Reporting dangerous drivers isn't
always clear-cut

Some doctors question mandatory reporting

By Sam Solomon

If your patient has a condition that could make driving dangerous, you're obligated to file a report with your province's Ministry of Transportation. And that's a good thing. Right?

Well, it turns out things aren't as simple as they seem. Rules about reporting a patient to the government for a fitness to drive review vary depending on where you practise. In Quebec, Nova Scotia and Alberta the decision to report a patient is left to the doctor's discretion.

And in provinces with mandatory reporting, some doctors have raised questions about the effectiveness and the benefits of such a policy.

BETRAYAL OF TRUST
"Few issues alienate patients from their doctors as much as this one does," according to the Canadian Cardiovascular Society's (CCS) most recent report on assessing cardiac patients' fitness to drive and fly. The report was written by a panel of physicians from across the country and vetted by regulatory officials.

Widespread concern persists that reporting patients to the government rather than dealing with the patient directly leads to a loss of trust. A 1992 study published in Epilepsia, conducted in Oregon, showed that because of this, mandatory reporting policies may in fact end up putting more unsafe drivers on the road because patients are less likely to report future reportable medical incidents. Twenty-eight percent of seizure patients said they would withhold information about breakthrough seizures if a mandatory reporting policy were in place; just 4% said they'd do so in the absence of mandatory reporting.

BUREAUCRATIC BACKLOG
Mandatory reporting is unhelpful when a patient has transient medical issues, like an undifferentiated syncopal spell or coronary artery bypass surgery, that clear up before the suspension begins, the CCS report also found.

In addition, the CCS wrote that patients' suspensions often go on too long and require unnecessary tests to overturn.

This very problem emerged earlier this year. An Ontario recovering alcoholic named Paul had his licence suspended after he suffered what he insists was heat stroke but was diagnosed by an ED doc as an alcohol withdrawal seizure. Paul has completed a hep C treatment program and abstinence from alcohol for over a year should qualify him for reinstatement. The government insists, despite two physicians' recommendations to the contrary, that Paul must still complete an alcoholism treatment program. "It took a doctor's note to take my licence away," he says, "but a doctor's note can't get it back."

"He's being denied his licence on the basis of alcohol, not on the basis of the seizure," says his doctor, who requested anonymity. "When some of these people lose their licences, they lose their jobs, their livelihood, everything. Paul only got in trouble when he stopped drinking — he was better off when he was drinking daily!"

"There are a lot of grey areas, especially with alcohol-related disorders," agrees Dr David Butcher, the editor of the CMA driving cessation guide. But he says in most cases, alcohol-related disorders are in fact underestimated and underreported by physicians.

Looking at Ontario statistics from 1996, a 2000 Canadian Journal of Cardiology study found only 1% of cardiac patients who met mandatory reporting criteria were actually reported, meaning an average of less than one death would be prevented per year.