Driver Medical Fitness Information for Medical Professionals
This web page provides specific driver medical fitness information and resources for medical professionals.
October 2013 message from the Superintendent of Motor Vehicles on Driver Medical Examination Reports
August 2013 message from the Superintendent of Motor Vehicles on Driver Medical Examination Reports
The Office of the Superintendent of Motor Vehicles (OSMV) is responsible for ensuring that individuals are medically fit to drive. All driver fitness cases are reviewed by a team of intake agents, adjudicators and case managers. Case managers, who are Registered Nurses, are responsible for making decisions on medically complicated cases and providing consultation to adjudicators as required. The 2010 BC Guide in Determining Fitness to Drive was developed in partnership with the British Columbia Medical Association (BCMA) and provides the decision making framework to help OSMV staff make driver fitness determinations.
The Guide was developed to help ensure that driver fitness determinations are made using the best available evidence.
The BC Driver Fitness Handbook for Medical Professionals is a condensed, quick-reference version of the more detailed 2010 BC Guide in Determining Fitness to Drive. The Handbook was developed for the use of medical professionals who may have to consider a patient’s fitness to drive and also to assist medical professionals faced with discussing driving ability with their patients. The Handbook provides medical professionals with specific details as to the information that is required by OSMV when determining a patient’s fitness to drive.
BC Guide in Determining Fitness to Drive
Driver fitness guidelines help OSMV and medical professionals better assess the effects that a medical condition or conditions have on the driver’s cognitive, sensory and motor functions necessary for driving. The policies and procedures in the Guide are the result of a lengthy and intensive process. In March 2006, OSMV, in partnership with the BCMA, launched the Guide to Drive Project. Over the course of four years, the BCMA played an integral role in creating medical condition guidelines and a decision-making framework for OSMV. The Guide represents the BCMA and OSMV’s continuing commitment to anchor driver fitness determinations on the best- available evidence. In response to case law, the Guide presents an approach to driver fitness focused on functional ability to drive, rather than on diagnosis.
To assist in determining an individual’s fitness to drive, the OSMV will mail a Driver Medical Examination Report (DMER) to an individual driver, and require them to have their physician complete it.
There are currently two types of DMER’s – blue forms which are sent to drivers with known, or suspected, medical conditions, and yellow forms which are sent to drivers when they turn 80 and every two years thereafter and to commercial drivers at specified intervals.
OSMV reimburses physicians $75 for completing a blue DMER on a patient’s behalf. Information regarding how to claim that reimbursement is printed on the form. Patients are responsible for paying any surcharge which medical professionals may levy beyond $75 for completion of the DMER. OSMV does not reimburse for completion of a yellow DMER.
OSMV will also accept DMER’s completed by Nurse Practitioners licensed to practice in B.C.
Driver Fitness Advisory Group (DFAG)
The OSMV Driver Fitness Advisory Group (DFAG) is a group of medical professionals representing various professional bodies and occupational fields who have an interest in driver medical fitness issues. Current members include representatives from the BC Medical Association (BCMA) and the College of Physicians and Surgeons of BC, plus members of specialized disciplines which include family doctors, occupational therapists, psychologists, registered nurses, nurse practitioners, and optometrists. DFAG members regularly provides expertise, advice, and recommendations to OSMV on driver medical fitness issues, guidelines, research, and best practise. The DFAG serves as an important two-way communications channel for sharing and receiving information with the medical community.
Reporting a patient who may be unfit to drive
Currently, medical professionals are mandated to report to the Office of the Superintendent of Motor Vehicles (OSMV) any patients who continue to drive after you have recommended they stop. Section 230 of The Motor Vehicle Act requires medical practitioners to report patients to the Office of the Superintendent of Motor Vehicles (OSMV) if:
- a patient has a medical condition that makes it dangerous to the patient, or to the public, for the patient to drive a motor vehicle, and
- continues to drive after the psychologist, optometrist, medical practitioner or nurse practitioner warns the patient of the danger.
When reporting a condition to OSMV, medical professionals are requested to complete, in full, the Report of a Condition Affecting Fitness and Ability to Drive form and fax it to OSMV at 250-952-6888.
As the decision making authority for driver licensing, only OSMV can revoke a driver’s licence.
If you, as a physician, have questions about this, you can speak with one of OSMV’s driver fitness staff in Victoria via a dedicated phone line for medical professionals: 250-953-8612.
All provinces protect the physician from litigation if they submit a report in good faith. We encourage medical practitioners to exercise responsible due diligence in reporting patients whose medical condition or functional impairment can reasonably be expected to affect their ability to drive.
As a medical professional, what is my role in the driver fitness assessment process?
As a medical professional, you play an important role in the driver fitness assessment process by:
- Providing critical medical examination and assessment information about your patient through the Driver Medical Examination Report (DMER) and other medical assessment reports.
- Talking to your patient about when they may need to eventually stop driving, and reminding them that they can exchange their licence for a free BC Identification Card.
- Providing driving cessation recommendations to patients and reporting to OSMV patients who you believe are continuing to drive after you have recommended they stop.
What do I do if OSMV requires my patient to have Drivers Medical Examination Report (DMER) completed?
When the Office of the Superintendent of Motor Vehicles (OSMV) is determining a driver’s fitness to drive, they will most often mail a Driver Medical Examination Report (DMER) to the driver and ask the driver to have their physician complete it. On completion of the DMER, fax a copy to OSMV as directed on the report. OSMV will review the completed DMER and any other information on your patient’s driving record to determine if your patient can continue to drive. If OSMV is unable to make this determination from the information available, OSMV may request additional information or require your patient to undergo further medical or functional assessments (e.g. DriveABLE assessment, occupational therapist assessment, driver re-examination road test).
If OSMV determines that your patient is not fit to drive, we will mail a letter to your patient explaining that decision and outlining what information is required in order to review the decision. ICBC will also send a follow-up letter advising them that their driver’s licence has been revoked. If OSMV determines your patient is safe to continue driving, OSMV does not send any correspondence to your patient. If you, as a physician, have questions about OSMV forms or Driver Fitness procedures, you can phone the dedicated phone line for medical professionals: 250-953-8612.
Why does OSMV require a DMER when a driver turns 80?
When a driver turns 80, and every two years thereafter, we send them a letter requiring them to have their doctor complete and submit a Driver Medical Examination Report (DMER). We require this because there are many age-associated medical conditions which can affect our driving. One example is cognitive impairment which increasingly affects our ability to drive safely as we age.
The BC Guide in Determining Fitness to Drive notes that 25% of Canadians aged 65 and older have some form of cognitive impairment, and that that incidence rises to 70% for those aged 85 and older.
In addition, statistics from ICBC indicate that BC drivers aged 80 and older are responsible for almost 70% of the crashes in which they are involved. Drivers aged 80 and older are also involved in more crashes per kilometre driven than almost any other age group, and are also much more likely to die in those crashes.
What do I do if I suspect my patient has a cognitive impairment?
Individuals with cognitive impairment or dementia are not able to compensate for their functional impairment. Driving cessation is inevitable at some point when the medical condition is progressive. When you, as a medical professional, have a patient whom you suspect has a cognitive impairment, driving issues should be addressed as soon as possible. Your patient and their caregivers need time to plan for the loss of driving.
If you suspect your patient has a cognitive impairment, it is recommended you administer a SIMARD MD screening test. The results of the SIMARD MD screening test will help identify if you need to report your patient to OSMV, who may further assess your patient through an additional functional DriveABLE assessment.
View more on SIMARD MD
View more on DriveABLE
What is SIMARD MD?
The SIMARD MD (Screen for the Identification of Cognitively Impaired Medically At-Risk Drivers, a Modification of the DemTect) is a valid and reliable screening tool for the identification of cognitively impaired medically at-risk drivers. It is referred to as a modification of the DemTect because it uses a subset of the items from that screening tool.
SIMARD MD was developed and validated against actual driving performance using a driving evaluation scientifically developed to identify cognitively impaired drivers who are unsafe to drive.
There are three possible outcomes for the SIMARD MD screen:
A score of:
≤ 30: flagged as unfit to drive
> 71: flagged as potentially fit to drive
When a patient is flagged as being either potentially fit to drive or unfit to drive, it is important you consider whether mitigating factors exist that could have influenced the result. For example, a language barrier could influence a patient to score lower than their true ability. Conversely, a highly intelligent patient could score higher than their true ability. In these cases, the SIMARD MD tool should not be solely relied-upon for licensing decisions. In such circumstances, document on the report to OSMV that the SIMARD MD result may not be valid based on your clinical opinion, and recommend the patient be referred for a DriveABLE assessment.
When should I administer a SIMARD MD?
It is recommended you administer a SIMARD MD screening test:
- When you first suspect a patient has a cognitive impairment
- When OSMV requests you to complete a Driver’s Medical Examination Report (DMER) on your patient.
- Every year for a patient with a progressive cognitive impairment who is still driving
- When a patient with cognitive impairment shows a clinically significant decline
If a SIMARD MD is administered and your patient scores in the ‘indeterminate’ or ‘flagged as potentially unfit to drive’ range and you have not been asked to complete a DMER, report this score to OSMV using a Report of a Condition Affecting Fitness and Ability to Drive form.
If you report a SIMARD MD score of less than 30, research indicates that it is very likely your patient does not have sufficient cognitive function for driving. If OSMV receives a SIMARD score between 0-30, OSMV will send your patient a letter advising them that their driver’s licence has been cancelled in the interests of public safety. OSMV will re-assess this decision if you submit a report detailing the nature and extent of an improvement in your patient’s cognitive impairment.
What is DriveABLE?
DriveABLE is the brand name for a research‐based, scientific assessment tool that evaluates driving errors related to cognitive impairment. It is used across North America to help licensing authorities determine an individual’s cognitive medical fitness to drive. The DriveABLE assessment tool was developed at the University of Alberta through extensive research comparing the abilities and driving of hundreds of medically safe and unsafe drivers.
Before DriveABLE was introduced as an assessment tool, OSMV often had to make licensing decisions based only upon the diagnosed presence of a cognitive medical condition. Through the use of the DriveABLE assessment tool, individuals who may have a cognitive impairment are now individually assessed to determine if they are safe to continue driving. If a cognitive condition does not adversely affect their ability to drive safely, they can be allowed to continue to drive.
DriveABLE consists of the following separate procedures:
- DriveABLE Cognitive Assessment Tool (DCAT) (in-office)
- DriveABLE On-Road Evaluation (DORE) (on-road)
The DriveABLE Cognitive Assessment Tool (DCAT) is an in-office assessment of cognitive abilities essential for safe driving. This includes tests of motor speed and control, attention, judgement, memory and decision-making, and making judgments of driving situations.
The DCAT measures only the specific cognitive functions needed for safe driving. It does not measure a person’s overall cognitive functioning or intelligence. Results are judged against someone without a cognitive impairment of the same age. The DCAT is presented on a touch screen and takes about an hour to complete. No knowledge of computers or their applications are needed; an individual only needs to touch the screen and press a button to complete the tasks. A mouse and a keyboard are never used. A trained healthcare professional (typically a kinesiologist or occupational therapist) administers the DCAT and guides the individual, and practice sessions are encouraged.
Drivers who do not pass the DCAT are offered a secondary opportunity to demonstrate their continued fitness to drive, via a DriveABLE On-Road Evaluation (DORE).
The DriveABLE On-Road Evaluation (DORE) is an on-road evaluation which consists of a standardized road course developed through scientific research to reveal competence-defining driving errors. Professional driving assessors trained and certified by DriveABLE administer the on‐road evaluation on special road courses designed to detect and assess driving errors associated with cognitive decline. Minor handling errors and bad driving habits are not part of the scoring; only errors related to cognitive abilities are scored. OSMV requires a DORE to be conducted in a dual‐brake vehicle, as that is the safest environment for the driver, the driving examiner, and other road users in the event of unsafe driving due to cognitive impairment.
DriveABLE Information Guide
What do I do if my patient is referred for a DriveABLE assessment?
If the Office of the Superintendent of Motor Vehicles (OSMV) refers your patient for a DriveABLE assessment, OSMV will send your patient a letter directing your patient to call the toll-free DriveABLE Access Line (1-888-475-4666) to book an appointment. In addition, if DriveABLE has your contact information, you will be sent a notification alerting you that OSMV has sent your patient a letter referring them to DriveABLE. Unlike in most other jurisdictions, in British Columbia, OSMV pays for all DriveABLE assessments which OSMV requests.
If DriveABLE has you listed as your patient’s physician and your patient does not pass the in-office assessment (DCAT), you will receive a notification that your patient has been referred for a DriveABLE on-road evaluation (DORE). This notification is for information purposes only; you do not need to take any action at that time.
When your patient has completed a DriveABLE assessment, a copy of the final report will be sent to OSMV and to the physician listed on your patient’s OSMV file. Note: If a physician other than yourself is named on your patient’s OSMV file, you will not automatically be sent these results.
OSMV cognitive assessment process flow chart
An individual is always free to request OSMV to review a driver fitness determination. There is no fee associated with requesting a review, and the process of how to apply for a review is outlined in the documents which your patient will have received detailing OSMV’s decision on their medical fitness to drive.
There are two types of review – a reassessment, and an appeal.
If a driver disagrees with an earlier driver medical fitness licensing decision, they can write in and appeal the decision and request the file be reviewed. In these cases, a different adjudicator or case manager will review the existing medical information and assessment results on file.
If a driver wants a reassessment, then they must be able to provide the Superintendent’s office with new medical information indicating an improvement in their condition. An adjudicator will then review this new information and may request additional information and/or assessments.
At the conclusion of either a reassessment or an appeal, the adjudicator or case manager will notify the driver in writing either confirming the original decision or advising of a different driver fitness decision.