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Archive for category: Automobile Safety and Insurance

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Reporting Unsafe Drivers: The New Role of Occupational Therapists in Ontario

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Co-written with Samantha Hunt, Student Occupational Therapist

My father-in-law was terminally ill and suffered from dementia.  Eventually, his decline became significant and his doctor filed a mandatory report with the Ministry of Transportation (MTO) to suspend his license pending a driver’s exam.  He refused to attend the exam yet continued to drive even without a valid license.  He still paid for car insurance because he knew this was important but was not well enough to connect his own disabilities to his safety and the safety of others.  The family planned to remove his vehicle from his possession but before we could he ventured out one night, got lost, and the police found him 8 hours later driving in a farmer’s field.  The good news was that no one got hurt and his car was beyond repair.  Now, he could no longer drive even if he wanted to.

Driving is an important daily activity for many and provides drivers with an independent means to get around and to manage our own needs outside of the home.  It reduces our reliance on others and provides us with freedom and control.  But it is a privilege, not a right, and sometimes people reach a point where driving is no longer safe, but yet they don’t voluntarily stop.

Up until recently, the ownness to report unsafe drivers has fallen to the legal responsibility of doctors, nurse practitioners and optometrists.  However, on July 1, 2018 the legislation will change to add a new class of “discretionary” reporting, and occupational therapists will be included in the list of professionals that can submit these “discretionary” reports. 

Considering this major change to the Highway Traffic Act (HTA), and the significance of this on OT practice in Ontario, we wanted to provide a brief overview of the key facts and guidelines for the OT’s that this may impact.

Background on Medical Reporting Legislation

Mandatory medical reporting for physicians and optometrists in Ontario has been in place since 1968 and was enacted to help protect the public from drivers diagnosed with certain medical conditions or impairments that made it dangerous for them to drive. Mandatory reporting is a legal requirement to report that pertains to physicians, nurse practitioners, and optometrists, outlined in the HTA. The legislation states that every prescribed person shall report to the MTO “any person who is at least 16 years old who, in the opinion of the prescribed person, has or appears to have a prescribed medical condition, functional impairment or visual impairment that may impair driving ability.”

What’s New

In 2015, amendments were passed that allowed for a new reporting model to be introduced in Ontario and were approved in February 2018. These include:

·       A combination of mandatory and discretionary reporting

·       Authority to add additional healthcare professionals

·       Specific requirements regarding what must be reported

Resulting from these amendments, the MTO regulations state that as of July 1, 2018, occupational therapists are identified as discretionary reporters. Discretionary reporting is not a legal requirement but gives authority for reporting to occupational therapists, physicians, nurse practitioners and optometrists for: “any person who is at least 16 years old who, in the opinion of the prescribed person, has, or appears to have, a medical condition, functional impairment or visual impairment that may make it dangerous for the person to operate a motor vehicle”. Discretionary reporting therefore allows OTs to report concerns about a client’s fitness to drive if they choose.

With respect to consent and confidentiality, OTs are protected from legal action for breaking confidentiality when making a discretionary report; the HTA states that the authority of a prescribed medical professional making a report to the MTO overrides the duty of that professional to maintain a client’s confidentiality. Nevertheless, an OT making a report would be expected to advise the client of this decision.

Summary of Discretionary Reporting Rules for OTs

·       OTs can report concerns about a client’s fitness to drive directly to the MTO.  There will be a standard MTO form to be used for this purpose.

·       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.

·       OTs can only make a report if they have met the client for assessment or service delivery.

·       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.

Prescribed medical conditions include the following:

1.     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.

2.     Sudden incapacitation: a disorder that has a moderate or high risk of sudden incapacitation, or that has resulted in sudden incapacitation and that has a moderate or high risk of recurrence.

3.     Motor or sensory impairment: a condition or disorder resulting in severe motor impairment that affects co-ordination, muscle strength and control, flexibility, motor planning, touch or positional sense.

4.     Visual impairment:

                 i.      A best corrected visual acuity that is below 20/50 with both eyes open and examined together.

                  ii.     A visual field that is less than 120 continuous degrees along the horizontal meridian, or less than 15 continuous degrees above and below fixation, or less than 60 degrees to either side of the vertical midline, including hemianopia.

                 iii.    Diplopia that is within 40 degrees of fixation point (in all directions) of primary position, that cannot be corrected using prism lenses or patching.

5.     Substance use disorder: a diagnosis of an uncontrolled substance use disorder, excluding caffeine and nicotine, and the person is non-compliant with treatment recommendations.

6.     Psychiatric illness: a condition or disorder that currently involves acute psychosis or severe abnormalities of perception such as those present in schizophrenia or in other psychotic disorders, bipolar disorders, trauma or stressor-related disorders, dissociative disorders or neurocognitive disorders, or the person has a suicidal plan involving a vehicle or an intent to use a vehicle to harm others.

·       OTs who make a report in good faith are protected from legal action but failing to report when they should have could be a breach of professional obligations.

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

Lastly, although OTs are not legally required to make discretionary reports, a professional obligation to identify a potential safety issue with a client (such as a concern about fitness to drive) and, taking action to address this concern, is expected of the OT. Taking action may or may not include making a discretionary report to the MTO.

Next Steps

Reporting, Intake, and Review Process

The three types of approaches for assessing fitness to drive include a General Functional Assessment, Driving Specific Functional Assessment, and/or a Comprehensive Driving Evaluation (more information can be found in the resources below). Once an assessment has been completed or a concern has been identified, an OT may fill out a report. A new standardized form that OTs (along with physicians and nurse practitioners) must use when making a report has been approved and will be available online as of July 1, 2018. Once reports are received by the ministry, they will be reviewed and the MTO is to take appropriate action following within 30 business days.  When an OT is reporting to the ministry, this does not mean the OT is taking the person’s license away. The licensing body has the responsibility to make this decision or to decide if more information is required.

For more information and resources, the College of Occupational Therapists of Ontario has created an Interim Guide to Discretionary Reporting of Fitness to Drive, which can be found at:  https://www.coto.org/resources/interim-guide-to-discretionary-reporting-of-fitness-to-drive-2018

Resources

www.coto.org/news/changes-to-medical-reporting-of-drivers-gives-ots-new-reporting-authority

www.coto.org/resources/interim-guide-to-discretionary-reporting-of-fitness-to-drive-2018

www.mto.gov.on.ca/english/safety.medical-review.shtml

www.youtube.com/watch?v=dOIJ7CrDTT0

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Warning: Long Weekend Ahead!

Warning:  Long Weekend ahead!  This warning is one we re-post every year as, unfortunately, many need a reminder to make smart and safe choices during this first long weekend of the season.

While the Victoria Day long weekend is often a kick-off to summer, it is also known as one of the deadliest weekends in Canada.  Impaired driving and boating numbers are highly elevated during long weekends and MADD Canada estimates that impaired driving kills between 1,250 and 1,500 people every year, and injures more than 63,000 in Canada.  The following PSA is a great reminder of the effects drinking and driving can have on your life and on the life of someone else.

So please, while you enjoy this first long weekend of the season, think smart and be safe.  Don’t drink and drive.

 

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Distracted Driving Kills: Will Harsher Penalties Make a Difference?

The other day I was traveling on a major highway as I was heading to a shopping center.  I had five teenagers with me – my own four kids and a significant other.  We were in the middle lane and the mini-van in front of us was slowly drifting.  It would drift a bit right then correct, a bit left then correct.  Sometimes it would go slightly over the line, sometimes a lot.  Years ago I would have assumed that the person driving might have been drinking.  This time I said to my car full of teens “I bet this person is texting and driving – watch them”.  The teens acknowledged quickly that the car was definitely all over the place.  I decided to speed up and pass this vehicle (much safer for us to have her behind us than in front of us).  As we passed her, sure enough, this middle-aged looking woman was texting.  I honked and we all stared at her as we passed.  I hope she got the point.  And yes, sure, maybe she was texting a dying relative, telling a sick child she was “on her way” to get them from school, or solidifying the best business deal of her life…but, in the end, she was being selfish, insensitive and unsafe.  Not to mention was breaking the law.  If anything was more important in that moment then her need to drive her car safely then she needed to pull off the highway, deal with the issue and then continue on her way.

The benefit I have is that I work with people who may have been injured by their own “it won’t happen to me” mentality, or by others that have caused horrible accidents driving like this.  So, I drive with heightened awareness.  And people I am sorry, but it is pretty obvious what you are doing when your head is anywhere but forward while you are operating a vehicle.  I see several people a day texting or holding a phone to their ear while behind the wheel.  It is still COMMON.

I fully support these New Laws for Distracted Driving.  I also would support any opportunity to have a passenger in my car take a photo or video of a distracted driver to post online or to fire off to Crime Stoppers to deter this type of behavior.  I agree that “no text is worth a life” – even your own.

 

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How Can Occupational Therapists Best Support Older Adults as they Transition to Non-Drivers?

Guest Blogger Lauren Heinken, Occupational Therapist

It’s winter, and with the season comes decreased daylight and increased risk of weather-related adverse driving conditions. These factors can contribute to a higher incidence of motor vehicle collisions, and this may be particularly true for older adult drivers who are experiencing physical and cognitive health changes. The Ontario Ministry of Transportation (MTO) reports that senior drivers with cognitive impairment/dementia have up to 4.7 times the risk of being involved in a motor vehicle collision. The MTO’s Senior Driver License Renewal Program operates in an effort to ensure that older adult drivers are screened for health changes that may impact their ability to drive. Occupational Therapists (OTs) may be involved in the process by administering the screening tools that can play a role in determining an individual’s fitness-to-drive; however, physicians and the MTO work together to ultimately decide whether an individual is able to maintain their license or not.

Many older adults see driving as imperative for maintaining their independence, especially if they have been lifelong drivers or are relatively unfamiliar with other forms of transportation. More physically demanding forms of transportation, walking to bus stops, or cycling, may no longer be viable alternatives for many. Outside of the main urban centres, Canada’s population is dispersed across great geographic distances; in more rural areas, public transportation services may be sparse if available at all. The distances individuals need to travel on a frequent basis to access services and participate in activities of their choosing are often great. As health professionals who focus on helping individuals find ways to engage in their chosen occupations, it fits that OTs should be involved in supporting older adults who have lost, or are at risk of losing, their ability to drive.  OTs can work with their clients to minimize the way in which losing one’s license influences overall quality of life and ability to engage in chosen occupations.

As with any major life change, planning for the loss of one’s drivers license well in advance can help to limit the impact of the change when it happens. After all options for ensuring and promoting someone’s ability to drive safely have been exhausted, the next responsible therapist-client step would be to initiate discussions related to transportation alternatives, regardless of whether or not this lifestyle change will be occurring in the near future. It is understandable that OTs may be reluctant to initiate these discussions as safe continuation of driving is often an emotionally charged subject and can lead to very difficult conversations.  Introducing the subject slowly and matching the content of the conversation to the client’s comfort level can help to limit any negative effects on the OT-client therapeutic relationship. Below is a proposed progression of an OTs involvement with a client who has lost, or is at risk of losing their ability to drive.

 

 

 

 

OTs should let the changing seasons serve as a reminder to consider initiating these discussions during client sessions. Although clients may be unreceptive and unwilling NOW to accept intervention aimed at preparing for this lifestyle change for LATER, a brief discussion may be enough to get them thinking about this important topic to help them adjust to the possibility when / if it arises.  Sometimes as therapists the ideas we introduce early are not accepted for months or years later, but our role includes having the patience to work with clients around their comfort level and to support change when they are ready to accept it.

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Increasing Form 1 Rates Equals LESS CARE for Injured People in Ontario

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

I can only imagine that the general public is getting overwhelmed and confused by all the recent media, hype and dialogue over the current state of car insurance in Ontario.  The sad reality is that until you need your car insurance because you have been injured, you are likely not going to understand it.

But for those of us that work in this sector, understanding, fighting and trying to bring clarity to the challenging opinions of government, third-party consultants and insurers is a daunting task.

My only ask is why can’t the insurance sector be ruled by logic? 

Here is my latest example:

If you are injured in a car accident you may need care.  This is time other people will spend helping you manage the most basic activities – getting dressed, showering, taking medication, being safe in your home, etc.  The monies you have available for this care is calculated through a document completed by an Occupational Therapist (or a nurse).  It is actually pretty simple – an occupational therapist does an assessment, calculates the amount of care, and that is the care that can be provided.  But here is the lack of logic in how insurer’s and the industry seem to be interpreting this form to the disadvantage of the consumer:

1.      There is a cap to the maximum amount you will get anyway.  So, if you need $8000 in care per month, you will only get $3000 or $6000 depending on if you have a catastrophic injury or not.

2.      If your family wants to provide some care, they can’t get paid any of this money unless they are off work or incur an “economic loss” to provide the care.

3.      If your family is suffering an “economic loss” providing the care, they will only be paid the amount per hour of the form, not their actual loss, and the monthly maximum applies.

4.      As per a recent “raise” for care providers, the amount that is paid per hour for the services ranges from $14.00 to $21.11 per hour.  If your family member was making more than this per hour, it would cause hardship for your family if they decided to provide your care for a lesser rate of pay.  So, your option would be to hire help.

5.      PSW’s can provide this care, but they are typically $25-$30 / hour.  So, the services you need you cannot get because they charge more than the form allows.  The result is you get less help than you need because the time runs out faster when you are paying more.

6.      If your accident happened before January 1, 2018 then you actually don’t even get today’s minimum wage for your care.  You get the minimum wage (or less) for the time that your accident happened.  So, if your accident was before October 1, 2003 you are required to find or hire care for $7.00 per hour (see the below rate chart).

7.      There are two amounts in the document.  The “total” of all the time added up, and the “minute” time calculated for each section.  Some (many) insurers are now taking the position that they will pay for the “minute” time, not the “entire time”.  So, if I assess you to need 30 minutes per day of care that comes to $210 per month, the insurer will only pay for 30 minutes per day.  But PSW companies have minimums so they won’t come to your house for 30 minutes per day – they want 2 hours at the least.  But the insurer won’t pay them for 2 hours up to $210, they will only pay for $7.00 per day.

8.      Even if you can get your care at the amounts allowed, this will still come from your total claim budget that is also used for rehabilitation.  The choice becomes – get care or get better?

All of this to say that the system is not easy to navigate and getting the care you need will prove difficult.

So, what are the options?

Well, if minimum wage is going to continue to increase then it would only seem appropriate that ALL people with an OPEN CLAIM get TODAY’s rates for care – after all, it is today that they need the services – not in the era of their date of loss. 

It would also seem appropriate that the maximums for care coverage INCREASE proportionately to the raise in care pricing.   So, if $3000 a month was an appropriate maximum in 2003 when the care was at its lowest ($7.00 / hour), then why do we have the same maximum when the care costs have doubled?

Trying some simple math…

If I was eligible for 24-hour care in 2003 at a maximum of $3000, under the Level 2 rate then (see chart) of $7.00 / hour, I could get 14 hours of care (if family was willing to work for that).

If I am eligible for 24-hour care today at a maximum of $3000, under the new Level 2 rates of $14.00 / hour, I get 7 hours of care (if family was willing to work for that).

So, increasing the minimum wage for care providers only makes people get to the maximum more quickly, providing them access to LESS CARE. Thus, in the absence of an increase in the maximum’s allowed, these higher care costs are reducing people’s ability to get the total care they need.

My suggestion is that if the industry could be ruled by logic, then the maximums would increase with the care cost changes.  Using an average of care costs, here is where I think the maximums should be:

2003 average ((9+7+15)/3) = $10.33 per hour

2018 average (($14.90+14+$21.11)/3) = $16.67 per hour

% change between 2003 to 2018 = $16.67-$10.33 / $10.33 X 100 = 61%

So, if the hourly rate has increased 61% in 15 years, then wouldn’t logic tell us that the maximums for care should also increase by that same percentage:

$3000 (maximum in 2003) becomes $4830

$6000 (maximum in 2003) becomes $9660

Auto insurers have eroded so much from the customers of Ontario over the last 8 years and while this subtle increase in care costs seem to be provided in “good faith” to align with minimum wage increases, they actually cause people to get less care as they just reach the maximums more quickly.  Then, they create significant payment issues when they nickel and dime the form and pay by the minute.  Rock meet hard place.

However, I realize fully that even if insurers decided to proportionally increase care maximums as I have suggested, I know this care now comes out of a bigger budget that includes rehabilitation (when before care had its own budget).  These budgets are currently $65,000 (was $172,000) and $1,000,000 (was $2,000,000).  But the system is currently set-up for people to have “choice” between care and rehabilitation, so I still think the choice should be fair in that at care prices today, the maximums need to be increased.

If insurers really cared about people getting the personal support they need post-accident, they would:

1.      Pay today’s rates for everyone with an open claim.

2.      Increase the maximums proportionally to the increase in hourly pay.

3.      Make it easy for people to get the care – pay to the amount of the form so people can choose to pay a bit more for private services if that is what they need – it all comes out of the same budget anyway, so I am not sure why payment needs to be made difficult too.

The choice is ultimately care or rehabilitation…too bad when our premiums remain high and the outcomes of these losses can be devastating. 

For those working in the sector, here is the chart of rates spanning the last 15 years.

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When Self-Service is Not an Option – Refueling with a Disability

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

When I was a kid I loved the movie “Back to the Future” with Michael J Fox.  I remember clearly the scene where it shows his parents in the 50’s at a gas station – back then, “full serve” meant windows were cleaned, the car shined, tires pumped, and of course your gas tank refilled.  It was like the pit-stop at a NASCAR race where you would have multiple people at your vehicle getting you on your way quickly.  Fast forward to today where “full-serve” is uncommon, and finding a station where someone can fill your tank while you wait in the car might require you to venture out of your way. 

So, how does this translate for people with disabilities?  Well, firstly, there are many people that can and do drive a car regardless of a mobility impairment.  Cars can be modified to accommodate the specific needs of many people with physical challenges.  Hand controls, left-footed gas pedals, spinner knobs, automatic wipers, voice controls…to name a few.  That is all fine while the vehicle is being operated, but what about when it is time to refuel?  It is possible, but not always efficient or safe, for people with a physical impairment to get out of the vehicle, grab their mobility device, and wait outside the car in the elements to refuel.  Not to mention the safety risks of these tight spaces, other vehicles, and fall / slipping hazards of wet and uneven ground.

Considering the move away from “full-serve”, I wanted to look in detail at the services offered by gas stations to help people to refuel when mobility is a challenge.  I was surprised at what I found – some stations have well listed policies that are clear and supportive, while others have no policy or tell people to “call ahead” before coming to refuel.

Here is what I found about ways to refuel if getting out and around your car at a gas station is not the best choice for you…

I give the following companies a THUMBS UP:

ESSO

(https://www.esso.ca/en/gas-stations)

Drivers with disabilities can use the Esso Fuel Finder to find stations that offer the fueling option that best meets your needs: 

Split serve stations: Both full- and self-service options are available to customers
Full serve only stations: Full service is available to customers
Self-serve only stations: While some of our stations have designated Disability Fueling Assistant hours where more than one attendant is available, often there is only one attendant on duty at self-serve stations.

We recommend you call ahead to see if appropriate staffing arrangements can be made. Contact information is available on the Esso Fuel Finder.

SHELL

(http://www.shell.ca/en_ca/motorists/inside-our-stations/refueling-for-drivers-with-disabilities.html)

Drivers with a disabled parking permit will receive full service at self-serve prices at stations with both full and self-serve pumps. The gas station attendant will fuel your vehicle at the self-service island so that you pay only the self-serve price for fuel. Customers should identify themselves to one of our gas station attendants. Please note this service is available only during full service hours.

At self-serve only stations, staff will make every effort to help customers displaying disabled parking permits with refueling. Please identify yourself to one of our gas station attendants. We also encourage you to contact your local station to discuss your individual needs as some stations have limited staff and payment access.

PETRO CANADA

(http://retail.petro-canada.ca/en/stationsstores/customers-with-accessibility-needs.aspx)

At participating split-service stations, a site which provides self-service and full-service at the islands, drivers with an accessible parking permit will receive full-service at self-serve prices. The full-service attendant will fuel your vehicle at the self-service island so that you pay only the self-serve price for fuel.

Find a Petro-Canada station with full service

At participating self-serve stations, customers with an accessible parking permit can drive up to a two-way call station located at the fuel island and press the button to speak to the attendant inside the store to request assistance with fueling their vehicle.

The following get a THUMBS DOWN:

PIONEER

(http://www.pioneer.ca/Portals/1/Images/About%20Pioneer/Pioneer%20Accessiibility%20Policy.pdf)

Pioneer’s site only speaks to assistive devices, communication, support persons and service animals, but does not address the challenge of people with physical impairments being able to refuel.

CANADIAN TIRE GAS

For non-full serve stations, people are required to schedule an appointment with the retailer for refueling.  ONRoute locations offer full serve to all customers between the hours of 7am and 10pm, 7 days a week.  For service outside of these hours, an appointment is required.  Those using the full serve through the Disability Assistance Program will be charged self-serve prices.

COSTCO and ULTRAMAR:

No information is provided. 

In summary, I was impressed by what I found and applaud Shell, Esso and Petro-Canada for being so progressive and supportive on this issue. For the rest, I presume that the Accessibility for Ontarians with Disability Act (AODA) will require those that are behind in offering disability-friendly refueling options to develop policies and procedures and to post these to be easily found on their websites.   In the meantime, I trust those drivers with mobility issues will use and benefit from what Shell, Esso and Petro-Canada have to offer people in their situation.

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A MUST READ New Guideline for Insurance OTs in Ontario

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

With all the legislative changes in the very contentious auto insurance industry, it can be hard to stay current.  Case law, reports, position papers, and of course the high-profile circulations of the Toronto Star.  But sometimes what goes unnoticed is the work of the Colleges or Professional Associations that spend time and resources trying to provide guidance and support to those of us working in this everchanging area of practice.

In the world of Occupational Therapy, one recent document has been posted by the College of Occupational Therapists of Ontario that thoroughly speaks to the challenges, college expectations and tug-of-war that OT’s experience in this difficult sector.  This circulation, entitled “Guideline for Working with Third Party Payers” is a must-read for OT’s in the insurance industry, and serves as a useful tool for anyone (clients, lawyers, insurers, other professionals) who retain, work with, or otherwise engage with an OT for assessment or treatment services.  The guideline (https://www.coto.org/news/new-guidelines-for-working-with-third-party-payers) covers all important aspects of practice in the world of third party work, and includes the following summarized sections:

Providing Ethical and Competent Client Care reviews the Ethical responsibilities of the OT to be transparent, fair and impartial.

Defining Your Role and Setting Expectations with Stakeholders addresses how important it is for OT’s to follow the Standards for OT Assessment and to understand the limits to their own competencies when accepting referrals.

Consent and Personal Health Information discusses how to manage difficult consent situations, for example if another person indicates they got “consent” for the OT, or if a client later withdraws consent during an assessment or treatment. Importantly, it also talks to an OT’s requirement to get new consent when presented with a request to review or comment on new information that was not received when initial consent was obtained.  The submission of reports in draft form to third parties is also covered.

Managing Records and Reports reminds OT’s of their responsibility with record keeping, privacy legislation, and of course the client’s right to access their records.

Managing Conflicts of Interest considers the challenges in this high-stakes industry that is fraught with important funding decisions, conflicting agendas, and relationships that can be formed with clients, insurers, lawyers and the like.  This section deals with these competing interests, conflicting standards and opinions, personal conflicts between oneself and third parties, companies or even other professionals.  Also covered in this section is referrals received from friends or family members, being requested to observe an independent medical exam, and treating clients that are related.  OT’s are reminded that practicing within a conflict of interest (perceived, real or implied) is considered professional misconduct.

Managing Professional Boundaries are addressed and this section highlights different types of potential boundary crossings with clients and referral sources / payers.  It speaks to monetary relationships and financial / gift incentives as a boundary crossing and one that can jeopardize client outcomes and breach professional boundaries.

Use of Title is discussed as a reminder to the different titles an OT may have in providing service, and how to be clear about their role at all times.

Independent Practice reviews the nature of being an “independent contractor or provider” and the resources available to set up, and run, an independent operation.

Lastly, the guideline covers the expectations for providing services to clients who Live Outside of Ontario and reminds OT’s that the client’s location, not theirs, is the jurisdictional boundary and practicing outside of Ontario is not permitted unless the OT has a license in that location as well.

Overall, this document is a useful tool and hard reminder to OT’s of their obligations and expectations as licensed professionals in Ontario.  It may also prove helpful for other stakeholders to review, such that they too understand the rules and boundaries on OT’s so that they can be mindful of these in their working relationships with us.

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The GOS-E and Catastrophic Determination – Gathering EVIDENCE of Pre-Accident Function

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Over the last few months we have had the privilege of presenting to a multitude of Personal Injury Lawyers on the June 1, 2016 changes to catastrophic determination, most specifically on the Glascow Outcome Scale Extended (GOS-E).  If you are working in motor vehicle accident (MVA) rehabilitation or personal injury law, this scale is one you need to be familiar with.

To qualify for catastrophic under the GOS-E, it speaks openly about changes to QUALITY and FREQUENCY of participation in pre-accident tasks under the facets of independence in and outside the home, travelling locally and abroad, productivity, social / leisure participation and relationships.  Within this, it considers HOW OFTEN someone did something, but even bigger than that is FOR HOW LONG and at WHAT INTENSITY.

As OT’s working in this sector, it is important that we gather this information in great detail during our initial assessment to not only get a better picture of pre-accident lifestyle and function, but to create early records that could relate to catastrophic determination at 6 months, 1 or 2 years’ post-accident.

During a presentation, one lawyer questioned the “qualitative way” by which pre-accident information is usually gathered (by asking family or through client self-report).  He asked if there was better evidence, “proof” if you will, that could speak objectively to “pre-accident function”.  This was a great question because right now the only pre-accident “evidence” the industry tends to gather are medical records and these speak to health, not function (and the two can be very different).  Function is best outlined by finding out how people spent their time – something that one would think would be difficult to objectively measure for the purpose of “evidence”, but let’s think again.

The evidence of how people spend their time is actually everywhere.  My morning dog walk and sleep habits are tracked on my fit bit and transferred to my computer and phone.  My car logs the kilometers I drive, and the repair shop inputs these with every oil change.  The gym tracks my attendance.  My phone apparently stalks me by recording everywhere I take it, the websites I visit, the apps I use and the people I speak to, text and email.  The photos in my phone also tell the story of my life and where my time is spent.  My computer records the number of emails I send and receive and the places I visit online.   My emails are sorted and can detail the time I spend organizing and taking trips (local and abroad), socializing, and even my relationship communication habits.  If I had a personal Facebook account this would detail for you the people I chat with, how often, and the places I visit, take photos and upload.  Twitter, Instagram and Snapchat would do the same.  But honestly most of the information about my time spent would be easily revealed through my financial records.  Most of the things I do cost money.  My credit card and bank statements will show you the frequency by which I get a latte, the costs for my gym program, the amount of shopping I do, the people I pay to help manage aspects of my house, the places I eat or indulge, the number of times I visit the movies or do something fun, the things I enroll my children in, etc.  These will even tell you the therapies or treatments I might get privately that my doctor doesn’t even know about.

We know that being involved in the insurance system exposes aspects of people’s lives that they may not want to share.  All privacy is forgone when you want and need help from an insurer, or when you want and need to sue someone who was at-fault for causing you injury and harm.  Unfortunately, with the changes to Catastrophic Determination, the gap just widened in terms of the information that needs to be gathered and the “proof” that needs to be provided to access the benefits an injured person may need.  However, the information is out there – little is sacred or private anymore. 

If this is helpful, here is a list of information that could be gathered to support changes to FREQUENCY and QUALITY of participation in most activities before and after an accident.   Getting someone’s personal records for the year prior to an accident, and then for the first-year post, will be highly informative, helpful and revealing…if they are agreeable to share:

Bank Statements / Financial Records will show MOST purchases related to social / leisure activities:

Memberships / clubs / subscriptions
Dinners / coffees / movies
Vacations
Shopping habits
Sports / fitness
Gas / driving / parking habits

Other places will also have records:

Gym / rec center attendance
Schools / school records
Employment records
Evidence of trips / vacations / social events on SM – FB, Twitter etc (before the accident)
Car / vehicle records – how often the car was driven based on KM’s
Points cards for anything like movies, Starbucks, Airlines, etc
Call / cell records and communication habits
Medical records

I hope this helps the lawyers and injured people of the insurance system to find the “evidence” they might need to really demonstrate to an insurer how their life has been impacted following an accident.  And for the OT’s gathering similar data subjectively, be specific and thorough in your questioning under the GOS-E spheres.  Your reports are highly important and may become the difference between someone being deemed catastrophic or not.

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Drugs or Driving? You Might Have to Choose

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

The Ontario Trial Lawyers Association (OTLA) Blog recently posted this very interesting and informative article on the legalization of marijuana and how this may specifically impact the drivers of Ontario.  The proposed reforms to Impaired Driving Laws, as listed in the article, include:

For the first time, the Government of Canada has proposed prescribing limits to the amount of THC – an inebriating component of cannabis – detected in a person operating a motor vehicle. The Government is also proposing prohibiting any detectable levels of many other drugs while operating a motor vehicle.

The proposed changes include attempts to close loopholes in our current laws and providing for easier roadside testing by authorities, including:

  • allowing mandatory roadside saliva swab testing;
  • allowing blood tests taken by professionals on the scene who are not doctors;
  • allowing breathalyser testing of any driver (omitting to the current requirement for “reasonable suspicion” of impairment); and
  • changing the definition of impaired driving with blood alcohol levels over 80mg/100ml from “while operating a motor vehicle” to “within two hours of operating a motor vehicle” (an attempt to close legal loopholes where people claim to have drunk alcohol immediately before driving or immediately following an accident to account for an anticipated failed sobriety test).

People operating motor vehicles will be committing a criminal offence if they are found to have THC levels in their blood above 2ng/ml. Drivers with levels above 5mg/ml or levels above 2.5ng/ml combined with blood alcohol levels over 50mg/100ml will face more significant penalties.

The penalties are also generally going up, especially in the case of repeat offenders who may now be sentenced up to 10 years (up from the current five), and will now be eligible to be deemed “dangerous offenders” in appropriate circumstances.

So why is this so significant?  As an Occupational Therapist it is common for many of my clients to require the use of medication to manage their symptoms.  While most (or all) would love to be able to go without regular use of these drugs, it is typical for medications to be prescribed to help people manage initial and acute symptoms for things like sleep, depression, anxiety, pain, headaches, and spasms.  Often, that usage continues beyond the acute phase of recovery to help with the management of more chronic and relentless problems that don’t resolve in time.  It is no secret then that people with disabilities tend to be high consumers of medication.

More recently, as the benefits of medical marijuana become studied and well known, my clients are choosing to forgo the gut-wrenching and highly addictive narcotics for the milder but often effective marijuana option.  My clients that use medical marijuana report better sleep and more stability in their symptoms without the intense side-effects they experienced on other drugs. 

So my clients tend to use medication, some are switching to marijuana, but most concerning with this legislation change is that most of my clients are also drivers.  Very few actually don’t resume driving and in fact returning to driving is often one of their main objectives.  Driving provides freedom and convenience, and people who end up stranded at home tend to decompensate emotionally due to the isolation that comes from not being able to enter the community often and independently.  Sure, many places offer public transit options, but try having pain, reduced tolerances for activity, standing or sitting restrictions and then be expected to walk to, wait for, and then sit on a bus that has jerky starts and stops every few blocks.  Public transit is just not a great option for people that don’t tend to feel well.

I am all for the safety of Ontario drivers and I can appreciate how the laws in Ontario need to evolve with the introduction of new policies that can impact driving.  However, I am concerned that these changes unfairly target an already marginalized portion of our population without providing suitable alternatives to allow people to get around their community.  How will my clients who currently drive while medicated be able to continue to get around? 

Further, there is also a potential change to the mandatory reporting requirements for professionals around driving.  Currently, only doctors are required by law to report potentially unsafe drivers to the Ministry of Transportation.  There is talk that Occupational Therapists will also have this responsibility soon.  So, if I know that my client is taking narcotic medication and also drives to work daily, will I be required to report this?  If that is the case, then what about the doctor that prescribes the medication in the first place?  Is he going to give people the option of:  drugs or driving? 

Personally, I think the bigger problem on the roads is non-prescription related.  Drinking and texting seem to be causing more injuries and deaths than the use of properly prescribed and consumed medications.  I hope the lawmakers of Ontario are considering all the risks on the roads and working to develop solutions fair to all of us.