Licence Appeal Tribunal File Number: 16049/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:

Jennifer Thompson

Appellant

and

Registrar of Motor Vehicles

Respondent

DECISION

ADJUDICATOR:

Kailey Minnings, Member

APPEARANCES:

For the Appellant:

Jennifer Thompson

For the Respondent:

Sharon Nelson, Representative

HEARD: July 31, 2024

OVERVIEW

1Jennifer Thompson (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 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 mental 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 denies that she suffers from a mental condition and denies 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 their 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 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.

ANALYSIS

Does the appellant suffer from a mental condition?

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

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

• A medical condition report (MCR) from psychiatrist Dr. Geoffrey Leblond, dated September 26, 2023, which indicates a psychiatric illness due to psychosis, with symptoms of disorganized thinking and paranoia. The MCR was completed after a 10-day admission for mental health issues in September 2023, following an overdose of sleeping medication. The appellant chose to leave the hospital against medical advice and declined follow up treatment.

• A comprehensive outpatient progress note from Dr. Geoffrey Leblond dated February 7, 2024, which indicates a diagnosis of delusional disorder. In his note, Dr. Leblond writes that the patient has ongoing delusions of reference and paranoid delusions and dysfunction due to psychosis and associated distress. He notes that the appellant continues to decline to take the antipsychotic medication that has been “recommended many times”, and that she has not responded to alternative approaches to reduce her levels of distress. Dr. Leblond indicates that due to her consistent decline in his recommendations, the appellant was discharged from his care back to her primary care provider.

• A progress note dated May 19, 2024 and a discharge summary dated May 21, 2024, both completed by Dr. Geoffrey Leblond during an inpatient admission for mental health reasons. According to the medical notes, the appellant was admitted to Orillia Soldiers Memorial Hospital from May 18-21, 2024 for risk of harm to self and physical impairment. The notes explain that the appellant was brought to hospital by police after breaking conditions of a no contact order with her neighbour. It states that she has been arrested three times for this issue. The discharge summary refers to an emergency room crisis note, which indicates increasing paranoid delusions and a high risk of harm to others due to delusions. The appellant was discharged home on May 21, 2024 after Dr. Leblond’s assessment found that while she continued to have severe delusions and very poor insight, she did not meet criteria for involuntary admission.

• A Mental Health Disorder form dated May 31, 2024, completed by nurse practitioner Heather Jamieson, who had been the appellant’s primary care provider for approximately six years. On this form, Ms. Jamieson indicates that the appellant has been diagnosed with delusional disorder; that her current symptoms are agitation and delusions; that her most recent illness episode was less than 3 months ago; that she has demonstrated a pattern of non-adherence; and that she has difficulties in judgement and insight.

12The appellant denies that she suffers from a mental condition. She notes the original MCR indicated psychosis, which she denies ever experiencing nor does she have any of the risk factors for.

13Further, she disagrees with the assessment of both Dr. Leblond and Ms. Jamieson that she has delusional disorder. She testified that she has filed complaints against both practitioners and has been discharged from both practices. When asked whether she has delusional disorder, the appellant answered “no, but I would tell you anything if it helps me get my licence back.”

14The appellant relies on the following documents to support her position:

• A medication reconciliation form from her hospital discharge, dated September 23, 2023, which she notes does not include any antipsychotic medication. It is her opinion that this indicates that antipsychotic medication was not offered or recommended to her, aside from as “PRN” (which I, as a physician, understand is Latin shorthand for “as-needed”) during her hospital admission. She clarified that she had briefly taken two different antipsychotic medications but did not tolerate them due to side effects.

• A consultation note from psychiatrist Dr. Stephen Gelber. She testified that this consultation was arranged by the Canadian Mental Health Association as a second opinion and took place on May 9, 2024. The appellant attended via video conference with her crisis worker Evan Oliver. In the consultation note, Dr. Gelber writes: “diagnostically… there certainly might possibly be a delusional disorder and appears to be stable at this current time. I personally do not see any reason why her license should be suspended at this time even if she does have symptoms of delusional disorder, I do not see her as a risk. In regards to driving and certainly her lack of driving put increased stress in her inability to work. I would certainly recommend for all these reasons that her license be reinstated and do not feel that based on psychiatric reasons that it should continue to be withheld… further collateral from the family might indicate the possibility of a role of an atypical antipsychotic if there are still some residual symptoms but it appears that she seems to be well-controlled at this current time.”

15I prefer the assessments of Dr. Leblond and Ms. Jamieson, who have been involved in the appellant’s care over a period of time. I note that Dr. Gelber does, in fact, agree with a possible diagnosis of delusional disorder based on his one-time consultation. I do not find the appellant’s testimony that she has no mental conditions reliable.

16I find that the Registrar has established on a balance of probabilities that the appellant suffers a mental condition.

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

17I 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.

18The Registrar’s position is that the mental condition is neither stable nor being addressed with medical treatment. The Registrar relies on the medical notes from Dr. Leblond from February 7, 2024, May 19, 2024 and May 21, 2024; and the May 31, 2024 Mental Health Disorder form from Ms. Jamieson to support this position. The Registrar asserts that these documents indicate that the appellant lacks judgement and insight into her condition and poses a safety risk if she drives.

19According to their July 25, 2024 letter to the appellant, the Registrar requires confirmation of a 6 month period of mental and emotional stability; confirmation of adherence to treatment; confirmation that the symptoms of delusions have been successfully treated or resolved; and confirmation of improvement in both her condition and her judgement before considering reinstatement of her licence.

20The Registrar relies on the Canadian Council of Motor Transport Administrators Medical Standards for Drivers [February 2021] (the “CCMTA Standards”). Chapter 14 describes mental health conditions in general and the concerns with driving safely with respect to those conditions. Specifically, chapter 14.6.1 states that all drivers are eligible for a licence if:

i. the condition is stable;

ii. the driver has sufficient insight to stop driving if condition becomes acute;

iii. the functional abilities necessary for driving are not impaired;

iv. a treating physician supports a return to driving, for drivers who have stopped driving due to a psychiatric disorder; and

v. conditions for maintaining a licence are met.

21Section 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.

22The appellant argues that the alleged mental condition does not impact her ability to drive safely. She testified that she does not need antipsychotic medication, nor has she been recommended to take antipsychotic treatment by her care providers. She testified that while she has a lot going on, she is emotionally stable. She points to a favourable recommendation from psychiatrist Dr. Gelber to support her position. As described in detail above, Dr Gelber indicated, that as of May 9, 2024, her condition was stable; that he does not believe her to be a driving risk; and that he recommends that her licence be reinstated.

23I acknowledge that the appellant received a favourable recommendation from a psychiatrist, Dr. Gelber. However, I give more weight to the opinions of Dr. Leblond and Ms. Jamieson, both of whom have longer involvement in the appellant’s care, to the opinion of Dr. Gelber, who met the appellant one time via video conference. Both Dr. Leblond and Ms. Jamieson indicate ongoing symptoms of delusions and poor insight. It is well documented that the appellant was, on several occasions, recommended to take antipsychotic medications as treatment and the appellant declined. I note that while Dr. Gelber had reviewed the previous reports of Dr. Leblond and opined that the appellant’s condition was stable on May 9, 2024, she was admitted to hospital for mental health reasons shortly after, on May 18, 2024. Additionally, she testified that she presented to the emergency department as recently as July 29, 2024 for symptoms of anxiety and was started on anxiety medication.

24While I am not bound by the CCMTA Standards, I find them reasonable. As per the CCMTA Standards, a driver with a mental health condition is eligible to drive if, among other things, the condition is stable and there is sufficient insight. I take note of the appellant’s testimony that approximately 3 days prior to the hearing, she presented to the emergency department and was started on a new psychotropic medication. While I commend her for taking steps to improve her mental health and seek care, I find that the appellant would benefit from an increased period of time to demonstrate mental health stability, adherence to treatment, and to improve her awareness of her condition.

25According to the CCMTA Standards, insight means that a driver: is aware of their medical condition; understands how the condition may impair their functional ability to drive; and has the judgment and willingness to comply with their treatment regime and any conditions of licensing. The totality of evidence before me indicates that the appellant lacks insight into her condition.

26I 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

27I 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 condition, that is likely to significantly interfere with her ability to drive a motor vehicle safely.

ORDER

28For 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.