LICENCE TO KILL
Some doctors are refusing to sign fitness-to-drive certificates as concerns escalate over where to draw the line. Kellie Bisset reports
THE last thing Patsy Templeton wanted on her family’s conscience was the heartbreak of a major road smash. So she tried to talk her husband, Ronald, out of driving when it became clear Alzheimer’s disease was affecting his judgment.
They didn’t see eye to eye, but eventually he agreed to an independent driving test, which forced him off the road. It was a decision with a price: Ronald still blames his wife.
‘‘ It is the hardest thing,’’ she says. ‘‘ Each thing they lose is something you lose. But to finish off your life with [a fatal accident] hanging over you is just ghastly.’’
At least by biting the bullet, the Templetons avoided that far worse outcome. Not so for two elderly drivers given suspended jail terms in two separate NSW court cases last month.
An 85-year-old woman received a sixmonth suspended term after an accident that caused the death of a newborn and seriously injured her mother. In the other case, a 66-year-old man received a 12-month suspended sentence after an accident that caused the deaths of three people in another vehicle.
Both defendants were banned from driving for 10 years, but during sentencing Newcastle magistrate Michael Morahan said neither driver should be given another licence. He said the NSW Roads and Traffic Authority should have taken their licences away years ago.
And in Queensland late last year an epileptic driver suffered a seizure and caused the death of a two-year old boy and seriously injured his seven-year-old brother and the boys’ mother, prompting the Beattie Government to consider making it mandatory for doctors to report risky drivers. That driver was jailed for four years for dangerous driving causing death and grievous bodily harm.
But while recent court cases have sparked debate about when elderly drivers should be taken off the roads and whether those with medical conditions are slipping through the cracks, neurologists have brought the issue into sharp focus by deciding to boycott fitnessto-drive certificates.
The Australian and New Zealand Association of Neurologists (ANZAN) and the Epilepsy Society of Australia have both advised their members to stop certifying patients as fit to drive unless their ability to get behind the wheel is ‘‘ beyond doubt’’.
And they’ve also predicted members might stop assessing patients altogether if their concerns are not addressed.
They say that while officially, driver licensing authorities in each state are responsible for awarding or removing driving privileges, doctors are effectively forced into the role of de doctors for deterring patients from telling the facto licence cops, since in many cases their truth. ‘‘ In conditions like epilepsy it is a longmedical advice is the crucial information the term relationship of trust and respect you build authorities rely on to make the decision. with your patients, and then you undermine it
This, they argue, has a major impact on the by recommending their licence be removed,’’ doctor-patient relationship, as doctors feel says Professor Roy Beran, a practising neuroltorn between juggling what’s best for the ogist and president of the Australian College of patient and the potential road risk. Legal Medicine.
Patsy Templeton knows just how they feel He and other neurologists are calling for a — and says it’s vital for families to have an system where fitness-to-drive decisions are no independent third party, such as a doctor or a longer sheeted home to treating doctors. They driving assessor, take the decision. meet the transport regulation reform body, the
But neurologists say they have their own National Transport Commission (NTC), next conflict of interest, which not only impairs the week to discuss a way forward. quality of decisions they make on whether a Beran says he’s pretty strict on licence issues patient is fit to drive, but also deters patients — ‘‘ you have to be able to sleep at night’’ — from owning up about any medical conditions. even though he’s been threatened and abused And it’s feared that threats in Queensland to by patients for his position. make it mandatory for doctors to report But he knows other doctors far more lenient patients they suspect of being unfit to drive will than him and, unfortunately for public road just make the problem worse. Such systems safety, so do his patients. ‘‘ Doctor shopping operate in South Australia and the Northern most definitely goes on,’’ Beran says. Territory, and have been widely criticised by Professor Ernest Sommerville, chairman of ANZAN’s driving committee, has seen this happen too.
‘‘ I had a patient who was extremely unhappy and angry about my certifying him unfit to drive — this was someone I knew owned a gun — and he subsequently saw another neurologist, told him a different story and was certified fit,’’ he says. ‘‘ There is a lot of emotion about this because driving is considered a basic right.
‘‘ You have to have a positive relationship with the patient if you are going to get them to follow your advice, which might include accepting side effects of medication. It is easy to give patients the benefit of the doubt in terms of their [driving] fitness.’’
Recent research led by Beran and published last month in the Internal Medicine Journal (2007;37:251-57) shows doctors appear to be doing just that. The study of 236 neurologists showed that they were more lenient in assessing fitness to Continued inside, page 21
Tragedy: Families of failing elderly drivers anguish over the prospect of an accident