During an intense flare-up of her depression, Karysa Mackay checked into a Thunder Bay hospital for crisis care.
Three days later, Mackay had her licence suspended after a psychiatrist she doesn’t recall ever meeting reported her to the Ministry of Transportation.
For Mackay, 24, who relied on her Hyundai sedan to shuttle between her nursing school classes and two part-time jobs caring for elderly patients, it was “an absolute blindside.”
Medical condition reports, or MCRs, are little-known but widely used provincial forms that some medical professionals must file to the ministry when patients have certain potentially dangerous conditions that “warrant a licence suspension,” according to the ministry. When a report is submitted flagging these conditions, “it will result in a licence suspension,” a ministry document states.
MCRs take thousands of Ontarians off the road every year. In many cases, they can help make our roads safer.
But the system is vulnerable to abuse, inconsistency and misjudgment by doctors and government officials, a Toronto Star/Investigative Journalism Bureau investigation has found.
Drivers whose call for help results in a suspended licence often face sweeping consequences. Some lose their livelihoods overnight because they suddenly can’t drive. Others lose trust in the health-care system, becoming fearful of reaching out for any further help. And those already struggling with serious mental health challenges can fall deeper into despair with isolation and stress.
When frustrated drivers challenge their suspensions, many of them — 61 of 193, or roughly a third — are overturned by an Ontario appeal body.
And for roughly a quarter of those 61 drivers who won their appeals, the Ministry of Transportation officials could not prove the drivers even had any of the conditions that were the entire basis of their licence suspensions. In other cases, the appeal body found the suspension had gone on for too long and was no longer warranted.
Never-before-seen Ontario Health Insurance Plan (OHIP) data obtained by this investigation shows that from April 2011 until the end of 2020, Ontario physicians filed close to 350,000 MCRs — more than 35,000 a year — at a cost of $12.5 million in public health-care billings. Physicians bill the province $36.25 for each MCR.
The most common medical conditions in the data were dementia, epilepsy and strokes. But mental health and psychiatric conditions such as drug dependence, alcoholism, “anxiety neurosis,” “obsessive compulsive neurosis” and “reactive depression” were also common.
High-risk medical conditions reported by doctors — including certain substance use disorders, psychiatric conditions and cognitive impairments — trigger automatic licence suspensions. The data shows physicians also file reports under a wide range of other conditions, from cold sores to “sexual deviations,” which may not necessarily trigger a licence suspension upon review by the ministry.
Most MCRs filed since 2014 targeted drivers over 60 years of age. But one in five drivers was under 40.
Among the doctors who have filed MCRs, the median number is less than one a year. But dozens of physicians have submitted more than 1,000 reports over the past decade, billing up to hundreds of thousands of dollars, according to OHIP data. One Ottawa sleep specialist filed more than 4,800 — averaging more than one every day over the past decade — worth a little more than $175,000 in billings to the province. Another family and emergency room physician in the GTA filed nearly 3,700 MCRs for conditions that included venereal diseases, hay fever, the common cold and “disorders of menstruation,” according to the OHIP data.
The Star/IJB investigation will detail some of those billings later in this series.
The Ministry of Transportation declined to respond to detailed questions about the apparently disproportionate use of MCRs by some physicians, the management of the MCR system and the impacts on Ontarians whose licences are improperly suspended.
In a short statement, the ministry lauded Ontario as having “one of the most stringent programs in North America.
“The ministry applies consistent medical standards that are designed to balance road safety and mobility for Ontarians.”
Ontario’s ombudsman has documented a pattern of administrative errors and delays at the ministry dating back to 2012 which have jeopardized drivers’ livelihoods or outright cost them their jobs. The ombudsman received more than 1,250 complaints against the Ministry of Transportation’s medical review section since 2012. The section handles MCRs and other medical fitness-to-drive issues.
“In one egregious case,” noted the ombudsman’s 2016/17 annual report, “a driver lost his job because the Medical Review Section erroneously suspended his licence for nearly a year … even though he did not have a medical condition.”
Mackay, a fourth-year nursing student when she was suddenly stripped of her licence, appealed her suspension to the Licence Appeal Tribunal.
At her August 2019 hearing before the tribunal, which adjudicates various disputes involving licences and motor vehicles, Mackay testified that the crisis that led to her hospitalization the month prior happened when she was working “very hard and long hours” at two part-time jobs caring for elderly patients.
After quarrelling with her sister, she became so distraught while out with friends at a restaurant that she decided she should not drive home. She called her mother for a ride. After becoming more upset at home, she agreed to go to the hospital with a crisis response team that her mother had called.
Representing herself in the hearing, Mackay drew on a doctor’s report, a letter from her employer and testimony from two family members to challenge the suspension. She testified that the MCR incorrectly claimed she may have had a suicide plan involving a vehicle.
She also told the tribunal she has no recollection of meeting or talking to the physician who signed her MCR, Dr. Rachel Mitchell.
“She was not my psychiatrist while I was there for five days,” Mackay said in an interview, adding she was treated by a male psychiatrist who never mentioned the possibility of her licence being suspended.
“I do not recall seeing a woman coming in for a long enough time to make this decision … if at all.”
Mackay’s discharge summary — which describes her stay in hospital — includes no reference to suspending her licence nor to Mitchell.
Despite Mackay’s lack of memory of being treated by Mitchell, the tribunal decided to accept the psychiatrist had “some level of interaction” in her care.
But the ruling notes that Mitchell “can only have had one contact with the appellant. The MCR she prepared and submitted includes minimal information. It offers no observations that led to her conclusion regarding the diagnosis.”
Mitchell declined to comment on questions from reporters, even when provided with written consent from Mackay granting her permission to do so.
The tribunal panel found Mackay’s testimony “credible” and ruled there was “insufficient evidence” that she had a suicide plan involving a vehicle.
The tribunal determined the ministry failed to prove Mackay suffers from a mental condition that is likely to hamper her ability to drive safely and overturned her suspension in September 2019.
Mackay said that without her licence she had to rely on her mother, who works, to drive her to school. Mackay, 21 at the time, could also no longer care for one of her patients. That loss of income meant she would have had difficulty paying her tuition.
There can be lasting impacts for many Ontarians with clean driving records like Mackay, especially those with mental illnesses or substance use disorders.
The Canadian Medical Association’s guide on assessing if someone is well enough to drive safely notes that “in some cases, suicide has been attributed to the removal of driving privileges.”
“People don’t really realize the toll that not having a vehicle can take on your mental health, especially if you already have a mental health disorder,” said Mackay, now a registered nurse in Moose Factory, Ont. “Taking away independence is an added stressor.”
For drivers, notice of their licence suspensions often comes out of the blue. Doctors are not obligated to obtain consent prior to filing an MCR or even inform patients they are doing so, which means patients often learn they can no longer drive through a letter from the Ministry of Transportation.
Those who feel the suspension was unfair can send the ministry medical information indicating they do not pose a threat. Some will have to complete a driving-fitness assessment that typically costs between $400 and $800. Neither OHIP nor the Ministry of Transportation cover the assessment. The ministry gives suspension “the higher priority” over reinstatement, according to a 2014 report by Ombudsman Ontario.
The other option is to file an appeal, a time-consuming process that costs $106.
Nearly a third of appeals between January 2017 and March 2022 — 61 of 193 — overturned the judgments of physicians and ministry officials, and reinstated the licences, according to a review of all appeals of MCR-based suspensions of personal driver’s licences. (These appeals do not include those where the tribunal did not rule on the merits of the cases for various reasons.)
The appeals tribunal reinstates licences because the ministry was requiring a driver demonstrate their condition to be stable for unnecessarily long periods of time, or there was not enough evidence their conditions were likely to threaten road safety, among other reasons.
In one case, a man who sought help in a GTA hospital for an anxiety attack in April 2018 later learned his licence was suspended for alleged cannabis abuse. That decision was based on MCRs filed by an emergency physician who noted the man had driven “under the influence.”
In fact, there was insufficient evidence of that, the tribunal found. The suspension was based in part on a “very poor copy” of one of the man’s medical records, and the ministry failed to show the man had a cannabis addiction or had even driven that day.
The data compiled by the Star/IJB investigation also found an additional 35 cases in which Ontarians had their commercial driver’s licences suspended due to MCRs, effectively costing them their jobs driving vehicles including trucks, buses and ambulances.
In more than a third of those cases, the commercial licence suspensions were deemed inappropriate, with the LAT overturning the ministry’s suspension. Nearly half of these commercial licences suspensions lasted more than a year.
But even when Ontarians win their appeals, there is a much deeper cost. The process can take months of frustration and delays during which they are unable to drive.
Starting in late 2020, reporters attended dozens of appeal hearings, always held by teleconference, and witnessed delays and disconnections due to technical difficulties, as well as last-minute adjournments because appellants couldn’t be reached.
The LAT “takes access to justice seriously and understands that some appellants may have difficulties navigating the hearing process [and] strives to provide fair and accessible dispute resolution to all who come before it,” the tribunal said in a statement.
More than 90 per cent of appellants in the 193 cases reviewed by this investigation were self-represented.
Tyler English, 35, fought for his licence on his own before the tribunal in the summer of 2020.
The Niagara-based social worker, who specializes in addiction and mental health cases, was prescribed the opioid painkiller Percocet following dental surgery in October 2019 after being sober for seven years. In January 2020, he checked himself into rehab.
There, a physician warned him that if his treatment was “unsuccessful,” they would have to report the father of two to the Ministry of Transportation, English said.
“I happen to work in this field myself … I’ve never heard of that practice before.”
English was given a short-term pass to leave in early 2020 because his wife was experiencing an “emergency” related to her own substance use. He called the rehab on the day he was to return to say he couldn’t come back until the next day because he didn’t think it was safe to leave his wife by herself.
English was removed from the treatment program and his driver’s licence was suspended despite his perfect driving record.
And then his wife passed away.
He was left to father his two young children alone, grapple with the loss of his wife and attend daily recovery appointments and meetings without the ability to drive.
“At the time it felt insurmountable … I couldn’t even drive my son to the park,” he said. “Here I was only trying to get better, and now … it’s almost set me up to fail.”
For five months, English said he had to rely on at least 15 family members and friends and he spent at least $1,000 on Uber rides that summer.
“I felt angry at myself for reaching out for help,” he said. “It’s a major deterrent for seeking treatment.”
English got his addiction under control and appealed the suspension in July 2020, one month earlier than the six months of abstinence that the Ministry of Transportation said was the minimum required before it would consider reinstatement.
The tribunal overturned English’s suspension.
English’s “substance use disorder is controlled, and is not likely to significantly interfere with his ability to safely drive a motor vehicle,” the adjudicator ruled. “Every case is individual and must … be considered on its own merit.”
Dr. Ian Gillespie, a psychiatrist in B.C. with expertise in assessing fitness to drive, said English’s suspension “may reflect some overzealous reporting and some rigidity from the licensing authority.”
“(The suspension) was rendered to a driver on the basis of their history of substance use without any knowledge of what impact it had had on their driving.”
Though English was relieved, he wants the system to change to protect others like him.
“There’s got to be so many people that have had experience with this, such as myself, that are afraid to talk about things now,” he said. “Who knows if some people go back to using because (they) get frustrated because they feel like they’re succeeding and then they’re punished for seeking help.”
With files from Abeer Khan, Heidi Lee and Kayla Zhu (Toronto Metropolitan University) and Giulia Fiaoni and Katie Swyers (Investigative Journalism Bureau)