Licence Appeal Tribunal File Number: 17961/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:

Andre Micallef

Appellant

and

Registrar of Motor Vehicles

Respondent

DECISION

ADJUDICATOR: Dr. Isla McPherson, Member

APPEARANCES:

For the Appellant: Andre Micallef, Appellant

For the Respondent: Melissa Litrenta, Agent

Held by teleconference: December 9, 2025

OVERVIEW

1Andre Micallef (the “appellant”) appeals from the decision of the Registrar of Motor Vehicles (“Registrar”) to suspend his class G driving privileges 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 report from a treating physician stating that the appellant suffers from a medical condition that may affect his 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 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 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. The appellant does not dispute that he suffered from a hypoglycemic event causing a seizure, but denies he suffers from severe hypoglycemia. The appellant denies that he suffers from any medical condition that would interfere with his ability to drive a vehicle of the applicable class safely.

5Pursuant to s. 50(2) of the Act, after a hearing the Tribunal may confirm, modify, or set aside the decision or order of the Registrar.

6The Open Court Principle was reviewed at the outset of the hearing.

ISSUES

7The issue in this appeal is whether the appellant suffers from severe hypoglycemia, and, if so, if this condition is likely to significantly interfere with his ability to drive a motor vehicle safely.

8To resolve that issue, I will address the following questions:

i. Does the appellant suffer from severe hypoglycemia?

ii. If so, is this likely to significantly interfere with his ability to drive a vehicle of the applicable class safely?

9The Registrar bears the burden of proving on a balance of probabilities that the answer to each of the above questions is “yes.”

RESULT

10Having 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 vehicle of the applicable class safely and I confirm the Registrar’s decision to suspend the appellant’s driver’s licence.

ANALYSIS

Does the appellant suffer from severe hypoglycemia?

11The evidence presented at the hearing establishes that the appellant suffers from a medical condition, namely severe hypoglycemia.

12The Registrar’s position is supported by:

i. a Medical Condition Report (MCR) dated August 3, 2025, and

ii. Diabetes Assessment forms dated August 27, and November 19, 2025, and

iii. Seizure and Loss of Consciousness forms dated August 27, and November 19, 2025.

13Dr. A submitted an unsolicited MCR dated August 3, 2025, indicating the appellant suffered 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 a seizure caused by hypoglycemia.

14Following the receipt of the MCR, the Registrar requested further medical information. The appellant’s family physician, Dr. B, completed the Registrar’s Seizure and Loss of Consciousness form on August 27, 2025, documenting the appellant does not have a seizure disorder, but had a hypoglycemia induced seizure less than three months earlier. Dr. B also completed the Registrar’s Diabetes Assessment form on August 27, 2025, indicating the appellant had type one diabetes treated with insulin, the appellant had an episode of hypoglycemia unawareness in the past three months as well as an episode of severe hypoglycemia requiring outside intervention within the past six months, and adequate glycemic control had been re-established. Dr. B added the narrative comments that the appellant had one hypoglycemic event, on August 5, 2025, his HbA1c was 10.2 and he is followed regularly by an endocrinologist.

15Upon receipt of these forms the Registrar suspended the appellant’s licence due to severe hypoglycemia and required confirmation that there were no further episodes of severe hypoglycemia, that the condition had remained stable for a period of six months, that an A1c value that was congruent with blood logs and confirmation that glycemic control had been re-established.

16An updated Seizure and Loss of Consciousness form was completed by Dr. B dated November 19, 2025, reporting again the appellant had a hypoglycemic induced seizure and there had been no hypoglycemic events in the past 90 days. An updated Diabetes Assessment form was also completed by Dr. B dated November 19, 2025, indicating the appellant had not had an episode of hypoglycemia unawareness in the past three months but had an episode of severe hypoglycemia in the past six months and that glycemic control had been re-established. Dr. B added the narrative comment that he had reviewed the appellant’s blood sugar readings for the last 90 days and there were no hypoglycemic events.

17Following receipt of these forms, the Registrar continued the suspension of the appellant’s drivers licence and requested confirmation of no severe hypoglycemic reactions and that the condition remained stable for a period of six months, as well as a recently conducted A1C with confirmation that the level is congruent with blood logs, and confirmation that stable glycemic control had been re-established. The appellant did not submit any further documentation to the Registrar.

18The appellant testified that he had lived with type one diabetes for 13 years, and he managed his illness with insulin. He testified he does not suffer from severe hypoglycemia, but rather suffers from diabetes. He testified that on August 2, 2025, there was an accident with his insulin dose, and he had a seizure while sleeping due to a low blood sugar. He testified he had never had a seizure before this time. Since that incident he had started using a Dexcom continuous glucose monitor (CGM) and receives alerts when his blood sugar goes high or low. He has had no hypoglycemic events since he suffered a seizure.

19Under cross-examination he testified that the day of the hypoglycemic seizure he had been physically active during the day and not accounted for the increased activity when he administered insulin with his evening meal, which resulted in the hypoglycemic seizure. His girlfriend had called paramedics when she awoke to him seizing. He was treated by paramedics and taken to a hospital where he underwent further investigations and was observed for several hours before being discharged.

20I find the medical evidence in this case clear and the testimony of the appellant supportive of the Registrar’s position. While the appellant disagrees that he has severe hypoglycemia, he does not dispute that he suffered a seizure due to an episode of severe hypoglycemia. Both Diabetes Assessment forms and the Seizure and Loss of Consciousness forms completed by Dr. B further support that an episode of severe hypoglycemia led to the appellant’s seizure. Based on the information available, I find that the Registrar has established on a balance of probabilities that the appellant suffered from severe hypoglycemia.

Does the appellant’s medical condition of severe hypoglycemia interfere with his ability to drive a motor vehicle safely?

21The Registrar relies on the CCMTA Medical Standards for Drivers (“CCMTA Standards”), in particular Standard 7.6.4 (Episode of Severe Hypoglycemia, Non-Commercial drivers. Applies to severe hypoglycemia while sleeping). This Standard provides that drivers are eligible for a licence if: it has been 6 months since the last episode of severe hypoglycemia, but earlier re-licensing can be considered if an appropriate specialist indicates that glycemic control has been re-established and the conditions for maintaining a licence are met. The Registrar stated that internal policies indicate that the six month timeframe must be met, and the Registrar has not received confirmation that the appellant has had no hypoglycemic events in the past six months and that their decision is prudent and in keeping with road user safety.

22The CCMTA Standards also provide that there is clear evidence to show that both non-commercial and commercial drivers with diabetes are at an increased risk of motor vehicle crashes and those that are taking insulin have an elevated risk of crashes. Further, a relationship between hypoglycemia and crashes has also been found. The CCMTA Standards document that the neuroglycopenic symptoms that are associated with severe hypoglycemia can significantly impair the cognitive functions required for driving and a driver cannot compensate from the episodic impairment from severe hypoglycemia. There are other studies noting mild hypoglycemia may also impair these functions. Thus, experiencing a hypoglycemic episode while driving would significantly interfere with a driver’s ability to drive safely and present a safety risk to the driver themselves and other road users.

23Section 14(2)(a) of the Regulation permits 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 they are not binding.

24The appellant argues that he does not suffer from a medical condition that affects his ability to drive safely. The appellant testified that he was taught procedures for driving with diabetes when he learned how to drive. He keeps supplies in his car in case of a low blood sugar. Since his hypoglycemic seizure he has started using a CGM to assist in monitoring his blood sugars. He testified he has not had any further hypoglycemic events as supported by the three months of CGM data submitted. He testified he is into personal training and fitness. He described the challenges of having his licence suspended and the support required from others to drive him to and from school and to job sites.

25Under cross-examination, the appellant testified that he normally sees endocrinologist Dr. M every 6 months but had three appointments since the hypoglycemic seizure. Dr. M had explained to him that his licence would be suspended for 3-6 months as a result of the incident. He testified he does not use an insulin pump, and there have been no significant changes to his insulin doses as he rarely has had low blood sugars. He testified he feels best when his blood sugars range from 6 mmol/L – 10 mmol/L and checks his blood sugar with every meal and before bed, and up to ten times per day.

26The appellant was asked about how he manages his diabetes while driving. He testified that he checks his blood sugars prior to driving and keeps low blood sugar treatments with him as well as an inhaler. When asked about monitoring practices for longer drives he indicated he would pack more treatments for low blood sugar. He does not routinely check his blood sugar while driving, but with his new CGM would rely on the low alert. If he has a low blood sugar while driving, he testified he would pull over and treat and wait for 15 minutes before resuming driving.

27I have considered the appellant’s position that his diagnosis of severe hypoglycemia will not impact his ability to drive safely. While I understand the appellant has had no further severe hypoglycemic events, I find it concerning that the submitted CGM data demonstrates that his blood sugar values are persistently and considerably out of target range as defined by the submitted CGM graph, such that in the month prior to the hearing blood sugars are out of the designated target range (3.9 -10 mmol/L) 85% of the time, including 64% of the time classified in the “very high” range. Given the extent to which the blood sugar levels remain substantially out of the target range, the appellant was asked whether he was adhering to the treatment recommendations provided by his endocrinologist, and he responded affirmatively. The appellant testified that he feels best when his blood glucose levels are between 6 and 10 mmol/L, which are within the target range, and does not explain the blood sugar values persistently out of this range. Based on the medical evidence and testimony of the appellant, it is not clear why blood sugars are so persistently out of target range. The submitted CGM data is indicative of poor glycemic control and raises concerns regarding the appellant’s overall management of his condition.

28I am also concerned that the appellant does not report having a consistent or structured practice for checking his blood sugar while driving. While I recognize the safety risks and legal implications associated with using a mobile device while driving to check blood sugars, the absence of a planned or scheduled approach to monitoring blood sugars is troubling. The appellant testified that he now has an alarm on his CGM that can signal a low blood sugar, and it is noted this low alarm is set at 4.2 mmol/L on the submitted CGM documentation. The CGM is certainly a valuable intervention, but this technology is not infallible, and as a physician duly qualified to practice in Ontario and pursuant to s. 16(b) of the Statutory Powers Procedure Act, I am aware that CGM readings lag behind blood glucose values by up to 15-20 minutes. As scientific evidence demonstrates impairment to the functions required for driving with even minor hypoglycemia, it is concerning that the appellant may already be experiencing hypoglycemia before an alert from his CGM sounds. I am further concerned that the appellant testified to waiting 15 minutes to start driving after treating a low blood sugar. This practice is inconsistent with the condition for maintaining a licence outlined in the CCMTA Standards, which indicate the driver should wait at least 40 minutes after treating hypoglycemia, as it can take this length of time for judgement and reflexes to fully recover.

29I am also mindful that the appellant testified to meeting with his endocrinologist three times in the four months preceding the hearing and that Dr. M explained to him that his licence would be suspended for a period of three to six months. Despite Dr. M’s understanding of the appellant’s licence suspension, there are no submitted documents from Dr. M at all. As an endocrinologist, Dr. M would be the relevant treating physician as she has specific training and expertise in diabetes management. Neither of the submitted Diabetes Assessment forms were completed by Dr. M despite there being three appointments since the incident, nor was there documentation from Dr. M regarding the appellant’s glycemic control or support for reinstatement. Instead, the Diabetes Assessment forms were completed by Dr. B, who has specifically identified on the forms that the appellant’s diabetes is followed by an endocrinologist. Dr. B has also not documented any support for reinstatement of the appellant’s licence despite having several opportunities to do so, completing four different forms and adding narrative comments to each of them. There is a notable absence of physician support for reinstatement despite having multiple opportunities to provide the support both through frequent appointments and multiple forms completed.

30Furthermore, the appellant did not just experience an episode of severe hypoglycemia but had a seizure as a result of the hypoglycemic episode, and this type of seizure causes episodic impairment of the functions necessary for driving, for which a driver cannot compensate. Thus, experiencing a hypoglycemic 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.

31Although not bound by the CCMTA Standards, the Tribunal may consider them when making its decision. The reason is that they 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.

32I respect that type one diabetes is a complex and demanding condition that requires constant vigilance and decision making. I find it relevant and valuable that the appellant has begun using a CGM to help monitor his blood sugars to prevent further episodes of severe hypoglycemia. However, the poor glycemic control demonstrated on the data submitted, the testimony that he does not have a plan to check his blood sugar while driving, the testimony that he does not allow sufficient time for full cognitive recovery if treating hypoglycemia while driving coupled with the risks to cognitive functions necessary for driving associated with hypoglycemia, and that the appellant suffered from an event that resulted in complete incapacitation with an inability to compensate is concerning. In the absence of a supportive statement from either of his physicians for licence reinstatement, I find this insufficient to set aside the suspension. I am persuaded in this case to accept and apply the CCMTA guidance and note that the conditions for reinstatement have not been met.

33I acknowledge the burden that the lack of a driver’s licence has on the appellant, and I commend his new adaptation of a CGM, however, I find the medical and scientific evidence in this case relevant and compelling. As such, for the reasons cited, I am satisfied on a balance of probabilities that the appellant’s medical condition of severe hypoglycemia is likely to significantly interfere with his 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, and that this condition is likely to significantly interfere with his ability to drive a motor vehicle of the applicable class 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: January 7, 2026

` __________________________

Dr. Isla McPherson, Member