Licence Appeal Tribunal File Number: 16170 MED
In the matter of an appeal under subsection 50(1) of the Highway Traffic Act, R.S.O. 1990, c. H.8, from a decision of the Minister of Transportation to downgrade a licence pursuant to Section 32(5)(b)(i) of the Act.
Between:
Todd Blunt
Appellant
and
Minister of Transportation
Respondent
DECISION
ADJUDICATORS: Dr. Kailey Minnings, Member Rupinder Hans, Member
APPEARANCES: For the Appellant: Todd Blunt, Self-Represented For the Respondent: Sharon Nelson, Agent
Held by teleconference: September 12, 2024
OVERVIEW
1Todd Blunt (the "appellant") appeals the decision of the Minister of Transportation ("respondent") to downgrade his commercial licence for medical reasons, specifically syncope/loss of consciousness, under s. 32(5)(b)(i) of the Highway Traffic Act, R.S.O. 1990, c. H.8 (the "Act").
2Following the receipt of an unsolicited Medical Condition Report ("MCR") dated January 18, 2024, the appellant's driving privileges were suspended. Following receipt and review of additional medication documentation, the appellant's Class G driver's licence was reinstated. However, the respondent took the position that the appellant no longer met the national medical standards for a commercial licence, specifically Class B, due to syncope/loss of consciousness.
3The appellant appeals the downgrade of his commercial driver's licence and asks the Tribunal to reinstate his commercial driver's licence. He takes the position that he does not suffer from syncope/loss of consciousness, and denies that he suffers from a medical condition that is likely to significantly interfere with his ability to drive a commercial vehicle safely.
4Having considered all the evidence and for the reasons that follow, pursuant to s. 50(2) of the Act, we confirm the respondent's decision to downgrade the appellant's commercial driver's licence.
ISSUES
5The 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 commercial vehicle safely.
6To resolve that issue, we will address the following questions:
a. Does the appellant suffer from a medical condition, namely syncope/loss of consciousness?
b. If the appellant does suffer from syncope/loss of consciousness, is this likely to significantly interfere with his ability to drive a commercial vehicle safely?
RESULT
7We find that the respondent has satisfied its burden in establishing 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 commercial vehicle safely. As previously noted, we confirm the respondent's decision to downgrade the appellant's commercial driver's licence.
ANALYSIS
The Law
8Section 14(1)(a) of O. Reg. 340/94 enacted under the Act requires 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 his or her 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.
9Section 203(1) of the Act requires medical professionals to report a person who has or appears to have a prescribed medical condition, while s. 203(2) gives medical professionals the discretion to report a person who have or appear to have a medical condition that they believe may make it dangerous for a person to drive.
10Section 32(5)(b)(i) of the Act states that the respondent may impose the conditions authorized by the regulations, remove any conditions or endorsements or change the class or classes of driver's licence held by the person, in accordance with the results of the examinations and other prescribed requirements.
11Section 14(2)(a) of O. Reg. 340/94 allows the Minister of Transportation 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. The CCMTA Standards may also be considered but are not binding on this Tribunal.
12The respondent has the burden of establishing on a balance of probabilities that the appellant suffers from a medical condition that is likely to significantly interfere with his ability to drive a commercial vehicle safely.
13Pursuant to s. 50(2) of the Act, after a hearing the Tribunal may confirm, modify or set aside the decision or order of the respondent.
Does the appellant suffer from syncope/loss of consciousness?
14The evidence satisfies us, on a balance of probabilities, that the appellant suffers from syncope/loss of consciousness.
15The respondent's position that the appellant suffers from syncope/loss of consciousness is supported by the medical evidence presented. The MCR completed by emergency room physician, Dr. Andrew Jones, notes sudden incapacitation due to seizure and he checks the box entitled "Other" and states "unknown etiology".
16The appellant's family doctor, Dr. Timur Khamidbayev, completed a medical report, dated January 23, 2024. The medical report states that the appellant suffered a possible seizure, and is currently being investigated. The report further states that the appellant was evaluated in the urgent neurological clinic and it was unclear if the episode was a seizure or not.
17Subsequently, Dr. Khamidbayev provided more clarification in the completed seizures and loss of consciousness form in which he noted the appellant's primary medical condition as syncope/loss of consciousness and atypical vasovagal syncope (i.e., occurs in sitting position or is not preceded by warning signs). He further notes that the appellant had a normal EEG.
18In addition, we considered the report from neurologist Dr. Elizabeth Finger, dated August 12, 2024, who evaluated the appellant in the Urgent Neurology Clinic in January 2024. Dr. Finger notes that the nature of the spell and movements as described by the appellant's wife seemed atypical for a seizure, including lack of post-ictal period and that the brain imaging and EEG were within normal limits. The report further states that the appellant missed his evening dose of insulin the night prior and this may have contributed to the spell. He is noted as having no further episodes since that time.
19The appellant testified that, on the day of the episode on December 28, 2023, he had breakfast and then went to his bedroom and sat on the bed. He does not remember the episode but his wife came into the bedroom after the episode had occurred and found him lying sideways on the bed. He testified that he was incapacitated for a brief period of time but he returned to full consciousness and he found out that his wife had already called for assistance. He testified that he does not recall any warning symptoms. He believes that he had forgotten to take his nightly dose of insulin the night before.
20We find that the medical evidence presented at the hearing supports the conclusion, on a balance of probabilities, that the appellant has the medical condition of syncope/loss of consciousness and he had a single episode. We found particularly convincing the seizures and loss of consciousness form completed by Dr. Khamidbayev wherein he notes the appellant's medical condition as syncope/loss of consciousness and atypical vasovagal syncope.
21The appellant's own testimony further establishes that he was incapacitated for a period of time, although brief, and his wife called for assistance. He does not remember the episode but does recall regaining full consciousness.
22Given the evidence before us, we find on a balance of probabilities, that the Minister has established the appellant suffers from syncope/loss of consciousness condition.
Is the appellant's medical condition likely to significantly interfere with his ability to drive a commercial vehicle safely?
23The respondent has the burden of establishing that the appellant's medical condition is likely to significantly interfere with his ability to drive a commercial motor vehicle. We find that the respondent has satisfied this burden.
24The respondent points to the CCMTA Standards, chapter 19 which describes syncope as a partial or complete loss of consciousness. The respondent specifically relies on chapter 19.6.10 which states:
Atypical vasovagal syncope is a vasovagal syncope that occurs in the sitting position or is not preceded by warning signs that are sufficient to allow a driver to pull off the road before losing consciousness.
25The respondent relies upon chapter 19.6.10 which provides that a commercial driver is 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.
26The Tribunal is entitled to take the CCMTA Standards into consideration but is not bound by them. The overriding consideration in this appeal is whether the respondent has proven, on a balance of probabilities, that the appellant's medical condition is likely to significantly interfere with his ability to drive a commercial vehicle safely. While the CCMTA Standards are well-reasoned and provide assistance, every case must be considered on its own facts.
27The appellant testified that he has been a school bus driver for about four years for Sharp Bus Lines, and he drives elementary and high school children. He is eager to return to his employment as a school bus driver as the loss of his commercial Class B licence has resulted in economic hardship. He testified that he also does some charter work for school trips that can involve driving on highways at speeds of 110 kilometres per hour with up to 50 students in the school bus. He acknowledges that there are no airbags in the school buses he drives.
28The respondent takes the position that the appellant's medical condition could lead to a loss of consciousness not preceded by any warning signs that are sufficient to allow him to pull off the road before losing consciousness. This could occur while he is driving a school bus with the Class B licence. The respondent seeks confirmation that the appellant is episode free for at least one year in accordance with chapter 19.6.10 to ensure the safety of the public.
29The respondent relies upon the opinion of the appellant's family doctor, Dr. Khamidbayev who notes in the seizures and loss of consciousness form that the appellant's syncope/loss of consciousness is atypical vasovagal, meaning it occurs in the sitting position or is not preceded by warning signs. Dr. Khamidbayev further notes that the condition or underlying cause has not been successfully treated or resolved.
30We further note that the appellant presented no convincing medical evidence that the syncope was caused by his failure to take his insulin medication the night prior to the episode. While Dr. Finger notes that the appellant missed his evening dose of insulin the night before and this may have contributed to the spell, this is not convincing. We note that the appellant's own family doctor, Dr. Khamidbayev, makes no such mention in his medical report or the seizures and loss of consciousness form he completed. We note that the appellant testified that he is not under the care of neurologist Dr. Finger, and she only treated him once at the hospital. We prefer the medical opinion of the appellant's family doctor who makes no mention of a missed dose of insulin as a contributing factor. It would appear that the cause of the syncope is unexplained.
31We find that the CCMTA Standards are reasonable and should be followed in these circumstances. We note that experiencing an episode of syncope while driving a school bus full of children can have catastrophic consequences especially as the cause of the loss of consciousness has not been determined by the appellant's physicians. We are persuaded to apply chapter 19.6.10, which indicates that commercial drivers 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. We find that it has not been one year since the episode occurred on December 28, 2023. We find that the appellant falls short of the criteria set out in the CCMTA Standards. We find that the 12 month period recommended is a reasonable standard and should be followed in this case given the circumstances and risk involved.
32Lastly, while we are mindful that Dr. Finger in her August 12, 2024 report recommends reinstatement of the appellant's driver's licence, we note that the appellant's Class G licence has already been reinstated. We do not find Dr. Finger's recommendation persuasive with regards to the appellant's commercial licence, and she makes no mention of his commercial licence. Further, given that Dr. Finger only treated the appellant once at the hospital and is not providing ongoing care, we are not satisfied that she has sufficient knowledge of the appellant's medical history in order to come to this conclusion.
33We find the respondent has established that the appellant's syncope/loss of consciousness condition is likely to significantly interfere with his ability to drive a commercial vehicle safely.
34Based on a careful consideration of all the evidence before us, we are satisfied on a balance of probabilities that the appellant's medical condition is likely to significantly interfere with his ability to drive a commercial vehicle safely.
ORDER
35For the reasons set out above, pursuant to subsection 50(2) of the Act, we confirm the Registrar's decision to change the class of the appellant's driver licence.
Licence Appeal Tribunal
Dr. Kailey Minnings, Member
Rupinder Hans, Member
Released: October 10, 2024