Reporting to the ministry of transportation
When to report a patient
Physicians have a responsibility to report patients who they believe have a condition that may make it dangerous to operate a motor vehicle. In seven provinces and all three territories, reporting is mandatory. In Alberta, Nova Scotia and Quebec, reporting is discretionary (Canadian Medical Association [CMA], 2012).
The use of alcohol or other drugs is not in itself sufficient reason to report a person. However, any of the following, in combination with the physician's opinion, are reasonable grounds for reporting to the ministry of transportation:
- The patient admits to driving while impaired.
- A family member informs the physician that the patient often or regularly drives while impaired.
- The patient drinks or uses other drugs steadily throughout the day and drives regularly.
- The patient drove to the physician's clinic while intoxicated.
- The patient has experienced a withdrawal seizure, drives regularly and continues to drink.
- The patient has substance-related medical complications that impair driving ability (e.g., alcohol-related cerebellar ataxia).
Even in the absence of evidence that the patient is driving while impaired, consider reporting a patient with a current diagnosis of a substance use disorder, particularly if the person has other risk factors for impaired driving and is unable or unwilling to abstain and attend treatment. The CMA (2012) highlights these risk factors:
- previous impaired driving charge
- previous driving offence (especially if it is related to alcohol or other drug use)
- history of other criminal offences
- risk-taking behaviour, poor judgment or aggression in situations other than driving
- lifestyle associated with fatigue and lack of sleep
- intoxication during a routine office visit (even if the person didn't drive to the office).
The CMA's list of risk factors also includes younger age, male sex, lower educational attainment, illegal drug use and "antisocial tendencies" such as aggression and hostility.
See the CMA's handbook Determining Medical Fitness to Operate Motor Vehicles (CMA, 2012) for details about physicians' obligations to report patients using alcohol or other drugs.
Dealing with a patient who is intoxicated
The first step is to assess the patient for clinical signs of intoxication. The smell of alcohol is not enough, because even small amounts of alcohol have a detectable odour. Clinical signs of intoxication include:
- slurred speech
- emotional lability
- ataxia and inco-ordination (which can be elicited through walking heel to toe, rapid alternating movements, finger to nose).
When a patient is intoxicated, and especially when they intend to drive while intoxicated, you need to take immediate steps to prevent harm to the patient and others:
- Advise the patient to have a friend or family member drive them home, or to wait and be reassessed after several hours.
- Before releasing the patient, you must be sure that the only reason for the patient's presentation is intoxication and that no other factors are involved. A subdural hematoma due to a fall, for example, may have fatal consequences if undetected.
- Contact the police if the patient leaves the clinic against medical advice.
Informing the patient of a decision to report
Although you are not required to inform patients that you have decided to report their condition to the ministry of transportation, telling them about your decision ahead of time may help to allay their concerns or anger and preserve a positive relationship with them.
- Explain to the patient that you have a legal obligation to report.
- Explain that any decision to suspend the patient's driver's licence is made by the ministry, and the patient has the right to appeal that decision.
- Some patients may ask you to give them a chance to abstain and attend treatment before deciding to report them. However, trusting the patient to comply with your recommendations is not considered an adequate reason for failing to report.
- Use the opportunity to talk to patients about the need for reduced drinking or abstinence, and the need for counselling and treatment. Sometimes the embarrassment and inconvenience of the suspension are powerful motivators for change.
Where to report
The CMA website ("Provincial and Territorial Forms") includes links to reporting forms.
Ministry of Justice: Driver medical fitness information for medical professionals
Alberta Transportation: Driver fitness and monitoring
College of Physicians and Surgeons of Alberta: Reporting unfit drivers
Saskatchewan Society of Occupational Therapists: Mandatory reporting to SGI
Manitoba Public Insurance: Medical conditions and driving – Information for health care professionals
The Ministry of Transportation changed mandatory reporting requirements for healthcare practitioners (physicians, optometrists and nurse practitioners) in July, 2018. Details and forms are on the ministry website.
Physicians, optometrists, nurse practitioners and occupational therapists also have the discretionary authority to report conditions that, in the opinion of the healthcare practitioner, make it dangerous for a person to drive.
Prince Edward Island
Department of Transportation, Infrastructure and Energy – Highway Safety Division: Medical fitness to drive