Licence Appeal Tribunal File Number: 16148/MED
In a 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 Minister of Transportation to downgrade a licence pursuant to Section 32(5)(b)(i) of the Act.
Between:
Christian Molgat Appellant
and
Minister of Transportation Respondent
DECISION & ORDER
ADJUDICATORS: Dr. Kailey Minnings, Member Raymond C. Ramdayal, Member
APPEARANCES: For the Appellant: Christian Molgat For the Respondent: Sharon Nelson, Representative
Heard: September 18, 2024
OVERVIEW
1Christian Molgat (the "appellant") appeals from the decision of the Minister of Transportation (the "Minister" or "respondent") to downgrade his commercial licence under s. 32(5)(b)(i) of the Highway Traffic Act, R.S.O. 1990, c. H.8 (the "Act") after the Minister received a report from a treating health care provider that the appellant suffers from a medical condition that may affect their ability to drive safely. As a result, the Minister advised the appellant that they will change his commercial licence to a Class "G" licence.
2Section 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 Minister takes the position that the appellant suffers from a medical condition, namely syncope/loss of consciousness, that is likely to significantly interfere with his ability to drive a class AC vehicle safely and that this provides sufficient reason to change the class of his licence under s. 32(5)(b)(i) of the Act.
4The appellant appeals the suspension under s. 50(1) of the Act. While he acknowledges that he experienced syncope on November 4, 2023, he denies that this isolated episode causes him to suffer from a medical condition which interferes with his ability to drive a commercial vehicle 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.
ISSUE
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 class AC motor vehicle safely.
7To resolve that issue, we will address the following questions:
i. Does the appellant suffer from the medical condition alleged?
ii. If so, is this likely to significantly interfere with his ability to drive a class AC motor vehicle safely?
8The Registrar bears the burden of proving on a balance of probabilities that the answer to each of these questions is 'yes.'
RESULT
9Having considered all the evidence and submissions and for the reasons that follow, we find that the Minister has failed to satisfy its burden to establish that the appellant suffers from a medical condition that is likely to significantly interfere with his ability to drive a class AC motor vehicle safely and we set aside the Minister's decision to downgrade his driver's licence.
ANALYSIS
10By letter dated June 10, 2024, the Minister advised the appellant that his commercial driver's licence was under review following a medical report indicating a condition of syncope/loss of consciousness in November 2023. The Minister requested that a Seizure and Loss of Consciousness ("SLC") form be filled out by his medical practitioner. Further to that request, the appellant's doctor completed the SLC form which reflected a singular, unexplained syncopal episode. The Minister responded with a letter dated July 11, 2024, stating that the appellant no longer meets the national medical standard for a commercial licence due to his condition. As a result, the appellant's commercial licence was changed to a Class 'G' licence.
11The appellant's family doctor has provided a letter stating support for his ability to drive. However, the Registrar has not accepted this as sufficient to reinstate his commercial driver's licence.
12The appellant further argues that he has received favourable results from all medical tests taken. There is nothing to indicate any concern regarding his syncope and he believes it is an isolated incident for which there is no clear explanation.
13The Minister states that in order for the appellant to regain his commercial licence, he is required to file a further report from his treating physician, specialist or nurse practitioner, including confirmation that he has not experienced any further syncope or loss of consciousness episodes for at least one year. This is outlined in a letter the Minister sent the appellant on August 13, 2024.
14The evidence in front of the Licence Appeal Tribunal (the "Tribunal") indicates that the appellant has a medical condition which he acknowledges. However, he does not feel it interferes with his ability to drive a commercial vehicle safely. The respondent is intent on receiving an updated medical report confirming that the appellant has not had any syncope episodes for a period of one year, before considering reinstating his commercial licence. The respondent is relying on the Canadian Council of Motor Transport Administrators ("CCMTA") National Safety Code Standard 6: Determining Driver Fitness in Canada standard 19.6.10 which deals with Single or recurrent unexplained, single or recurrent atypical vasovagal, or recurrent typical vasovagal syncope – Commercial drivers.
Does the appellant suffer from the medical condition alleged?
15We find that the appellant does suffer from the medical condition alleged. The Tribunal received evidence comprising of medical notes from the ER and EMS, family doctor medical report form, and an SLC form which all supports that there was a syncopal episode on November 4, 2023. It was on that day that the appellant states he woke up to go to work as a milk truck driver. This is a role he has held since entering semi-retirement. He stated that he works approximately every other day and looks forward to his time there since it keeps him busy and gainfully employed.
16He began his day following his normal routine of eating breakfast, doing light stretches and weightlifting. It was upon completing a series of floor exercises (i.e., sit ups) when he tried to stand up but saw the room spinning. He then lost consciousness but soon awoke and laid on the ground for a few minutes to gather himself. He decided he was well enough to go to work despite feeling anxious of what had just occurred. The appellant stated he was particularly anxious having recently lost a friend to a heart attack.
17On his way to work, the appellant began to feel unwell and he decided to pull his vehicle off in a rest area to call his boss. He went into a small food establishment and asked staff to call an ambulance. While waiting outside for the ambulance to arrive, he vomited. He was taken to the ER via EMS. While in ER, he received IV fluids and anti-nausea medication. His symptoms resolved and he was discharged home.
18The appellant does not dispute the fact that he experienced syncope on November 4, 2023.
19Based on the evidence before us, there is medical information which supports that the appellant experienced a single syncopal episode. We did not receive any information which would dispute the diagnosis reached by the medical practitioners. As a result, on a balance of probabilities, we find that the Registrar has established that the appellant suffers from the medical condition alleged.
Is the appellant's medical condition likely to significantly interfere with their ability to drive a motor vehicle safely?
20We find that the appellant's medical condition is not likely to significantly interfere with his ability to drive a commercial vehicle safely.
21Section 14(2)(a) of the Regulation allows the Minister to consider the Canadian Council of Motor Transport Administrators Medical Standards for Drivers ("CCMTA Standards") when determining whether the requirements of s. 14(1) are met. Similarly, the Tribunal may take the CCMTA Standards into consideration, although they are not binding requirements. In this matter, the Minister is relying on the CCMTA standard relating to syncope.
22The Minister relies on CCMTA standard 19.6.10 for commercial drivers with unexplained syncope, which indicates that commercial drivers with a single unexplained episode of syncope are eligible for a licence if it has been at least 12 months since the last episode of syncope, and the conditions for maintaining a licence are met.
23The respondent testified that this episode of syncope is classified as unexplained because the appellant's family doctor checked off "unexplained" on the June 25, 2024 SLC form.
24The appellant testified that the episode in question occurred when he was changing position from laying down with legs in the air, to being propped up and attempting to sit. Furthermore, according to the appellant's description of the incident and what is medically documented, he experienced prodromal (warning) symptoms of dizziness and feeling unwell, prior to easing himself back down and losing consciousness for approximately 10-20 seconds.
25The CCMTA Standards emphasizes the importance of position and prodromal symptoms in the classification of syncope. This is referenced in the CCMTA rationale for the standards which states:
These guidelines are based primarily on recommendations contained in the final report of the 2003 Canadian Cardiovascular Society (CCS) Consensus Conference Assessment of the Cardiac Patient for Fitness to Drive and Fly. When applying these standards, the CCS indicates that waiting periods may be modified based on individual factors such as length of any reliable warning symptoms (prodrome), reversible or avoidable precipitating factors, and position from which the individual experiences syncope.
26In this case, we find that the appellant had clear warning signs and importantly, the episode occurred when changing position from laying down with legs in the air to getting up. As a physician duly licenced to practice medicine in Ontario, Dr. Minnings knows that syncope that occurs when changing positions from supine (laying down) to sitting or standing is considered orthostatic or postural, and is explained by a transient decrease in blood pressure. She takes note of this pursuant to s. 16(b) of the Statutory Powers Procedure Act.
27While we find the CCMTA Standards well-reasoned, we must consider each case on its own merits.
28We acknowledge that Dr. Zaraket checked off "unexplained syncope" on the SLC form. However, we note that postural syncope is not an option on the checklist. We also note that Dr. Zaraket emphasized the appellant's warning signs, writing "preceding nausea and dizziness".
29We also note that the appellant has been episode-free for 10.5 months as of the time of the hearing. He has received an appropriate medical workup, including a CT scan of the head, and echocardiogram, and bloodwork, which has been unremarkable. We have also received documentation from his family doctor who fully supports his return to commercial driving.
30For these reasons, we do not accept the respondent's position that the appellant's condition is likely to interfere with his ability to drive a commercial motor vehicle safely. There is also no evidence from any health care provider citing his inability to drive safely. On the contrary, his family doctor provides an endorsement for the return of his commercial driver's licence.
31We find that the Minister has failed to prove that the appellant's medical condition is likely to significantly interfere with his ability to drive a commercial vehicle safely.
Conclusion
32While we find that the Minister has discharged the onus of establishing on a balance of probabilities that the appellant suffers from a medical condition, namely syncope, we find that they have not done so to establish that this condition is likely to significantly interfere with their ability to drive a commercial vehicle safely.
ORDER
33For the reasons set out above, pursuant to subsection 50(2) of the Act, we set aside the Minister's decision to downgrade the appellant's driver's licence.
LICENCE APPEAL TRIBUNAL
Dr. Kailey Minnings, M.D., Adjudicator
Raymond C. Ramdayal, Adjudicator
Released: October 11, 2024