New guidelines will help relieve the concerns of doctors who are unsure of their reporting obligations.
Knowing when to report a patient to the relevant licensing authority will be made easier from the 1st of October 2016 when the 2016 Medical Standards for licensing and clinical management guidelines come into effect.
These standards which have been approved by Commonwealth, state and territory transport ministers, are outlined clearly in Assessing Fitness to Drive for Commercial and Private Vehicle Drivers (2016 Edition).
Legislation relating to reporting
The new guidelines have not altered the legislative framework relating to the reporting of impairment (physical or mental) that adversely affects an individual’s ability to drive safely. Apart from the Northern Territory and South Australia there is no mandatory reporting requirement for health practitioners to notify authorities.
In the states and territories where mandatory reporting is not a requirement, legislation1 provides an indemnity against any civil or criminal liability; if a health practitioner, in good faith informs the relevant authority that a person they have examined is or may be unfit to drive, or it may be dangerous for that person to hold a current license.
Before making a discretionary report to a licensing authority the guidelines recommend that doctors inform the patient of the impact their condition has on their ability to drive safely and their responsibility to self-report to the relevant licensing authority. The guidelines also recommend that doctors:
- Recommend restrictions pending rehabilitation or training
- Treat and monitor the patient’s condition and give ongoing consideration to their fitness to drive
- Provide the patient with a report regarding their fitness to drive to provide to the licensing authority
Doctors have a legal and ethical duty to maintain patient confidentiality but there is an exception if public safety is or may be at risk and the patient is:
- Unable to understand or accept the impact of their condition or
- Unable to follow the health practitioners’ recommendations due to cognitive impairment or
- Continues to drive contrary to advice and there is a serious and imminent risk to the public or to the individual.
Before making a discretionary report it is recommended that practitioners inform their patient that if they do not self-report, in the interests of public safety they have an ethical duty to make a direct report. This advice should be documented in the patient record.
So long as the discretionary report is made in good faith doctors are indemnified from civil and criminal liability. The only exception is the Northern Territory.
In the Northern Territory there is a mandatory notification obligation but no protection against any criminal or civil liability. For doctors practising in the Northern Territory it is important to ensure that mandatory notifications are made in good faith and after considering the requirements set out in the guidelines.
South Australia also imposes a mandatory notification obligation but the legislation in that state provides an indemnity if the notification is made after forming a reasonable belief that a driver would be likely to endanger the public if he/she continues to drive while suffering from a physical or mental condition.
Key take outs
The new guidelines should assist doctors in making more confident and uniform assessments of patients’ fitness to drive.
The guidelines do not alter the requirement for doctors in the Northern Territory and South Australia to make a mandatory report if a person would be likely to endanger the public if they continue to drive.
Communication with the patient of any concerns about their fitness to drive should always be made prior to reporting them to the licensing authority. Always make careful documentation of findings and reasons for your concerns, as well as the content of any discussions regarding this with the patient.
If you need guidance on your reporting obligations in relation to fitness to drive assessments, call the Avant Medico-legal Advisory Service on 1800 128 268.
Our Avant Learning Centre has resources to assist doctors in managing difficult patients and privacy and confidentiality obligations.
1 Road Transport (Driver Licensing) Act 1999 (ACT); Road Transport Act 2013 (NSW); Transport Operations (Road Use Management) Act 1995 (Qld); Vehicle and Traffic Act 1999 (Tas); Road Safety Act 1996 (Vic); Road Traffic (Administration) Act 2008 (WA)
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