Licence Appeal Tribunal File Number: 17599/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:

Robert Hill

Appellant

and

Registrar of Motor Vehicles

Respondent

DECISION

ADJUDICATOR: Dr. Isla McPherson, Member

APPEARANCES:

For the Appellant: Robert Hill, Appellant

For the Respondent: Melissa Litrenta, Agent

Held by teleconference: October 7, 2025

OVERVIEW

1Robert Hill (the “appellant”) appeals from the decision of the Registrar of Motor Vehicles (“Registrar”) to suspend his class G driving privileges 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 report from a treating physician stating that the appellant suffers from a medical condition that may affect his 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 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 severe hypoglycemia, that is likely to significantly interfere with his ability to drive a vehicle of the applicable class 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. The appellant does not dispute that he suffered severe hypoglycemia. The appellant however denies that he suffers from any medical condition that would interfere with his ability to drive a vehicle of the applicable class safely.

5Pursuant to s. 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 severe hypoglycemia, and, if so, if this condition 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 severe hypoglycemia?

ii. If so, is this likely to significantly interfere with his ability to drive a vehicle of the applicable class 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 vehicle of the applicable class safely and I confirm the Registrar’s decision to suspend the appellant’s driver’s licence.

ANALYSIS

Does the appellant suffer from severe hypoglycemia?

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

11The Registrar’s position is supported by:

i. a Medical Condition Report (MCR) dated May 22, 2025, and

ii. Diabetes Assessment Forms dated May 22, and June 9, 2025, and September 18, 2025.

12Dr. S submitted an unsolicited MCR dated May 22, 2205, indicating the appellant suffered from a disorder that has a moderate or high risk of sudden incapacitation, or that has resulted in sudden incapacitation and that has a moderate or high risk of recurrence due to hypoglycemia requiring intervention of a third party or producing loss of consciousness.

13Following the receipt of the MCR, the Registrar suspended the appellant’s licence due to hypoglycemia unawareness and requested confirmation of no further episodes for 3 months, a recently conducted A1c result with confirmation that the level was congruent with blood logs, confirmation that stable glycemic control had been re-established, and a Diabetes Assessment Form completed.

14The Diabetes Assessment Form was completed by the appellant’s family physician, Dr. M, on June 9, 2025. The Form indicated the appellant had type 1 diabetes treated with insulin and noted the appellant had an episode of hypoglycemia unawareness in the past three months as well as an episode of severe hypoglycemia requiring outside intervention within the past six months and adequate glycemic control had been re-established. Dr. M added the narrative comments that the appellant had one episode of hypoglycemia caused by a medication error.

15Following receipt of this Form, the Registrar continued the appellant’s suspension but changed the medical reason to severe hypoglycemia. With this new medical condition, the Registrar required confirmation that there were no further episodes of severe hypoglycemia and that the condition had remained stable for a period of six months, along with an A1c value that was congruent with blood logs and confirmation that glycemic control had been re-established.

16Another Diabetes Assessment Form was completed by Dr. M on July 9, 2025, again confirming the appellant had an episode of hypoglycemia unawareness in the past three months and an episode of severe hypoglycemia requiring outside intervention within the past six months and that adequate glycemic control had been re-established. A third Diabetes Assessment Form was completed by Dr. M on August 14, 2025, indicating the appellant had not had an episode of hypoglycemia unawareness in the past three months and had not had a reported episode of severe hypoglycemia requiring outside intervention within the past six months. The Registrar responded with a letter indicating that a medical report received June 9, 2025, had indicated a reported episode of severe hypoglycemia requiring outside intervention.

17A fourth Diabetes Assessment Form completed by Dr. M completed September 18, 2025, confirmed an episode of severe hypoglycemia in the past 6 months and that glycemic control had been re-established.

18Under cross-examination, the Registrar explained that the suspension period was changed from three months to six months when the medical condition changed from hypoglycemia unawareness to severe hypoglycemia.

19Under cross-examination, the appellant asked the Registrar if his spouse had given herself insulin in error whether her licence would be suspended, as he felt that because he had type one diabetes he was placed in a different category. The Registrar responded that they suspend anyone’s licence when a MCR is submitted.

20The appellant testified that he has type one diabetes, and on May 22, 2025, he mistakenly took the wrong insulin. He testified he set his short-acting insulin on the counter to refill the cartridge, and then shortly afterwards administered this short-acting insulin instead of his long-acting insulin by mistake. He then showered and when he exited the shower lost consciousness and awoke in the hospital. He testified as to not hearing his glucose monitor beep which would normally alert him as to a low blood sugar.

21The appellant testified under cross-examination that he did not feel any symptoms of hypoglycemia before he lost consciousness. He testified that he had lost consciousness for probably close to an hour before his spouse found him and called 9-1-1. He testified he was taken to the hospital and discharged after staying overnight.

22The appellant’s spouse testified that she woke up during the night and realized that her husband had not come to bed, so went to find him. She found him unresponsive, and she was unable to rouse him. She could not administer any juice or glucose tablets to bring up his blood sugar due to him being totally unresponsive and she called 9-1-1. She also reiterated that her husband’s glucose monitor had not alarmed as it should have done with a low blood sugar.

23I find the medical evidence in this case clear and the testimony of the appellant and his spouse supportive of the Registrar’s position. Based on the information available, I find that the Registrar has established on a balance of probabilities that the appellant suffered from an episode of severe hypoglycemia.

Does the appellant’s medical condition of severe hypoglycemia interfere with his ability to drive a motor vehicle safely?

24The Registrar relies on the CCMTA Medical Standards for Drivers (“CCMTA Standards”), in particular Standard 7.6.4 (Episode of Severe Hypoglycemia, Non-Commercial drivers). This Standard provides that drivers are eligible for a licence if: it has been 6 months since the last episode of severe hypoglycemia, but earlier re-licensing can be considered if an appropriate specialist indicates that glycemic control has been re-established and the conditions for maintaining a licence are met.

25Section 14(2)(a) of the Regulation permits 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 they are not binding.

26The CCMTA Standards also provide that there is clear evidence to show that both non-commercial and commercial drivers with diabetes are at an increased risk of motor vehicle crashes and those that are taking insulin have an elevated risk of crashes. Further, a relationship between hypoglycemia and crashes has also been found. The CCMTA Standards document that the neuroglycopenic symptoms that are associated with severe hypoglycemia can significantly impair the cognitive functions required for driving and a driver cannot compensate from the episodic impairment from severe hypoglycemia. There are other studies noting mild hypoglycemia may also impair these functions. Thus, experiencing a hypoglycemic episode while driving would significantly interfere with a driver’s ability to drive safely and present a safety risk to the driver themselves and other road users.

27The appellant argues that he does not suffer from a medical condition that significantly affects his ability to drive safely. The appellant testified that he goes above and beyond to stay on top of his sugar levels and keep them in great shape. He had switched to the Freestyle Libre 2 about two years ago and that it continuously monitors his blood sugars, and it keeps him on track. He testified he made a mistake when he administered the wrong insulin, and it will never happen again. He testified that he works in agriculture, and this is crop season and he should be on the road. The appellant further testified that he drives the world’s biggest vehicles which haul up to a 200-tonne load, more than two to three times the weight of a transport truck, and it is not easy to hire someone to drive these vehicles, and he needs to do so himself. He testified he does not drink or smoke, but just had a wrong scenario with a medicine. The appellant testified that he is being penalized when someone else in the same situation without diabetes would not have been penalized.

28The appellant submitted a narrative letter from Dr. M dated September 16, 2025, that documented the appellant has had diabetes since age 21 and follows a good diabetic regiment and attends all appointments. It states the appellant has never had any episodes of low blood sugars until June of this year and this was a result of a medication error where he administered the wrong insulin. The letter states that the appellant knows to check his sugars, and most be above 5 mmol/L to drive, and that he uses a Libre 2 Sensor to track his blood sugars. It further states the appellant requires his licence to support his family and has been without a paycheque for a month so anything to expedite the process would be appreciated.

29The appellant was asked about whether he kept glucagon available to treat severe hypoglycemia, and whether he or his spouse had attempted to use it when he suffered the severe hypoglycemic event. The appellant responded that he had a product that was the consistency of a toothpaste that he would swallow if he needed to treat severe hypoglycemia, but he was not responsive enough to swallow at the time of the event.

30The appellant was asked about how he manages his blood sugar while driving. The appellant reported that he checks his blood sugar on his phone within 10 minutes of leaving and checks it frequently while driving, at least every hour. The appellant was questioned as to what blood sugar value he targets while driving, and he did not provide any numerical value he assesses for but indicated that as long as his blood sugar looked like it was not going to plummet or skyrocket, he would drive. When asked specifically about the threshold under which he would not drive, he indicated that his glucose monitor will alarm at 3.3 or 3.4 mmol/L and he will treat with a cookie if his blood sugar reaches that level. He testified in response to questioning that he always keeps something with him in his lunch kit and would typically treat low blood sugar levels with cookies.

31As the appellant and his spouse had testified as to the failure of the glucose monitor alarming as a significant factor in them not having an earlier response to the appellant’s severe hypoglycemia, the appellant was asked about his practice of carrying and using a capillary blood sugar testing kit to test blood sugar. The appellant responded that he has not taken his blood sugar with a capillary blood sugar monitor in years; not since he started using his glucose monitor. He was then further questioned as to what he would do if his glucose monitor failed as it had the night he had the severe hypoglycemic event. He testified that he brings a back up glucose monitor with him, but also that there is a warm up time of an hour where he would not have a blood sugar reading.

32The appellant was asked what changes he has made to ensure that the same mistake did not happen again. He testified that he now always keeps his short-acting insulin in his lunch kit, and that he has followed up with the diabetic nurse and his family physician. He was questioned whether he has had a diabetes specialist, an endocrinologist, involved in his care, but he does not.

33The appellant was asked whether he has a commercial licence, as he had testified to driving a vehicle carrying a 200-tonne load and qualified this as a load two to three times heavier than a transport truck. He indicated he does not need a commercial licence due to his work in agriculture, where these vehicles are exempt from requiring a commercial licence. The appellant was asked as to his driving habits and testified that he drives 12-15 hours per day, and at times, over 20 hours per day.

34Under cross-examination the appellant was asked about the charge on his extended driver’s record on August 19, 2025, of “no driver’s licence or improper class of licence”. The appellant responded that he was pulled over by police and told that he should not be driving as his licence was under suspension and fined several hundred dollars. The appellant further testified that he was driving with one of the completed Diabetes Assessment Forms in his pocket. The appellant was asked whether Dr. M had told him he was safe to drive, and he indicated he had not. He was asked whether Dr. M had suggested he drive with the papers, and he reported he did not. He was asked whether Dr. S had indicated it was safe to drive, and he indicated that Dr. S had told him he would be reporting him to the Ministry for concerns regarding his medical condition and driving. The appellant was asked if he had received the Registrar’s letter of suspension, and he confirmed he had received the letter shortly after his hospital stay on May 22, 2025. The appellant was asked how long he had been knowingly driving with a suspended licence and without the support of any medical practitioner, and he responded that he had never stopped driving after the severe hypoglycemic event until he was pulled over by the police.

35I have considered the appellant’s position that his diagnosis of severe hypoglycemia will not impact his ability to drive safely. However, I find it concerning that, contrary to what Dr. M has written, the appellant has testified that he checks his blood sugar after he starts driving, not beforehand, and has his glucose monitor alarm set to 3.3 or 3.4 mmol/L, which I know as a physician duly licensed to practice medicine in Ontario and pursuant to s. 16(b) of the Statutory Powers Procedure Act, is more than 0.5 mmol/L into the hypoglycemic range. This is concerning because as indicated, research supports that even mild hypoglycemia can impair cognitive functions required for driving.

36I also find it concerning that the appellant does not keep a capillary blood sugar testing kit with him while driving but relies exclusively on his glucose monitor. This is problematic as this technology can fail, which was the situation identified by the appellant and his spouse, when his glucose monitor did not alarm the night of his severe hypoglycemic episode. Further, should the appellant be required to change his glucose monitor, there is a warmup period of an hour which may leave the appellant without a blood sugar value during a critical period while driving if he does not have the option of taking a capillary blood sugar.

37I am further concerned that the appellant did not demonstrate he understood what glucagon is, and how it works when he indicated it was an oral treatment with a consistency of toothpaste. As a physician duly qualified to practice in Ontario and pursuant to s. 16(b) of the Statutory Powers Procedure Act, I am aware that glucagon is a medication that is not administered orally, but only as an injection or a nasal spray. This is concerning because glucagon is critically important in the treatment for severe hypoglycemia, is routinely prescribed to people with type one diabetes, and it is imperative to know how and when to use to abort a severe hypoglycemic episode.

38I recognize that the appellant has a G class licence that is suspended, but also that the vehicle he is driving, and the time spent driving, are consistent with a commercial vehicle. I recognize further that standards for holding a commercial licence are require a higher level of fitness than those that operate G class vehicles. The standard for driving a commercial vehicle is higher for the reasons that these drivers spend many more hours driving, often drive under far more adverse conditions, are often unable to select their hours of work, cannot readily abandon their cargo should they become unwell on duty, may also be required to undertake heavy physical work such as loading or unloading vehicles, and lastly, because should the commercial driver suffer a collision, the consequences are much more likely to be serious. The appellant testified that many of these conditions are present in the work he does in agriculture, including that he drives one of the heaviest vehicles on the road and spends up to 20 hours per day driving.

39Insight is an important consideration when considering safety to drive. Insight into a chronic disease means that a driver is aware of their medical condition, understands how the condition may fluctuate over time, recognizes that their medical condition may impair their functional ability to drive at times, and has the judgment and willingness to comply with the suggested treatment regimen. I find it concerning that the appellant paid no respect to the suspension of his driver’s licence. Driving is a privilege, not a right, and I conclude that the appellant’s choice to drive a motor vehicle in disregard for his licence suspension that is based on medical recommendations, demonstrates that he has limited insight into the understanding of hypoglycemia and its associated risks and consequences while driving, particularly while driving a 200-tonne vehicle.

40The appellant’s testimony that he does not check his blood sugar prior to driving, has an alarm set for his blood sugar that is well within the hypoglycemic range, does not carry a capillary blood sugar kit to ensure he can always determine his blood sugar level, does not demonstrate an understanding of how to use glucagon in the setting of severe hypoglycemia and drives the equivalent of a commercial vehicle while his licence is under suspension is concerning. While I recognize Dr. M has written a letter of support, there are several inconsistencies in what Dr. M has documented and the appellant’s testimony, and it is also clear from the appellant’s testimony that Dr. M was not aware the appellant was driving without a licence. Lastly, Dr. M has not indicated his explicit support for reinstating the appellant’s licence either. Given that severe hypoglycemic can result in complete incapacitation with no ability to compensate while driving, I accept and apply the CCMTA guidance that having a period of stability is reasonable.

41As noted above, although not bound by the CCMTA Standards, the Tribunal may consider them when making its decision. The reason is that they 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. While each appeal including this one must be judged on its own merits, I am persuaded to apply the CCMTA Standards here. My review of the evidence shows that the conditions recommended for relicensing outlined in the CCMTA Standards have not been met.

42I acknowledge the burden that the lack of a driver’s licence has on the appellant; however, I find the medical and scientific evidence in this case relevant and compelling. As such, for the reasons cited, I am satisfied on a balance of probabilities that the appellant’s medical condition of severe hypoglycemia is likely to significantly interfere with his ability to drive safely.

Conclusion

43I find that the Registrar has discharged the onus of establishing on a balance of probabilities that the appellant suffers from a medical condition, and that this condition is likely to significantly interfere with his ability to drive a motor vehicle of the applicable class safely.

ORDER

44For 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.