Licence Appeal Tribunal File Number: 17377/MED

An appeal under subsection 50(1) of the Highway Traffic Act, R.S.O. 1990, c. H.8, from a decision of the Minister of Transportation to downgrade a licence pursuant to Section 32(5)(b)(i) of the Act.

Between:

Donald Chisholm Appellant

and

Minister of Transportation Respondent

DECISION

ADJUDICATOR: Dr. Isla McPherson, Member Gurleen Thethi, Member

APPEARANCES: For the Appellant: Donald Chisholm, Appellant For the Respondent: Stephen Grootenboer, Agent

Held by teleconference: August 20, 2025

OVERVIEW

1Donald Chisholm (the “appellant”) appeals from the decision of the Minister of Transportation (“Minister”) to downgrade his commercial AB licence to a G class licence under s. 32(5)(b)(i) of the Highway Traffic Act, R.S.O. 1990, c. H.8 (the “Act”) after the Minister received an unsolicited medical report from a physician indicating that the appellant suffers from a medical condition that may affect his ability to drive a vehicle of the applicable class safely.

2Section 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 may require a driver to provide satisfactory evidence that they are able to drive safely.

3Section 32(5)(b)(i) of the Act states that the Minister may impose the conditions authorized by the regulations, remove any conditions or endorsements or change the class or classes of driver’s licence held by the person, in accordance with the results of the examinations and other prescribed requirements.

4The Minister takes the position that the appellant suffers from a medical condition, namely Implantable Cardioverter Defibrillator (ICD), that is likely to significantly interfere with his ability to drive a commercial vehicle safely and that this provides sufficient reason to downgrade his licence under s. 32(5)(b)(i) of the Act.

5The appellant appeals the downgrade under s. 50(1) of the Act. He does not deny that he has an ICD but denies that he suffers from a medical condition which interferes with his ability to drive a commercial vehicle safely.

6Pursuant to section 50(2) of the Act, after a hearing the Tribunal may confirm, modify, or set aside the decision or order of the Minister.

ISSUES

7The 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 commercial vehicle safely.

8The downgrade letter from the Minister dated June 27, 2024, indicated that the appellant’s licence was downgraded due to a cardiac condition. It was clarified with the Minister what cardiac condition was the basis for the downgrade. The Minister explained that the medical condition was an ICD secondary to underlying cardiac conditions of coronary artery disease and ischemic cardiomyopathy.

9To resolve that issue, we will address the following questions:

i. Does the appellant have an ICD?

ii. If so, is this likely to significantly interfere with his ability to drive a commercial vehicle safely?

10The Minister bears the burden of proving on a balance of probabilities that the answer to each of the above questions is “yes.”

RESULT

11Having considered all the evidence and submissions and for the reasons that follow, we find that the Minister 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 commercial vehicle safely and we confirm the Minister’s decision to downgrade the appellant’s driver’s licence.

ANALYSIS

Does the appellant have an ICD?

12The evidence presented at the hearing establishes that the appellant has a medical condition, namely an ICD.

13The Minister’s position is supported by:

i. a Medical Condition Report (MCR) completed by cardiologist Dr. D, dated March 15, 2024

ii. a Cardiovascular Assessment Form completed by family physician Dr. L dated June 17, 2025

14The MCR submitted by Dr. D indicates the appellant suffers from 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, due to heart disease with pre-syncope/syncope/arrhythmia. Dr. D added narrative comments for further explanation, “Cardiac arrest treated with external defibrillation and subsequent defibrillator implant”.

15Following the receipt of the MCR the Registrar suspended the appellant’s commercial and G class licences and requested the completion of a Cardiovascular Assessment Form.

16This Cardiovascular Assessment Form was completed by the appellant’s family physician, Dr. L, and reported that the appellant had coronary artery disease and suffered a ST-elevation myocardial infarction in 2005 where he received percutaneous coronary intervention with placement of two stents. He subsequently was diagnosed with ischemic cardiomyopathy. He suffered a cardiac arrest on March 9, 2024, and was shocked with an automated external defibrillator in the community, transferred to hospital and received left heart catheterization which did not show any culprit lesion but moderate multivessel disease. The cardiac arrest was suspected to have been scar mediated ventricular tachycardia / ventricular fibrillation +/- ischemia and the appellant subsequently had an ICD implanted for secondary prevention.

17Following the receipt of the Cardiovascular Assessment Form, the appellant’s G class licence was reinstated June 27, 2024, but he was deemed ineligible for a commercial licence.

18The appellant did not dispute that he has an ICD, coronary artery disease or ischemic cardiomyopathy. He testified that he has two stents in his heart from a previous heart attack but had been doing very well medically before his cardiac arrest, with good control of his blood pressure and cholesterol. He testified he had filled out medical reports for the Ministry for many years and everything had been acceptable until the event on March 9, 2025, occurred. He testified that in the few weeks leading up to his cardiac arrest he had been dealing with a rash on his arms for a few weeks he believed was caused by a virus, and on the day of the arrest he was drinking a lot of strong coffee. He wondered if both the caffeine and the virus causing the rash on his arms might have contributed to his cardiac arrest. He described that while curling he experienced an overwhelming feeling that something was wrong before losing consciousness and waking up in the hospital where he was told he had suffered a cardiac arrest and been revived with a defibrillator. He testified he subsequently underwent several medical investigations and was told the arrest was caused by scar tissue in his heart and was advised he would need an ICD. While the appellant did not dispute that he had an ICD, he questioned whether the ICD was needed.

19The medical evidence before the Tribunal includes documents from Dr. D and Dr. L who both reported the appellant has an ICD. The appellant confirmed he has an ICD.

20We find the medical evidence in this case clear and the medical condition not under dispute. Based on the information available, we find that the Minister has established on a balance of probabilities that the appellant has an ICD.

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

21We find that the Minister has proven on a balance of probabilities that the appellant’s medical condition is likely to significantly interfere with his ability to drive a commercial vehicle safely.

22The Minister argued that the appellant’s medical condition of having an ICD interferes with his ability to drive a commercial vehicle safely and relies on the Canadian Council of Motor Transport Administrators Medical Standards for Drivers [2025 Update] (the “CCMTA Standards”). The Minister noted that these standards are written by physicians and experts across the country and used in Ontario and other jurisdictions to assess driver fitness in the setting of certain medical conditions.

23The Minister argued that the appellant’s medical condition is likely to interfere with his ability to drive a commercial vehicle safely and relied on Chapter 3 of the CCMTA Standards which indicates that drivers with cardiovascular disease have a higher risk of adverse driving outcomes than those without cardiovascular disease. The Minister highlighted that the CCMTA Standards were updated in 2025 to reflect the latest Guidelines from the Canadian Cardiovascular Society. Standard 3.6.24 applies to commercial drivers who have declined an implantable cardioverter defibrillator (ICD) or have an ICD implanted. This Standard states that drivers with ICDs or declining an ICD are not eligible for a commercial licence.

24The Minister stated that they do not take the downgrade lightly but have a duty to protect all road users in Ontario and their decision is reasonable and in line with the law and the CCMTA Standards. The Minister noted that commercial drivers spend more time on the road, carry heavy loads and if there was a medical event while driving the results could be much more catastrophic than for a class G licence which reflects their higher threshold for licencing. The Minister identified that the appellant’s cardiologist did not support the reinstatement of the appellant’s commercial licence.

25Section 14(2)(a) of the Regulation allows the Minister 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 is not bound by them. There is no regulatory obligation on the Tribunal to consider the Canadian Cardiovascular society’s Guidelines; however, they too many be considered by the Tribunal.

26During cross-examination the appellant asked the Minister if there are other drivers with ICDs and the Minister responded that there probably were, but he was not aware of any statistics.

27The appellant testified that he has an appreciation for the importance of public safety and has been driving all his life. He testified that he drove for 9 years as a coach driver across Canada and the United States, and then switched to more local truck driving which has been doing for 40 years. He testified he no longer drives long distances, drives only during the daytime, and has maintained a clean driving record with no convictions or accidents. He testified that he loves his work and would like to continue to work until he is ready for retirement. He testified he has done his own research and learned that very few accidents are caused by medical conditions. He further testified that he is compliant with instructions from his doctors, and his blood pressure and cholesterol are controlled, and his cardiac condition is stable. He testified he has undergone many investigations including echocardiograms, ICD evaluations and a Holter monitor which confirm his stable condition. He testified that most occurrences with cardiac arrests occur within a year of having an ICD and it has now been a year and a half since his ICD, and there have been no concerns identified during his doctors’ appointments. He testified he has the support of his physicians and is committed to maintaining the highest standards of safety.

28Under cross-examination the Minister questioned the appellant regarding what it would feel like to receive a shock from his ICD. The appellant responded that he had been told it would feel like a large kick to the chest, and the Minister questioned as to what might happen if this occurred while driving. The appellant testified that he would pull over right away and because he had already suffered a cardiac arrest, he understands what this would feel like more than someone who had not previously had a cardiac arrest.

29The appellant was questioned about the discussion he had with his cardiologist regarding returning to commercial driving. The appellant testified his cardiologist had told him that he would not override the guidance of the Minister, and the appellant could appeal the downgrade if he wanted, but he was certain that his appeal would be denied.

30The appellant was questioned as to his vehicle and driving habits and responded that he drives a large transport vehicle, 45 feet in length and drives between 160-220 km per day on country roads and a highway making eight or nine stops per day.

31We acknowledge the appellant’s position that he has driven a commercial vehicle safely for decades, that continuing to drive a commercial vehicle with an ICD for secondary prophylaxis after a cardiac arrest would not pose a risk to road safety, and that he has the support of his doctors. However, in review of Dr. M’s consultation note his only reference to commercial driving is that he acknowledges the appellant is disqualified, “Unfortunately his history of shockable rhythm with impaired level of consciousness is disqualifying with respect to commercial driving”. Dr. M does not state that he supports reinstatement, and this position is corroborated by the appellant’s testimony of his conversation with Dr. M. While Dr. L offered support for his appeal by questioning why the appellant would not be eligible for a commercial licence if he has a private licence, we give more weight to Dr. M’s opinion as a cardiologist given the suspension is due to a cardiac condition. Furthermore, Dr. L has provided no reasoning why standards should be the same for commercial versus private driving. We recognize the CCMTA Standards require a higher level of fitness for commercial drivers than those that operate G class vehicles. We acknowledge that the differences in these standards are significant to the appellant, but we disagree that there is no additional risk to road safety when operating a commercial vehicle. The standard for driving a commercial vehicle is higher for the reasons that these drivers spend many more hours driving, often drive under far more adverse conditions, are often unable to select their hours of work, cannot readily abandon their cargo should they become unwell on duty, may also be required to undertake heavy physical work such as loading or unloading vehicles, and lastly, because should the commercial driver suffer a collision, the consequences are much more likely to be serious. The appellant testified that many of these conditions are present in the work he does as a commercial driver.

32We further acknowledge that if the appellant’s cardiac condition can cause episodic impairment through partial or complete loss of consciousness that incapacitates the driver and for which a driver cannot compensate. Thus, experiencing a cardiac arrest would significantly interfere with a driver’s ability to drive safely and present a safety risk to the driver themselves, and other road users. We further acknowledge that on the Cardiovascular Assessment Form completed by Dr. L she has responded to the question of whether the annual risk of sudden incapacitation is felt to be 1% or less by checking the box “unknown”. We do not find it supportive of reinstating a commercial licence when the risk of sudden incapacitation is unknown.

33Although not bound by the CCMTA Standards, we acknowledge that they are updated in 2025 to reflect the recently updated Canadian Cardiovascular Society Guidelines, which are produced by cardiovascular researchers and clinicians, and updated periodically in response the best available evidence regarding advances in investigation and management of cardiovascular diseases. Given the absence of a supporting statement from the appellant’s cardiologist, the complete incapacitation with inability to compensate that can occur with the appellant’s condition, and the catastrophic results that could occur if experiencing a cardiac arrest while driving a 45 foot truck, we are persuaded to apply the CCMTA Standards.

34We appreciate the burden that the lack of a commercial driver’s licence is having on the appellant. This is weighed against the current and relevant medical evidence that the appellant does not meet the criteria for relicensing.

35As such, for the reasons cited, we are satisfied on a balance of probabilities that the appellant’s medical condition is likely to significantly interfere with his ability to drive a commercial vehicle safely.

Conclusion

36We find that the Minister has discharged the onus of establishing on a balance of probabilities that the appellant suffers from a medical condition, namely an ICD, and that medical condition is likely to significantly interfere with his ability to drive a commercial vehicle safely.

ORDER

37For the reasons set out above, pursuant to subsection 50(2) of the Act, we confirm the Minister’s decision to downgrade the appellant’s driver’s licence.