Licence Appeal Tribunal File Number: 16624/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 Hamilton

Appellant

and

Registrar of Motor Vehicles

Respondent

DECISION

ADJUDICATOR: Dr. Isla McPherson, Member

APPEARANCES:

For the Appellant: Robert Hamilton, Appellant

For the Respondent: Stephen Grootenboer, Agent

Held by teleconference: February 11, 2025

OVERVIEW

1Robert Hamilton (the “appellant”) appeals from the decision of the Registrar of Motor Vehicles (“Registrar”) to suspend his Class AZ and G licences 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 condition report from a treating physician stating that the appellant suffers from a medical condition that may affect his ability to drive a motor vehicle of the applicable class 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 safely drive a motor vehicle of the applicable class safely. Under s. 14(2)(b) of the Regulation, the Registrar may require a driver to provide satisfactory evidence that they are able to drive a vehicle of the applicable class safely.

3The Registrar takes the position that the appellant suffers from a medical condition, namely seizure due to alcohol withdrawal, 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 does not deny that he suffered from a seizure due to alcohol withdrawal 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 seizure due to alcohol withdrawal?

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.”

WITNESSES

9At the outset of the hearing, the appellant indicated that he would like to call his spouse as a witness. As a witness list had not been shared with the Registrar nor the Tribunal prior to the disclosure date, submissions were taken from the respondent’s agent as to the Registrar’s position. The respondent’s agent did not object to the appellant calling his spouse as a witness during the hearing.

RESULT

10Having 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 seizure due to alcohol withdrawal?

11The evidence presented at the hearing establishes that the appellant suffers from a medical condition, namely seizure due to alcohol withdrawal.

12The Registrar’s position is supported by:

i. a Medical Condition Report (MCR) dated October 30, 2024, completed by Dr. C;

ii. a Substance Use Assessment Form dated November 19, 2024, completed by Dr. LC; and

iii. a narrative letter dated February 3, 2025, written by Dr. LC

13Dr. C submitted an unsolicited MCR to the Registrar following the appellant’s presentation to the emergency department on October 30, 2024. The unsolicited MCR identified two medical conditions. Dr. C. reported that the appellant suffered from a seizure due to alcohol/drug withdrawal and checked the box on the form indicating that this disorder has a moderate or high risk of sudden incapacitation or has resulted in sudden incapacitation, and that it has a moderate or high risk of recurrence. In addition, Dr. C checked a second box on the MCR indicating that the appellant has a diagnosis of an uncontrolled substance use disorder with alcohol and is non-compliant with treatment recommendations.

14Following the submission of the MCR, the Registrar suspended the appellant’s driver’s licence effective November 17, 2024, and requested the completion of a Substance Use Assessment Form.

15The appellant submitted a Substance Use Assessment Form completed by family physician Dr. LC, dated November 19, 2024, which also supports the Registrar’s position. Dr. LC checked the box indicating that the appellant suffers from severe substance use disorder due to alcohol. She has additionally indicated that he had suffered a seizure on October 30, 2024, and that this seizure was due to alcohol withdrawal.

16A narrative letter from Dr. LC dated February 3, 2025, comments that the appellant suffered from a seizure due to alcohol withdrawal.

17The appellant testified that while he does not dispute that he suffered from an alcohol withdrawal seizure on October 30, 2024, he disagrees with the documentation on the MCR completed by Dr. C that identifies he is non-compliant with treatment recommendations. He argued that he has been compliant with all treatments to address his alcohol use.

18The appellant described that this seizure occurred on October 30, 2024, when he was riding as a passenger in a vehicle driven by his wife. He testified that with no advanced warning, he suffered a loss of memory and awoke in the hospital and was told that he had suffered from an alcohol withdrawal seizure. He testified that he was subsequently admitted to hospital for five days where he was given medications to prevent further seizures and treat the heart condition of atrial fibrillation.

19The appellant’s spouse testified that while she was driving her husband, he became unresponsive and started shaking all over. After briefly stopping the vehicle to call for help, she decided to take him to a nearby hospital, where a seizure due to alcohol withdrawal was diagnosed.

20The medical evidence before the Tribunal includes documents from Dr. C and Dr. LC who both confirm the appellant has been diagnosed with a seizure due to alcohol withdrawal. The appellant and his spouse both confirm he has this condition.

21I find the medical evidence in this case clear and the medical condition not in dispute. Based on the evidence before me, I find that the Registrar has established on a balance of probabilities that the appellant suffers from seizure due to alcohol withdrawal.

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

22I 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.

23The Registrar relies on the CCMTA Standards, in particular Chapters 17.6.3 (Alcohol Withdrawal Seizures) and 15.6.3 (Substance Use Disorder) along with internal policies at the Ministry of Transportation. Chapter 17.6.3 provides that all drivers are eligible for a licence if:

i. The treating physician has confirmed that the cause of the seizure was alcohol withdrawal (i.e., the driver is not epileptic)

ii. They have undergone addiction treatment and have received a favourable report from an addiction counsellor;

iii. And the criteria for licence reinstatement are met in accordance with the Substance Use Disorder Standard (see 15.6.3).

24Chapter 15.6.3 provides that all drivers suffering from alcohol use disorder may be eligible for a licence if they meet the criteria for remission and/or have abstained for twelve months. It also states that earlier relicensing may be considered upon favourable recommendation from an addiction specialist and/or treatment physician recognized by the licensing authority, and the successful completion of a drug rehabilitation program. The respondent’s agent indicated that the Registrar is requiring a minimum of six months of abstinence.

25The CCMTA Standards indicate that seizures, such as the type of seizure the appellant is reported to have suffered, cause an episodic impairment of the functions necessary for driving and a driver cannot compensate. Thus, experiencing a seizure would significantly interfere with a driver’s ability to drive safely and present a safety risk to the driver themselves and other road users.

26Section 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.

27The appellant argued that he does not suffer from a medical condition that significantly affects his ability to drive safely. The appellant testified that he brought on the seizure himself when he stopped drinking abruptly a few days prior to the seizure after consuming alcohol daily for many years. He testified he had not been warned that a seizure may occur by his family doctor. He testified that he never had a seizure before the incident. He also testified that he hasn’t had a seizure or an alcoholic drink after the incident. He testified he has had no withdrawal symptoms and that his abstinence is evident as his bloodwork shows improvement in his liver, and is confirmed by Dr. LC. He testified he has been meeting with an addiction counsellor weekly for an hour and these sessions helps keep him on track and reduces his stress. He testified although he uses his AZ licence, he would be satisfied with reinstatement of his class G licence, which he requires to drive daily between job sites. He testified he has never had a car accident. He also testified that he believes he is not and never has been a threat on the roads.

28The appellant submitted several narrative letters to support his position, including two letters from Dr. LC. dated December 6, 2024, and February 3, 2025. The first letter identifies that the appellant has been abstinent since October 27, 2024, is compliant with treatment, his financial livelihood depends on his ability to drive, and she advocates for reinstatement. The second letter confirms he has had no further seizures, has been compliant with treatment, his bloodwork has demonstrated some improvement, and she is in support of reinstatement of his driving privilege. To accompany this letter are laboratory values documenting liver enzymes from August 15, 2024, December 5, 2024, and January 29, 2025. The liver enzymes are trending downwards but remain abnormal in all of the laboratory submissions. A third letter is submitted from the appellant’s addiction counsellor and indicates that the appellant has attended two sessions in each of November 2024, December 2024, and January 2025.

29Under cross-examination the appellant testified that he has consumed alcohol on a daily basis since his early 20s and is now 67 years old. During the vast majority of this time period he consumed six drinks per day after work and on weekends. He denied that he would consume more on the weekends. He used to drink hard liquor, as well as beer and wine, but in an effort to cut back over the past year has stopped drinking hard liquor. The appellant has also reduced his intake to four drinks per day. He reduced his intake citing health and family reasons. He testified he had been diagnosed with alcohol related liver disease and his family doctor had referred him to a specialist whom he continues to see. While in hospital for his alcohol withdrawal seizure he was also diagnosed with atrial fibrillation and was told that alcohol was not good for his heart. He cited that his wife and his daughter have been concerned about how much alcohol he consumes, and his wife has provided him with resources in an effort to help him reduce his intake. He testified he at times has felt guilty at how much he drinks. He has never participated in a treatment or addictions program previously. He has tried to cut back alcohol over the past year but has not stopped drinking previously.

30When asked when he last consumed alcohol by the respondent’s agent, he testified he had wine over Christmas when celebrating with family. When questioned further about this alcoholic drink after his seizure, the appellant then denied he had a drink over Christmas time. Later in his testimony, he volunteered unprompted that the drink he had at Christmas time was non-alcoholic.

31The appellant was questioned by the respondent’s agent about his testimony that he had attended weekly sessions with an addiction counsellor since his discharge from hospital. The respondent’s agent noted that the letter from the appellant’s counsellor indicated he was attending two sessions per month which would be equivalent to every other week. The appellant suggested the discrepancy might be due to missing a session over the Christmas holiday and maybe the counsellor had cancelled a session, but reiterated that he attended weekly.

32The appellant testified that he sees his family physician Dr. LC. for checking his “health” which was explained as following his liver disease. He testified that he discusses his alcohol addiction and treatment progress with his addiction counselor.

33The appellant’s spouse testified that her husband had been drinking daily for several decades and she had not thought this to be a concern previously, as it did not seem to impact his personality. In the last few years, she noted that his drinking had made him more tired, and he was “just not there”, so she along with their daughter urged him to cut back on drinking. She testified that he never drove after drinking alcohol, but drinking was the first thing he did when he came home from work, and he would drink until he fell asleep, which took away from their quality of life. She testified he has replaced the habit of drinking alcohol with non-alcoholic beverages. She testified that the appellant is following all the recommendations of his healthcare providers and has been abstinent since his seizure. She testified he sees an addiction counsellor weekly, but had seen a different counsellor or two early on in his treatment program. She corroborated the history that he used to drink six drinks per day but has cut back to four; however, she also testified that he drank more on weekends.

34I appreciate that the appellant has dramatically decreased the amount of alcohol he has consumed over the past three months and attended an alcohol treatment program with regularity. However, I am concerned about some of the discrepancies in the appellant’s testimony and between his testimony and the medical submissions. Firstly, I note that there is inconsistency in the appellant’s testimony as to when he last consumed alcohol; he initially testified that he had a drink at Christmas, then retracted that statement stating he didn’t have a drink, then he later volunteered unprompted that he had a drink, but it was non-alcoholic. Secondly, although he has attended weekly counselling sessions, this is not reflected in the letter from his addiction counsellor, nor fully addressed in the appellant’s explanation as to why there is a discrepancy in the attendance over three months. The appellant’s spouse had explained that the appellant had seen a different counselor or two initially, but this still falls short of explaining why the addiction counselor does not document more frequent sessions in the last two months.

35I acknowledge the appellant’s letters of support and that Dr. LC. has offered her support for reinstatement of his driving privileges. I find the medical documentation unusual in that Dr. LC offered her support for reinstating a commercial driver’s licence only two weeks after confirming the conditions of severe substance use disorder and alcohol withdrawal seizure. Furthermore, Dr. LC. has indicated on the Substance Use Assessment Form dated November 19, 2024, that the appellant is anticipated to finish a treatment program at the end of November 2024. The appellant testified that he is in ongoing treatment with no completion date set, which brings into question what was being communicated to Dr. LC at the time leading up to her letters if she expected his treatment to be finished at the end of November 2024, and it is still ongoing in February 2025. I take note that the appellant testified he sees his family doctor for his health concerns related to his liver disease but sees his addiction counselor for concerns related to his alcohol consumption. For these reasons, I give more weight to the narrative letter from the addiction counselor than Dr. LC’s submissions, and the letter from the addiction counsellor offers no support for reinstatement of driving privileges.

36While I commend the appellant for his reduction in alcohol intake, I also acknowledge there is an extensive history of alcohol consumption, as the appellant has consumed alcohol daily for a minimum of 40 years. As the appellant’s spouse testified, it is a very engrained habit for the appellant to drink as soon as he gets home from work and continue drinking until he falls asleep. I also appreciate that substance use disorders are chronic relapsing disorders that often require long term pharmacological and psychosocial interventions to prevent relapse. For these reasons, I agree with the CCMTA Standards that requires a treatment program be completed to consider early reinstatement, and the appellant has testified that he has not completed an alcohol treatment program, nor has a completion date been set.

37Furthermore, I think that completing a treatment program is reasonable and prudent for road safety in the context of alcohol withdrawal seizures, as the appellant would experience sudden incapacitation with no ability to compensate if a seizure were to occur. This total incapacitation without warning experienced was confirmed in the testimony of both the appellant and his spouse.

38Moreover, I find the appellant has not demonstrated insight into the risks associated with alcohol consumption, having consumed well beyond safe drinking guidelines for over four decades and only reducing his intake when showing signs of liver damage. Furthermore, the appellant’s testimony that he has never been a risk on the roads fails to take into consideration the complete inability to drive while having a seizure. This is of particular concern as the appellant’s privilege to drive a commercial vehicle as authorized by a commercial driver’s licence is a subject of this appeal.

39Risk to road safety is escalated when operating a commercial vehicle for various reasons. Commercial drivers often 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 last but certainly not least, should the commercial driver suffer a collision, the consequences are much more likely to be serious. As the risk of impairment with alcohol withdrawal seizures is sudden incapacitation with no ability to compensate, should the appellant suffer a seizure while driving, it is not difficult to understand how the consequences could be disastrous for the appellant and other road users.

40The CCMTA Standards indicate that seizures must be controlled as a prerequisite to driving and the purpose of a seizure free period for a provoked seizure is to establish that the likelihood that the provoking factor has been successfully treated or stabilized. As alcohol use is the provoking factor in this scenario, I am concerned that there was an inconsistent response to having an alcoholic drink six weeks ago in December; the process of changing a habit of over 40 years duration can be very difficult; there is ongoing elevation of the liver enzymes; the appellant’s addiction counsellor does not offer support for reinstatement of his driver’s licence; the appellant continues to require treatment with both counselling and prescription medication, and there is no planned date for completion of the alcohol treatment program. All of these factors do not suggest that the provoking factor of alcohol use has been successfully treated. Given the complete incapacitation experienced when having a seizure, I accept and apply the CCMTA guidance that having a period of stability of the provoking factor of a seizure is reasonable, and at only half of the recommended period of abstinence passing, I find this relatively short period of time to be insufficient to set aside the suspension.

41Although not bound by the CCMTA Standards, the Tribunal may consider them when making the decision for the reason that these Standards 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 been met.

42As such, for the reasons cited, I 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

43I find that the Registrar has discharged the onus of establishing on a balance of probabilities that the appellant suffers from a medical condition, namely seizure due to alcohol withdrawal, and that condition is likely to significantly interfere with his ability to drive a motor vehicle 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.