Duties and responsibilities

Expectations of physicians in practice

Fitness to drive: When do physicians have a duty to report?

Originally published December 2015
P1505-1-E

Most Canadians depend on being able to drive to participate in many activities in their lives. Although many consider driving to be a right, the law states it is a privilege. Losing this privilege, even when justified, can result in emotional stress, loss of independence, and financial consequences for the individual. And yet, an unfit driver may endanger his or her life and the lives of others. It is for this reason that all provinces and territories have legislation for reporting patients who are considered unsafe to drive.

In most jurisdictions, legislation requires physicians to report any patient who, in their opinion, has a medical condition that may make it dangerous for the patient to drive.1 Meanwhile in Alberta,2 Québec,3 and Nova Scotia4 reporting is discretionary, meaning that physicians are permitted, but not required, to report. While the law in Québec allows for discretion in deciding whether to report, the Collège des médecins states that if the physician has reason to believe the patient will continue to drive despite being warned not to and the patient represents a serious risk to public safety, the physician must report.5 In British Columbia, reporting is mandatory only if the patient continues to drive after being warned not to.6

While a patient may wish to continue driving, the physician must consider the safety of the patient and the community when deciding whether to report. The ultimate decision whether to restrict driving privileges is made by the provincial or territorial motor vehicle licensing authority.

Physicians may be unsure what conditions need to be reported, or when a patient’s cognitive or functional status justifies a report. In these situations, it is helpful to consult the Canadian Medical Association’s CMA Driver’s Guide and other relevant guidelines from specialty societies.7

The CMPA experience

In a review of 95 closed medical-legal cases between 2009 and 2013 involving fitness to drive issues, medical-legal outcomes were generally favourable for CMPA members. Three-quarters of the cases were complaints to regulatory authorities (Colleges) and 23 were legal actions. During the same period the CMPA also responded to over 1,200 member enquiries related to fitness to drive.

The following were the principal themes in the cases:

  • A physician failed to report a patient.
  • A report made to a provincial or territorial licensing authority was inappropriate.
  • A physician refused to support an application to reinstate driving privileges.

Allegations of failure to report

Allegations of failure to report often followed motor vehicle collisions in which a person was injured or killed. In some cases the injured person or his or her insurer sued both the driver and the driver’s physician, alleging that the physician failed to advise the patient not to drive or failed to make a report. Most legal actions related to patients with seizure and other neurological disorders, diabetes, psychiatric conditions, and vision problems.

In one case, a patient with a neurological condition and various physical impairments injured others in a motor vehicle collision. All of the physicians involved in the care assumed the patient had stopped driving but did not verify that the patient had indeed ceased to do so. The CMPA paid a settlement on behalf of the members to those injured.

Such cases illustrate the importance of each treating physician independently complying with the applicable reporting legislation. Legislation provides protection for physicians from civil actions when a report is made in accordance with the legislation and in good faith, but it does not prevent patients from filing a College complaint. It may be helpful for physicians to inform other healthcare providers in the patient’s circle of care. Certainly, physicians should document the steps they have taken.

Complaints that a report was inappropriate

The majority of patients who believed that a report should not have been made to the licensing authority filed a College complaint. The patients often challenged the accuracy of the diagnosis and whether there was sufficient evidence to justify a report to the licensing authority. Other complaints were the result of doctors not speaking with patients about their medical condition and the obligations physicians have with respect to reporting. In some cases the complaint resulted from a physician not having adequate office procedures to track forms sent to the motor vehicle licensing authority.

Medical conditions associated with these College complaints included seizure disorders, dementia, drug and alcohol dependency, psychiatric conditions, and vision problems.

In the majority of cases, the Colleges were supportive of the physician’s decision to report. Occasionally, Colleges advised physicians to inform patients of their intent to make a report and to discuss the results of testing.

Complaints about refusing to assist in reinstatement of driving privileges

Some patients seek the assistance of their physician to have their driver’s licence reinstated. Some patients may file a College complaint if their physician does not support their application for reinstatement.

In some of the CMPA cases the physician was not satisfied that the patient had fully recovered (e.g. recent cardiac problems) or that the patient’s condition (e.g. diabetes, seizure disorders, obstructive sleep apnea) was sufficiently controlled. The Colleges were supportive of the physician, particularly if the documentation in the medical record justified the continuing concerns regarding driving.

Reporting of individuals working in aviation and railway services

Physicians are generally required to report individuals with a medical condition, and who work in aviation and railway services and are in a position critical to safety.8

Consider the case of a male patient, a commercial airline pilot, who is seen by his family physician after his employer notices behavioural changes. The physician assesses the pilot and is concerned about alcohol dependency and depression.

The physician informs the patient that his conditions could affect flight safety and makes a report to the regional civil aviation medical office. The patient’s licence is suspended and he complains to the College that the decision was influenced by his employer.

The College determines the physician’s report was supported by the medical history and that the documentation confirms the patient had been informed.

Managing conflict

Assessing fitness to drive issues can be challenging for physicians and the decision to report may introduce conflict in the doctor-patient relationship. To help minimize such conflict, physicians will want to communicate to the patient the rationale for making the report and the regulatory reporting requirements to which physicians are subject. Physicians might emphasize that the ultimate decision to restrict driving privileges is made by the licensing authority. Members are encouraged to contact the CMPA for individual advice.

Risk management considerations

Physicians should consider the following suggestions based on the CMPA’s review of cases relating to fitness to drive:

  • Consider consulting the recommendations of the CMA and other medical organizations on medical conditions that may pose a danger when operating a motor vehicle.
  • Perform an objective and thorough assessment of patients and when appropriate, incorporate functional or cognitive assessments, or consult specialists.9
  • Familiarize yourself with the reporting legislation in your province or territory. If you are uncertain about the legislation in your jurisdiction or whether it applies to a particular patient, contact the CMPA for advice.
  • Limit the information in your report to what is required by the legislation.
  • Inform patients of your intention and obligation to report. Remind them that the decision to restrict or revoke their licence rests with the provincial or territorial licensing authority.
  • Remember to warn patients not to drive in the interim, since it may take time for the licensing authority to make a decision.
  • Document your discussion and advice provided to patients regarding driving and whether you have made a report. If the risk is not imminent, document your concerns and reasons to reconsider the issue at a future time.
  • Do not assume that another physician has made a report, since the legislation requires each treating physician to report.
  • When asked to assist patients with reinstating a licence, carefully consider whether the clinical condition that led to the restriction has improved enough to satisfy earlier concerns.
  • Ask patients who have complex medical conditions about whether they drive and consider developing a driving cessation plan if warranted in the circumstances.
  • Be sensitive to the patients’ circumstances and provide support to patients distressed about possibly losing their licence.
 
 

References

  1. The Traffic Safety Act, SS 2004, c T-18.1, s 283; The Highway Traffic Act, CCSM c H60, s 157; Highway Traffic Act, RSO 1990, c H.8, s 203; Motor Vehicle Act, RSNB 1973, c M-17, s 309.1; Highway Traffic Act, RSPEI 1988, c H-5, s 233; Highway Traffic Act, RSNL 1990, c H-3. s 174.1; Motor Vehicles Act, RSNWT 1988, c M-16, s 103; Motor Vehicles Act, RSY 2002, c 153, s 17(3); Motor Vehicles Act, RSNWT (Nu) 1988, c M-16, s 103.
  2. Traffic Safety Act, RSA 2000, c T-6, s 60-60.1.
  3. Highway Safety Code, CQLR c C-24.2, s 603.
  4. Motor Vehicle Act, RSNS 1989, c 293, s 279(7).
  5. Collège des médecins du Québec, Guide d’exercice, L’évaluation médicale de l’aptitude à conduire un véhicule automobile (mars 2007).Accessed October 29, 2015 from:
    http://www.cmq.org/publications-pdf/p-1-2007-03-01-fr-evaluation-medicale-aptitude-conduire.pdf
  6. Motor Vehicle Act, RSBC 1996, c 318, s 230.
  7. For more information see the Canadian Medical Association’s CMA Driver’s Guide: Determining Medical Fitness to Operate Motor Vehicles available at www.cma.ca, and the Canadian Council of Motor Transport Administrators’ Determining Driver Fitness in Canada available at www.ccmta.ca.
  8. Canadian Medical Association, CMA Driver’s Guide: Determining Medical Fitness to Operate Motor Vehicles, 2015. Accessed October 29, 2015 from: https://www.cma.ca/en/Pages/drivers-guide.aspx
  9. For more information see the Canadian Geriatrics Society’s Driving and Dementia Toolkits for Health Professionals and for Patients and Caregivers available at
    www.canadiangeriatrics.ca, and the Regional Geriatric Program of Eastern Ontario’s The Driving and Dementia Toolkit for Patients and Caregivers available at www.rgpeo.com.

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.