Why is Ontario suspending so many licenses?

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Jordan Heath-Rawlings With a couple of very notable exceptions, most of us expect absolute privacy from our doctors about what we reveal to them. The exceptions include situations where someone is in danger. In those cases, doctors are required to report it without regarding your privacy, and that brings us to how thousands of people who lose their driver’s licenses every single year. Look, there is no question that in some cases, what patients tell their doctors means that they could be a danger on the roads, and it is a matter of safety, rapidly failing eyesight, the progression of Alzheimer’s or other neurological disease. There are legitimate reasons to take people’s licenses away from them, but what about depression or admitting to a drinking problem without any evidence of ever driving drunk or a report filed by a doctor that the person in question can’t even recall meeting? These are real examples that our guest today has helped track down. Those people lost their licenses and they aren’t alone, and their stories aren’t unique for many people. With their licenses suspended, there are jobs and incomes at stake. So what is Ontario doing and to who? Who is reporting these cases and why? And what options do drivers have when it happens to them? I am Jordan Heath-Rawlings. This is the big story. Declan Keogh is a senior reporter at the Investigative Journalism Bureau, which is a nonprofit newsroom based at the University of Toronto’s Dala Lana School of Public Health. He was an investigator on the Suspended series. Hey Declan.

Declan Keogh Hi. How you doing?

Jordan Heath-Rawlings I’m doing well. Thanks for joining us.

Declan Keogh Thank you very much for having me.

Jordan Heath-Rawlings Why don’t we start with this because I, I don’t know how many people know that this exists or what it does, but what exactly is a medical condition report?

Declan Keogh So they’re a, uh, form, they’re a provincial form here in Ontario that certain health professionals are required to send into the Ministry of Transportation if they see a patient who has either a condition that they think might impact their driving or a certain set of conditions, which must be reported to the ministry.

Jordan Heath-Rawlings And how often are those filed? And I guess the follow up question is how often did they result in, uh, a license actually being suspended or taken away from?

Declan Keogh It’s a good, good question. We spent years getting data from the Ministry of Health, which pays doctors who filed these things through the OIP system. And according to that data, something around over 30,000 every year are billed by these doctors. And the question of whether they all result in license suspension is, is a tricky one. But we do know from our, our reporting on this that when certain conditions are reported, they automatically suspend the license.

Jordan Heath-Rawlings And now’s when we get into talking about, uh, these conditions, and let’s first, you know, in an ideal world where everything’s working as it’s supposed to, what kind of medical conditions are supposed to result in these being filed?

Declan Keogh I mean, the first thing that came to my mind is, you know, somebody that’s getting really elderly and is losing eyesight or losing reflexes, but I, is that what we’re talking.

Jordan Heath-Rawlings Uh, yes, yes.

Declan Keogh You know, things like dementia, some forms of sleep apnea, which cause sleepiness, some motor sensory impairments, uh, like vision and as well, uh, other things that must be reported are certain psychiatric conditions, uncontrolled substance use disorders, so all kind of things that could, you know, realistically affect how someone drive. Once one of those is filed, that doesn’t automatically in, in most cases, suspend or revoke a license.

Jordan Heath-Rawlings So who decides who looks at these and decides whether or not, uh, they should take a license away?

Declan Keogh Well, there’s, um, guidelines that are used to assess whether someone’s condition could affect their driving, but, but as I said, the conditions, which must be reported, these psychiatric conditions, uncontrolled substance use, they’re all in, in the legislation they generally do results as far as we can tell in an, in an automatic license suspension. So how many total results in suspensions is hard to say, but from our reporting, many of them do.

Jordan Heath-Rawlings Okay. So that’s how the system works. Now, obviously for you guys to dig in like this, something must be, uh, a little fishy somewhere. Why did you decide to begin investigating? What kinds of conditions show up on these and, and lead to it?

Declan Keogh It’s, it’s one of those, uh, you just hear something. My aunt worked at a treatment facility for people’s addictions, and she’s told me, I think it was four years ago now, that some of her clients would come in for help and would leave without their license. And it was turn, it would make people not want to get help. And I just, it sat with me for, for quite a while and I started looking into it almost four years ago actually, and it just sat with me as something that didn’t quite make sense as. People trying to get help and they end up being deterred from that help by what they perceive as a punish.

Jordan Heath-Rawlings You produced with the Star a whole series of articles about this. Maybe before we get into sort of the systemic problems here, you could give us a couple of stories of, of people who you spoke to and what happened to them and what caused them to lose their license.

Declan Keogh Yeah. We spoke with a lot of people for this and we ended up featuring quite a few. And the one that really sticks with me is, um, Cara McKay, who at the time, she’s a a, in nursing school in Thunder Bay. I think she was 24 years old, and she had issues with depression, um, for most of her life. And she found herself in a depressive episode. And, and she did what any responsible person would do is she called someone and said, I gotta go to the hospital. Can you take me? So she gets a ride to the hospital, she’s there for a couple days, and she leaves. She’s feeling better and thinks nothing of it. And then, A couple weeks later in the mail, uh, something arrives. It says she lost her license because of that depressive episode. And from there things almost went into a tailspin. She almost lost her job. She almost couldn’t finish her school because she was traveling around driving to patients across the city. You know, it, it really turned her life on its head for quite a while. What happens to somebody, and I know this varies by person, and you must have heard stories about this, like how devastating can the loss of a driver’s license. It can be totally life altering. We spoke with people who, who were trying to sell their houses in the province to move because they didn’t think they would be able to live in, in this province in a rural area. Dream Homes built with family members that would end up on the market if, if they couldn’t get their licenses back. People who couldn’t care for their elderly parents who are requiring trips to hospitals all around the province. School. Um, It really, you know, it’s one of those things you don’t think about, and especially in rural areas. It is, it is a lifeline, and if you don’t have it, you’re not taking your kids anywhere. You’re not, you’re not going anywhere really. You’re, you have to rely on people to, to take you places, to get to work, to get groceries, to go to hockey, whatever, whatever it is you’re doing. In, in, in many much of this province requires a vehicle.

Jordan Heath-Rawlings Does doctor patient confidentiality apply to this kind of stuff? Like, I know you mentioned that the doctors are paid to file these. These are really sensitive private things that people are discussing with their physicians.

Declan Keogh No, it, it doesn’t really, I mean, it, it’s a, they’re required to report it. It is in the law, it is carved out and they have to report it to the ministry.

Jordan Heath-Rawlings So you’d heard these stories, you dug in and started hearing more and more of them. Tell me about the investigation itself. What did you do? And in broad strokes, what did you find?

Declan Keogh So we looked at it from a few different ways. One was the, the data from the Ontario Ministry of Health. And we had to do that because we couldn’t get it from the Ministry of Transportation. It was not gonna happen. So we went, uh, kind of a circular route around and, and got the data through the Ministry of Health, started looking at the types of conditions that were being reported. Where, who was reporting and, and we also looked at, so one of the things people can do is if they disagree with their suspension, they can go to something which is called the, uh, license appeal tribunal. And that is a third party adjudication panel of doctors who will hear the, the appeal in the case. And then the ministry will come and, and argue their case and, and decide whether. Or not to keep the suspension or to lift it. And that was really eye-opening for us. We went through five years worth of cases, over 200 decisions, and we found that roughly a third were overturned. So a third of them, an independent, uh, panel of doctors said this person should have their license.

Jordan Heath-Rawlings And what did you find out about who was filing these?

Declan Keogh So the vast majority of of physicians in, in the data that we obtained file less than a handful, like we’re talking one, two, a year. That is the overwhelming majority. And then there are just some outliers who seem to file, well, they do file far more, thousands of times, more. We’re talking hundreds and hundreds a year. One physician in Ottawa. We, we were able to identify in the data, filed over one every single day for 10 years. We’re talking evenings, weekends, every single day for 10 years.

Jordan Heath-Rawlings How does that happen? How would a physician be in contact with that many patients who are a risk to be driving?

Declan Keogh We asked that question and what we got back was, I’m a busy doctor. I am a specialist in sleep. I see a lot of patients and this condition is one of the conditions which must be reported. I am, I am merely following the law.

Jordan Heath-Rawlings This is where I’m gonna ask a question and, and try not to lead you on. And I know, um, you may not be able to make conclusions, but it, is it reasonable to wonder if doctors might file more of these because there’s money to be made in it?

Declan Keogh Yeah. You know, it’s certainly what people have said to us, like, why does this happen? Could it be related to the money? We’re not talking a lot about a lot of money. It’s $36.25, to fill out the form. You, you multiply that by a couple thousand times. You know, it’s, it’s a decent chunk of change, but it’s, it’s hard. I mean, we don’t know. We don’t know that either way, but people have definitely raised that to us as an option.

Jordan Heath-Rawlings When you talk to people who are involved in making these decisions, whether it’s the ministry itself or whether it’s, and I don’t know if you got to talk to the doctors that review these decisions, but. Should a third of them be getting overturned? That seems high.

Declan Keogh It seemed high to us, certainly. And we, we broke it down a bit further than just whether it was overturned, which is the, the first metric. There’s also another metric, which is that there was no evidence put forward by the ministry in these, in these appeals that the person whose license was suspended ever had the condition which they were alleged to have had and, and caused the loss of their license. Uh, it wasn’t all of them. I think it was a third of the third. These are big numbers to us, and of course a small number of people go through this appeal process. We looked at five years. And it was about 200 cases. Um, but we know this happens 35,000 times a year. Most people don’t go through this process. It takes time. It’s, it’s not easy to get up in front of, uh, tribunal and argue your case in a coherent manner. It’s expensive. It costs, I think, $106 just to file the appeal. And most people, you know, don’t have any legal representation either. There’s no duty counsel, there’s no publicly funded person that, that, that is there. So most people do it on their own. 90% of all the cases we looked at were self-represented.

Jordan Heath-Rawlings Is there a better way to do this? Does this only happen in Ontario? What happens in the rest of Canada?

Declan Keogh Yeah, so it’s, it’s interesting. This is one of those things that is just unsettled. There’s a lot of different ways to do it. We looked at jurisdictions across the country in the United States. It varies by state, by state. In, in Europe, it varies by country, by country. So there really is no consensus on the best way to do this. But in Canada, Ontario, from all the experts we’ve spoken with in Canada, Ontario, Is viewed as the most stringent, you’re guilty until proven innocent. Because what happens is you, the form is filed, you lose your license, and then only after that can you start to make your case or say, Hey, wait a second. What ha, what just happened here? Whereas in BC, for example, it is also a mandatory reporting law, like similar to Ontario, except the doctors are only required to report the patient. If they’ve been told not to drive or they’ve been warned that their condition could affect their driving and, and to get further testing, and they ignore that. So if the doctor sees someone and they say, you know, this condition could affect your driving. Let’s do some more work and, and, and understand how it could affect you. Then there’s no obligation for them to report the patient. Whereas here, that would be it. There would, there would be a report filed, and in places like Alberta there, it’s up to the doctor’s discretion. There’s no requirement for them to report. Do doctors in Ontario or can, I guess the, the proper question is can doctors in Ontario inform a patient that, you know, if they broach a particular condition that like you should know.

Jordan Heath-Rawlings This condition reported could result in you losing your license. Um, do they do that? Is that part of it? Because you mentioned at the beginning you know, that this could really discourage people with dangerous conditions from bringing them up with their doctors.

Declan Keogh Yeah, so doctors, this is again, something that kept coming up in, in all with all the people we’ve spoken with. They want to hear their doctors tell them, oh, I’ve just reported you, there’s actually no requirement for a doctor to, to, to inform their patients. In the law of this. It is recommended by both the, the College of Physicians and the ministry itself recommends this, but there’s no requirement. And so often we hear, we hurdle from a lot of people who said, you know, we, we spoke with one man, he fainted on a hot summer day heat stroke, something like this. He goes to the emergency room, he leaves, and then. His license is suspended, you know, now he, now he says he’s not going back unless he’s, you know, life or death. Uh, he just does not trust the, the healthcare system, which is what something that just emerged again and again, both from the patients and from physicians who do not really like to do this because it does fracture that relationship. So it is having a big, I think, consequence on overall public. Perceptions in, in terms of whether people trust their doctors and whether they’re gonna be honest with them, uh, about these types of.

Jordan Heath-Rawlings When you brought all this to the government or the ministry, you know, the results of your investigation and then also kind of what you’ve told me about, about other systems and how experts say this is the most draconian, um, and it could fracture the relationship between, uh, the healthcare system and a patient. What do they say?

Declan Keogh So we, we really did wanted to give them the opportunity to present their case and do a thoughtful contextualized interview. We spent years on this. We wanted to make sure it was right and we weren’t doing a drive by and, and what we got really was. A short statement that says, you know, we are dedicated to road safety in Ontario and we have some of the safest roads in North America, which is, which is true, but we also looked in places like, uh, Australia, which has a very different model and, and it is seen as a leader in road safety and has a, a kind of an inverted model where the suspension happens only after a long process and people often report themselves because they know their license isn’t gonna be automatically suspended and there will be a careful review. And we looked at kind of fatality statistics and it showed that it was either similar or, or maybe even slightly safer there than it is here, which, which shows in our mind kind of whether. It, it brings the question up whether this is the best way to do it, given all of the repercussions that we note in our stories, and from the, the stories that we’ve heard from people, they just, they, they keep coming in. It really has struck a chord. Dozens and dozens of people have reached out at this point with.Varying stories of I lost my license. I don’t know what to do. I think this is unfair.

Jordan Heath-Rawlings Declan, thank you for your work on this. And I’m sorry there’s no solution yet, but, uh, thank you for bringing it to our attention and our listeners.

Declan Keogh Oh, thank you very much for having me.

Jordan Heath-Rawlings Declan Keogh of the Investigative Journalism Bureau.Since we recorded this interview, there have been a couple of updates to this story. Declan, as well as his colleagues, Robert Crib published a story in the Toronto Star that revealed Ontario Transportation Minister Caroline Mulroney’s office had actually intervened to prevent staff from sharing information about the medical license suspensions in the province. One piece of information that came to light was the fact that between 2011 and 2020, 280,000 medical license suspensions were handed out in the province. You can read that story at the Toronto Star on their website. We will link to it in the show notes. You will probably be hearing more about this very soon at question period at Queens Park in Toronto. That was the big story. For more, you can add to the big story podcast.ca. You can find us on Twitter at the big story fp. You can email us hello also at the big story podcast.ca, and you can call us and leave us a message, 4 1 6 9 3 5 5 9 3 5. You can find this podcast. You typically find podcasts and your smart speaker will play it if you ask it to play the Big Story podcast. Thanks for listening. I’m Jordan Heath Rawlings. Have a great weekend. We’ll talk Monday.