Monday, February 20, 2017
BC Motor Vehicles Fitness to Drive
A member’s bitter experience led us to look into the DriveABLE program. His wife's driving licence was revoked after failing a computer-based test. We did some digging and "put out the word". Our members and others are really angry. Rather than a scientific breakthrough in public safety, we have a program based on out of date research. We have privatized public policy developed by consultants, delegated to clerks and computers and outsourced to independent contractors.
On March 19, 2016 Shirley Bond, Minister of Justice and Attorney General, announced changes to the DriveABLE program: "… a decision regarding a person’s ability to continue driving will not be made solely from an in-office computer assessment. People who fail the computer assessment will be offered a DriveABLE road assessment. The results of the in-office assessment combined with the on-road evaluation and medical information will ensure licence decisions are made in the fairest manner possible. The Province will pay for the cost of both assessments."
Our efforts, and those of others advocating for seniors have had some impact. Drivers' licences will no longer be suspended "on the spot" as a result of a screening test.
Are we there, yet? No.
We believe that efforts to improve the program's PR and accessibility are simply wrongheaded. The program is not "misunderstood" – it is wrong. It should be cancelled. Improving access will only result in more people's lives being damaged.
There are two programs under the Office of the Superintendent of Motor Vehicles (OSMV) that affect seniors' driving: the 80+ medical assessment and DriveABLE.
• After the age of 80, accident free or not, drivers are required to get a doctor’s assessment of their medical fitness to drive. While most receive a positive report, others may be referred for further assessment. (DriveABLE)
• Under the DriveABLE program, a report from the police, health care provider or "concerned citizen" may result in having to take a DriveABLE test. The purpose of the test is to assess cognitive fitness.
The DriveABLE program is based on an out-of-date view of the world. Twenty years ago, there was what amounts to a moral panic about aging and driving; an apocalyptic vision of a "grey wave" of demented "wrinklies" careening down the roads. It was not hard to convince funding agencies and academic journals of the risks inherent in the rising tide of demented drivers. Clever entrepreneurs have used fear, uncertainty and doubt to promote their agenda and their products.
The real world, thank goodness, has not cooperated. Seniors' accident and death rates have gone down, not up. Cooler heads have prevailed in the academic world. Where mass screening of drivers for cognitive fitness was sliced bread in the '90's, a respected voice in health care now says:
…the available literature fails to demonstrate the benefit of driver assessment for either preserving transport mobility or reducing motor vehicle accidents."
adding their reasons:
the cognitive test that most strongly predicted future crashes would … prevent six crashes per 1000 people over 65 screened, but at the price of stopping the driving of 121 people who would not have had a crash.
Attitudes about senior drivers are changing but we still have work to do. Too many conversations about aging drivers include words like these:
"No one wants unsafe drivers on the road"
thus justifying almost any level of heavy-handed intervention into seniors' lives.
This is unhelpful. We will always need to strike a balance between mobility and safety. The only way to have no unsafe drivers on the road is to have no drivers or close the roads. Drawing neat little lines in the sand isn't possible.
Our Continuing Concerns
• The harm caused by the DriveABLE program far outweighs the benefits. The program casts too wide a net, damaging people's lives. We have seen little acknowledgement of the impact of driving cessation. We need a balanced, thoughtful review of this program with community input. The review must exclude those who have an institutional bias or business interest in the outcome. • The driving record should be the "gold standard" not the DriveABLE road test.
• The over 80 medical exam should be discontinued. In reviewing European experience, the UK Transport Research Laboratory stated: "There is no evidence that any licence renewal procedure or requirement for a medical examination has an effect on the overall road safety of drivers aged 65+"
• Since the fatal crash rate for 70-74 year olds, 75 - 79 year olds and 80+ year olds is now less than that of 35-54 year olds there is no justification for discriminating against seniors.
• Retraining and remediation are absent from the OSMV's program. The belief seems to be that cognitive impairment is incurable, decline inevitable and remediation impossible. This doesn't square with modern science. One cognitive factor which modern research has found to be strongly predictive of crashes is the Useful Field of View - UFOV. Training is readily available which remedies UFOV problems and would undoubtedly reduce risks and promote independence. There are likely other remedial approaches. OSMV relies solely on driving cessation.
• Our doctors have been misled into believing that they are liable for damages under case law if they don't report on those they believe unfit to drive. A professional development document for BC doctors cites a 1973 precedent that was overruled in 2003. A minor quibble, you say? Ask your doctor how she feels about being misled and bullied into reporting. We believe this program damages the doctor-patient relationship; patients becoming guarded about disclosing information to doctors; doctors reluctant to bring up the subject of driving. Medicine doesn't work on a "don't ask, don't tell" basis. We support the Neurologists position; physicians should be free to report or not report based on their assessment of the needs of the individual, the family and the community.
• If seniors must be screened and assessed, then individual and community needs must be taken into consideration. We believe that physicians - people we trust - should be the major players in the complex decisions about driving restriction, retraining, remediation or cessation. We need the "meaningful and trusted consultation" that only our doctors can provide, not a heavy-handed approach with all of the decisions being made by clerks, computers and contractors.
If you or anyone you know has lost a drivers' licence through taking a DriveABLE test, you should write to:
Office of the Superintendent of Motor Vehicles
Attn: Driver Fitness Unit
PO Box 9254 STN PROV GOVT Victoria, BC V8W 9J2
and request a road test.