Doctor shopping and fitness to drive – a dangerous mix

Case history

Ms C was the driver at fault in a fatal motor vehicle accident on 18 July 2013. Her licence had been reinstated only seven days earlier, after being cancelled in February 2012.

A coronial inquest was held into Ms C’s death in August 2016¹. It was noted that Ms C had attended the same GP practice from November 2005 until April 2012, receiving treatment for multiple issues including insomnia, osteoarthritis, chronic lower back pain, sleep apnoea and multiple falls.

Ms C had a prolonged admission to hospital in November 2011, following a fall, which was the sixth in 12 months. It was during this admission that Ms C was advised not to drive, because of her unsteadiness, and an assessment by her GP of her fitness to drive.

On 9 January 2012, three of Ms C’s friends attended the local Police Station to express concerns about her ability to drive.

Following receipt of this notification, a police officer visited at her home on 13 January 2012. The officer completed a report to the driver licensing authority (DLA), noting that Ms C appeared frail and struggled to walk. Ms C informed the officer that she would continue to drive, notwithstanding the advice she had received from her treating doctors.

On 25 January 2012, the DLA wrote to Ms C proposing to cancel her licence and seeking a medical certificate confirming her fitness to drive. Ms C requested a certificate from her GP on 23 February 2012, but was advised that she would first need to undergo a driving assessment. Ms C’s licence was cancelled on 27 February 2012.

However, at Ms C’s 17^th consultation with Dr P on 1 July 2013, he provided her with a medical fitness to drive certificate.

Medico-legal issues

The Coroner noted that Dr P had not requested copies of Ms C’s clinical notes from her previous treating GP, despite not having seen her for seven years. Further, although Dr P knew that Ms C’s licence had been cancelled, he did not ask why.

The Coroner rejected Dr P’s conclusion that Ms C had good mobility at an assessment on 1 July 2013, because this was inconsistent with all other medical evidence. The Coroner also observed that Dr P’s notes were extremely sparse.

The Coroner found that:

• Ms C was not fit to hold a drivers licence
• Dr P had failed to follow and apply the relevant Austroads guidelines², or to obtain any corroborating information about her medical history
• Dr P had not demonstrated any insight into his conduct and failings.

However, despite this, the Coroner decided not to refer Dr P to a professional or disciplinary body.

Discussion

Beware of the patient who requests certification of fitness to drive at their first consultation – you can and should refuse to provide certification if you feel uncomfortable doing so. At a minimum, having access to copies of the previous GP notes is essential.

Providing an inaccurate medical certificate to a patient can have very serious consequences for your medical registration.

Julie Brooke-Cowden
Medico-legal Adviser, MDA National

References

1. Inquest into the death of Ruth Capps, Coroners Court Southport, delivered on 21 December 2016.
2. Austroads. Assessing Fitness to Drive for Commercial and Private Vehicle Drivers: Medical Standards for Licensing and Clinical Management Guidelines. 1 October 2016 as amended up to August 2017.