Coroner acknowledges complexity of fitness to drive assessments for GPs

Key messages from the case

Doctors may need to report to the licensing authority if they believe a patient will pose a danger to the public by continuing to drive when unfit.  Assessing a patient’s fitness to drive can be complex, as a coroner’s investigation highlights. Doctors can only act on information available to them. Individuals, families and communities all have a role in supporting patients when they can no longer drive safely.

Details of the decision

Fitness to drive

Mr W (aged 89) was found to have been at fault in a head-on car accident with a motorcycle that caused the death of the rider. Shortly after the accident, Mr W was diagnosed with vascular dementia, and he died approximately four months later. 

A coronial investigation was conducted into the accident and the death of the motorcyclist. The coroner was asked to consider whether to refer a GP to the Medical Board over their assessment of Mr W’s fitness to drive.

At the time of the accident, Mr W had been involved in several traffic accidents over the previous five years. As a driver over 75 he was required to hold a current medical certificate permitting him to drive. Mr W’s certificate had expired. The licensing authority advised him he needed to provide a current medical certificate, otherwise his licence would be cancelled.

His past medical history included memory problems, referrals to a geriatrician that he did not act on, and discharges from hospital against medical advice after falls. He was repeatedly advised to have a licence assessment. 

Eventually, Mr W attended a GP practice requesting a certificate. The GP did not know Mr W well, and was not aware of his history. However, since the GP’s assessment did raise some concerns, the GP:

• declined to provide a new certificate
• referred Mr W to a specialist geriatrician for assessment before his licence was renewed
• warned Mr W and his carer that he should not be driving, and, at the very least, not on highways.

The GP did not report Mr W to the licensing authority.

With hindsight, the GP said they wished they had reported Mr W. But at the time they did not consider Mr W lacked decision-making capacity and believed he had accepted the need for specialist assessment of his driving capacity. Since the incident the GP had sought further education on assessing fitness to drive.

Outcome

The coroner noted that in the relevant state jurisdiction, there is no mandatory requirement for doctors to report a patient to the licensing authority if medical conditions affect their fitness to drive. Doctors are permitted to report if they believe a patient may pose a danger to the public.

The coroner accepted medical expert opinion that in all circumstances the GP had acted appropriately. The GP had examined Mr W and formed an appropriate management plan, declining to authorise Mr W to drive and referring him for further assessment. The GP reasonably believed Mr W understood he should not be driving. They also took steps to minimise risk of harm by involving Mr W’s carer. Based on the information available to them, the GP did not have grounds to foresee Mr W posed a danger to the public, and therefore did not have grounds to report him to the licensing authority.

The coroner also noted that the licensing authority had already contacted Mr W, advising that they had proposed to cancel his licence unless he provided a valid medical authorisation, and it was unclear whether he had responded. The coroner noted that Mr W was recalcitrant and failed to act on advice and correspondence from the licensing authority and engaged in GP shopping for medical certification, He noted that Mr W’s carer appears to have enabled this behaviour, including by giving incomplete information to his providers.  

The coroner declined to refer the GP to the Medical Board.

Key lessons

Individuals are required to self-report to the licensing authority if they have a condition that makes them unfit to drive.

As a medical practitioner, you are obliged to advise the patient if it is unsafe for them to drive at any time, due to long- or short-term conditions or treatments.

If you believe a patient is likely to endanger the public by driving when they are medically unfit, consider whether you also need to notify the state or territory licensing authority.

In South Australia and the Northern Territory, you must notify the licensing authority in this situation. In other jurisdictions, you may need to notify as part of your ethical duty to protect the public.

You are protected by law if you make a report to a licensing or regulatory authority in good faith. This is not a breach of privacy or your duty of confidentiality to the patient.

With the patient’s consent, involving family members or carers may assist in supporting patients who are no longer fit to drive.

References and further reading

Avant factsheet – Fitness to drive

Avant video – Assessing fitness to drive

Austroads publication – Assessing fitness to drive