ARE THEY SAFE TO DRIVE?
Jennifer Mason OT Reg. (NS)
Tobi Flewwelling OT Reg. (NS)
CFPC CoI Templates: Slide 1
Faculty/Presenter Disclosure
CFPC CoI Templates: Slide 2
Disclosure of Commercial Support
Presentation Objectives
To review and clarify:
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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
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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
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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
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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
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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
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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)
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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
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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
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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
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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
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When Patients are Non-Compliant
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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
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Requirements for Driving
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Physical Function
Strength and Range of Motion
 Reaction Time
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Visual-Perceptual Function
Vision – acuity, visual field, contrast sensitivity, glare, night
vision
 Visual-spatial neglect, spatial relations, figure ground, visual
scanning
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Requirements for Driving
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Cognitive Function
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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
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Initial Assessment
Client identifies driving
as a valued occupation
Multidisciplinary Approach to Driver Evaluation
Physician explains potential need for
driver evaluation
Team completes usual
assessments/interventions
Impairment identified in one or more of the following areas:
IADL: Meal preparation, money management, medication management
Physical functioning that could translate to difficulty operating a vehicle
Perception
Cognition
YES
Further assessment
Needed?
NO
No further intervention
related to driving
YES
NO
Referral to
Comprehensive Driver
Evaluation Program
Discussion re: driver cessation
Team explores alternate forms of transportation with client
Physicians letter to Registry of Motor Vehicles
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
NSHA Comprehensive Driver Evaluation
Program
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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
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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
AdaptationsSimple Mechanical
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Hand controls
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Left foot accelerator-
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Steering device- Spinner knob/tri pin
Transfer/lift seats
Ramps/Lifts
Transfer of Mobility Equipment
Results
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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
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NSHealth Website: Driver Evaluation Program
http://www.cdha.nshealth.ca/rehabilitation-supportive-careservices/assistive-technology/driver-evaluation-program
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Medical Fitness to Drive CMA guide
https://www.cma.ca/EN/Pages/drivers-guide.aspx
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Driving Brochures: Driving safely as you age
http://www.olderdriversafety.ca/consumer/resources/index.html
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Driving and Dementia
https://www.candrive.ca/en/resources/physician-resources/19-drivingtoolkit.html
Contact Information
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Driver Evaluation Program (902) 473-1299.
Jennifer Mason OT jennifer.mason@nshealth.ca
Tobi Flewwelling OT tobi.flewwelling@nshealth.ca