Licence Appeal Tribunal File Number: 16492/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 Registrar of Motor Vehicles to suspend a licence pursuant to Section 47(1) of the Act.
Between:
Mohamed Ali Issa
Appellant
and
Registrar of Motor Vehicles
Respondent
DECISION & ORDER
ADJUDICATORS: Dr. Dimitri Louvish, Member Raymond C. Ramdayal, Member
APPEARANCES:
For the Appellant: Mohamed Ali Issa For the Respondent: Sharon Nelson, Representative
Heard: December 18, 2024
OVERVIEW
1Mohamed Ali Issa (the “appellant”) appeals from the decision of the Registrar of Motor Vehicles (the “Registrar” or “respondent”) to suspend their driver’s 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 their ability to drive 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 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 a mental health condition and substance use disorder, that is likely to significantly interfere with their ability to drive safely and that this provides sufficient reason to suspend their licence under s. 47(1)(g) of the Act.
4The appellant appeals the suspension under s. 50(1) of the Act. They deny that they suffer from the medical conditions alleged and deny that any such medical condition interferes with their ability to drive safely.
5Pursuant to section 50(2) of the Act, after a hearing the Licence Appeal Tribunal (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 their ability to drive a motor vehicle of the applicable class safely.
7To resolve that issue, we will address the following questions:
i. Does the appellant suffer from either or both of the medical conditions alleged?
ii. If so, is this likely to significantly interfere with their ability to drive a motor vehicle of the applicable class safely?
The Registrar bears the burden of proving on a balance of probabilities that the answer to each of these questions is ‘yes.’
RESULT
8Having considered all the evidence and submissions and for the reasons that follow, we 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 their ability to drive a motor vehicle of the applicable class safely and we confirm the Registrar’s decision to suspend the appellant’s driver’s licence.
ANALYSIS
9By letter dated January 26, 2024, the Registrar advised the appellant that his driver’s licence was being suspended in relation to a mental health condition and substance use disorder. They reached this decision after receiving a Mental Health Assessment form and a Substance Use Disorder form, both completed by a nurse practitioner and dated January 25, 2024.
10In addition to the above correspondence, the appellant has received multiple letters from the Registrar over several years. The respondent provided a historical recount of the appellant’s interaction with the Ministry of Transportation (MTO). The Tribunal is focused on the appellant’s current medical condition and safety to drive rather than historical issues. In their January 26, 2024 letter, the Registrar has advised the appellant that in their view certain steps are required before the Registrar will consider reinstating the appellant’s licence. Specifically, the Registrar is requesting confirmation from a physician or nurse practitioner that the appellant has remained abstinent from drugs for a period of one year. This period may be reduced to six months if the healthcare practitioner confirms that he has successfully completed a drug treatment program and is supportive of his driving privilege. The appellant has yet to provide this.
11It is the appellant’s position that he receives regular examinations from a physician who has assured him that he is in excellent health and free of any medical condition that would affect his ability to safely operate a motor vehicle. He denies having any history of alcohol or substance abuse and states that he has never been involved in any incidents of impaired driving. It is the appellant’s claim that most of his interaction with the MTO stems from a misunderstanding or incorrect assessment of his health.
12Despite his denial of a medical condition, the appellant was admitted to CAMH from July 27 to August 5, 2022. This was followed by regular outpatient visits which appeared to stabilize his medical condition. That medical condition was identified in a further Mental Health Assessment form dated December 23, 2022, showing a condition of schizophrenia or other psychotic disorder. Further assessments from his healthcare practitioner also reveal bipolar disorder and substance use. The appellant has also been admitted to hospital in the past year experiencing anxiety, agitation, and delusions. The appellant was prescribed medication which they did not adhere to.
13The respondent states that the appellant has demonstrated a pattern of non-compliance and misuse of medication in the past. He has also failed to attend medical appointments and shows a lack of motivation towards adhering to any recommended treatment regimen.
14The appellant’s most recent hospital visit in October 2023 was the result of inappropriate use and cough syrup medication. At the hearing, the appellant avoided discussion about his specific pattern of use. It is alleged by the respondent and confirmed in medical reports that he was consuming 2-3 bottles of cough syrup per day, which he later reduced to 2-3 bottles per week. During his recent hospitalization, the appellant declined any addiction services to address his outstanding substance use.
15The respondent presented multiple medical reports over the years which supports their position that the appellant suffers from both a mental health condition and substance use disorder. They include multiple mental health assessments and comprehensive neuro-ophthalmology examinations.
16The Tribunal places greater weight on the most recent medical reports. They include reports from Nurse Practitioner J. Connor, R.N., dated February 21, 2024, and March 1, 2024, where she confirms the appellant’s medical condition, history of non-compliance with psychiatric treatment regimens, and substance use disorder. In addition to this, a Mental Health Disorder form and Substance Use Assessment form, both dated January 25, 2024, identifies the appellant’s primary mental illness as depression/dysthymia, bipolar disorder, schizophrenia and other psychotic disorder. It also notes substance use with less than six months of abstinence. The appellant’s substance use disorder is active and ongoing and he has failed to provide documentation to the Registrar which would suggest otherwise.
17The Tribunal did take into consideration the fact that the appellant has endured personal challenges and family trauma in the past. It appears that he is estranged from certain members of his family resulting in a lack of social supports around him. However, his unfortunate personal circumstances cannot outweigh the overwhelming evidence of his medical condition and the concerns that it may impact his ability to drive safely. As such, public safety must take precedence.
18To date, the appellant has not been able to provide any of the documentation requested by the Registrar which confirms that he has remained abstinent from drugs for a period of one year nor anything which would qualify him for a reduction to six months if his healthcare practitioner confirms that he has successfully completed a drug treatment program and is supportive of his driving privilege.
Does the appellant suffer from the medical conditions alleged?
19We find, on a balance of probabilities, that the appellant does suffer from the medical conditions of bipolar disorder, schizophrenia and other psychotic disorders and substance use disorder.
20We accept the opinion of the Nurse Practitioner over the evidence of the appellant, and find on a balance of probabilities, that the appellant suffers from the medical conditions alleged.
21We assign less weight to the appellant’s self-assessment that he does not suffer from substance use disorder. The appellant did not submit any written medical evidence to dispute the diagnosis and findings from the multiple assessments. In addition to this, he has shown a history of non-compliance with medication to treat his mental health disorder. When medication is used, it is done so inappropriately and not for its intended use (e.g., cough syrup) which demonstrates a significant and active substance use disorder.
22The respondent relied on the fact that the appellant was hospitalized in the past year for the same medical conditions being alleged. This was confirmed by the appellant’s nurse practitioner. Although there was a period where the appellant appeared to stabilize in 2022, he relapsed again in 2023 and has been non-compliant with medication since.
Is/are the appellant’s medical condition(s) likely to significantly interfere with their ability to drive a motor vehicle safely?
23We find that the appellant’s medical conditions individually or cumulatively are likely to significantly interfere with his ability to drive a motor vehicle safely.
24The Registrar’s representative stated that mental health disorder and/or substance use disorder can interfere with a driver’s ability to drive safely and presents a safety risk to other road user’s safety. They further stated that the Registrar has not received sufficient information indicating his abstinence from drugs which would allow them to consider reinstating his driver’s licence.
25Section 14(2)(a) of the Regulation allows the Registrar to consider the Canadian Council of Motor Transport Administrators Medical Standards for Drivers [February 2021] (the “CCMTA Standards”), Similarly, the Tribunal may take the CCMTA Standards into consideration, although they are not binding requirements.
26The respondent is relying on the CCMTA Standards, in particular Standard 14.6.1 which deals with Psychiatric disorder – All drivers and Standard 15.6.3 which deals with Substance Use Disorder – All drivers, and internal policies at the MTO.
27As discussed above, the appellant denies that he suffers from either a mental health disorder or substance use disorder. The appellant feels that he should be allowed to drive a vehicle, feels he can do so safely and self-reports that he is in excellent health and can safely operate a motor vehicle.
28While the CCMTA Standards are well-reasoned and provide assistance, every case must be considered on its own facts. Although we are not bound by the CCMTA Standards, we find them to be reasonable and are persuaded to apply them in the circumstances of this case given the evidence before us.
29The CCMTA Standards state that in context of a driver with a medical condition, 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 licencing.
30Chapter 14 of the CCMTA Standards indicates that a driver’s level of insight is a critical consideration when assessing the risk of an episodic impairment of functional ability due to a mental health disorder. It states, “Drivers with good insight are more likely to be diligent about their treatment regime and to seek medical attention and avoid driving when experiencing acute episodes and have the judgment and willingness to adapt their driving to these limitations”.
31We share the respondent’s concerns, which is also confirmed in the medical reports reviewed, that the appellant appears to have difficulty exercising good judgement and lacks insight.
32Most importantly, there is no evidence before us from any treating healthcare provider supporting the appellant’s ability to drive safely at this time. The Tribunal holds the public interest and safety as paramount and the evidence satisfies us that either or both of the appellant’s mental health condition or substance use disorder pose a significant risk to those considerations.
33For these reasons, we agree with the respondent’s position that, on a balance of probabilities, the appellant’s medical conditions individually or cumulatively are likely to significantly interfere with his ability to drive a motor vehicle of the applicable class safely.
Conclusion
34We find that the Registrar has discharged the onus of establishing on a balance of probabilities that the appellant suffers from medical conditions that are likely to significantly interfere with his ability to drive a motor vehicle of the applicable class safely.
ORDER
35For the reasons set out above, pursuant to subsection 50(2) of the Act, we confirm the Registrar’s decision to suspend the appellant’s driver’s licence.
LICENCE APPEAL TRIBUNAL
Dr. Dimitri Louvish, M.D., Adjudicator
Raymond C. Ramdayal, Adjudicator
Released: January 17, 2025