Inquest highlights doctors’ discretionary powers to report unfit drivers

Megan Prideaux, BA (hons) LLB, GDLP Grad Dip Hlth & Med Law, Solicitor, Avant

Dr Mark Woodrow, MBBS, MBA, GDipAppLaw, GCertArts, EMCert(ACEM), MACLM, AFRACMA, General Manager – Medical Advisory Services, Avant

Thursday, 25 March 2021

A recent coronial inquest reminds GPs of the important role they play in assessing a patient’s fitness to drive, and if voluntary notification to the licensing authority of any relevant medical conditions or injuries is necessary.

A 60-year-old man was driving his Landcruiser when he veered off the road and collided with gas bottles at the back of a café. It caused a fatal explosion that killed two people and injured 19 people inside the café.

The driver had a history of epileptic seizures for a decade and had been admitted to hospital on at least three occasions prior to the accident for mental health. He was advised by hospital doctors not to drive and was referred to his GP for follow-up care.

The man did not drive for about a month after the first seizure but continued to drive despite concerns from friends and family.

The matter was referred to an inquest by the coroner but the driver and his GP had both passed away prior to the coroner’s hearing. Criminal charges against the driver for negligent driving had been discontinued because he was not considered mentally fit to stand trial.

Medical standards for licensing

All doctors have a clearly defined duty to their patient. However, they have a less clearly defined duty to act in the public interest, to ensure public safety and protect the community from harm. The difficulty lies in the potential conflict between duty to patient versus duty to public, autonomy versus justice.

In all states and territories, all vehicle licence holders have a statutory obligation to report any medical conditions which may adversely affect their ability to drive.

A doctor’s reporting obligations in relation to patient’s fitness to drive is discretionary in all jurisdictions except South Australia and the Northern Territory, where doctors have mandatory reporting obligations.

If in a doctor’s clinical judgment a driver does not meet the medical standard, it is inappropriate for a doctor to certify the patient’s fitness to drive.

Coroner's findings

The driver’s regular GP had been treating him for many years, yet the GP’s notes did not include whether he made any inquiries about the driver’s seizures, his mental health conditions, or reinforced he should not drive for any specified period of time.

Foremost, the patient-doctor relationship is defined by trust and doctors have an ethical and a legal responsibility to maintain patient confidentiality. It was for this reason that the coroner did not recommend imposing a mandatory duty on doctors to notify the Department of Transport, particularly since this case was in Queensland.

Doctors have an ethical duty to report if the patient potentially puts the public at risk and doctors are protected under the relevant roads and traffic legislation if they report in good faith.

However, it is not only the responsibility of GPs to report patients who may be a danger. Other practitioners who are in contact with the driver in question, including in the ED, can also make voluntary notifications and should be aware of the Ausroads guidelines.

The coroner found that the driver was not fit to drive at the time of the accident and should not have held an unconditional driver’s licence. He made recommendations that the Department of Transport facilitate an educational campaign for the professional development of GPs and doctors, to better understand the pathways to notify and report medical conditions that impact on fitness to drive.

Doctors' discretionary powers

One of the key issues considered by the coroner was the role and obligations of GPs when patients have medical conditions or injuries that may impact their ability to drive. The coroner stated that a patient’s regular GP is in the best position to consider a person’s fitness to drive and discuss not driving with them. The coroner concluded that GPs must have a greater awareness of their discretionary power to report unfit drivers.

If considering whether a voluntary notification is necessary, a GP should examine if there is a serious threat to anybody in the public. In this case, the doctor had an obligation to give clear advice to the patient because of their previous and current history with seizures. Doctors have an ethical obligation to act to protect the public if their patient is potentially putting the public at risk.

Ultimately is it up to the licensing authority to determine whether a patient is fit to drive, based on the GP’s clinical assessment. However, if the GP clears someone fit to drive against the Ausroads criteria and the driver has an accident, the doctor may be open to criticism. It would be necessary for the GP to document their clinical assessment appropriately in the circumstances, including the advice and information given to the patient.

Useful resources

If you need guidance on your reporting obligations in relation to fitness to drive assessments, please visit Avant’s Medico-legal Advisory Service website, contact us on nca@avant.org.au or call 1800 128 268, 24/7 in emergencies.