Licence Appeal Tribunal File Number: 18034/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:

Dwayne Patton

Appellant

and

Registrar of Motor Vehicles

Respondent

AMENDED DECISION

ADJUDICATOR: Dr. Isla McPherson, Member

APPEARANCES:

For the Appellant: Dwayne Patton, Appellant

For the Respondent: Melissa Litrenta, Agent

Held by teleconference: December 19, 2025

OVERVIEW

1Dwayne Patton (the “appellant”) appeals from the decision of the Registrar of Motor Vehicles (“Registrar”) to suspend his class D and 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 a Diabetes Assessment form 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 severe hypoglycemia. The appellant however 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.”

PRELIMINARY MATTER

10At the outset of the hearing the appellant indicated he had a support person present.

11The role of a support person was clarified with the appellant.

12The Registrar had no objection to the appellant’s support person attending.

RESULT

13Having 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?

14The evidence presented at the hearing establishes that the appellant suffers from a medical condition, namely severe hypoglycemia.

15As a commercial driver, the appellant has been followed with cyclical requests for medical information for over a decade. The Registrar’s submissions included the entire driver medical file which consistently documented the presence of type one diabetes treated with insulin since 2014. The Registrar reviewed the complete medical file, including historical documentation of low blood sugars including:

i. Family physician Dr. K documented the appellant had a history of having a significant hypoglycemic episode requiring medical intervention in 2005.

ii. Internist Dr. W submitted a Medical Condition Report in 2016 documenting a history of seizure with recent low blood sugars. This report resulted in a suspension of the appellant’s driver’s licence. As part of the documentation that followed this suspension, endocrinologist Dr. B documented in 2016 the appellant had a history of having more than one episode of hypoglycemia unawareness in the previous 12 months and a reported episode of severe hypoglycemia requiring outside intervention within the previous 6 months.

16The Registrar’s position on the current suspension is supported by a Diabetes Assessment form, completed by the appellant’s family physician, Dr. K, dated October 16, 2025. On this form Dr. K reported the appellant had type one diabetes treated with insulin, and he suffered from an episode of severe hypoglycemia requiring outside intervention within the past six months and adequate glycemic control had been re-established. Dr. K added the narrative comments that the appellant had suffered an episode of nocturnal hypoglycemia requiring emergent medical intervention which was due to inadvertent insulin dose by the insulin pump and a lock on the pump had been put in place to prevent recurrence.

17Following receipt of this form, the Registrar suspended the appellant’s licence due to severe hypoglycemia and required confirmation that there were no further episodes of severe hypoglycemia and that the condition had remained stable for a period of six months, confirmation that a diabetic diary with blood glucose testing at least four times daily for the last 30 days has been assessed and includes the number of blood levels which are below 4.0 mmol/L, and a recently conducted A1c with confirmation that the level is congruent with blood logs and confirmation that stable glycemic control has been re-established.

18A Driver Medical Report was completed by Dr. K on November 4, 2025, also documenting the appellant had type one diabetes treated with insulin and had suffered an episode of severe hypoglycemia requiring outside intervention within the past six months. Dr. K had added the narrative comment that the appellant was unresponsive with a decreased level of consciousness secondary to severe nocturnal hypoglycemia secondary to insulin pump malfunction.

19The appellant testified that he went to bed on the evening of August 28, 2025, and when he awoke the following day, he was in the hospital and was informed he had an episode of hypoglycemia, and his wife had called an ambulance. The appellant testified that his wife had administered intranasal glucagon at home in an attempt to bring up his blood sugar, but it had not been successful, and paramedics were called and transferred the appellant to hospital. The appellant testified that he felt lucky to be alive and was grateful his wife was there to assist him.

20I find the medical evidence in this case clear and the testimony of the appellant supportive of the Registrar’s position. Based on the information available, I find that the Registrar has established on a balance of probabilities that the appellant suffered from an episode of 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 Canadian Council of Motor Transport Administrators Medical Standards for Drivers (“CCMTA Standards”), in particular Standard 7.6.7 (Episode of Severe Hypoglycemia, Commercial drivers. Applies also 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.

22Section 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.

23The CCMTA Standards also provide that there is clear scientific 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.

24While cross-examining the Registrar, the appellant asked if it was documented that he was over medicated at the time of the 2016 suspension, because at the time he was taking hydromorphone and muscle relaxants for an injury that made it very difficult to determine if he was experiencing a low blood sugar. The Registrar responded that the submitted medical reports did not indicate he was over medicated.

25The appellant argues that he does not suffer from a medical condition that significantly affects his ability to drive safely. The appellant testified that the episode of severe hypoglycemia was an isolated incident caused by an anomaly with his insulin pump. The evening after the incident he pulled out his pump to enter the number of carbohydrates he planned to eat and bolus the appropriate insulin when he found the pump screen displayed unexpected and unusual information, such that there were an extremely high number of carbohydrates (997 g) and units of insulin (83.08 units) already entered into his pump and ready to be delivered. The appellant submitted a photograph of his pump screen to support his testimony. The appellant found this alarming and very dangerous, as well as concerning in light of the previous night’s unexpected episode of severe hypoglycemia. As such, he reached out to the insulin pump’s customer service for assistance. With assistance from customer service, he reviewed the history of insulin delivery on his pump and discovered his pump had administered 15 units of insulin at 1:34 am the night before, shortly prior to the episode of severe hypoglycemia. The appellant testified that his pump administered a large volume of insulin (15 units) on its own while he was sleeping, and this had never happened before despite having the same insulin pump for several years. The customer service agent suggested this was possibly due to the pump screen being ‘touchy’. The appellant was advised to add a second security PIN on the pump to avoid inadvertent insulin boluses. To support his testimony, the appellant submitted a document dated November 13, 2025, from the insulin pump company, summarizing the conversation he had with a customer service agent on August 29, 2025. The author of the document was a different customer service agent then the one who had provided support on August 29, 2025.

26The appellant testified as to further safety features that exist on his diabetes technology, including alarms on his insulin pump and continuous glucose monitor (CGM) that sound when blood sugars are out of normal range, and since the hypoglycemic episode he had changed the maximum dose of insulin being administered at one time from 15 units to 12 units. The appellant further testified that he follows regularly with a diabetic clinic every 3-4 months where he sees an endocrinologist, a nurse and a dietician, and has maintained good control of his blood sugars. Following the incident, the appellant testified he had an appointment at the diabetic clinic and was advised he should get a new insulin pump as the two incidents were concerning for the pump malfunctioning.

27The appellant submitted a letter dated December 8, 2025, from Registered Dietician SK who commented that the appellant uses an insulin pump and a CGM as per the standard of care according to Diabetes Canada. She provided information documenting the frequency of his low blood sugars being 1.6 – 3.2% from July – November 2025 and that he had a severe low blood sugar on August 29, 2025, but this was unique, and he was not driving at the time. She documented the appellant is meeting the international diabetes consensus guidelines of low blood sugars. The record contains no comment supporting reinstatement of the appellant’s driver’s licence.

28The appellant testified he hadn’t always made the best choices but is now taking good care of himself, including giving up alcohol, which he testified has helped control his blood sugar levels. He testified he tends to run higher blood sugars while driving out of respect for others and his family. He testified it is not fair to run lower blood sugars just for better control if it creates a risk while driving.

29Under cross-examination the appellant was asked about the screen of his pump being ‘touchy’ and how the buttons on his insulin pump could be pushed due to normal movements while sleeping. The appellant responded to questions confirming that administering a large bolus of insulin would take approximately eight to nine steps on his pump, all sequentially entered. He testified this was unlikely for all of these steps to occur, however, he highlighted the circumstance that if there was a situation where the carbohydrates and insulin were already entered like he found on the day after the incident, it would take much fewer steps, possibly only one or two steps to administer a large amount of insulin. The appellant was questioned about the concerns the diabetic clinic had regarding a pump malfunction and plans to replace the pump. The appellant testified that he had been told at his clinic appointment following the incident that there may be something wrong with the pump and it couldn’t be trusted in light of the incident. The appellant planned to try and work with the insulin pump company to investigate further and possibly get a replacement insulin pump.

30Under cross-examination the appellant testified as to how he manages his diabetes while driving. He testified that he keeps drinks and snacks in his vehicles at all times to treat low blood sugars. He testified he always has a capillary blood sugar kit and glucagon with him in his vehicles. He targets a blood sugar of 7 mmol/L or above while driving. The appellant was asked several times how frequently he monitors his blood glucose while driving; however, he did not provide a direct response. Upon the third inquiry, he stated he is not tech-savvy but indicated his blood glucose data are available on his phone and insulin pump. No scheduled or planned approach to blood sugar monitoring while driving was described. When asked regarding his practices of experiencing hypoglycemia while driving, he indicated he would pull over and wait until he has an arrow going up on his CGM before resuming. He testified he uses his DZ licence to move heavy equipment, such as a skid steer, on the back of a dump truck to bring to job sites. He testified to not driving long distances with his commercial licence.

31I have considered the appellant’s position that his diagnosis of severe hypoglycemia will not impact his ability to drive safely. However, I find it concerning that the appellant has testified as to both his and his diabetic healthcare providers concern that his insulin pump is faulty. If the appellant’s insulin pump is administering large doses of insulin at unexpected times without notification, this can be extremely dangerous. Even though the appellant testified that he was told by the customer service agent that the insulin pump can be ‘touchy’, and this may have caused the unplanned 15 unit insulin bolus, it seems highly unlikely that the correct sequence of steps could have taken place to administer 15 units of insulin given that at least eight buttons needed to be pushed in the proper order to administer that insulin. Hence, adding a second security PIN, as suggested, would not likely be protective.

32The appellant has testified as to the unexpected finding on his pump the following day where the 83.08 units of insulin were entered on his pump without his knowing. I recognize that the appellant has a maximum insulin bolus set to 12 units, but what this suggests is there was a second incident where the pump was not functioning as expected. These two incidents combined with the concerns of his diabetic healthcare provider that his pump cannot be trusted, suggest that the insulin pump requires further attention to ensure it is working correctly or if it needs to be replaced.

33While I appreciate the appellant has testified that he has alarms on both his CGM and his insulin pump to alert him if his blood sugar is out of range, these were in place prior to his severe hypoglycemic episode and neither of these alarms were sufficient to avoid the incident that led to the suspension, and therefore I don’t think can be relied on to abort a situation of inadvertent insulin administration. It is also troubling given that the appellant did not testify to having a planned or scheduled approach to monitoring blood sugars while driving, particularly if his pump is administering unplanned insulin boluses and furthermore because the scientific evidence in the CCMTA Standards demonstrates impairment to the functions required for driving with even minor hypoglycemia.

34I recognize further that standards for holding a commercial licence are require a higher level of fitness than those that operate G class vehicles. 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. While I recognize that all of these conditions may not apply to the appellant’s commercial driving, it is not difficult to understand the severity of the consequences should a collision occur while driving a dump truck hauling heavy equipment.

35The appellant’s testimony that his insulin pump has administered insulin unexpectedly without him knowing, the concern of his diabetic healthcare team about his pump malfunctioning, and the testimony that he doesn’t have a scheduled routine to check his blood sugar while driving is concerning in light of these circumstances, particularly in the setting of driving a heavy commercial vehicle and that the scientific evidence demonstrates hypoglycemia causes impairment in the functions required for driving. Furthermore, I recognize that the appellant has had a previous suspension for hypoglycemia causing a seizure. While I recognize the appellant has implemented an additional PIN to avoid an accidental insulin bolus, this does not seem to fully address the incident given both the appellant’s and his diabetic healthcare provider’s concerns. Given that severe hypoglycemic can result in complete incapacitation with no ability to compensate while driving, and the appellant has previously suffered a hypoglycemic seizure, I accept and apply the CCMTA guidance that having a period of stability is reasonable. With only half of the expected period in the CCMTA Standards elapsed, I find this insufficient to set aside the suspension in the absence of support for reinstatement from his diabetes clinic or endocrinologist.

36Although 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. While each appeal including this one must be judged on its own merits, I am persuaded to apply the CCMTA Standards here. My review of the evidence shows that the conditions recommended for relicensing outlined in the CCMTA Standards have not been met.

37I acknowledge the burden that the lack of a driver’s licence has on the appellant, and I respect that type one diabetes is a complex and demanding condition that requires constant vigilance and decision making. However, 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

38I 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

39For 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 16th, 2026

` __________________________

Dr. Isla McPherson, Member