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Management

Assessing a patient's fitness to drive

08/02/2018
By Karen Crouch
With an increasingly ageing population, KAREN CROUCH explains the sometimes-complicated task practitioners face when reviewing the fitness levels of their elder patients and their ability to drive.

People are living longer and, with the support of advanced medications, diet and exercise, elderly drivers enjoy far improved health conditions than their predecessors.

However, from time to time, even the healthiest of drivers may experience problems that impact their ability to drive competently.

If it is apparent that a patient has a condition that may affect their ability to drive, the tending practitioner should inform them of the impact it could have on their driving effectiveness.

In normal circumstances, the onus of notification to the Roads and Maritime Services (RMS) of permanent or long-term injury or illness that impairs a driver’s ability to drive rests with the licence holder.

However, in some instances a patient may be incapable of understanding, or, regardless of practitioner advice, decide to continue driving. If this occurs, you should seriously consider reporting the matter to the RMS.

"It would be prudent for the practitioner to advise a patient who is deemed to be ‘unfit-to-drive’ of their obligation to report the matter to the rms."

Naturally, as such action will likely have a negative impact on the ongoing relationship with the driver/patient, it is up to the practitioner to address the situation appropriately.

Regardless, it is advisable in such situations, to not only pay heed to the practitioner/patient relationship, but also to the potential negative impact on other drivers or road users.

RMS Guidelines set out specific conditions that must be reported as a statutory duty. However, the situation is not so simple or straightforward in respect of circumstances that fall outside these clearly reportable categories.

At this point, there is no statutory obligation to report to the RMS and, as yet, Australian courts have not imposed positive duties upon medical practitioners to warn third parties (drivers/patients) of serious risk of harm to that person’s life or health (not to mention the potential for harm to other innocent parties).

However, it is possible that future courts may impose such a duty if statistical evidence proves that the incidence of ‘unfit-to-drive’ persons are found to be the cause of increasing numbers of accidents.

As a suggested starting point, it would be prudent for the practitioner to advise a patient who is deemed to be ‘unfit-to-drive’ of their obligation to report the matter to the RMS.

However, if a practitioner does deem it necessary to report a situation and elects to lodge a report, the Road Transport Act 2013 (NSW) provides appropriate protections for medical practitioners from civil or criminal liability for expressing “in good faith, an opinion formed as a result of having carried out the test or examination”.

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Further, an individual will not incur civil or criminal liability for disclosure to the RMS “in good faith, information that discloses or suggests that another person is or may be unfit to drive”.

Some patients may be unwilling to stop driving
Some patients may be unwilling to stop driving

The Privacy Amendment (Private Sector) Act 2000 further permits disclosures of information to lessen or prevent serious and imminent threat to an individual’s life, health or safety, or a serious threat to public health or safety.

As noted above, these protections apply only where a practitioner has formed an educated “unfit-to-drive” opinion based on actual tests and the patient/ driver appears unlikely to discharge their responsibility of reporting the condition to the RMS.

Admittedly, these obligations involve careful consideration and exercise of discretion in deciding on the most appropriate course of action. Medical practitioners have two conflicting responsibilities that must be weighed against each other: Their duty to protect confidentiality of patients and the information collected; and their duty to protect third persons and/or the public from potential danger (and subsequent injury) that may be created (or caused) as a result of a patient’s condition while driving.

Summary: When to report your patient to the RMS

It is advisable that medical practitioners who, having counselled a patient appropriately and recommended that they report an impairment to the RMS, become aware that the patient has not done so, and continues to drive, particularly in the case of commercial drivers, report the matter to the RMS.

Provided the report is made in good faith, medical practitioners should be assured of adequate personal protections under the Road Transport Act 2013 (NSW) and the Privacy Amendment (Private Sector) Act 2000.

The Assessing Fitness to Drive Guidelines 2003 contains Commercial/Private Standards and necessary Questionnaire and Examination Proforma to follow when completing an RMS medical certificate.

 

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