Fitness to drive

Andrew was referred to a geriatrician for a review of his cognitive function and memory. The geriatrician’s report outlined cognitive impairment, low RUDAS score, visual-spatial impairment, and a lack of insight regarding the decline.

Andrew holds a heavy-vehicle license. While he does not own a heavy vehicle, he hires them to teach learners how to operate them. Andrew also recently disclosed he was thinking of buying a car.

At Andrew’s next consultation, Dr Powell discussed the results with him and advised that his ability to drive had likely been impacted.

Dr Powell encouraged Andrew to contact Transport for NSW to disclose the condition and undergo a practical driving test.

Andrew became very aggressive, claiming his driving was fine and that he would continue teaching learners. He also confirmed he had purchased a new car and was driving it.

Andrew threatened to sue Dr Powell if he notified Transport for NSW. Dr Powell was also concerned about breaching privacy laws with his disclosure to Transport for NSW.

Medico-legal discussion

Medical professionals play a vital role in helping patients understand the impact their medical conditions have on their day-to-day functioning, including fitness to drive.

Unfortunately, some patients disagree with their doctor’s clinical advice and continue to drive. A question often arises about whether the medical practitioner has a legal obligation to notify their relevant state driving authority about the patient’s impacted fitness to drive.

Notification

Each state has slightly different legislation addressing the issue of notifying the state driving authority.

The first thing to recognise is that all states impose an obligation on the patient to self-notify to the relevant driving authority if they have a certain health condition.

The legislative wording differs between states, but the general principle is that if a patient suffers from a condition, classified as a long-term or permanent physical or mental condition, injury or disability that affects their ability to drive and may endanger the public, they must notify the state authority.

Examples include:

• vision/eye conditions
• cardiovascular conditions
• substance misuse
• dementia and cognitive impairment
• psychiatric conditions
• seizures and epilepsy
• age (in NSW, patients over 75 must undertake a fitness-to-drive assessment).

Most states do not have a mandatory reporting obligation to report a patient whose condition impacts their driving. Exceptions are the Northern Territory (NT), South Australia (SA) and the Australian Capital Territory (ACT).

If a medical practitioner in the NT or SA believes a patient has a long-term or permanent physical or mental condition, injury or disability that affects their ability to drive and may endanger the public, they must notify the relevant authority. The ACT is slightly different, as discussed in more detail below (under ‘Heavy or commercial vehicles’).

The doctor’s role

A doctor’s primary role is to assess a patient’s fitness to drive and to advise patients on how the condition may impact their ability to drive. Part of this discussion may include advising a patient of the requirement to self-notify to the driving authority and/or assist them in the completion of an online medical report.

It is useful for patients to understand that a notification does not automatically mean their license will be suspended. They may instead receive restrictions or conditions on the license. For example, they may be allowed to only drive during the day.

While there is not always a mandatory reporting obligation, you may have an ethical obligation to report the patient’s condition and fitness to drive. This will often arise when a patient lacks insight or judgement due to their condition, or they disregard clinical advice to self-report which places the public at risk of harm. In this case, you should consider reporting the patient to the state driving authority.

If a patient poses an immediate risk to the public (or themselves) due to a serious condition, then the police can be notified. Conditions applicable to this circumstance include driving under the influence, suicidal ideation, and severe mental or physical impairment.

If you believe a patient needs to be reported to the state driving authority or the police, you can contact MDA National for advice.

Heavy or commercial vehicles

Patients who operate heavy or commercial vehicles are required to meet a higher health standard due to the increased risk to the public associated with operating these vehicles.

In the ACT, there is a mandatory reporting requirement that patients holding or applying for heavy-vehicle licenses must be reported to Access Canberra within seven days if they have a permanent or long-term condition that impacts their ability to operate the vehicle safely.

Protection against disclosure

Andrew’s threat of litigation, and Dr Powell’s concerns about breaching privacy, are common considerations when a doctor is faced with the prospect of reporting a patient to the driving authority. All states allow anonymous reporting and provide protection from civil and criminal liability, when the report is made in good faith.

Unsolicited third-party information

Information about a patient’s condition can often be provided by a friend or relative without the patient’s knowledge. Unsolicited collateral information, while often well-meaning, can have privacy implications if the third-party declines to allow the doctor to discuss those concerns with the patient. For more information, see our article: Managing unsolicited patient information from third parties.¹

If you are not permitted to discuss the concerns raised, you can inform the third party to directly contact the driving authority, invite them to attend a consultation with the patient, or make your own independent enquiries about the patient’s fitness to drive as part of your ongoing therapeutic relationship.