By Dr David Pakchung
Head of Claims, Queensland, Avant Mutual
A story about Jet
Twenty-two month old Jet Rowland was killed when a driver with unstable epilepsy travelling in the opposite direction suffered a seizure, crossed the median strip on the Logan Motorway, south of Brisbane, and collided with the car Jet was travelling in with his mother Anita and his brother Bailey, aged six.
Anita Rowland sustained life-threatening injuries after the combined 200 kilometre per hour impact. Bailey’s spinal cord was severed, causing instant paraplegia. Jet died that night at Brisbane’s Mater Children’s Hospital due to massive internal injuries.
The case highlighted and demonstrated the importance of managing any medical condition as the driver who collided with the Rowlands’ vehicle had been experiencing frequent seizures and therefore should not have been driving. The driver went to gaol for four years. The actions of the hospital doctors, general practitioner and specialists were examined.
How is this relevant to optometrists and what are the issues?
Research has found that glaucoma sufferers are up to four times more likely to have a car accident than the average Australian, representing a major potential cause of injury, hospitalisation or death. Drivers with glaucoma can have reduced peripheral vision which may prevent them from seeing cars close to them when pulling in or out of traffic or when overtaking, or seeing pedestrians.
Side vision loss, sensitivity to lights such as sunlight or headlight glare, blurred vision and an increase in near-miss crashes are all warning signs that should prompt the individual to seek professional help to evaluate their ability to drive safely.
There are issues for:
- the patient, who could be injured or gaoled
- the public, who could be injured
- the optometrist, general practitioner or ophthalmologist, who could be sued or face disciplinary action through AHPRA.
The relevant guidelines and legislation are:
- Assessing Fitness to Drive – Austroads 2016 (austroads.com.au) and
- relevant legislation such as the Queensland Transport Operations (Road Use Management -Driver Licensing) Regulation 2010 (including Jet’s Law – s50-51) or the state equivalent.
Communicating driving restrictions
It is very important to engage the patient about your clinical assessment and management, and explain any decisions about driving restrictions, otherwise the patient may just go around the corner and see another optometrist to obtain their desired driving approval. These discussions may be over several years if the patient’s vision is deteriorating.
You should assess the patient referring to the guidelines, complete the official form or certificate and give it to the patient for certification by their doctor, for presentation to the driver licensing authority by your patient. You need to decide whether the patient should drive or be restricted. If there is a restriction, what is the restriction and for what period does it apply? These restrictions need to be appropriate for the patient’s condition.
Reporting health conditions
All states and territories in Australia have laws about reporting health conditions that might affect a person’s ability to drive safely. These laws have been created to protect public safety and are summarised in Appendix 3 of Assessing Fitness to Drive. The laws require drivers to report to the driver licensing authority any permanent or long-term illness that is likely to affect their ability to drive safely. Failure to notify the authority carries a maximum penalty of $6,600 and cancellation of the driver’s licence.
As the relationship between patient and health professional is confidential, the health professional will not usually communicate directly with the driver licensing authority, but through the patient. However, in South Australia and the Northern Territory, legislation currently requires the health professional to report directly to the licensing authority if they are concerned about the impact of the patient’s health on their ability to drive safely.
What the patient needs to do
The patient should submit the medical certificate or form, with your assessment, to the driver licensing authority and carry the medical certificate while driving, if allowed to drive.
What to do when the patient does not follow your medical recommendation
Health professionals also have an obligation to public safety so, if a health professional believes that a patient is not following advice to cease driving, he or she may report directly to the driver licensing authority.
If you have questions regarding your legal and ethical responsibilities as a health professional, you may wish to seek advice by contacting Avant on 1800 128 268 or Optometry Australia’s National Professional Services manager Luke Arundel on 03 9668 8560 or firstname.lastname@example.org. If you believe that a driver is driving against your optometry advice, you may wish to discuss this with your patient’s doctor and consider contacting your driver licensing authority.
If the driver continues to drive despite the intervention of the driver licensing authority, consider discussing the situation with the police for consideration of intervention.
It is very important to document in detail what you have said to the patient and how you have warned them. You should also document your interaction with the authorities.
Optometrists are protected by law against breaching confidentiality for reporting drivers to driver licensing authorities.
What happens if you disagree with the patient’s ophthalmologist?
You should discuss this with the ophthalmologist and try to reach consensus on restrictions.
Disclaimer: This publication is not comprehensive and does not constitute legal or medical advice. You should seek legal or other professional advice before relying on any content, and practice proper clinical decision making with regard to the individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgment or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Avant is not responsible to you or anyone else for any loss suffered in connection with the use of this information. Information is current only at the date initially published.
Avant provides professional indemnity insurance cover to Optometry Australia on behalf of its members