Discretionary Reporting of Fitness to Drive Legislation, Roles and Responsibilities Elizabeth Weldon, Program Advisor Ministry of Transportation, Licensing Services Branch Kara Ronald, Deputy Registrar College of Occupational Therapists of Ontario Webinar May 29 th, 2018
Webinar Instructions What to expect. One hour Ask questions by selecting the question icon Questions will be addressed at the end of the webinar Recording of the Webinar will be posted on the website Questions that are not addressed during the webinar will be recorded and responses provided on the website For specific questions about your practice, contact the Practice Resource Service 2
Webinar Agenda A. Medical Reporting Elizabeth Weldon 1. Medical Report Program Background 2. Medical Reporting Legislation & Regulations 3. Understanding Mandatory vs. Discretionary Reporting 4. Reporting Forms & Process B. Discretionary Reporting of Fitness to Drive for OTs 1. Application of Legislation to OT Practice 2. OT Responsibilities for Discretionary Reporting 3. Assessment and Reporting 4. Conscious Decision Making 5. Consent, Privacy and Access 3
MEDICAL REPORTING Ministry of Transportation Licensing Services Branch May 2018
Program Background O Mandatory medical reporting for physicians and optometrists has been in place since 1968, O It is one of the most stringent programs in North America. O Was enacted to help protect the public from drivers diagnosed with certain medical conditions or impairments that made it dangerous for them to drive, O Medical community was concerned over their inability to persuade patients who were unfit to stop driving. 5
Program Background O The face of primary healthcare has evolved, O Expanded scope of nurse practitioners, O Use of multidisciplinary health teams. O Existing requirements are broad medical community requires clarity, O Longstanding concerns around physician liability. 6
Medical Reporting Legislation Legislative Amendments O Amendments passed in 2015 allow for a new reporting model in Ontario; O Combination of mandatory and discretionary reporting, O Authority to add additional healthcare practitioners, O Specific requirements regarding what must be reported e.g. patient information. 7
Medical Reporting Legislation O Mandatory reporting by certain prescribed persons for high risk medical conditions, functional impairments and visual impairment, and O Discretionary reporting by certain prescribed persons for any condition that, in the opinion of the health care practitioner, may make it dangerous for a person to drive. 8
Medical Reporting Regulations Regulatory Amendments O Approved in February 2018 with an effective date of July 1, 2018. O New requirements, incorporated into s14 of Regulation 340/94, work hand-in-hand with legislation, O Prescribe who must report, who may report, O Prescribe what must be reported establish a clear threshold, O Statement regarding transient conditions, 9
Medical Reporting Regulations O Speak to scope of practice for optometrists, O Continue to reference most recent edition of CCMTA standards, O Continue to provide legal protection when making reports. 10
Understanding Mandatory vs. Discretionary MANDATORY REPORTING O Health care practitioners who are listed ( prescribed ) under the mandatory reporting section must report conditions according to threshold established in regulation. DISCRETIONARY REPORTING O Health care practitioners who are listed ( prescribed ) under the discretionary reporting section may report, O any person who has or appears to have a condition that may make it dangerous for the person to drive. O Practitioners listed as discretionary may also report conditions listed as mandatory in regulation. 11
Understanding Mandatory vs. Discretionary Mandatory Reporting Discretionary Reporting Physicians Physicians Optometrists Optometrists Nurse Practitioners Nurse Practitioners Occupational Therapists 12
New Reporting Forms O New reporting form for use by physicians, nurse practitioners and occupational therapists. O New reporting form for vision only for use by optometrists. O Will be posted to the government s Central Forms Repository for July 1 can also be accessed via Medical Review site at www.ontario.ca/driverimprovement 13
New Reporting Forms O New medical form works hand-in-hand with the regulations, O Drop down boxes under each category for conditions that have met the threshold and warrant a licence suspension, O Consistent with national medical standards, O Section for discretionary reports freeform for practitioner to indicate condition/impairment. 14
Intake Process O Reports are faxed or mailed modernization of medical review will see future electronic submission of reports. O Medical reports are reviewed and the appropriate action taken within 30 business days. The ministry is currently meeting or exceeding this standard; O Unsolicited reports from physicians and optometrists that warrant a licence suspension are prioritized within the queue, O Where an additional report has been submitted by a driver, 94% are reviewed in less than 10 business days. O An acknowledgement letter is sent to the reporting practitioner at the time of the file review. 15
Medical Standards Ontario Regulation 340/94 O Basic Medical Standards for all drivers, O Mandatory vision standards for all classes, O Mandatory hearing standards for certain classes e.g. bus and ambulance. 16
Review Process Medical Standards National Medical Standards O Canadian Council of Motor Transport Administrators (CCMTA) Determining Driver Fitness in Canada O Developed by the medical community and licensing authorities across Canada O Used by Ontario and licensing authorities in other jurisdictions to assess driver fitness O Allow for consistency and licensing reciprocity throughout Canada 17
Review Process O When the decision is made to suspend driving privileges, the ministry sends, O A notice of suspension, O A letter to the driver that advises what type of medical information is required to consider reinstatement O In some cases, a condition specific form is included. O If report indicates medical standards are met, and there are no other outstanding requirements/suspensions on the driving record the ministry sends, O A letter to the driver that advises of the outcome of the review, O Where applicable, a notice of reinstatement. 18
Contact Us Website: http://www.mto.gov.on.ca/english/safety/medical-review.shtml Email: DriverImprovementOffice@ontario.ca Mail: Ministry of Transportation Medical Review Section 77 Wellesley Street St. W, Box 589 Toronto, ON M7A 1N3 Phone: 416-235-1773 1-800-268-1481 Fax: 416-235-3400 1-800-304-7889 19
Discretionary Reporting of Fitness to Drive for OTs What does this mean for your practice? Kara Ronald, OT Reg. (Ont.) Deputy Registrar May 29, 2018
What s New and What s Not New? What s New OTs ability to make a discretionary report directly to the MTO What s Not New OTs identifying and addressing concerns related to fitness to drive 21
Interim Guide to Discretionary Reporting of Fitness to Drive Overview Medical Reporting Provisions under the Highway Traffic Act, 1990 Responsibilities of OTs for Discretionary Reporting of Fitness to Drive National Medical Standards and Resources Related to Reporting Occupational Therapy Assessment and Discretionary Reporting Conscious Decision Making and Fitness to Drive Consent, Privacy, and Access Documentation and Reporting of Fitness to Drive Interprofessional Collaboration 23
Discretionary Reporting Rules for OTs OTs can report concerns about a client s fitness to drive directly to the MTO OTs may report a driver but are not legally required to do so OTs can make a report without client consent to prevent or reduce risk of harm 24
Discretionary Reporting Rules for OTs OTs can only make a report if they have met the client for assessment or service delivery OTs must submit discretionary reports using the standardized form provided by the MTO OTs can report on both prescribed conditions and any other medical conditions, functional impairments or visual impairment that may make it dangerous for a client to drive 25
Discretionary Reporting Rules for OTs Conditions that are not prescribed in legislation are referred to as discretionary OTs are NOT expected to report on conditions that, in their opinion, are of: A transient or non-recurrent nature Modest or incremental changes in ability OTs who make a report in good faith are protected from legal actions 26
Prescribed Medical Conditions Ontario Regulation 340/94: Drivers Licences (Section 14) 14.1(3) prescribed medical conditions, functional impairments and visual impairments that a prescribed person shall report: 1. Cognitive impairment 2. Sudden incapacitation 3. Motor or sensory impairment 4. Visual impairment 5. Substance use disorder 6. Psychiatric illness 27
Prescribed Medical Condition (Example) Cognitive impairment: a disorder resulting in cognitive impairment that, i. affects attention, judgment and problem solving, planning and sequencing, memory, insight, reaction time or visuospatial perception, and ii. results in substantial limitation of the person s ability to perform activities of daily living. Ontario Regulation 340/94: Drivers Licences (Section 14) 28
Legal Requirements and Professional Obligations Legal Requirements OTs are not legally required to report concerns about a client s fitness to drive. Professional Obligation HOWEVER OTs are expected to address client safety concerns that arise within their practice including fitness to drive issues. Discretionary reporting provides OTs with one more option to address fitness to drive concerns. 29
Responsibility for Assessing Fitness to Drive Are all OTs now required to assess fitness to drive? Highway Traffic Act, 1990 does not require an OT to report College does not specify the nature and types of assessments OTs must perform within their practice OT Essential Competencies Able to identify the knowledge, skills, and attitudes required to provide the appropriate service to their clients Able to identify and assess occupational performance issues that are important to their clients within the OT s role 30
College Expectations OTs working with clients who are at least 16 years of age should determine if assessing functional abilities related fitness to drive is relevant to their clients and their current scope of practice Driving is a high risk activity and if fitness to drive concerns arise in practice, OTs should be prepared to address the concerns 31
Reflecting on your practice Questions to ask yourself when considering assessing functions related to driving Are your clients 16 years of age or older? Does your role involve addressing a client s ability to perform ADLs and IADLs in the community? Are your clients currently driving or will they be returning to driving? Do your clients or the client populations you work with have medical conditions, functional and/or visual impairments known to have an impact on fitness to drive? What is your current process for addressing fitness to drive concerns when they arise? 32
Resource Functions Needed for Driving Canadian Council of Motor Transport Administrators, Determining Driver Fitness in Canada, 2017 33
Assessment and Discretionary Reporting Types of Approaches for Assessing Fitness to Drive General Functional Assessment Driving Specific Functional Assessment The College advises OTs against getting into a vehicle with a client unless the OT has experience in driver assessment and the necessary safeguards are in place. Comprehensive Driving Evaluation 34
Guide to Discretionary Medical Reporting for Drivers Conscious Competence Understand your practice environment Understand the rules and how they apply to your practice Know your strengths and limits Leverage available resources Make good choices consciously and deliberately use your judgement Provide a reasonable rationale for any action or inaction explain why? 35
Conscious Decision-Making and Fitness to Drive 36
Possible Options (One or More) Discussing driving concerns with the client/family/or other care providers Discussing driving concerns with interprofessional colleagues on the client s care team Collaborative exploration with client about alternate transportation plans Seeking a client s agreement to cease or self-limit driving Consulting with an OT colleague who practices in the area of driver assessment and rehabilitation Referring a client for further driving assessment Making a discretionary report to the MTO Recommending and/or initiating a referral for driver rehabilitation, adaptive driving equipment or vehicle modifications 37
Consent, Privacy and Access Special Considerations for Fitness to Drive Authority for making a discretionary report overrides duty to maintain client confidentiality (HTA, s. 203(3)) 1. Informed Consent assessment & treatment 2. Knowledgeable Consent - personal health information Use caution when discussing consent and be transparent with clients - Client s may not have the option to withdraw consent for disclosure of information if there is a risk to the client or others. 38
Documentation and Reporting Documentation Client record should include: concerns about fitness to drive observations and assessment findings discussions with the client any actions taken recommendations and/or plan Reporting MTO makes determination of driving privileges OTs must use standardized MTO Form available on website Prescribed conditions and impairments suspension issued Discretionary conditions and impairments suspension issued or additional information requested 39
Interprofessional Collaboration OTs on interprofessional teams or working collaboratively with interprofessional colleagues should consider how the OT s new authority for discretionary reporting may impact roles and responsibilities Who will make reports when concerns are identified? Who will determine when a report should be made for a specific client? 40
Discretionary Reporting Key Messages Understand how discretionary reporting applies to OT practice Reflect on your current practice to determine if any changes could be made to better identify or address fitness to drive Use your OT knowledge, skill and ability to asses and address functions related to fitness to drive based on your competence and the scope of your role Consider discretionary reporting as an option for addressing fitness to drive concerns Apply conscious decision-making to ensure actions are based on sound professional judgement Seek additional knowledge and training to build competence and confidence in addressing fitness to drive concerns 41
Connect with the College Practice Resource Service practice@coto.org 416-214-1177 or 1-800-890-6570 ext. 240 Standards & Resources www.coto.org Facebook Twitter LinkedIn facebook.com/collegeofots @CollegeofOTs linkedin.com/company/college-ofoccupational-therapists-of-ontario 42