Licence Appeal Tribunal File Number: 16802/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:

Debra Howard

Appellant

and

Registrar of Motor Vehicles

Respondent

DECISION

ADJUDICATOR: Dr. Isla McPherson, Member

APPEARANCES:

For the Appellant: Debra Howard, Appellant

For the Respondent: Stephen Grootenboer, Agent

Held by teleconference: April 14, 2025

OVERVIEW

1Debra Howard (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 Medical Condition Report (MCR) 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 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 cognitive impairment, 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 denies that she suffers from cognitive impairment and 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 cognitive impairment?

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 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 confirm the Registrar’s decision to suspend the appellant’s driver’s licence.

ANALYSIS

Does the appellant suffer from cognitive impairment?

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

11The Registrar’s position is supported by a MCR dated January 27, 2025, from Dr. M.

12Dr. M, a specialist in internal medicine, checked the box on the MCR indicating the appellant suffers from Dementia or Alzheimer’s and provided the following narrative comments, “Patient recently hospitalized with profound anemia, weight loss, bleeding, lacks insight into poor health, obvious memory impairment, cognitive decline”.

13Following the submission of the MCR, the Registrar suspended the appellant’s driver’s licence effective February 9, 2025, and requested the completion of a Cognitive Disorders Form.

14The appellant disagrees that she has Dementia or Alzheimer’s or cognitive impairment. The appellant testified she was admitted to hospital from January 10 to 13, 2025 after experiencing abdominal pain. She testified that during her admission, she received a blood transfusion, and was then told by a nurse she was very healthy and had nothing wrong with her at discharge. She testified she was called for a follow up appointment with Dr. M on January 27, 2025, which she attended with her daughter. During this appointment Dr. M did a physical examination of some wounds on her legs and told her he had made a referral to Dr. K. The appellant testified she told Dr. M she did not need any other doctors as she was healthy. The appellant testified that Dr. M then yelled at her that he would steal her car if she did not attend the appointment and the appellant replied that she would call the police if he stole her car.

15After receiving a call from geriatrician Dr. K’s office, the appellant testified she attended the appointment with her estranged husband on March 3, 2025. During this appointment, she was asked to draw something, name animals, and repeat words and then recall them approximately 10 minutes later. She testified she had difficulty recalling all the words and naming all the animals. When questioned about the outcome of the appointment, the appellant testified that Dr. K told her she was stupid and yelled at her, so she left the appointment before it was over.

16The appellant testified she did not want her daughter to come to the appointment with Dr. K because of what she had done to her. The appellant testified that her daughter told Dr. M and Dr. K that she is not cooking for herself, not eating well and not cleaning her apartment. The appellant described that her daughter lied, and this information is untrue. The appellant explained how she routinely cleans her apartment.

17Under cross-examination the appellant was asked whether she had requested Dr. M or Dr. K to complete the requested Cognitive Disorders Form requested by the Registrar, and she stated that she had not.

18The appellant testified as to a recent appointment she sought at a walk-in clinic to obtain a refill of her cholesterol medication. She testified her family doctor had left the area approximately six months ago and she needed the medication refilled. The Registrar asked if she had requested the doctor in the clinic to complete the Cognitive Disorder Form, and the appellant responded that she had not told the doctor that her licence was suspended or why it was suspended and had not asked him to complete the requested Form.

19While the appellant disagrees with a diagnosis of cognitive impairment, she has not provided any medical evidence to dispute the diagnosis.

20The medical evidence before the Tribunal comprises a MCR completed by Dr. M that documents the presence of Dementia or Alzheimer’s with supporting statements that the appellant suffers from obvious memory impairment and cognitive decline.

21I find the medical evidence in this case relevant and persuasive. Based on the information available, I find that the Registrar has established on a balance of probabilities that the appellant suffers from cognitive impairment.

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

23The Registrar’s position is supported by the Canadian Council of Motor Transport Administrators Medical Standards for Drivers [February 2021] (the “CCMTA Standards”).

24Section 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.

25Within these Standards, the Registrar relies on Chapter 6 that describes cognitive impairment including dementia and the concerns with driving safely. In these Standards, it states that research clearly indicates that those with dementia are at higher risk for adverse driving outcomes.

26Specifically, Standard 6.6.1 states that drivers who are diagnosed with cognitive impairment would be eligible for a licence if:

i. Complete medical assessment indicates cognitive functions necessary for driving are not impaired;

ii. Where required, functional driving assessment shows condition does not affect ability to drive; and

iii. Conditions for maintaining a licence are met.

27The Registrar stated that no medical information has been received to show that the medical condition has resolved or improved to the point that it would not affect the appellant’s ability to drive. The Registrar stated that the law has been applied reasonably and correctly, that their decision is in line with the national medical standards, and on the balance of probabilities, the appellant does have a condition that will interfere with her ability to drive safely.

28The appellant testified that she is a safe driver and has no accidents. She recalled one situation a few years ago where a driver almost hit her vehicle. She testified she uses her car to run errands and visit friends. She testified she keeps her car in good condition and will need to take the snow tires off this month.

29Under cross-examination, the appellant was questioned as to whether she would follow up with Dr. K, the geriatrician, as she had left the office before the appointment was finished. The appellant testified she would not go back to an appointment with Dr. K. The appellant was also questioned if she would return for an appointment with Dr. M. The appellant stated she would not, and reiterated that he had threated to steal her car. She further testified that Dr. M is a liar and a lot of people in her town agree with this opinion.

30I considered the appellant’s position that the diagnosis of cognitive impairment will not impact her ability to drive safely. However, this is weighed against:

i. the scientific research that cognitive problems often have a direct effect upon fitness to drive as outlined in the CCMTA Standards,

ii. the appellant has not provided a medical opinion or any evidence that is inconsistent with the medical evidence which supports the Registrar’s position that her condition is likely to significantly interfere with her ability to drive a motor vehicle safely;

iii. the appellant has had three medical doctors involved in her care since her licence was suspended, and has not asked any one of them to provide documentation to support her position.

iv. the appellant has testified that her daughter has raised concerns with two of her doctors as to the appellant’s ability to care for herself.

31Although this Tribunal is not bound by the CCMTA Standards, they can be considered when making the decision. 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. Accordingly, I am persuaded to apply them here. My review of the evidence shows that none of the conditions recommended for relicensing outlined in the CCMTA Standards have been met.

32I acknowledge the burden that the lack of a driver’s licence is having on the appellant. However, the medical evidence is relevant and compelling.

33As 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 her ability to drive safely.

Conclusion

34I find that the Registrar has discharged the onus of establishing on a balance of probabilities that the appellant suffers from a medical condition, namely cognitive impairment, and that condition is likely to significantly interfere with her ability to drive a motor vehicle safely.

ORDER

35For 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.

Released: April 24, 2025

__________________________

Isla McPherson MD

Adjudicator