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.
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, 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.
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?
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
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
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.
Published News Articles
Check this out! Apparently, this is the first publication in a peer-reviewed journal article on psychiatric Occupational Therapy in Saskatchewan since 1956! Use the following Sage link to find the newly published article in the British Journal of Occupational Therapy, entitled “Development of the Saskatchewan Psychiatric Occupational Therapy Driving Screen” by Alicia Carey (SSOT member), Carolyn Burton, Aleksandra Grochulski (SSOT member), Paige Pinay, and AJ Remillard.