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Fitting cars to older drivers
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SOME epileptics should have their fitness to drive decided by an expert panel rather than their doctor, neurologists say.
Conflicts of interest arise as some doctors are pressured by patients to allow them to drive, particularly if a licence is needed for work, an article published today in the Medical Journal of Australia said.
Associate Professor Ernest Somerville and two other neurologists said the system was ''unsafe'' and open to abuse because patients are able to shop around in an attempt to regain their licence.
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''A review mechanism to deal with uncertain or exceptional cases is important in any certification system. Ideally, this should be an expert panel of neurologists, indemnified by [driver licensing authorities],'' they write.
Other relevant conditions are heart problems, brain tumours and insulin-dependent diabetes.
Professor Somerville, a neurologist at Prince of Wales Hospital and chair of the driving committees of the Epilepsy Society of Australia and the Australian and New Zealand Association of Neurologists, said determining fitness was sometimes ''guesswork''.
''It can lead to unsafe decisions because doctors can feel pressured by the patients. You've got a patient sitting opposite you saying, 'You can't do this to me','' he said.
''It damages the doctor-patient relationship in a big way.''
The article said doctors were at risk of being sued or charged with criminal offences if a person they certified fit to drive had a seizure at the wheel resulting in an accident.
In 2007, a coroner terminated an inquest and recommended criminal charges against Ronald Brooder, a neurologist whose patient Greg Petrie had a seizure and crashed a minibus near Albury in 2002. He and three others died.
Dr Brooder was not charged.
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A person with a spinal injury steers his powered wheelchair up a ramp and into his van, docks it into the driver's position and starts driving.
Elsewhere, a woman who has had a stroke drives her car with one hand using spinner knobs to steer and operates the indicators, wipers and lights with electronic switches.
They are among several innovative modifications to cars which are helping people stay on the road despite severe disabilities. The clever devices include left-foot accelerators and hand controls for brake and accelerator.
In WA, there are only a few of the drive-from-the-wheelchair vehicles in which the cost of modification alone is about $80,000.
Gerri Clay said people were driving with all sorts of physical and cognitive impairments that included head injury, stroke, spinal injury, multiple sclerosis, cerebral palsy, dementia, neuro-degenerative disorders, and loss of limb, hand or foot.
And the number of drivers with disabilities would certainly increase as the population aged, she said.
Nicki Longmire, project manager for disability equipment grants, said statistics showed that people with a disability were no more likely to be unsafe when driving than people without a disability.
"The issue is the ageing population and that people may have a changing situation that needs to be assessed to find out whether they can continue to drive safely," she said.
"That is particularly an issue with people with altered mental states such as early dementia or neurological conditions such as Parkinson's or multiple sclerosis."
One of the big stumbling blocks is access to appropriate assessment. "We have limited services available in WA," Ms Longmire said.
Ms Longmire said the assessment was carried out by an occupational therapist with postgraduate qualifications in driver assessment.
The finding of whether the candidate is fit to drive is relayed to their GP, who then makes a recommendation to the Department of Transport. However, the person may still be required to undergo a DoT driving test.
Another hardship for many people is the cost of the assessment and, for those who need them, the vehicle modifications.
The Disability Equipment Grants program helps defray the costs. Funded by Lotterywest, the program provides means-tested grants for assessments and vehicle modifications for eligible people.
But Ms Longmire said many people were not eligible and had to pay $350 to $500 for the assessment.
"It is a significant amount when the majority of people are probably on a pension," Ms Longmire said, adding that if people could not afford to be assessed they were likely to have their licence suspended or cancelled.
People with physical impairments are likely to need modifications to their vehicles while those with cognitive problems such as dementia, or neurological conditions such as Parkinson's might be issued with a licence that restricts them to driving in daylight hours, off freeways, or locally, such as to the shops or their doctor.
"Some people may have a disability that causes fatigue but if they are aware of their fatigue and monitor their driving habits accordingly, then they will not necessarily pose a risk," she said.
The disabilities that totally rule out driving include blindness and high-level spinal injury.
Ms Longmire travelled to the UK, Denmark and Sweden in June to look at innovation in providing services and designing modified vehicles for people with disabilities and would like WA to follow their lead.
"They all had a good, supported-driver assessment service where people had access to that assessment for little or no cost," she said. In the UK, the maximum they paid was $150 but the service was often free.
Some of the innovative modifications, available only overseas, included a car which can be steered with the left foot while the accelerator and brake are operated with the right foot.
In another advance, a car can be driven using a small, plate-size steering wheel that responds to fingertip pressure.
Warning on gophers
They may look harmless enough and are a godsend for seniors but motorised mobility scooters - or gophers - can prove deadly, new figures show.
The figures, released by the Australian Competition and Consumer Commission, found there were 71 gopher-related deaths and hundreds of injuries across Australia since mid-2000, prompting the Federal Minister for Competition Policy and Consumer Affairs, Craig Emerson to issue a warning in August about the dangers of gopher use.
Injury Control Council of WA chief executive officer Deborah Costello said gopher users were at an increased risk of death and serious injury because generally they were older and suffered the perceptual, cognitive and physical deteriorations associated with ageing.
"The number of gopher users is increasing and will continue to do so as Australia's population ages," Ms Costello said.
She said a number of issues needed to be addressed to reduce the incidence of injury, including driver and community awareness, driver training and lowering the maximum speed limit - which is now 10km/h - to mirror an appropriate walking speed.
Compulsory registration and insurance under a special vehicle category for all gopher owners was another ICCWA recommendation, Ms Costello said.
"People aged 65 years and over contribute to one third of the total number of pedestrian deaths yet this age group only accounts for one-eighth of the total population," she said.
"Like all injuries, deaths and hospitalisations due to a gopher- related incident are preventable." Insp. Neil Royle, from the South Metropolitan District, said gopher users were classified as pedestrians by law, meaning they could travel on footpaths and in shopping centres if they did not exceed a speed of 10km/h.
In situations where a footpath was not available, similarly to pedestrians, the gopher must be ridden against the flow of traffic for visibility. He said there were no licence, training or safe-handling obligations for people to ride gophers and safety features, including seatbelts, helmets or warning devices were not required.
"Gopher users are generally not the most agile or alert members of our community, so if they have impaired hearing or vision they might misjudge the size of potholes or the height of kerbing and fall off or out, which causes significant injuries to frail bodies," he said.
Matt Brown, head of member advocacy at the RAC, said while most gopher retailers limited the speed of gophers to a maximum of 10km/h, there was no law which prevented unscrupulous operators importing gophers that could reach much higher speeds.
"The greater majority of retailers appear to be doing the right thing but the public need to know that if their gopher exceeds 10km/h, even if you don't go that fast, by law they cannot use it in a pedestrian area," Mr Brown said.
"The psychology behind gophers is that they are there to replace cars for people who no longer drive. We have to change this psychology somewhat as gophers don't replace cars; gophers are there as an alternative to walking if you can no longer do so. Maybe we could look at a system where if you buy one or have one bought for you that you have to undergo some training."
Ms Costello said the ability of the person riding the gopher was another key issue. She said if a loved one had lost their driver's licence due to physical and cognitive deteriorations, then they may not be suitable for a gopher.
"All gopher users should have basic skills in co-ordination and strength, physical balance and endurance, vision, perception, thought processes and memory and judgment," she said.
"If gopher users and their families have any doubts about their ability to operate their gopher safely, it is advised they visit their GP, occupational therapist or physiotherapist for a full assessment.
"Everyone has a role to play in preventing gopher-related injuries, including gopher users themselves, the community, policy developers, local government, health professionals and manufacturers."
Independent Living Centre director Gerri Clay advised prospective gopher drivers to do their homework in selecting a model that suited their needs and abilities.
The centre, which offers a free information and advisory service, had a selection of up to 20 models, and an outdoor "track" incorporating varying slopes and terrain, over which the motorised scooters could be tried.
"Often families consider getting their elderly members a scooter if they have lost their driver's licence," Ms Clay said.
"But it doesn't necessarily follow that they can manage one - there are a range of health, cognitive and perceptual abilities that will affect their safety."
"However, when all those aspects are considered, the appropriate model can give independence and a new lease of life."
Drivers to disclose health problems
Tens of thousands of WA drivers are risking being fined for not reporting medical conditions ranging from high blood pressure to depression to the Department of Transport.
Under new rules introduced in March last year, all WA drivers must notify the department "as soon as practicable" of a range of medical conditions that have the potential to affect driving ability - from reducing perception, judgment and response time to general physical capability.
The broad list of conditions which the department says needs to be reported includes diabetes, heart disease, chronic arthritis, sleep apnoea, attention deficit and hyperactivity disorder, high or low blood pressure, giddiness, lung disease and depression.
Other conditions on the list are those with obvious impairment issues such as stroke, epilepsy, glaucoma, cataracts and macular degeneration, drug and alcohol dependency, Parkinson's disease and Alzheimer's.
But the implications of not reporting your medical conditions may be so mild that many drivers will choose not to inform the department.
Since the rules were introduced, the department said about 7000 West Australians had notified it of medical conditions, but many thousands more might be driving unaware of their obligation.
The change was made in response to recommendations made by the State Coroner after a fatal road accident in which a driver was killed after colliding with another driver who had been having an epileptic seizure.
Initially, the coroner recommended just people with epilepsy report their conditions, however this has been widened, bringing WA into line with other States and Territories.
A spokesman for the department said reporting a condition did not necessarily mean any restrictions would be placed on a person's ability to drive.
"It may lead to a provision being added, for example there may be a stipulation that a medical assessment is required prior to renewal or that medication is to be taken as prescribed," he said in a statement.
"No specific medical information about the condition or treatment will be added to the licence card."
The department insists that all medical information will be kept private, "and is available only to a very limited number of key transport personnel for the sole purpose of determining a person's fitness to drive".
This includes not informing insurance companies of specific medical conditions, even if the driver is involved in an accident.
"All information in relation to a driver's medical condition is kept by the Department of Transport in the strictest confidence, and not released to anyone, including insurance companies," the spokesman said.
"Notations in relation to requirements such as optical aids and the requirement to take medication are made on the driver's licence card but with no reference to the specific medical condition."
Insurers contacted by The West Australian said that - for now at least - not reporting a medical condition would not affect insurance claims.
If a driver does inform the department, however, and a variation is made to the licence, then a driver could invalidate a claim if they remained on the road without heeding the change.
The Insurance Commission of WA, which oversees all third-party injury claims, said a driver who continued to drive after the Department of Transport suspended or cancelled their licence would "suffer the consequences if they cause a crash which results in a personal injury claim".
However, "if they fail to declare a condition and are involved in a crash causing a personal injury claim, even though he/she would be liable for sanctions under the mandatory reporting legislation, there would be no breach of the (compulsory third party) policy as their driver's licence was current at the time the incident occurred. No such instances have been reported to ICWA."
RAC manager of technical claims Glen Walker said drivers were covered by insurance provided they were abiding by the relevant laws for driving a vehicle, meaning non-disclosure of medical conditions would not invalidate their insurance.
"We are reviewing our position at the moment," he said. "It is expected an amendment to the insurance product disclosure statement will reflect the legislation, that drivers are obliged to disclose their medical conditions to the department."
A report provided by the WA Comprehensive Epilepsy Service to the coroner at the time of the seizure inquiry noted that while epilepsy and diabetes were factors in some road accidents, they together represented the cause of around one in every 200 traffic deaths in the US, while heart conditions were responsible for eight in 200 traffic deaths.
Alcohol was responsible for a third of deaths.
WA Police spokesman Sgt Graham Clifford said a few road deaths each year could be linked clearly to medical conditions, but such factors were not always obvious.
Clinical Professor John Dunne, a consultant neurologist at RPH, said mandatory medical reporting by drivers made good sense and doctors who saw drivers with deteriorating mental or physical health were now able to remind them of their legal obligation to report their conditions.
But Dr Dunne said any move to require doctors to report their patients' conditions should be resisted as it would undermine the doctor-patient relationship and make people less likely to seek treatment.
Ruth Callaghan, The West Australian November 12, 2009, 6:00 am
Independent Liberal Member of Parliament, Dr Janet Woollard, is calling on the Government to change the way the Department for Planning and Infrastructure (DPI) is implementing mandatory reporting of medical conditions for drivers.
“Under the new legislation introduced in March this year, it is compulsory for all drivers to report any permanent or long-term medical conditions that may impair their ability to drive. This includes common conditions such as diabetes, lung disease, heart disease and high or low blood pressure,” said Dr Woollard.
“The regulations put in place were based on national guidelines to improve road safety the DPI has overstepped their boundaries in interpreting how the law needs to be enforced.”
“In Queensland and Victoria, someone with a medical condition which could affect their ability to drive, are required to discuss their condition with their own doctor who would complete a medical report or certificate that the person lodges with the relevant transport authorities,” said Dr Woollard.
“In WA however, the DPI requires drivers to report the medical conditions directly to the department, which then reviews the information and decides on what action drivers need to take and how their licence will be affected. Failure to report may result in a $500 fine.”
Dr Woollard said that under the current guidelines, most people over the age of 65 will probably be required to provide the DPI with details of their medical history.
“The DPI said that the regulations were made following recommendations made by the State Coroner, but as I understand, the Deputy State Coroner recommended mandatory reporting for only one condition, that is epilepsy,” said Dr Woollard.
“There are only rare instances where conditions such as diabetes or hypertension interfere with the ability to drive safely and there is simply no need for the DPI to collect sensitive medical details of hundreds of thousands of Western Australians,” said Dr Woollard.
“The community were alarmed when the DPI released confidential motorist information to a private company. It is not appropriate for this department to have the information they are asking for when it is not going to affect someone’s driving abilities.”
“I will be seeking legal advice as I believe this encroaches on our personal rights. I will be taking this up with the government to modify how the regulations are enforced,” said Dr Woollard.
On 17 March 2008, Mandatory Reporting of Medical Conditions was introduced.
This means that all drivers in WA (or those applying to drive) who have not already done so, are legally required to notify the Department for Planning and Infrastructure (DPI) of any permanent or long term medical condition that they suffer from that is likely to impair their ability to control a motor vehicle.
By the term "medical condition" the legislation refers to any medical condition, mental disorder or physical disability that may impair a person's ability to drive safely. This is also known as "Driving Impairment".
It also includes certain medical treatments that may impair a driver's perception, judgement, response time and reasonable physical capability.
It is an offence not to notify DPI. The penalty is $500.
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