Info for OTs

Fitness to drive information for occupational therapists

This fact sheet explains the medical review process for occupational therapists, including patient responsibilties.

Key points

Fitness to drive is an important consideration for health professionals as it has implications for a patient’s safety and that of other road users.
Health professionals have an important role in providing advice to patients, carers and family about the impact of medical/disability conditions on driving, explaining driver legal reporting obligations and recommending strategies for management and monitoring to enhance community independence.
Assessing Fitness to Drive (AFTD) guidelines provides guidance and criteria for consistently managing fitness to drive.
All drivers have a legal responsibility to report to Medical Review if they have a permanent or long-term health condition or disability that might affect their ability to drive safely.
Having a medical condition or disability doesn't mean a person is ineligible to hold a licence. In most cases, referral to Medical Review doesn't result in licence cancellation. It may result in a conditional licence and/or medical monitoring to optimise ongoing fitness to drive.
While health professionals aren't legally mandated to report directly to Medical Review, they're ethically obliged to act to ensure public safety if they're aware a patient is continuing to drive despite advice to the contrary. Health professionals reporting a driver to Medical Review can do so anonymously and are indemnified under Victorian law.

What is fitness to drive and why is it important?

Driving is a complex task which requires good vision, judgement, problem-solving, perception and physical abilities. Many health conditions and disabilities (or interventions/medicines used to treat them) may affect these attributes with impacts on driving as well as other forms of community mobility.

Fitness to drive is an important consideration when you are supporting clients to manage daily living skills.

Examples of conditions that may affect safe driving include:

blackouts
cardiovascular conditions
diabetes
dementia and cognitive impairment
seizures and epilepsy
neurological conditions
musculoskeletal conditions
psychiatric conditions
sleep disorders
alcohol, drug/other substance misuse
vision and eye disorders

What's my role as an occupational therapist?

Occupational therapists are responsible for evaluating personal and community mobility including driving.

They are in a prime position to assist patients to consider fitness to drive issues and obligations. However, assessing and managing fitness to drive can be complex and challenging due to the need to balance driving independence with social needs, employment and road safety.

To assist you, the AFTD guidelines are a national publication containing information about assessing and managing fitness to drive. Fitness to drive should be considered in both the short and long term.

For a person diagnosed with a progressive condition (e.g. dementia), early discussions about driving will help the person and their family/carers prepare for non-driving, even though they may initially be safe to continue driving.

Regular medical monitoring is required to assess how condition progression affects driving skills.

For other conditions (e.g. seizures/ epilepsy, stroke, cardiovascular events), fitness to drive will require immediate consideration with likely requirements for periods of driving abstinence.

Reporting obligations

In Victoria, there is no mandatory reporting requirement for health professionals. However, you have an ethical and public health duty of care obligation to support patient and public safety.

If you believe a patient lacks insight/judgement, and/or isn't heeding advice to cease driving or self report, you may report directly to Medical Review. This can be done anonymously.

If you believe the driver poses an immediate risk to public safety, you should report directly to Victoria Police.

Always keep treating medical practitioners informed of your concerns.

What are drivers’ responsibilities? How can I help patients fulfil these?

Explain to your patient that drivers are required by law to notify Medical Review of any long term medical conditions or permanent disabilities that may impact on driving in the longer term:

when they apply for/renew a licence, or
as soon as possible when they become aware of new conditions or disabilities.

Such a notification will initiate the Medical Review process.

Medical Review will ask them to provide a medical report evaluating how they meet national guidelines to drive.

You should advise the driver that they may also require a practical on-road driving test with an occupational therapy driver assessor to determine whether their disability or health condition is affecting their driving skills.

You can assist your patient to report a serious, permanent or long term illness, disability, mental condition or injury by advising them to consult their GP for completion of an online fitness to drive medical report.

Alternatively you can advise their GP directly of your advice.

What's the role of Medical Review?

Medical Review has a role in supporting health professionals fulfil their advisory responsibilities to their patients.

Medical Review has fact sheets to support conversations with patients about:

specific conditions (e.g. dementia, sleep apnoea, seizures, diabetes)
the medical review process
driving tests (medical review drive test, occupational therapy drive test)
older driver issues (e.g. ageing and driving, health conditions and driving, retiring from driving)

While health professionals provide advice about fitness to drive, Medical Review is solely responsible for issuing, renewing, suspending, refusing or cancelling, or reinstating a person’s driver licence (including a conditional licence).

Diagram showing an overview of the medical review process and case-by-case assesment process

What's a conditional licence?

It’s helpful if patients understand that having a medical condition or disability and reporting it doesn't necessarily lead to a loss of licence.

A conditional licence provides a mechanism for optimising driver and public safety while maintaining driver independence under certain conditions.

Most drivers in medical review retain their licence through options such as conditional licences and requirements for periodical medical reviews to monitor conditions.

Licence conditions may specify:

medical management (e.g. requirement for periodical reviews)
vehicle modifications
driving permitted only within a specified radius from home (e.g. 5km)
no night driving
only to drive with auto transmission or zero blood alcohol content (BAC).

Early discussion of conditional licence options will help allay concerns and raise awareness of these provisions especially for patients with long term/deteriorating conditions.

What happens if a patient doesn’t follow my advice?

If a person continues to drive despite advice and they don't report their condition to Medical Review, they're not fulfilling their legal responsibility.

If they're involved in a crash and it's determined their health condition/disability was a contributing factor, they may be prosecuted and their insurance may not be valid.

Always keep up to date records in the patient’s file of the advice you give and any actions you instigate regarding fitness to drive.

What happens when a patient is referred to Medical Review?

If a notification is received, Medical Review will request that the driver provide a medical fitness to drive report.

Medical Review considers allied health and medical information together with the patient’s licence history and any other information (e.g. from Victoria Police, or the courts).

Medical Review makes a risk assessment and licensing decisions on a case-by-case basis with reference to the AFTD guidelines. The majority of people with a first notification retain driving privileges, often with a conditional licence.

Screening and on-road tests may be recommended to help establish driving skills and assist patients improve awareness of how their condition may be affecting their driving.

Medical Review will write to the customer to advise the outcome and next steps.

Are there special requirements for commercial drivers?

Reflecting the increased risks associated with driving commercial vehicles, more stringent health standards apply to commercial drivers (e.g. bus, taxi, bulk/dangerous goods and heavy vehicle drivers).

These requirements are outlined in the AFTD guidelines.

It's important for health professionals to ask about possible driving requirements for work so that the relevant standards can be applied. A person who does not meet the commercial vehicle medical or eyesight criteria may still be eligible to retain a private vehicle driver licence.

Resources

Austroads
Advice in this fact sheet is based on Austroads' Assessing Fitness to Drive guidelines.

AFTD is the national publication containing detailed information about clinical assessment and management of drivers, including criteria for determining fitness to drive for particular medical conditions.

Download a PDF of this page: fitness to drive information for occupatinal therapists (PDF).