Fatima Carvalho v. Registrar of Motor Vehicles, 2025 CanLII 66340

Licence Appeal Tribunal File Number: 17154/MED

In the 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:

Fatima Carvalho

Appellant

and

Registrar of Motor Vehicles

Respondent

DECISION

PANEL: Dr. Kailey Minnings Caley Howard

APPEARANCES:

For the Appellant: Fatima Carvalho, Self-represented

For the Respondent: Melissa Litrenta, Representative

Heard by Teleconference: June 19, 2025

OVERVIEW

1Fatima Carvalho (the "appellant") appeals from the decision of the Registrar of Motor Vehicles ("Registrar") to suspend their 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 a report from the appellant's treating endocrinologist, Dr. Sandra Kim, that the appellant suffers from a medical condition that may affect their safety to drive.

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 severe hypoglycemia, 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 acknowledge that they suffer from the medical condition alleged but deny that it interferes with their 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 their ability to drive a motor vehicle safely.

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

i. Does the appellant suffer from severe hypoglycemia?

ii. If so, is this likely to significantly interfere with their 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, 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 safely and we confirm the Registrar's decision to suspend the appellant's driver's licence.

ANALYSIS

Does the appellant suffer from severe hypoglycemia?

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

11The Registrar's position is supported by the medical condition report completed by Dr. Kim on May 20, 2025. Dr. Kim's report indicates that the appellant experienced hypoglycemia requiring the intervention of a third party or producing loss of consciousness and the respondent submits that this is the definition of severe hypoglycemia.

12The appellant testified that she has Type 1 Diabetes and that Dr. Kim has been her treating endocrinologist for over ten years. She sees Dr. Kim between two and three times per year, approximately once every six months. She has blood work done about a week prior to her appointments and Dr. Kim goes over the results with her.

13At the hearing, the appellant acknowledged that she had two episodes of very low blood sugar (hypoglycemia) in the past few months that resulted in her being transported to the hospital for treatment by ambulance and that she reported those episodes to Dr. Kim during her most recent appointment. The appellant recalled the first episode occurred early in the morning on December 31, 2024. The second episode occurred earlier this year, but the appellant was unable to recall the exact date. Both episodes occurred at approximately 3:00 am, while the appellant was asleep. The appellant's parents called the ambulance to have her transported to hospital on both occasions to receive treatment, as they were unable to treat her low blood sugar by having her drink juice due to her altered level of consciousness.

14We find that the Registrar has established on a balance of probabilities that the appellant suffers from severe hypoglycemia.

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

15We 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.

16The Registrar argues that severe hypoglycemia interferes with the appellant's ability to drive safely because, as indicated in Dr. Kim's report, it involves a moderate or high risk of sudden incapacitation, or has resulted in sudden incapacitation, and a moderate or high risk of recurrence.

17The Registrar relies on the Canadian Council of Motor Transport Administrators Medical Standards for Drivers [February 2021] (the "CCMTA Standards") which states, in s. 7.6.4, that episodes of severe hypoglycemia, including episodes of hypoglycemia while sleeping, indicate a lack of glycemic control and an increased potential for further hypoglycemic episodes.

18Section 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 also take the CCMTA Standards into consideration but is not bound by them.

19The CCMTA Standards recommend that a driver who has been diagnosed with severe hypoglycemia be considered eligible for a licence if they have experienced no further episodes of severe hypoglycemia within the past 6 months. Earlier re-licensing can be considered if an appropriate specialist indicates that glycemic control has been re-established.

20We give significant weight to the medical condition report of Dr. Kim because she has been treating the appellant's diabetes for over ten years and, as an endocrinologist, specializes in treating patients with diabetes.

21The appellant argues that the severe hypoglycemia does not impact her ability to drive safely because she has taken steps to prevent episodes of severe hypoglycemia from reoccurring.

22The appellant testified that at the time of the two episodes of severe hypoglycemia, she was not wearing her continuous glucose monitor. Without the continuous glucose monitor, the appellant's insulin pump relies on the appellant to determine the rate at which the pump delivers insulin. If the pump delivers too much insulin to the appellant, an episode of hypoglycemia can result. When she wears the continuous glucose monitor, the pump uses an algorithm to determine the basal rate of insulin that will be delivered throughout the day. The appellant testified that she must be cautious when she exercises as the pump and continuous glucose meter together can sometimes cause her glucose levels to drop too rapidly after exercise.

23The appellant testified that since her most recent appointment with Dr. Kim, she has started wearing the continuous glucose monitor, has addressed certain problems that she experienced with it in the past by wearing the monitor in a different location and using a different adhesive product, has increased the amount of walking she does, and has adjusted her eating habits. The appellant submitted the daily review printouts from her continuous glucose monitor for the period of May 20, 2025 to May 26, 2025.

24The appellant testified that the continuous glucose monitor tests her glucose level every five minutes and, as long as it is in use, her pump sounds an alarm before her blood sugar drops to a hypoglycemic level. The appellant further testified to the steps she regularly takes to avoid hypoglycemic episodes while driving, including testing her blood sugar about an hour before she drives home from work.

25While we find that the appellant has a good understanding of her condition and has taken positive steps to prevent further episodes of severe hypoglycemia, the appellant did not complete and submit the diabetes form, as requested by the Registrar. As a result, the only medical evidence we have before us respecting her glycemic control relates to a single week of readings from her continuous glucose monitor. As stated above, we give significant weight to the fact that the appellant's treating endocrinologist found the two episodes of severe hypoglycemia of sufficient concern to complete the medical condition report and submit it to the Registrar.

26While we are not bound by the CCMTA Standards, in this case we agree that in the absence of evidence that it has been six months since the appellant has experienced an episode of severe hypoglycemia, and in the absence of confirmation of support for reinstatement from the appellant's treating physician, the single week of blood glucose data submitted by the appellant falls short of proving that the appellant's glycemic control has been re-established.

27Therefore, we are satisfied on a balance of probabilities that the appellant's medical condition is likely to significantly interfere with her ability to drive safely.

Conclusion

28We find that the Registrar has discharged the onus of establishing on a balance of probabilities that the appellant suffers from a medical condition, namely severe hypoglycemia, that is likely to significantly interfere with her ability to drive a motor vehicle safely.

ORDER

29For 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.