Assessing fitness to drive in elderly patients - requirements a medical practice should take
The recent Inquest into the death of Ruth Capps (Queensland) outlines the requirements a medical practitioner should take into consideration when medically assessing an elderly patient’s fitness to drive.
In that matter, a medical practitioner had been consulted by Ms Capps and provided her with a medical clearance to drive. One week later Ms Capps died in a motor vehicle accident. The medical practitioner had not seen Ms Capps for more than 7 years prior to the assessment and made no attempt to obtain her health records from any other medical practitioner.
In relation to assessing fitness to drive, the Coroner made the following recommendations to medical practitioners:
‘The Guidelines clearly establish the medical standards for licensing and provide comprehensive and consistent procedures for medical practitioners to follow when assessing a patient’s fitness to drive. It is fundamental that a medical practitioner conducting an assessment of a patient’s fitness to drive has a thorough and complete understanding of that patient’s medical history and the guideline requirements for undertaking such an assessment.’
In New South Wales, once a person reaches the age of 75, they are required to undertake a NSW Fitness to Drive Medical Assessment (health assessment) conducted by a medical practitioner in order to retain their licence.
When completing a health assessment, medical practitioners should refer to Assessing Fitness to Drive for Commercial and Private Vehicle Drivers (the guidelines) which detail the medical standards for driver licensing.
The key role of the medical practitioner is to assess a patient’s fitness to drive based on relevant clinical and functional information and in accordance with the guidelines.
Although medical practitioners have a duty to maintain patient confidentially, there are rare occasions, where they are justifiable or required to breach confidentiality. With respect to assessing and reporting fitness to drive, medical practitioners should consider reporting directly to the licensing authority in situations where the patient is either:
- Unable to appreciate the impact of their condition; or
- Unable to take notice of the medical practitioner’s recommendations due to cognitive impairment; or
- Continues driving despite appropriate advice and is likely to endanger the public.
In making a decision to report directly to the licensing authority, it may be useful for a medical practitioner to consider:
- The seriousness of the situation (i.e. the immediate risks to public safety);
- The risks associated with disclosure without the individual’s consent or knowledge, balanced against the implications of non-disclosure;
- The medical practitioner’s ethical and professional obligations; and
- Whether the circumstances indicate a serious and imminent threat to the health, life or safety of any person.
Relevantly, under the Road Transport Act 2013 (NSW), a medical practitioner will not incur liability for reporting to a licensing authority, in good faith, information that discloses or suggests that another person may be unfit to drive.
Medical practitioners will also not incur liability for providing to the licensing authority, in good faith, a health assessment based on an opinion formed as a result of carrying out the appropriate medical examination.
Incorrectly authorising a patient fit to drive can have very serious ramifications both for the medical practitioner, the patient and members of the general public. When determining a patient’s fitness to drive, a medical practitioner’s role is to:
- Pay due regard to a patient’s medical history and relevant clinical and functional information;
- Diagnose any medical conditions;
- Assess, as far as reasonably possible, the degree of functional impairment arising from those medical conditions;
- Advise the patient that he or she is not fit to drive (if that is the case); and
- Report to the licensing authority if necessary.
If you are ever in doubt as to any of these issues, you should contact your medical defence organisation or seek legal advice.
Kylie Agland, Partner
Antonia Quinlivan, Solicitor