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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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O-Tip of the Week: Try the ’10 Minute Rule’

Our O-Tip of the week series we will be providing valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living. 

Occupational Therapists are a vital part of a team of professionals that assist with the rehabilitation from brain injury.  For the month of June, Brain Injury Awareness Month, our series will be providing solutions to assist with some of the many symptoms of brain injury. 

Struggling to complete a daunting task?  Continuously pushing it to tomorrows to do list?  Try the 10 Minute Rule Instead of trying to complete this task all at once, set a timer and spend just 10 minutes a day on this task until you are able to finish it.

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Concussion Recovery: An OT Can Help!

If you ask a crowd of people if they have ever had a concussion, about 1/3 will raise their hand. Direct hits to the head and closed head injuries are not uncommon in children and young adults, decrease in frequency in adulthood, but increase again in seniors.

Symptoms of concussion range and some can dramatically impact someone’s ability to work, drive, go to school, manage daily routines, or even participate in social or leisure activities.  Occupational Therapists can help those who have suffered a concussion manage symptoms and for those who are struggling to participate in important life roles, we can help them to return to work / home / school / fun! 

Learn more about Occupational Therapy’s vital role in our OT-V Episode:  Managing a Concussion

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Computerized Cognitive Training – Does it Help?

How do you stay “mentally fit?”  In our previous post, Working up a Cognitive Sweat, we suggested some online ways to provide a “workout” for your brain through computer “brain training” programs or computerized cognitive training.  The following care of the McMaster Optimal Aging Portal discusses research which confirms that these training programs do provide benefit, even to those who with mild cognitive impairment.   Learn more about this research below and take a look at our OT-V episode, Cognition and Aging — Keeping the Mind Sharp, for more ways to keep your brain cognitively fit!

The McMaster Optimal Aging Portal:  Computer brain games for treating cognitive impairment

 

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O-Tip of the Week: Plan Your Weeks and Days

Our O-Tip of the week series we will be providing valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living. 

Occupational Therapists are a vital part of a team of professionals that assist with the rehabilitation from brain injury.  For the month of June, Brain Injury Awareness Month, our series will be providing solutions to assist with some of the many symptoms of brain injury. 

Brain injuries may result in cognitive deficits which can affect memory and concentration.  Additionally, a brain injury often affects energy levels, leaving many fatigued by completing daily tasks.  Spreading activities throughout the week and thoroughly planning each day will go a long way to help someone with a brain injury accomplish more and feel more in control.  An OT can help!

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Stay Sharp with the 30 Day Healthy Brain Challenge

June is Brain Injury Awareness Month and, in recognition, Solutions for Living created the 30 Day Healthy Brain Challenge.  We challenge you to complete these 30 simple activities and tips which, when incorporated into your lifestyle, can help improve memory, boost mental health, prevent brain injury and reduce cognitive decline.

Try the 30 Day Healthy Brain Challenge and after the month let us know how many activities you were able to complete!

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O-Tip of the Week: Encourage Active Kids with “Build Your Best Day”

Our O-Tip of the week series we will be providing valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living. 

Spring has finally sprung and it’s time than to add some healthy activity to your life.  So, for the month of May our series will be providing tips to help you get physical!

We came across this great tool for helping kids ensure they are meeting physical activity, screen time, and sleep recommendations each day.  Check out Build your Best Day by Participaction to help kids find fun ways to get the 60 minutes of physical activity they need each and every day!

Participaction: Build Your Best Day

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Some Thoughts on Mindful Self-Compassion

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

For the last several weeks I have been enjoying a course in Mindfulness Self-Compassion.  Taught through the Program for Faculty Development at McMaster University, the course is for health professionals, but the strategies and teachings are very relatable to all of us in our daily lives.  While the course is not over, I wanted to share some of the main concepts I have found most helpful so far.

Here is the scenario:  you are heading home from work and you get a panicked call from a close friend or family member.  They are upset and really need your help.  How do you react?  Well, when I did this exercise I thought my reaction would probably include:  asking them what I could do that would be most helpful, clearing my evening schedule to go provide them with support, visiting with them to listen, offering support, helping to distract them through activity or fun if appropriate, assisting them to move through the situation, arranging for follow-up and checking in the next day.  Something like that.  But, what if the crisis is happening to me?  Would I react differently?  Well, historically, yes, I would.  In fact, I would probably treat myself very differently than I would my friend.  Or, more honestly, if I treated my friend the way I would treat myself, I wouldn’t have many friends.  My reaction to myself would be more like: “you don’t have time for this, get over it, there are bigger problems in the world”, or I would simply try to ignore the issue, bury the associated feelings and move on.  I probably would see my own name on the call display, roll my eyes, hit “decline” and wonder “why is she calling again”? Wow, what a difference.  Self-compassion then can be as simple as affording yourself the same compassion, love and respect that you afford to those around you.  Try it!

I also found it very helpful when the course addressed our “inner critic”.  This is the internal voice we all have that bully’s us into thinking we are not “good enough, smart enough, fit enough, competent enough” etc.  In truth, part of the reason I wanted to take the course in the first place was to try and sucker punch that bully and get her (mine is female) to leave me alone.  But when the course had me really evaluating the thoughts and feelings that my inner critic berates me with, I did come to realize that perhaps I should give her more credit.  Maybe it is my critic that ensures I complete 90% of my goals.  Maybe I need that critic for my willpower, drive and determination.  Perhaps some of my behavior is directed at proving her wrong (I am stubborn that way).  Because of the course I now have an increased appreciation for her and am now grateful that she keeps me in line.  By acknowledging that she exists and being open to her presence has actually diffused her, softened her approach, and now I find her voice more loving and supportive.  Go figure!

Lastly, I found the half-day silent retreat very refreshing.  While I had been on a silent retreat before, this time I was sure to be much more mindful throughout the process and the results were more enjoyable.  Not being pressured to talk or engage verbally with others really helped me to calm my thinking, slow my brain waves and see things that I usually ignore.  Nature, food and silence have never before been so enjoyable.  I left there with feelings equivalent to a restful nights’ sleep, a relaxing vacation, or a good meal with friend.  Soothing, comforting and rejuvenating.  Silence is definitely something I am going to work into my life more regularly.  My brain requires it.

While there have been other helpful and impactful parts of this course, I have highlighted my favorite three so far.  And though I am still learning the art of mindfulness (and am not yet “practicing” as much as I should), and I still struggle with meditation and working this into my day, the benefits of this course are many and the teachings important.  Mindfulness, self-compassion and human kindness are all pivotal concepts in this course that this world so desperately needs us all to embrace.  I am enjoying learning more about them all.

To close, here is one of my favorite poems from the course:

Allow

by: Danna Foulds

 

There is no controlling life.

Try corralling a lightening bolt,

containing a tornado. Dam a

stream and it will create a new

channel. Resist, and the tide

will sweep you off your feet.

 

Allow, and grace will carry

you to higher ground. The only

safety lies in letting it all in –

the wild and the weak; fear,

fantasies, failures and success.

 

When loss rips off the doors of

the heart, or sadness veils your

vision with despair, practice

becomes simply bearing the truth.

 

In the choice to let go of your

known way of being, the whole

world is revealed to your new eyes.