Licence Appeal Tribunal File Number: 16662/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:

Veronique Giroux

Appellant

and

Registrar of Motor Vehicles

Respondent

DECISION

ADJUDICATOR: Dr. Isla McPherson, Member

APPEARANCES:

For the Appellant: Veronique Giroux, Appellant

For the Respondent: Ian Sookram, Agent

Held by teleconference: February 20, 2025

OVERVIEW

1Veronique Giroux (the “appellant”) appeals from the decision of the Registrar of Motor Vehicles (“Registrar”) to suspend her Class G licence under s. 47(1) of the Highway Traffic Act, R.S.O. 1990, c. H.8 (the “Act”) after the Registrar received an unsolicited police report stating that the appellant suffers from a medical condition that may affect her 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 safely drive a motor vehicle of the applicable class safely. Under s. 14(2)(b) of the Regulation, the Registrar of Motor Vehicles 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, that is likely to significantly interfere with her ability to drive safely and that this provides sufficient reason to suspend her licence under s. 47(1)(g) of the Act.

4The appellant appeals the suspension under s. 50(1) of the Act. She does not dispute that she suffers from a mental health condition and but denies that she suffers from a medical condition which interferes with her 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 her ability to drive a motor vehicle safely.

7To resolve that issue, I will address the following questions:

i. Does the appellant suffer from a mental health condition?

ii. If so, is this likely to significantly interfere with her 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.”

RESULT

9Having considered all the evidence and submissions and for the reasons that follow, I find that the Registrar has not satisfied its burden to establish that the appellant suffers from a medical condition that is likely to significantly interfere with her ability to drive a motor vehicle safely, and I set aside the Registrar’s decision to suspend the appellant’s driver’s licence.

PROCEDURAL MATTERS

10At the outset of the hearing, a late submission from the appellant was discussed. The appellant had filed a Motion Request for an extension of time for disclosure from February 12, 2025, to February 18, 2025, as she had been unable to book an appointment with her family physician until this time, and wished to submit updated medical documentation from her physician. The appellant had been advised a ruling would be made at the hearing.

11The respondent’s representative submitted that they had no objection to the late submission. The respondent’s representative also indicated that the late submission does not change the position of the Registrar.

12I allowed the appellant’s late submission, specifically updated medical documentation from the appellant’s physician, and took the medical evidence into consideration when making a determination.

ANALYSIS

Does the appellant suffer from a Mental Health Condition?

13The evidence presented at the hearing establishes that the appellant suffers from a medical condition, namely a mental health condition.

14The Registrar’s position is supported by:

i. a Police Report dated December 29, 2025, from officer TB;

ii. a Mental Health Assessment Form dated January 22, 2025, from Dr. C;

iii. a Medical Report Form dated January 22, 2025, from Dr. C;

iv. a narrative letter from Dr. C dated February 18, 2025.

15The Police Report dated December 29, 2025, submitted by officer TB indicated the appellant was an alcoholic, suffered from deteriorating mental health, was at risk for becoming involved in a collision and had been apprehended under the Mental Health Act, R.S.O. 1990, c.M7.

16Following receipt of this Police Report, the Registrar suspended the appellant’s driver’s licence effective January 12, 2025, without listing a medical condition and requested the completion of a Mental Health Assessment Form, a Substance Use Assessment Form and a Medical Report Form along with details of the circumstances leading up to the incident on December 29, 2024, including details of residual deficits and other disqualifying medical concerns.

17The Mental Health Assessment Form completed by family physician Dr. C, documented that the appellant had a diagnosis of bipolar disorder, and the condition was stable with symptoms resolved.

18The Medical Report Form from Dr. C documented that the appellant had a psychiatric condition and demonstrated normal mental competence and judgment with no evidence of instability, neuroses, psychosis, alcoholism or drug habituation. It also indicated Dr. C had been the appellant’s physician for 13 years.

19Following receipt of the requested forms, Dr. C’s documentation on the Substance Use Assessment Form satisfied the Registrar that a suspension was not warranted due to substance use disorder. The Registrar’s position was that the appellant’s driver’s licence remained suspended due to a mental health condition. The Registrar requested confirmation of 3 months of stability and the Mental Health Assessment Form to be completed again.

20The appellant subsequently submitted a narrative letter from Dr. C dated February 18, 2025, which documented that the appellant had suffered a mental health episode after discontinuing her medication but since that time had been taking her medication and was stable with her mental health.

21The appellant testified that she had been diagnosed with bipolar disorder on December 29, 2024, by psychiatrist Dr. A while in hospital and started on a neuroleptic medication that controlled her symptoms.

22The medical evidence before the Tribunal includes three documents from Dr. C that confirm the appellant has been diagnosed with a mental health condition. The appellant also confirms she has this condition.

23I find the medical evidence in this matter clear and the medical condition not in dispute. Based on the evidence, I find the Registrar has established on a balance of probabilities that the appellant suffers from a mental health concern.

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

24I find the Registrar has not proven on a balance of probabilities that the appellant’s medical condition is likely to significantly interfere with her ability to drive a motor vehicle safely.

25The Registrar relies on Chapter 14 of the Canadian Council of Motor Transport Administrators Medical Standards for Drivers [February 2021] (the “CCMTA Standards”) along with internal policies at the Registrar of Motor Vehicles. Chapter 14 of the Standards documents that psychiatric disorders can result in either a persistent or episodic impairment of the functions necessary for driving and highlights 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 psychiatric disorder.

26The Registrar relies on Standard 14.6.1. This Standard indicates a driver is eligible for a licence if the condition is stable, the driver has sufficient insight to stop driving if the condition becomes acute, the functional abilities necessary for driving are not impaired, and a treating physician supports a return to driving. In addition to this Standard, the Registrar relies on their internal policies when they require confirmation of three months of mental and emotional stability before considering reinstatement of the appellant’s driver’s licence.

27Under cross-examination the Registrar’s representative was asked as to the role of a police report in triggering a medical suspension. The Registrar’s representative testified that the Registrar receives many police reports with regards to signs and symptoms that do not trigger a medical suspension, but a medical suspension is triggered for anyone apprehended under the Mental Health Act until the requested medical forms are completed.

28The Registrar’s representative was further questioned as to which of the criteria for reinstatement the appellant had not met. The Registrar’s representative testified that the appellant had met all of the criteria for reinstatement under CCMTA Standard 14.6.1, but had not met the internal policy that outlined the time frame of three months of stability.

29The appellant testified that she has established a period of mental and emotional stability, her mental health concern has not impacted her personal and professional life and does not impact her ability to drive. She supports her position with reference to three documents:

i. A letter of support from her clinical nurse manager dated February 7, 2025;

ii. A letter of support from her spouse dated February 6, 2025;

iii. A letter of support from Dr. C dated February 18, 2025.

30The appellant testified that she was admitted to hospital for 24 hours due to a mental health incident on December 29, 2024. During this admission, she was assessed by on-call psychiatrist, Dr. A, and was started on a long-acting neuroleptic medication, Abilify, that is administered by intramuscular injection every three weeks, and she remains under the ongoing care of Dr. A. She testified the episode occurred while she was on holiday in December, and she returned to work at her next scheduled shift as a registered nurse less than a week after her admission to hospital, and has continued to work without difficulty or needing time off. She testified that she has never drank alcohol and driven and has never had any concerns with the police related to drinking and driving and has no pending court dates. She reported consuming alcohol to control intrusive thoughts associated with her manic symptoms and reported being abstinent from alcohol since the incident, and this is corroborated in the medical evidence from Dr. C. She described her work as a full-time registered nurse in a hospital setting in addition to working part-time as an instructor for a nursing program. She testified that her nursing licence requires her to have mental and emotional stability to perform her job, and there are no concerns with her performance at work.

31The appellant supported her position of being able to work full-time without any impairment from her mental health with a narrative letter from the clinical nurse manager who oversees her work. The letter from her manager was dated February 7, 2025, and documented that the appellant is employed as a registered nurse at the local hospital and has worked at this location for the past 12 years. The letter also documents that the appellant has consistently demonstrated a strong work ethic and exceptional skills while consistently showing professionalism and attention to detail. The letter further documents the appellant maintains excellent relationships with patients, their families, and her colleagues, fostering a positive and collaborative work environment. The clinical manager adds that he has full confidence the appellant will continue to excel in any future endeavour.

32The appellant further testified that her spouse also corroborates her mental and emotional stability. She referenced a letter written by her spouse dated February 6, 2025. This letter documented that her spouse was writing both in his role as the appellant’s husband as well as a qualified mental health nurse with 15 years of experience. He identified that he has had the privilege of closely observing the appellant’s mental health and well-being while being involved in her care and was confident that she is mentally stable and fit to drive a vehicle. He documented that she has been consistently compliant with her prescribed medication regimen, demonstrated a thorough understanding of her treatment plan and was adhering to it diligently. He expressed she was not experiencing any side effects or changes in her mental or physical state that would impair her ability to safely operate a vehicle. He concluded that in his professional opinion, based on his medical expertise and personal observations he had no concerns regarding her mental stability or ability to drive responsibly while on medication.

33The appellant testified that her family physician has also recorded her mental and emotional stability and is in support of the reinstatement of her driver’s licence. She testified Dr. C knows her well as he has been her doctor for over a decade and has prescribed her neuroleptic for over a year. The appellant read from a narrative letter from Dr. C dated February 18, 2025. In this letter Dr. C wrote, “This is a letter of support for miss Giroux’s ability to regain her driver’s license”. He reported she had a mental health episode with suicidal ideation due to stopping her medication. Since that time, she had been taking her medications as prescribed and been stable with her mental health, and given this stability stated, “I have no concerns with her ability to drive or her driver’s license being reinstated”.

34The appellant testified that she is currently under the care of psychiatrist Dr. A, and is compliant with her medication. She requires her licence to travel to work and to support her children. In addition to her clinical position, she described her work as an instructor for a university nursing program, and believes that the fact that she is able to parent her children and perform at a high level in her nursing positions is evidence of her mental and emotional stability.

35Under cross-examination, the appellant testified that she had a history of taking an anti-anxiety medication over a year ago that precipitated symptoms of hypomania. She described that she had insight into her symptoms given her nursing background and a family history of bipolar disorder and therefore sought help from a relative who is a psychiatrist who suggested she take the neuroleptic medication Abilify. The appellant approached her family doctor with her concerns, and she was prescribed the medication by Dr. C. Subsequently, she testified her mental health was stable until she missed several doses of her medication during the busy time preparing for the December holidays with her children. She indicated that she never experienced psychosis, but had racing thoughts that she tried to control with drinking alcohol and then resorted to a suicide attempt to stop the thoughts. This attempt was aborted by the intervention of her family, where she cited support from her spouse and her sister. The police were called, and the appellant was taken to the emergency department. The appellant testified the police had also been called two days earlier when she had reached out for support from her father-in-law disclosing to him her suicidal thoughts which resulted in him notifying the police and her presenting to the hospital. However, as she agreed to a safety plan at that time, she was discharged home from the emergency department without any treatment.

36The appellant testified that she has never been admitted to hospital for mental health prior to this 24-hour hospitalization and never needed time off work due to mental health concerns. She had never experienced an episode of mania or depression or had a suicide attempt prior to the presentation in December 2024. She testified she had demonstrated mental stability on Abilify when taken orally and quickly re-established stability when she received the same medication by injection.

37The appellant testified that following her admission to hospital, she has received follow up care from her psychiatrist, Dr. A, in early February and had two appointments with her family doctor, Dr. C. She has her next scheduled appointment with Dr. A in May 2025, and can make an appointment with Dr. C as needed, just like she had done leading up to the hearing. She testified she recognizes the need to stay under the care of a psychiatrist long term and has no intentions of not continuing to follow the psychiatric treatment plan. She testified there is no risk of her going off her medication as she understands it is required for her to function as a mother and a nurse. She only had difficulty with her mental health when she missed doses during a very busy time in her life. She has addressed the risk of forgetting her oral medication by having her medication administered by injection every three weeks by her spouse who is a mental health nurse.

38The appellant’s position is supported by the medical documentation requested by the Registrar and completed by Dr. C. On the Mental Health Assessment Form completed January 22, 2025, Dr. C documented that the appellant’s condition was stable with symptoms were resolved. In addition, there are several important questions on the Mental Health Assessment Form that ask the completing physician to identify any concerns related to insight and judgement. Dr. C has specifically not checked the boxes on this form that ask if the appellant demonstrates poor insight, lacks understanding of their illness and the impacts on the ability to drive, demonstrates non-compliance or has any ongoing symptoms that may impair her ability to drive. Dr. C has however checked the box that indicate there is no impaired cognition, attention or judgement. Additionally, on the Registrar’s requested Medical Report Form, Dr. C has checked boxes indicating that there is no instability, neurosis or psychosis. I give weight to this documentation from Dr. C as he has been the appellant’s physician for 13 years and a primary provider of her mental health care since her onset of symptoms over a year ago, which situates him very well to give an informed opinion.

39I understand that the Registrar has suspended the appellant’s licence due to a police assessment of the appellant’s mental health. However, I give weight to the fact that the appellant has received care from four different physicians (two emergency room physicians, Dr. A, and Dr. C) and none of these physicians submitted documentation that raised concerns about the appellant’s ability to drive safely.

40The only reference to the appellant’s ability to drive from a physician is a letter of support from Dr. C that was written contemporaneously just two days prior to the hearing and states, “Given the stability, I have no concerns regarding her ability to drive or having her driver’s licence reinstated”.

41I also give weight to the appellant’s testimony that she required only a 1-day admission to hospital and was stable enough to return to work within days of this admission after returning to the same medication that had controlled her symptoms for a year, and at the time of the hearing had been working full time as a registered nurse for approximately seven weeks. This testimony as to her level of functioning illustrates a picture of mental stability. This testimony is supported by the documentary evidence from her clinical manager. Further, her personal functioning and mental stability is illustrated with documentary evidence from her spouse and her physician. I acknowledge that her spouse is a healthcare provider in the field of mental health but also recognize that his personal relationship with the appellant impairs his clinical objectivity and for this reason his letter is not recognized as that of a treating healthcare provider for the appellant. However, his letter of support is accepted as the appellant’s spouse with intimate knowledge of the appellant’s personal life.

42Insight is critical to enable drivers to drive within their limitations and to know how and when these limitations change. I am aware that the appellant demonstrated sufficient insight to recognize her symptoms of hypomania previously, seek assistance from a family member who is a psychiatrist and then follow up with Dr. C to request a medication. I also recognize during this episode she reached out to family members for support when her symptoms escalated, and subsequently started a treatment with a long-acting medication administered intramuscularly in order to reduce any risk of relapse. I also give weight to the evidence that Dr. C finds the appellant does not demonstrate poor insight and does not lack understanding of how her illness may impact her ability to drive.

43Section 14(2)(a) of the Regulation allows the Registrar to consider the CCMTA Standards when determining whether the requirements of s. 14(1) of the Regulation are met. The Tribunal may take the CCMTA Standards into consideration but are not bound by them.

44Although the CCMTA Standards are well reasoned, each case must be considered on its own merits. The overriding consideration in this appeal is whether the Registrar has proven, on a balance of probabilities, that the appellant’s mental health condition is likely to significantly interfere with her ability to drive a motor vehicle safely.

45I give weight to the testimony of the Registrar’s representative that the appellant has in fact met the criteria for reinstatement under the CCMTA Standards, and her licence remains under suspension due to the Registrar’s internal policy that outlines a timeframe that has not been presented as being based in scientific evidence nor expert opinion. Moreover, this internal policy is not published publicly nor open to public scrutiny. I also acknowledge that the appellant has already completed two-thirds of this requested period of stability at the time of the hearing.

46The Registrar’s position that a longer period of stability is required due to their internal policy is weighed against the following evidence in support of the appellant:

i. Dr. C. is well known to the appellant having been her physician for 13 years, has been the primary provider of her mental health care for over a year, and has articulated in three different documents spaced apart by four weeks that the appellant is stable with all symptoms resolved.

ii. The appellant’s mental health stability is demonstrated in that it has not had an impact on her ability to perform her job as a registered nurse as confirmed by her manager.

iii. The appellant has the support of her spouse who has confirmed her mental stability on medication and noted the medication has been well tolerated with no side effects observed.

iv. While having interacted with four physicians to address her mental health concerns, no physician has reported any concern with respect to her ability to drive a motor vehicle safely.

v. The appellant has demonstrated she is knowledgeable and has insight as to why she cannot go off her medication in the future and has taken steps to ensure this will not happen.

vi. The appellant has the explicit support of Dr. C for reinstatement of her driver’s licence.

47After careful consideration of the evidence before me, for the reasons cited, I am satisfied on a balance of probabilities that the appellant’s medical condition is not likely to significantly interfere with her ability to drive safely.

Conclusion

48I find that the Registrar has not established on a balance of probabilities that the appellant suffers from a medical condition, namely a mental health condition, that is likely to significantly interfere with her ability to drive a motor vehicle safely.

ORDER

49For the reasons set out above, pursuant to subsection 50(2) of the Act, I set aside the Registrar’s decision to suspend the appellant’s driver’s licence.

Released: March 20, 2025

_________________

Isla McPherson MD

Adjudicator