Driver medical fitness information for medical professionals

 

Yes, there is no change to the current process for an Enhanced Road Assessment or commercial class re-examination referrals. RoadSafetyBC nurses and adjudicators will review the information provided on the report and determine whether or not a functional assessment is required, taking into consideration medical professional recommendations. 

Yes. If RoadSafetyBC determines that a driver requires further evaluation, they may be referred to an  Enhanced Road Assessment or a commercial class re-exam. 

Yes. A Driver's Medical Examination Report can be completed virtually. However, doctors should determine whether a virtual appointment is appropriate on a case-by-case basis. An in-office assessment may be required for some drivers with existing or progressive conditions. 

Welcome to RoadSafetyBC’s Driver Medical Fitness Program Overview Presentation [PDF, 1.5MB]. 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 CCMTA Medical Standards with B.C. Specific Guidelines is the decision guiding tool used by RoadSafetyBC in determining driver licence status and is a reference for medical practitioners when they are assessing driver fitness. The CCMTA Medical Standards with B.C. Specific Guidelines was developed to ensure that driver fitness determinations are made using the best available evidence.

The Canadian Medical Association continues to be a clinical reference for physicians when they are counseling patients regarding driving.  Additionally reference materials and supports including College of Physicians and Surgeons, the Canadian Medical Protective Association, and RoadSafetyBC, also remain valid references for medical practitioners.

To assist in determining an individual’s fitness to drive, RoadSafetyBC will mail a Driver's Medical Examination Report 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 examination reports – 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 assessment report 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 report. RoadSafetyBC does not reimburse for completion of a yellow examination report.

RoadSafetyBC will also accept a Driver's Medical Examination Report completed by nurse practitioners that are licensed to practice in Canada or the United States.

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 practice. The Driver Fitness Advisory Group serves as an important  two-way communications channel for sharing and receiving information with the medical community.  

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 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 whom 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 completed?

When RoadSafetyBC is assessing a driver’s fitness to drive, in most cases a Driver Medical Examination Report will be sent to the driver. The driver will be required to have their physician or nurse practitioner complete the examination report.

When a medical professional is completing an examination report, it is essential that complete and thorough details about any noted conditions are provided so that RoadSafetyBC may make a fully informed licensing decision. Incomplete information may result in RoadSafetyBC requesting that the driver return to their physician for additional information.

The completed report must be faxed to RoadSafetyBC as directed on the report. RoadSafetyBC staff will review the completed report 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. Enhanced Road Assessment, occupational therapist assessment, or ICBC road test re-examination).

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 driver's 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 Driver's Medical Fitness Report when a driver turns 80?

When a driver turns 80, 85, and every two years thereafter, they are required to have their doctor complete and submit a Driver's Medical Examination Report. 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. 

Statistics indicate that B.C. 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 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
• 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 Driver's Medical Examination Report, report your findings in detail to RoadSafetyBC using a Report of a Condition Affecting Fitness and Ability to Drive form [PDF, 273KB]

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 Urgent licence reviews for more information.

• Canadian Medical Association Driver’s Guide
• Driver's Medical Examination Reports
• Mini-Mental State Examination (MMSE)
• MoCA-Test
• University of Alberta – Medically at Risk Driver Centre
• Understanding the Driver Medical Examination Process Flow Chart

• Improvements to the program will be implemented over the next year
• A new case management system and online submission of Driver’s Medical Examination Reports will be released in phases. Please stay tuned for any future updates
• A select group of medical practitioners will test the online form prior to full implementation

• Reduced errors and elimination of duplicate Driver's Medical Examination Reports
• Improved quality and completeness of information received in a Driver’s Medical Examination Report
• Improved efficiency and new features like notifications
• Simplified process of completing, submitting and monitoring the status of a Driver’s Medical Examination Report
• Enhanced public safety and contributions to RoadSafetyBC’s Vision Zero goal