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Mandatory Reporting to SGI

On May 4, 2012 amendments were enacted to The Driver Licensing and Suspension Regulations to expand the definition of duly qualified medical practitioner to include nurse practitioners and occupational therapists for the purposes of Section 283 of The Traffic Safety Act.

1)  Section 283 of Traffic Safety Act (TSA) as of May 2012

(1) Any duly qualified medical practitioner shall report to the administrator the name, address and clinical condition of every person who:

(a) is 15 years of age or older attending on the medical practitioner of medical services; and

(b) in the opinion of the medical practitioner, is suffering from a condition that will make it dangerous for that person to operate a vehicle.

(c) No action shall be brought against a medical practitioner who makes a report in good faith.

The result of this change in legislation will require occupational therapists to report to Saskatchewan Government Insurance (SGI) any client whom in their opinion is suffering from a condition that may impair a person's ability to safely operate a vehicle or requires the use of vehicle adaptations. SGI recognizes the value of our skills, knowledge and abilities and Saskatchewan is one of the first provinces to include occupational therapists as a mandatory reporting profession.

DriveABLE and Driver Ability Assessment Process

Cognitive Assessment form - blank


Regarding the DriveABLE and Driver Ability Assessment process
OT’s, as well as Physicians, Optometrists, NP’s, are required to report drivers who are not medically safe to drive. Your obligation is to provide relevant medical information; it is not your responsibility to make a licensing decision regarding driving. 
The MRU staff will review the information in your report. There may be additional considerations for the MRU to take into account when they make their licensing decisions that you may not be aware of, such as other medical reports, driving history, police reports, confidential letters, etc. 
Identifying specific areas of concern with drivers who have cognitive impairments pose special challenges for health professionals and SGI’s Medical Review Unit (MRU). Licensing decisions about driving safety are more challenging because cognitive impairment may be less ‘visible’ in comparison to more readily observable physical and visual impairments. Diminished cognitive capacity remains an exceptional concern because of the consequences of driving with impaired memory, attention, judgment, and decision making.
In an effort to streamline their process in determining medical fitness to drive, the MRU is asking health professionals to send a report to the MRU before referring their patients with cognitive impairment for further driving assessment.
If the MRU determines that further assessment should be completed for licensing purposes, the driver may be asked to complete the following:
 

  • Saskatoon Driver Evaluation Program (DEP) or Regina Driver Assessment program (DAP)
    Example: For persons with both cognitive and physical deficits, or when there is a need for special adaptations to a vehicle
  • SGI Driver Ability Assessment (DAA)
    Example: When there are questions about physical ability or if there are special adaptations in the vehicle, i.e. hand controls
  • DriveABLE DCAT                       
    Example: When there are concerns about cognitive ability

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, 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.
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 an occupational therapist or kinesiologist administers the DCAT and guides the individual.
The DCAT is completed at 4 different CBI clinics:

  • Regina                      Gold Square – 306-585-0855
  • Saskatoon                 CBI Centre – 306-664-7275/ CBI Preston Centre – 306-664-3604
  • North Battleford          CBI Centre – 306-446-5670

Results of the DCAT TM will be sent to the MRU. The 3 different types of results are:

  • Pass – Driver can continue driving. SGI follows up periodically regarding cognitive status.
  • Indeterminate – Driver can continue driving. The driver is required to complete the DEP at Saskatoon City Hospital or DAP at the Regina Wascana Rehabilitation Centre, or a functional driving assessment with a SGI driver examiner, at the driver’s cost.
  • Fail - Driver's Licence will be suspended.  The driver is provided with appeal options allowing the driver to take the DCAT again or complete an assessment with DEP or DAP at their cost.

When the MRU receives the DCAT results, a licensing decision regarding driving will be made.  SGI pays for the cost of the first DCAT, if a driver fails and chooses to complete the DCAT again, the driver pays the cost of $99.00.  If a person is directly referred by a health professional for a DCAT, the cost will be the responsibility of the driver.  

SGI Driver Ability Assessment (DAA)
In June, 2013, the MRU implemented a new in-car assessment for drivers with medical conditions.  There is no cost to the driver for the assessment and it is completed by SGI driver evaluators.  Experienced evaluators were selected from a number of communities throughout the province and participated in an interactive, intense two day program.

The DAA is based on the functional ability of the driver to compensate for their medical condition, not on a score.  Evaluators work with the MRU to provide fair and consistent in-car assessments.

MRU will provide evaluators with information about a driver's medical symptoms that may affect their ability to drive.  For example, if a driver has Parkinson's the MRU may indicate that the driver has tremors and note their severity.

Evaluators will take the driver out for a drive and observe for any deficits or errors.  During the drive, the evaluator will pull over to discuss the errors with the driver and then continue the drive.  The evaluator will again observe to see if the driver corrects the errors or compensates for their medical condition.

Once the assessment is completed, the evaluator will discuss the results with the Driver and send a detailed report to the MRU who will make the final licensing decision.

If you have any questions, please contact the Medical Review Unit 1-800-667-8015, ext. 6176, or e-mail mruinquries@sgi.sk.ca
Leann Nixon, R.N
Supervisor Medical Review Unit
(306) 751-1500

SSOT/SGI Education Sessions

Education sessions were held in Saskatoon on September 20, 2012 and in Regina on September 25, 2012.  The following Powerpoint presentations were presented at those sessions.  

SGI Powerpoint Presentation

SSOT Powerpoint Presentation

 

SGI Medical Reporting Form

If you, as an OT, are concerned regarding a client's capacity for driving you should complete the SGI Form.  If you feel that your client should not drive now and/or in the future please note that concern and why you are concerned on the SGI Medical Reporting Form.
If you feel that your client should go through a driving assessment in Saskatoon or Regina ensure to note this recommendation on the SGI Medical Reporting Form.  If you are recommending a driving assessment it is important that you also complete and fax a referral form to the appropriate driving assessment program to get your client on the waitlist and document relevant information in your therapeutic chart notes. 
SGI Medical Reporting Form
Saskatoon Driver Evaluation Program Referral Form (306) 655-8612
Regina Driver Assessment Program Referral Form  (306) 766-5600
SGI Medical Review Unit (306) 775-6176

The Health Information Protection Act (HIPA) Section 27(4) states...

"a trustee may disclose personal health information in the custody or control of the trustee without the consent of the subject individual in the following cases: a) where the trustee believes, on reasonable grounds, that the disclosure will avoid or minimize a danger to the health or safety of any person…"

Different Roles of OTs in reporting driving concerns

Occupational Therapy Process for Driving and Community Mobility Algorithm 

The Occupational Therapy Process for Driving and Community Mobility is an algorithm for general practice occupational therapists when considering the complex instrumental activity of driving.  It specifies the clinical reasoning process for determining occupational therapy services for community mobility and when to refer to a driving specialist. 

This algorithm is taken from Dickerson, A., Reistetter, T., Schold Davis, E., & Monahan, M., (2011). Evaluating driving as a valued instrumental activity of daily living. The American Journal of Occupational Therapy, 65(1), 64-75.

What role is there for OT in determining the capacity for safe driving?

Generalist
- Ask each client about community mobility in the context of assessment.
- May perform basic screening
- May provide general education on community mobility, driving alternatives, warning signs.
- May gather information from functional observation that suggests driving concerns exist

Advanced training
- All of the above
- Screening, education and functional observation
- Assessments specifically to determine driving readiness or readiness to proceed with the next level of evaluation. (in clinic only)
- Vehicle and equipment recommendations
- Ingress/egress (transfer) training
- Mobility device and seating prescription
- Remediation or retraining of pre-requisite skills

Advanced/Specialized
- Driver Rehabilitation Specialist
- May perform all of the above plus:
- Performs a comprehensive, function based driving assessment usually including an on-road evaluation
- Gives an opinion on medical fitness to drive
- Specialized/Advanced equipment recommendations

Korner-Bitensky,N., Toal-Sullivan, D., & von Zweck, C., (2007). Driving and older adults: a focus on assessment by occupational therapists. Occupational Therapy Now, 9(4), 3-5.
Vrkljan, B., McGrath, C., & Letts, L., (2011). Assessment tools for evaluating fitness to drive: A critical appraisal of evidence. Canadian Journal of Occupational Therapy, 78(2), 80-96.

Domains of Driving Assessment

The following section outlines the cognitive, sensory and motor (sensorimotor) functions that are necessary for driving, taken from the "2010 BC Guide in Determining Fitness to Drive" (pages 17-23) .  These functions should be taken into consideration when selecting the most appropriate assessment tools for your client's specific needs when evaluating capacity to drive. 

OT Resources

1) College of Physicians and Surgeons Guidelines Determining Fitness to Drive
2) Driver’s Decision Workbook
3) Dementia and Driving Handbook
4) CAOT Driving Blueprint
5) Delivery of Services Relating to the use of Motor Vehicles: Guide for Occupational Therapists
6) BC Guide to Determining Fitness to Drive
7) Canadian Council of Motor Transport Authorities (CCMTA) Medical Standards for Drivers
8) AMA - Physician’s Guide to Assessing and Counseling Older Drivers
9) AOTA – OT Practice Guidelines for Driving and Community Mobility for Older Adults
10) Redepenning, Sue.  An OT Guide – Driver Rehabilitation Across Age and Disability, (2006).
11) Australian OT Journal (2012) 59 (Special issue on driving)
12) AJOT  - March/April 2010 Vol 64/Number 2 Special Issue on Older Driver Safety  and Community Mobility
13) OT Now - 2010 September/October Vol 12 Special Issue – Community Mobility, Driving and OT
14) CJOT - 2011 April 78(2) (Special issue re: Driving)
15) Canadian Journal of Psychiatry, Vol 51, No 13, November 2006.  Menard, I., et al.  Canadian Psychiatrists’ Current Attitudes, Practices, and Knowledge Regarding Fitness to Drive in Individuals with Mental Illness:  A Cross-Canada Survey
16) CAOT additional resources for driving
17)  The Canadian Association of Occupational Therapists (CAOT ) is proud to have developed a new resource for older drivers, their families and healthcare professionals that include an Older Driver’s Safety website and a new series of brochures entitled “Keeping on the go: Driving safely as you age.”   Valuable information on safe driving strategies and planning for driving retirement can be found in translated brochures in English, French, Italian, Punjabi, and Chinese (simplified and traditional)
18)  The Fitness-to-Drive Screening (FTDS) Measure is a web-based tool for caregivers and/or family members of older drivers and occupational therapy practitioners (OT) to identify at-risk older drivers. Caregivers and/or family members who have driven with the driver in the last three months, can rate a driver's difficulties with 54 driving skills, through this on-line screening. After completing the screening, a keyform or rating profile, of  the driver is available which includes a classification of the driver into one of three categories (at-risk driver, routine driver, or accomplished driver). Based on the specific driver category, recommendations are given as follow-up steps.
19) The Saskatchewan Psychiatric Occupational Therapy – Driving Screen (SPOT-DS)  Alicia Carey, recipient of the SSOT Presentation Grant,  shared her work in the development of this tool in a poster presentation at this year’s CAOT Conference.   Congratulations to Alicia and thank you for making this resource accessible to OTs throughout the province.