ARE THEY SAFE TO DRIVE?Jennifer Mason OT Reg. (NS)Tobi Flewwelling OT Reg. (NS)

Faculty/Presenter Disclosure

CFPC CoI Templates: Slide 1

Disclosure of Commercial Support

CFPC CoI Templates: Slide 2

Presentation Objectives

To review and clarify: The Family Physicians’ responsibilities in identifying

and reporting patients deemed unsafe to drive The criteria considered when making the

assessment Guidelines on imposing permanent vs temporary

driving restrictions When to report an unsafe driver and if advising the

patient not to drive is adequate What to do when patients are discovered to be non-

compliant

Driving - Provincially Regulated Driving is provincially regulated The regulatory body for Nova Scotia is the

Registry of Motor Vehicles (RMV) RMV has 2 divisions

The Medical Division Driver Compliance

Key features of the Medical Division are the Medical Fitness Coordinator and Medical Advisory Council (MAC)

Duty to Report

“ All provinces and territories impose a statutory duty on physicians relating to the reporting of patients deemed unfit to drive. This duty may be mandatory or discretionary, depending on the jurisdiction. The duty to report prevails over a physician’s duty of confidentiality.”

CMA Driver’s Guide

Provincial Regulations regarding Reporting by Physicians

Nova Scotia, Quebec, – Discretionary Alberta – Not directly addressed –

interpreted as discretionary BC – Mandatory if the unfit driver has

been warned of the danger and continues to drive

All other provinces and Territories – Mandatory

Physician Responsibility in NS Discretionary not Mandatory Common Law dictates that the physician

can still be held responsible if someone is driving when it was reasonable to think they would be unsafe

Legislation protects physicians from legal action brought against them for making a report

Suspension

The duty is to report a change in medical status that is likely to effect driving

Can specifically request a suspension Medical details are not required if

requesting suspension The suspension is made by the Registry

and the patient receives a letter from them

License is suspended, not revoked

Registry of Motor Vehicles (RMV)

Will suspend if it is recommended by physician

May go to MAC if there are conflicting medical opinions

May require a Comprehensive Driver Evaluation through the Nova Scotia Rehabilitation Centre

Medical Examination Report

A Physician will receive a request to complete the medical examination report:

If the letter sent to the RMV did not clearly recommend suspension

If patient is flagged by Access NS when renewing their license

If patient has a condition that may progress and they are being monitored by the RMV

Permanent or Temporary Restrictions Suspended license – may be temporary or

permanent i.e. suspension can be lifted Revoked license (license taken away) Temporary/defined time driving

restrictions - usually unnecessary to inform the RMV :e.g. For post surgery/illness restrictions

that are for a defined length of time

Reporting vs. Advising Not to Drive The Registry of Motor Vehicles would like all

patients reported (except for temporary cases)

Many physicians choose not to formally report but advise the patient to stop driving

Considerations: Competency Compliance Family involvement Physician responsibility

Reporting vs. Advising Not to Drive

Advising the patient not to drive may be enough if: The driving restriction is temporary (e.g. post

surgery, new medication trial) There is confidence that the patient will be

compliant and/or family is able to assist in enforcing

Note: the majority of patients we see do not remember being told not to drive Needs to be clearly stated May help to write it (prescription) Inform patients of insurance issue

When Patients are Non-Compliant If they haven’t been reported – report

them to the RMV If they are suspended and you have

reason to believe that they are driving: Contact the police – the police in their

community will be asked to watch for the individual

The RMV can suspend the vehicle plates but that eliminates anyone else from using the car

Requirements for Driving

Physical Function Strength and Range of Motion Reaction Time

Visual-Perceptual Function Vision – acuity, visual field, contrast sensitivity,

glare, night vision Visual-spatial neglect, spatial relations, figure

ground, visual scanning

Requirements for Driving

Cognitive Function Attention, processing speed, problem solving,

judgment, memory, multi-tasking Considerations

Driving is contraindicated for frontal/Lewy Body dementias

Paper/pencil tests are poor predictors of on-road performance

There are no “cut-off” scores for driving There is some evidence that decline in IADL’s is

more correlated to on-road performance

Multidisciplinary Approach to Driver Evaluation

Driver Evaluation Program (902) 473-1299 If you have questions contact Tobi Flewwelling OT tobi.flewwelling@nshealth.ca

or Jennifer Mason OT jennifer.mason@nshealth.ca

Initial AssessmentClient identifies drivingas a valued occupation

YES NO

Physician explains potential need fordriver evaluation

Team completes usual assessments/interventions

No further interventionrelated to driving

Further assessmentNeeded?

YES NO

Referral to Comprehensive Driver

Evaluation Program

Discussion re: driver cessationTeam explores alternate forms of transportation with clientPhysicians letter to Registry of Motor Vehicles

Impairment identified in one or more of the following areas:

IADL: Meal preparation, money management, medication managementPhysical functioning that could translate to difficulty operating a vehicle PerceptionCognition

NSHA Comprehensive Driver Evaluation Program

Only program of its kind in Nova Scotia Based at the Nova Scotia Rehab Centre Established 1978 Fee for service model: $440.00 Physician referral required Evaluation requested/accepted by RMV

Evaluators

The evaluation is completed by an occupational therapist who has successfully met the requirements for a Certified Driver Rehabilitation Specialist (CDRS)

On-roads are carried out with a certified driving instructor in a dual-brake vehicle

Vehicle is equipped with hand controls and steering aids or left foot gas if needed

The final recommendation is made by the occupational therapist

Evaluation

Clinical Assessment (family member encouraged to attend, especially for client’s with memory concerns)

Driving history Physical assessment Cognitive/perceptual screen Reaction time

Evaluation

On Road Assessment 40 minutes Dual brake vehicle Vehicle equipped with adaptations (hand

controls, left foot gas, steering aids) Standard routes – one for city drivers, one

for those who don’t typically drive in the city

Can individualize if appropriate All patients are taken on-road

Adaptations- Simple Mechanical Hand controls

Left foot accelerator-

Steering device- Spinner knob/tri pin

Transfer/lift seats

Ramps/Lifts

Transfer of Mobility Equipment

Results

Assessment results are reviewed with client and family

Recommendations and Final Report- sent to referring physician and family physician

Only sent to RMV with client’s consent Client requires final decision from physician

unless already suspended Client is provided with equipment

prescription if appropriate and instructions on purchase, installation and regulations

Resources

NSHealth Website: Driver Evaluation Programhttp://www.cdha.nshealth.ca/rehabilitation-supportive-

care-services/assistive-technology/driver-evaluation-program

Medical Fitness to Drive CMA guidehttps://www.cma.ca/EN/Pages/drivers-guide.aspx

Driving Brochures: Driving safely as you agehttp://www.olderdriversafety.ca/consumer/resources/

index.html Driving and Dementia

https://www.candrive.ca/en/resources/physician-resources/19-driving-toolkit.html

Contact Information

Driver Evaluation Program (902) 473-1299.

Jennifer Mason OT jennifer.mason@nshealth.ca

Tobi Flewwelling OT tobi.flewwelling@nshealth.ca