Licence Appeal Tribunal File Number: 16905/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:

Benjamin Givlin

Appellant

and

Registrar of Motor Vehicles

Respondent

DECISION

ADJUDICATOR: Dr. Isla McPherson, Member

APPEARANCES:

For the Appellant: Benjamin Givlin, Appellant

For the Respondent: Ian Sookram, Agent

Held by teleconference: May 1, 2025

OVERVIEW

1Benjamin Givlin (the “appellant”) appeals the decision of the Registrar of Motor Vehicles (“Registrar”) to suspend his 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 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 holder of a driver’s licence 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 a seizure, 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. While he does not dispute that he suffered from a seizure, he denies that this condition interferes with his ability to drive a vehicle of the applicable class 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 of the applicable class safely.

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

i. Did the appellant suffer from a seizure?

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

ANALYSIS

Did the appellant suffer from a seizure?

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

11The Registrar’s position is supported by:

i. a Medical Condition Report (“MCR”) dated, March 3, 2025, from Dr. V;

ii. a Seizure and Loss of Consciousness (LOC) Form dated, March 27, 2025, by Dr. B;

iii. a narrative letter dated, April 16, 2025, by Dr. B; and

iv. a second Seizure and LOC Form from Dr. B dated, April 18, 2025

12On the MCR dated March 3, 2025, emergency room physician, Dr. V, checked the box indicating the appellant suffered from epilepsy, and that this is 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. Dr. V added narrative comments that the appellant had suffered a five-minute tonic-clonic seizure, that this was the appellant’s first seizure and further investigation was required.

13Following receipt of this MCR the Registrar suspended the appellant’s driver’s licence effective March 15, 2025, and requested the completion of a Seizure and LOC Form.

14The appellant’s family physician, Dr. B, completed the requested Seizure and LOC Form on March 27, 2025, and checked the box indicating that the appellant had suffered from a provoked seizure caused by a structural brain abnormality less than three months prior. Dr. B added narrative comments that the appellant had a brain abscess secondary to an ear infection that was treated with surgery and required intravenous (IV) antibiotics.

15Following review of the Seizure and LOC Form, the Registrar requested confirmation that it had been six months since the provoking factor had been stabilized, resolved, or corrected with or without treatment before reinstating the appellant’s driver’s licence.

16The appellant submitted an updated Seizure and LOC Form and a narrative letter from Dr. B which both confirmed again the diagnosis of a provoked seizure caused by a brain abscess secondary to an ear infection.

17The appellant testified that he did not dispute that he experienced a seizure on March 3, 2025, after suffering from an ear infection for several days. He testified the cause of the seizure was due to the brain abscess that had spread from the mastoid bone behind the ear. He further testified he required surgery to drain the abscess and he subsequently received a six-week course of both oral and IV antibiotics.

18The medical evidence before the Tribunal comprises four medical forms that all document the appellant suffered from a seizure. The appellant does not dispute this diagnosis.

19The medical evidence in this case is clear and the appellant’s testimony supports that a seizure occurred. Based on the available information, I find that the Registrar has established on a balance of probabilities that the appellant suffered from a seizure.

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

20I 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.

21The Registrar’s position is supported by:

i. The Canadian Council of Motor Transport Administrators Medical Standards for Drivers [February 2021] (the “CCMTA Standards”).

22The Registrar argued that the appellant’s medical condition is likely to interfere with his ability to drive safely and relies on the CCMTA Standards. Chapter 17 describes seizures and the associated concerns with driving. Standard 17.6.1 applies to drivers who have been diagnosed with a provoked seizure caused by a structural brain abnormality, and states that a driver is eligible for a licence if:

i. They have undergone a neurological assessment to determine the cause of the seizure, and epilepsy is not diagnosed.

ii. It has been six months since the provoking factor stabilized, resolved, or was corrected, with or without treatment, and they have not had a seizure during that time.

iii. The treating neurologist or neurosurgeon indicates that further seizures are unlikely.

23The CCMTA Standards indicate that seizures, such as the type of seizure the appellant is described to have suffered, cause an episodic impairment of the functions necessary for driving, for which 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.

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.

25Under cross-examination of the Registrar, the appellant questioned which of the criteria in CCMTA Standard 17.6.1 he had not met. The Registrar answered that he was not a medical advisor and was not involved with making decisions regarding medical suspensions. However, it appeared that the appellant had not met the criteria of six months elapsing since the provoking factor stabilized, resolved, or was corrected.

26The appellant testified that every appeal needs to be considered on a case-by-case basis, and the source of his seizure had been identified and treated and he believes he has met two of the three criteria outlined in CCMTA Standard 17.6.1. He testified the only criteria he has not met is the six-month time frame. The appellant submits that his position is supported by a narrative letter from his family physician, Dr. B, dated April 16, 2025, and a consultation letter from, Dr. K, an Ear Nose Throat (ENT) surgeon, dated April 15, 2025

27The narrative letter from Dr. B indicated that the appellant had undergone neurological assessment to determine the cause of the seizure, and another provoked seizure caused by a structural abnormality was unlikely. He documented the appellant had a seizure on March 3, 2025, which was treated surgically on March 6, 2025, and there had been no concerns during the appellant’s recovery. The appellant had a follow up MRI on April 10, 2025, which showed no remaining infection in the brain, and that the appellant would complete his antibiotic medication on April 16, 2025.

28The consultation letter from Dr. K indicated that the appellant had experienced left acute otitis media complicated by a brain abscess. The letter documented the appellant had a tube placed in his left ear at the time of the craniotomy on March 6, 2025, and the appellant no longer had any drainage from the tube.

29Under cross-examination the appellant was asked about a post-operative appointment with his neurosurgeon. The appellant testified that his discharge instructions from the hospital indicated he would have an appointment with the neurosurgeon within six weeks of discharge, but his neurosurgeon had experienced a family emergency and he had not yet had the appointment.

30The Seizure and LOC Form completed by Dr. B on March 27, 2025, and April 18, 2025, documented that the appellant’s neurosurgeon, Dr. R, had indicated that further seizure activity was not expected. The appellant was asked how Dr. B understood Dr. R’s risk assessment for further seizures if the appellant had not yet seen Dr. R for his post-operative appointment. The appellant testified that he asked a resident/fellow at the time of discharge about his risk of seizure recurrence and then shared this information with Dr. B.

31The appellant further testified that an infectious disease specialist, Dr. A had consulted on his case. The appellant was asked if he had a post-operative appointment with Dr. A. The appellant indicated that he had an appointment in April and will continue to be followed by Dr. A for another few months, with another appointment in June 2025.

32The appellant was asked about anti-seizure medication, and he testified he had been prescribed anti-seizure medication for two weeks upon discharge. He testified that he was unclear who was overseeing the duration of this prescribed medication. There is no written medical evidence that comments on the use of prophylactic medication to prevent further seizures.

33I understand that the appellant testified he had been told verbally by a resident/fellow that further seizures are not expected, but I am concerned that the appellant has not completed his follow up appointment with neurosurgeon Dr. R, nor reviewed the results of the post-operative MRI or EEG with Dr. R. Although Dr. B has commented on the MRI result, there is no written medical evidence commenting on the EEG results. I am further aware that the appellant testified as to the ongoing follow up required with the infectious disease physician following his care.

34I have considered the appellant’s position that his history of a provoked seizure secondary to a brain abscess will not impact his ability to drive safely. However, I find it concerning that the appellant has testified that Dr. B made his assessment based on what a resident/fellow told the appellant who then told Dr. B, rather than on the recommendation of the neurosurgeon following a post-operative appointment. I further find it concerning that the appellant has not met with the neurosurgeon to review the results of the MRI or EEG, nor the duration of anti-seizure medication. I also find it concerning that the appellant finished a course of six weeks of antibiotics only two weeks prior to the hearing and has a follow up appointment with his infectious disease physician next month. Undergoing craniotomy to drain a brain abscess is a serious medical intervention. As the appellant testified, he was required to take anti-seizure medication for two weeks following the surgery, it suggests the risk of seizure recurrence does not immediately resolve following the surgery, which is what the appellant testified he was told by the resident/fellow.

35I acknowledge that acute otitis media is a very common illness, however experiencing a brain abscess causing a seizure secondary to an ear infection is an unusual complication. While I acknowledge Dr. B’s overview of the appellant’s post-operative treatment course, this is not a common condition followed in family medicine, as evidenced by the testimony of the appellant that his medical condition required the consultation of three different specialists and two surgical interventions. For this reason, I think that completing the post-operative follow up with Dr. R and Dr. A is important to determine any associated risks of further seizure.

36The CCMTA Standards describe that seizures must be controlled as a prerequisite to driving, and that the purpose of a seizure free period elapsing for a provoked seizure prior to returning to driving is to establish that the provoking factor has been successfully treated or stabilized and another seizure is unlikely to recur. Furthermore, given the complete incapacitation experienced when having a seizure and the inability to compensate while driving, I accept and apply the CCMTA guidance that having a period of stability is reasonable. With less than two months since the surgery and only two weeks since finishing antibiotics, far less than half the time that is required to meet the six-month CCMTA Standard has passed. Given the absence of a medical opinion form the treating neurosurgeon, no follow-up with the neurosurgeon, and no supporting statement from any physician regarding the reinstatement of driving privileges, I find this insufficient to set aside the suspension.

37I appreciate the hardships that the appellant is experiencing with the loss of his driver’s licence, but based on the medical evidence and the individual merits of this case, I believe a longer seizure-free period is reasonable.

38As 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

39I find that the Registrar has discharged the onus of establishing on a balance of probabilities that the appellant suffers from a medical condition, namely a seizure, and that condition is likely to significantly interfere with his ability to drive a motor vehicle safely.

ORDER

40For 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.