Driver Medical Fitness Information for Medical Professionals
This web page provides specific driver medical fitness information and resources for medical professionals.
April 2014 message from the Deputy Superintendent of Motor Vehicles on the urgent licence cancellation process
FORM for Reporting a Condition Affecting Fitness and Ability to Drive
Welcome to RoadSafetyBC’s Driver Medical Fitness Program Overview PowerPoint Presentation. This presentation contains a condensed overview of the Driver Medical Fitness Program to help increase health professionals’ awareness of assessment methods and requirements for reporting of medical conditions.
RoadSafetyBC is responsible for determining whether 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 RoadSafetyBC staff make driver fitness determinations.
The BC 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 BC Guide. 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 RoadSafetyBC when determining a patient’s fitness to drive.
BC Guide in Determining Fitness to Drive
Driver fitness guidelines help RoadSafetyBC and medical professionals better assess the effects that a medical condition or conditions, may have on the functions necessary for driving. The policies and procedures in the Guide are the result of a lengthy and intensive process. In March 2006, RoadSafetyBC, 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 RoadSafetyBC. The Guide represents the BCMA and RoadSafetyBC’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, RoadSafetyBC will mail a Driver Medical Examination Report (DMER) to an individual driver, and require them to have their physician complete it. Under the Motor Vehicle Act, it is the driver’s responsibility to ensure that their address is current.
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.
RoadSafetyBC 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. RoadSafetyBC does not reimburse for completion of a yellow DMER.
RoadSafetyBC will also accept DMER’s completed by Nurse Practitioners that are licensed to practice in Canada or the United States.
Driver Fitness Advisory Group
The RoadSafetyBC Driver Fitness Advisory Group is made up of RoadSafetyBC staff and 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 Doctors of BC, the College of Physicians and Surgeons of BC and members of specialized disciplines which include family doctors, occupational therapists, psychologists, registered nurses, nurse practitioners, and optometrists. Driver Fitness Advisory Group members regularly provide expertise, advice, and recommendations to RoadSafetyBC on driver medical fitness issues, guidelines, research, and best practise. The Driver Fitness Advisory Group 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
Every legally qualified and registered psychologist, optometrist, medical practitioner and nurse practitioner has reporting obligations to the Superintendent of Motor Vehicles. Specifically, Section 230 of the Motor Vehicle Act requires medical practitioners to report patients to the Office of the Superintendent of Motor Vehicles 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 RoadSafetyBC, medical professionals are requested to complete, in full, the Report of a Condition Affecting Fitness and Ability to Drive form and fax it to RoadSafetyBC at 250-952-6888.
As outlined in our April 2014 message, following a BC Supreme Court decision,
RoadSafetyBC is required to have clear evidence of the medical issue(s) affecting driving and compelling evidence of the need for urgent intervention, prior to making a driver medical fitness urgent licence cancellation decision. The provision of detailed information to RoadSafetyBC will ensure that we are better able to make informed and timely decisions. For more information please see the Urgent Driver's Licence Reviews and Reconsiderations Fact Sheet.
Physicians and other medical practitioners play an important role in driver fitness assessment. However, only the Superintendent of Motor Vehicles and his delegates have the authority to make driver fitness licensing decisions. Those decisions are informed by medical information and the role that physicians and other medical practitioners play in driver fitness assessment is important.
Medical professionals with questions about roles and responsibilities in relation to driver fitness assessment can speak with one of RoadSafetyBC’s Registered Nurse Case Managers in Victoria through a dedicated phone line for medical professionals: 250-953-8612.
Section 230(3) of the Motor Vehicle Act also provides protection for medical professionals from legal liability where they have submitted a driver fitness report in good faith.
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 RoadSafetyBC patients who you believe are continuing to drive after you have recommended they stop.
What do I do if RoadSafetyBC requires my patient to have Drivers Medical Examination Report (DMER) completed?
When RoadSafetyBC is assessing a driver’s fitness to drive, in most cases a Driver Medical Examination Report (DMER) will be sent to the driver. The driver will be required to have their physician or nurse practitioner complete the DMER.
When a medical professional is completing a DMER, it is essential that complete and thorough details about any noted conditions are provided so that RoadSafetyBC may make a fully informed licencing decision. Incomplete information may result in RoadSafetyBC requesting that the driver return to their physician for additional information.
The completed DMER must be faxed to RoadSafetyBC as directed on the report. RoadSafetyBC staff will review the completed DMER and any other information on the patient’s driving record. If RoadSafetyBC is unable to make a determination on the basis of the information provided, RoadSafetyBC may request additional information or require your patient to undergo further medical or functional assessments (e.g. Road test re-examination, DriveABLE assessment, or occupational therapist assessment,).
If RoadSafetyBC determines that your patient is not fit to drive, we will mail a letter to your patient explaining that decision and outlining the information required in order to review the decision. ICBC will also send a follow-up letter advising the driver that their driver’s licence has been revoked.
RoadSafetyBC does not send any correspondence to the patient where it has determined that the person is fit to continue driving and there is no change in the status of their drivers licence. If you, as a physician, have questions about RoadSafetyBC forms or Driver Fitness procedures, please contact RoadSafetyBC through the dedicated phone line for medical professionals: 250-953-8612.
Why does RoadSafetyBC require a DMER when a driver turns 80?
When a driver turns 80, and every two years thereafter, they are required to have their doctor complete and submit a Driver Medical Examination Report (DMER). There are many age-associated medical conditions which can affect driving including dementias where, even in its mild and moderate forms, increase crash risk by anywhere between two and eight times. When cognitive impairment is progressive, those affected by it will eventually have to stop driving at some point. 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.
Statistics 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.
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.
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 privileges.
If you suspect your patient has a cognitive impairment, it is recommended you administer one or more of the following screening tools: MMSE, MOCA, SIMARD MD, Trails A/B. The results of the screening test(s), in addition to any other clinical information you consider, will help identify if you need to report your patient to RoadSafetyBC. All of your clinical observations should be included in your report to RoadSafetyBC.
When a patient is flagged as being either potentially unfit to drive, or definitively unfit to drive, it is important that 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, a screening tool should not be solely relied-upon for licensing decisions. In such circumstances, document on the report to RoadSafetyBC that the screening results may not be valid based on your clinical opinion, and provide your clinical observations and recommendations.
When should I administer a cognitive screening test?
It is recommended you administer a cognitive screening test:
- When you first suspect a patient has a cognitive impairment;
- When RoadSafetyBC requires a Driver’s Medical Examination Report (DMER) for any of your patients that may be at risk for cognitive decline;
- Every year for a patient with a progressive cognitive impairment who is still driving; or
- When a patient with cognitive impairment shows a clinically significant decline.
If a cognitive screening test is administered and your clinical assessment indicates that cognitive impairment may be present to the point that you have concerns about your patient’s ability to drive and you have not been asked to complete a DMER, report your findings in detail to RoadSafetyBC using a Report of a Condition Affecting Fitness and Ability to Drive form.
What is DriveABLE?
DriveABLE is the brand name for a research‐based, assessment tool that evaluates driving errors related to cognitive impairment. It is used in many jurisdictions across North America to help licensing authorities determine an individual’s cognitive medical fitness to drive. The DriveABLE assessment tool provides a means to individually assess drivers who may have a cognitive impairment.
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) includes tests of motor speed and control, attention, judgment, 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 results of a person of the same age who has no cognitive impairment. 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 individuals are provided the opportunity to have practice sessions to familiarize themselves with the tool through trial sessions that are not formally scored.
Drivers who do not pass the DCAT are offered a secondary opportunity to demonstrate their continued fitness to drive, through 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 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. RoadSafetyBC 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.
DriveABLE Information Guide
What do I do if my patient is referred for a DriveABLE assessment?
If RoadSafetyBC refers your patient for a DriveABLE assessment, RoadSafetyBC will send your patient a letter directing them to call the toll-free DriveABLE Access Line (1-888-475-4666) to book an appointment. RoadSafetyBC pays for all DriveABLE assessments which RoadSafetyBC requests.
When your patient has completed a DriveABLE assessment, a copy of the final report will be sent to RoadSafetyBC and to the physician listed on your patient’s RoadSafetyBC file. Note: If a physician other than yourself is named on your patient’s RoadSafetyBC file, you will not automatically be sent these results.
Decision Reviews and Reconsideration
When a driver has been denied a driver’s licence, or a driver’s licence has been downgraded or cancelled, the information required by RoadSafetyBC to review that decision is set out in RoadSafetyBC’s letter to the driver. When this information is received at RoadSafetyBC an adjudicator or case manager will review it and determine if it is sufficient to change the previous decision, or if additional information and/or assessments are required.
If a driver disagrees with an earlier driver medical fitness licensing decision, they can write in and request that the decision be reconsidered. In these cases, a different adjudicator or case manager will review the existing medical information and/or assessment results on file and determine if the decision stands.
At the conclusion of either a review or reconsideration the adjudicator or case manager will notify the driver in writing either confirming the original decision or advising of a different driver fitness decision.
Some driver medical fitness decisions are made by an Urgent Driver’s Licence Review and have specific timelines and criteria, please see the Urgent Licence Review fact sheet.