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 Weekend Australian - Travel - - Health -

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

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