Deciding whether to report a patient who may be unfit to drive can be challenging. Physicians may worry about patients blaming them for the related emotional stress, loss of independence, and financial consequences, and they may further worry about patients commencing legal action or complaining to the medical regulatory authority (College) or privacy commissioner.
CMPA is not aware of any Canadian cases in which physicians were found negligent for fulfilling their statutory duty to report fitness to drive. However, there have been cases where physicians were found negligent for failing to fulfill their reporting obligations.
Case example
A patient with Type I diabetes reports to her family physician that she is having serious hypoglycemic episodes. She is subsequently found to be at fault in a car accident. The occupant of the other vehicle suffers serious head injuries, and a legal action is initiated against the patient, her family physician, and others. Experts conclude the physician fell below the standard of care to advise the patient not to drive and to report to the motor vehicle licensing authority. Without expert support, CMPA, on behalf of the physician, contributes to a settlement paid to the occupant of the other car.
Threshold for reporting
It is important to know the requirements in your province or territory for reporting individuals who are unfit to drive.
Mandatory reports
In most jurisdictions, you must report patients with a medical condition that may make it dangerous to drive. 1 You must make a report even if the patient says they will not drive or if another physician has already reported. And, a report must be made irrespective of whether the patient has a valid licence; it is sufficient in most jurisdictions that they are of driving age. 2
If you practise in British Columbia, however, reporting is mandatory only if the patient continues to drive after being warned not to. 3
Discretionary reports
Reporting is discretionary in Alberta 4, Québec 5, and Nova Scotia 6. In Ontario, the duty is discretionary for medical conditions that fall outside the list for mandatory reporting as determined by the Ministry of Transportation. 7
While Québec allows for discretion in reporting, the Collège des médecins states that you must report if you have reason to believe the patient represents a serious risk to public safety and continues to drive despite being warned not to. 8
Temporary conditions
The decision to report patients who suffer from temporary conditions that will not impact their long-term driving ability (e.g. post-surgical transient conditions) is not an easy one. It requires discretionary clinical judgment.
If unsure about the patient’s prognosis or recovery time, consider scheduling a follow-up appointment within a reasonable time to reassess the patient. If after the assessment, you feel the patient continues to suffer from a condition that may make them unfit to drive based on your review of the CMA Driver’s Guide, 9 inform the patient, and make a report.
Reporting and privacy obligations
You will generally not be faulted for breaching patient confidentiality if you make a report in good faith.
Report only the information required and only in the circumstances specified in the legislation or guidelines. 10 Reports should be based on your assessment of the patient’s symptoms, diagnosis, and recommended treatment plan.
Permission to warn
You may be concerned about safety in instances where the patient continues to drive despite being warned not to or despite having their licence suspended. When you reasonably believe that a patient who continues to drive with a medical condition may pose a risk of serious harm, you may be justified in alerting a third party who can assist in preventing the harm (e.g. the police or employer).
The Supreme Court of Canada has recognized that, in certain circumstances, danger to public safety can justify the disclosure of confidential patient information without consent. 12 The permission to warn is also recognized in applicable privacy legislation in all provinces and territories.
Reporting patients who work in safety-sensitive positions
You may also be required to report individuals with a medical condition who work in positions critical to safety in aviation, shipping, and railway services. 9, 13
As well, you may feel it necessary to report patients with medical conditions that may make it unsafe to operate heavy equipment (e.g. forklift, backhoe, etc.). In these circumstances, you should consider whether the patient’s medical condition creates a risk to safety that would permit you to notify the employer or other third party. Before doing so, you should make the patient aware of your concerns and encourage them to independently notify the employer or otherwise address the risk.
Minimizing conflict
To maintain a trusting relationship, you should generally speak with patients before making a report. You should discuss the risks of driving as a result of their medical condition and warn them not to drive. You should talk about the rationale for and the nature of the report, and your legal obligation to make the report. Emphasize that it is the licensing authority that makes the decision to restrict driving. Also, provide appropriate support and advice to patients. If you are concerned that they will respond aggressively, consider taking precautions such as asking a staff member or colleague to join in any discussions.
Your assessment of patients, rationale for the report, and the advice given to them about driving, should be documented in the medical record.
The bottom line
- Review applicable mandatory and discretionary reporting obligations. Limit the information disclosed to what is required by the legislation.
- Warn patients not to drive when their medical condition makes it unsafe. When appropriate, inform patients of your obligation and intention to report. Document assessments, discussions, and advice in the medical record.
- Consider whether to warn third parties, such as police or employers, if concerned about the risk posed by the patient’s continued operation of a motor vehicle or equipment.
- Contact CMPA for case-specific advice.
References
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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(1); 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.
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In Manitoba and Yukon, a report is required if the patient is of driving age and holds a valid driver’s licence.
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Motor Vehicle Act, RSBC 1996, c 318, s 230
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Traffic Safety Act, RSA 2000, c T-6, s 60-60.1
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Highway Safety Code, CQLR c C-24.2, s 603
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Motor Vehicle Act, RSNS 1989, c 293, s 279(7)
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Highway Traffic Act, RSO 1990, c H.8, s 203(2)
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Collège des médecins du Québec, Guide d’exercice, L’évaluation médicale de l’aptitude à conduire un véhicule automobile (Mars 2007)
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Canadian Medical Association. CMA Driver’s Guide. 9th ed. Ottawa (CA): CMA; 2017
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Canadian Council of Motor Transport Administrators. Determining Driver Fitness in Canada: Part 1: A Model for the Administration of Driver Fitness Programs, and Part 2: CCMTA Medical Standards for Drivers. 13th ed. Ottawa (CA); CCMTA; 2013
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Canadian Public Health Association [Internet]. Ottawa (CA): CPHA;2018 Dec. Cannabasics [cited 2019 Feb 26]. Available from: https://www.cpha.ca/cannabasics
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Smith v Jones, [1999] 1 SCR 455
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Aeronautics Act, s. 6.5(1); Canada Shipping Act, s. 90(1); Railway Safety Act, s. 35(2)
