Effective July 1, 2018: Discretionary Reporting of Potentially Medically Unsafe Drivers
OTs in Ontario are now authorized to directly report potentially unsafe drivers to the Ministry of Transport (MTO). This authority is discretionary, not mandatory.
New Medical Reporting Form
The new Medical Condition Report and Guide on how to complete the Medical Condition Report form are now available on the Government of Ontario Central Forms Repository website. This form will be used for both mandatory and discretionary reporting by physicians, nurse practitioners and occupational therapists.
View a Ministry of Transportation fact sheet on Medical Reporting for Occupational Therapists.
Ontario's Highway Traffic Act (HTA) was amended to include new provisions for reporting of potentially unsafe drivers that addressed both mandatory and discretionary reporting for certain healthcare practitioners with a goal to strengthen requirements to enhance road safety, clarify which conditions health care professionals are required to report and improve the Ministry of Transportation's ability to identify potentially unsafe drivers. New regulations, under the Act, were passed in February to enable implementation of the act and it has come into effect on July 1, 2018.
It is now mandatory for physicians, nurse practitioners and optometrists to report certain high risk medical conditions, functional impairments and visual impairment. The list of prescribed conditions can be found in Ontario Regulation 340/94. Also included are provisions for discretionary reporting by physicians, nurse practitioners, optometrists and occupational therapists for any person who, in the opinion of the health care professional, has or appears to have, a medical condition, functional impairment or visual impairment that may make it dangerous for the person to drive.
Prescribed Medical Conditions, Functional Impairments & Visual Impairments
For the purposes of subsection 203 (1) of the Act, the following are the prescribed medical conditions, functional impairments and visual impairments that a prescribed person under subsection (1) shall report:
- Cognitive impairment: a disorder resulting in cognitive impairment that,
- affects attention, judgment and problem solving, planning and sequencing, memory, insight, reaction time or visuospatial perception, and
- results in substantial limitation of the person’s ability to perform activities of daily living.
- Sudden incapacitation: a disorder that has a moderate or high risk of sudden incapacitation, or that has resulted in sudden incapacitation and that has a moderate or high risk of recurrence.
- Motor or sensory impairment: a condition or disorder resulting in severe motor impairment that affects co-ordination, muscle strength and control, flexibility, motor planning, touch or positional sense.
- A best corrected visual acuity that is below 20/50 with both eyes open and examined together.
- A visual field that is less than 120 continuous degrees along the horizontal meridian, or less than 15 continuous degrees above and below fixation, or less than 60 degrees to either side of the vertical midline, including hemianopia.
- Diplopia that is within 40 degrees of fixation point (in all directions) of primary position, that cannot be corrected using prism lenses or patching
- Substance use disorder: a diagnosis of an uncontrolled substance use disorder, excluding caffeine and nicotine, and the person is non-compliant with treatment recommendations.Psychiatric illness: a condition or disorder that currently involves acute psychosis or severe abnormalities of perception such as those present in schizophrenia or in other psychotic disorders, bipolar disorders, trauma or stressor-related disorders, dissociative disorders or neurocognitive disorders, or the person has a suicidal plan involving a vehicle or an intent to use a vehicle to harm others.
For a full listing of conditions to guide reporting and exclusions view the Regulation.
Implications for Occupational Therapists
The legislated identification of occupational therapists as key health professionals involved in the assessment of physical, cognitive and functional ability and the identification of risk related to driver safety is important for the profession of occupational therapy. The authority to provide discretionary reports when a client is deemed unsafe, enables the occupational therapist to act to the fullness of their professional and ethical standards which would lead to communication of identified concerns to appropriate levels of authority. The authority to report supersedes the requirement for consent when a therapist identifies through assessment of the client a potential risk to the client or the public relating to the client's ability to drive.
OSOT has engaged a new Driving Community of Practice to facilitate member engagement and support around these new provisions and to facilitate access to resources, feedback and peer advice. Join the Community here.