATOR:

Kailey Minnings

APPEARANCES:

For the Appellant:

John Omoruan

For the Respondent:

Sharon Nelson, Representative

Heard by Teleconference: July 16, 2024

OVERVIEW

1John Omoruan (the “appellant”) appeals from the decision of the Registrar of Motor Vehicles (“Registrar”) to suspend his 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 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. 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 stroke, 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. He acknowledges that he suffered a stroke but denies that he suffers from a medical condition which interferes with his 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 his ability to drive a motor vehicle safely.

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

i. Does the appellant suffer from stroke?

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, 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 his ability to drive a motor vehicle safely and I confirm the Registrar’s decision to suspend the appellant’s driver’s licence.

ANALYSIS

Does the appellant suffer from stroke?

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

11The Registrar’s position is supported by the following medical reports:

i. An admission note dated March 14, 2022 by internist Dr. Liam Finlay, which states a diagnosis of atrial fibrillation and “bilateral occipital infarcts, presumably cardioembolic secondary to atrial fibrillation.”

ii. An unsolicited medical condition report (MCR) dated April 8th, 2022, completed by physician medicine and rehabilitation specialist Dr. Matthew Godleski, which indicates cerebral vascular accident and physical and cognitive impairment.

iii. A Cerebrovascular Diseases, Traumatic Brain Injury, Tumor or Other Neurological Diseases form dated September 15th 2022, completed by neurosurgeon Dr. Mahmood Fazl, which indicates the appellant had a cerebellar infarct requiring decompression surgery on March 16, 2022.

iv. A second Cerebrovascular Diseases, Traumatic Brain Injury, Tumor or Other Neurological Diseases form, dated June 5, 2024, completed by neurologist Dr. Courtney Scott, on which the primary diagnosis of “Transient Ischemic Attack/Cerebrovascular accident/Stroke” is checked off.

v. Clinical notes from neurologist Dr. Courtney Scott, including a consult note dated March 15, 2022; and progress notes dated August 16, 2022, November 22, 2022, May 23, 2023, and June 5, 2024 respectively. The notes all describe diagnoses of atrial fibrillation and bilateral cerebellar infarcts.

12I am aware that a cerebellar infarct is a type of stroke that occurs when blood flow to a part of the brain (cerebellum) is blocked, leading to damage. I am also aware that atrial fibrillation is a condition characterized by irregular heart rhythm that can cause blood clots to form in the heart, which may travel to the brain and block the blood supply causing an infarct. For this reason, treatment of atrial fibrillation often includes a blood thinner medication. I take note of these facts as a physician duly licenced to practice medicine in Ontario, pursuant to s.16(b) of the Statutory Powers Procedure Act.

13The appellant’s position is that the MCR should not be considered valid because it was not signed by Dr. Godleski. The appellant acknowledges that in March of 2022, he had a blood clot in the brain and that he is taking a blood thinner medication. He denies, however, that he has atrial fibrillation or that the stroke was related to underlying atrial fibrillation.

14I find the MCR reliable despite the lack of a physician signature, as it appears to have been completed electronically and is stamped with a record of fax from St. John’s Rehab facility, where Dr. Godleski works and where the appellant completed rehabilitation. There is no indication or reason to suspect that it was forged. On a balance of probabilities, I find that it is likely that Dr. Godleski completed the MCR report. Furthermore, even without reliance on the MCR, there is sufficient other medical documentation outlined above that establishes that the appellant had a stroke in March 2022.

15I find that the Registrar has established on a balance of probabilities that the appellant suffered a stroke in March of 2022.

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

16I 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.

17The Registrar argues that stroke interferes with the appellant’s ability to drive safely in that cognitive, sensory or motor function may be affected. The Registrar relies on the Canadian Council of Motor Transport Administrators Medical Standards for Drivers [February 2021] (the “CCMTA Standards”), specifically the standard in section 4.6.2, which states that drivers with a history of cerebrovascular accident are eligible for a licence if, among other things, medical assessments show no residual effects and the functional abilities necessary for driving are not impaired. The final paragraph of Section 4.4 of the CCMTA Standards states that medical assessments and a functional assessment are the appropriate tools to measure persistent impairment following a cerebrovascular accident.

18The Registrar points to the two Cerebrovascular Diseases, Traumatic Brain Injury, Tumor or Other Neurological Diseases forms to support their position. The first form, dated September 15, 2022 and completed by neurosurgeon Dr. Fazl, indicates a physical impairment; the second form, dated June 5, 2024 and completed by neurologist Dr. Courtney Scott, indicates a cognitive impairment or limitations.

19The Registrar further relies on the results of a functional driving assessment (FDA) which took place on May 9, 2024 with a driving instructor and an occupational therapist, Mr. Shah Baqar. Results contained in the Functional Driving Assessment – Medical form indicate that the appellant had overall variable results on cognitive testing. Importantly, it indicates skill deficits in his on-road driving ability and makes note of the following errors: moderately slow driving x 3; slowed unnecessarily at intersections x 2; slow highway merger and driving; slow lane changes x 2; driving left of centre in lane x 2; giving up right of way at 4-way stop; initiated lane change before observing (intervention as vehicle was approaching in lane); rolling forward/initiating turns when unsafe x3. The appellant did not pass. Driving lessons for rehabilitation were recommended prior to establishing fitness to drive.

20The appellant’s position is that he does not have any impairments that would affect his ability to drive. He disagrees with Dr. Razl’s September 15, 2022 assertion that he has physical impairment. He states that he did not undergo a physical assessment at the time the form was completed. Further, he disagrees with Dr. Scott’s assessment that he has a cognitive impairment. He states that he has not undergone any cognitive testing with his physicians.

21Additionally, the appellant disagrees with the findings from the functional driving assessment. He states that, in his view, he should not have failed the assessment and that apart from some misunderstandings, he did well and made no significant errors. He argues that Mr. Baqar, the occupational therapist, is not a physician and therefore is not qualified to determine whether a medical condition interferes with his driving ability. The appellant states that Mr. Baqar unfairly interfered with the driving assessment by “barking” at him repeatedly. When asked about this further, he explains that Mr. Baqar was telling him to speed up on several occasions throughout the test.

22The appellant states that he has not yet pursued the recommended driving lessons due to cost and that he does not believe he requires them.

23After considering the evidence and submissions of the parties, I find on a balance of probabilities that the appellant does suffer from a condition, namely stroke in March 2022, that is likely to interfere significantly with his ability to drive a motor vehicle safely.

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, and while I am not bound by them, I find them reasonable.

25The standard in section 4.6.2 of the CCMTA states that drivers with a history of cerebrovascular accident are eligible for a licence if, among other things, medical assessments show no residual effects, and the functional abilities necessary for driving are not impaired. I prefer the assessments of neurosurgeon Dr. Razl, neurologist Dr. Scott, and occupational therapist Mr. Baqar to the appellant’s own assessment of his abilities. Mr. Baqar is an occupational therapist who works at a FDA centre. I am aware that Occupational Therapy is a regulated profession in the province of Ontario. Pursuant to s. 14.2 of the Regulation and s. 203 of the Act, occupational therapists are prescribed persons who are allowed/obligated to report to the Ministry if they are of the opinion that a person has a medical condition, functional or visual impairment. Based on this, I find that Mr. Baqar is qualified to identify functional deficits.

26I note that there is no medical evidence before me to support the appellant’s position that there are no lasting impairments or deficits. In addition, I find that the appellant demonstrates an overall poor insight and understanding of his health conditions, recommended investigations and treatments.

27I am satisfied on a balance of probabilities that the appellant’s medical condition is likely to significantly interfere with his ability to drive safely.

Conclusion

28I find that the Registrar has discharged the onus of establishing on a balance of probabilities that the appellant suffers from a medical condition, namely stroke, that is likely to significantly interfere with his ability to drive a motor vehicle safely.

ORDER

29For 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.