When, as a physician, you have a patient who is suspected of having a cognitive impairment, driving issues should be addressed as soon as possible. Your patient and caregivers need time to plan for the loss of driving.

If you suspect your patient has a cognitive impairment, it is recommended you administer a SIMARD MD screening test. This is a valid and reliable screening tool for the identification of cognitively impaired medically at-risk drivers.

There are three possible outcomes for the SIMARD MD test:

• Flagged as fit to drive
• Indeterminate
• Flagged as unfit to drive

Note: Review the section on SIMARD MD for more detail on determining these outcomes

If your patient is ‘flagged as unfit to drive’ or the outcome is ‘indeterminate’, recommend to your patient to stop driving and report this to the OSMV using either the ‘Report of a Condition Affecting Fitness and Ability to Drive’ or your preferred mode of communication with the OSMV.

If your patient is ‘flagged as fit to drive’ plan to repeat the SIMARD MD in one year or if there is a change in your patient’s medical status.

• As part of your continuing care, talking to your patient about the need to eventually stop driving, and reminding them that they can trade in their licence for a free BC Identification Card, which is valid as picture ID everywhere a driver’s licence is valid.
• Administering the SIMARD MD screening test every six months or when your patient’s medical status changes.
• Reporting ‘indeterminate’ and ‘flagged as unfit to drive’ SIMARD MD results to the OSMV.
• Recommending patients who get a negative result on either the SIMARD MD screen or DriveABLE assessment to cease driving, or at the very least, to stop driving until they receive a letter from the OSMV.

Reporting to the OSMV patients who you believe are continuing to drive after you have recommended they stop.

The SIMARD MD was developed and validated against actual driving performance using a driving evaluation scientifically developed to identify cognitively impaired drivers who are unsafe-to-drive.

There are three possible outcomes for the SIMARD MD screen:

A score of:

• ≤   30:        flagged as unfit to drive
• 31-70:        indeterminate
• >   71:        flagged as fit to drive

When a patient is flagged as either fit to drive or unfit to drive it is important you consider whether mitigating factors exist that could have influenced the result. For example, a language barrier could influence a patient to score lower than their true ability. Conversely, a highly intelligent patient could score higher than their true ability. In these cases, the SIMARD MD should not be relied upon for licensing decisions.  Document on the report to OSMV that the SIMARD MD result may not be valid based on your clinical opinion and recommend the patient be referred to DriveABLE.

SIMARD MD Tool

• When you first suspect a patient has a cognitive impairment
• When OSMV requests you to complete a Driver’s Medical Examination Report (DMER) on your patient.
• Every year for a patient with a progressive cognitive impairment who is still driving
• When a patient with cognitive impairment shows a clinically significant decline

If a SIMARD MD is administered and your patient scores in the ‘indeterminate’ or ‘flagged as unfit to drive’ and you have not been asked to complete a DMER, report this score to the OSMV using either a ‘Report of a Condition Affecting Fitness and Ability to Drive’ or your preferred method for communicating with the OSMV.

The OSMV will review the completed DMER and any other information on your patient’s driving record to determine if your patient can continue to drive. If the OSMV is unable to make this determination from the available information, the OSMV may require your patient to undergo further medical or functional assessments (e.g. DriveABLE).

If the OSMV determines that your patient is not fit to drive, they will mail a letter to your patient explaining that decision, and ICBC will send a follow-up letter revoking their driver’s license.

If the OSMV determines your patient is safe to continue driving, the OSMV does not send any correspondence to your patient. To confirm the OSMV fitness to drive determination, your patient can phone the OSMV toll-free at 1-855-387-7747.  If you, as a physician, have questions about OSMV forms or Driver Fitness procedures, you can phone an OSMV hotline in Victoria which is just for medical professionals: 250-953-8612.

DriveABLE consists of two procedures:

• DriveABLE Cognitive Assessment Tool (DCAT)
• DriveABLE On-Road Evaluation (DORE)

The DCAT is an in-office assessment of cognitive abilities essential for safe driving. It has been validated against actual driving performance. The DCAT includes tests of motor speed and control, attention, judgment, memory and decision-making, and making judgments of driving situations.

The tasks are presented on a touch sensitive screen. The tasks only require your patient to either touch the screen or push a button to make a response.

Note: While the evaluator uses a computer to present each task on the screen, your patient does not have to have any skills or knowledge about computers to do the tasks. A qualified assessor guides your patient through each task.

The DORE is an on-road evaluation which consists of a standardized road course developed through scientific research to reveal competence defining driving errors.

All patients referred to DriveABLE will complete the DCAT assessment. Only those patients who score in the ‘inconclusive’ range on the DCAT will undergo a DORE.

If DriveABLE has you listed as your patient’s physician and your patient scores within the ‘inconclusive’ range on their DCAT, you will receive a notification that your patient is required to undergo a DORE. The notification is for information purposes only; you do not need to take any action at that time.

When your patient has completed a DriveABLE assessment, a copy of the final report will be sent to the OSMV and the physician listed on your patient’s OSMV file.

Note: If a physician other than yourself is named on your patient’s OSMV file, you will not automatically be sent these results. To enquire about results you can call the OSMV at 250-387-7747.

Following are the possible final results and your recommended actions:

DCAT results

The DCAT score represents the ability to predict your patient’s outcome of an on-road assessment. Following are possible scores on a final report:

Note: DCAT scores between 30 to 70% are considered ‘inconclusive’. Your patient will undergo a DORE assessment and you will be sent a final report when your patient has completed the DORE.

DORE results

The DORE scoring is based on the type and severity of driving errors the patient makes:

When you receive the final report from DriveABLE, review the results. If your patient’s score falls within the ‘impaired’ range recommend they do not drive. Your patient will receive a letter from OSMV informing them that their license has been revoked. This can take several weeks.

If your patient’s DCAT or DORE score falls within the ‘normal’ or ‘borderline normal’ range they will not receive any communication from the OSMV. It is recommended you relay these results to your patient. To confirm the OSMV fitness to drive determination your patient can call the OSMV at (250) 387-7747.

Before DriveABLE was introduced as an assessment tool, the Superintendent of Motor Vehicles often had to make licensing decisions based only upon the diagnosed presence of a cognitive medical condition.  Through the use of the DriveABLE assessment tool, individuals who may have a cognitive impairment are now individually assessed to ensure that they are safe to continue driving. If a cognitive condition does not adversely affect their ability to drive safely, they can be allowed to continue to drive. DriveABLE consists of the following separate procedures:

• DriveABLE Cognitive Assessment Tool (DCAT)
• DriveABLE On-Road Evaluation (DORE)

The DriveABLE Cognitive Assessment Tool (DCAT) is an in-office assessment of cognitive abilities essential for safe driving. This includes tests of motor speed and control, attention, judgment, memory and decision-making, and making judgments of driving situations.

The DCAT measures only the specific cognitive functions needed for safe driving. It does not measure a person’s overall cognitive functioning or intelligence. Results are judged against someone without a cognitive impairment of the same age.

The DCAT is presented on a touch screen and takes about an hour to complete. No knowledge of computers or their applications are needed. An individual only needs to touch the screen and press a button to complete the tasks. A mouse and a keyboard are never used.

A trained healthcare professional (typically a kinesiologist or occupational therapist) administers the DCAT and guides the individual, and practice sessions are encouraged. During the practice session, if the healthcare professional perceives an individual to be highly nervous or overly stressed, they will suggest that the individual re‐book an appointment for another day. During the assessment, the healthcare professional will not let the person being assessed proceed to the next task until they’re sure the person being assessed fully understands what is expected of them.

Drivers who do not pass the DCAT will be provided with a secondary opportunity to demonstrate their continued fitness to drive, through the DriveABLE On-Road Evaluation (DORE).

The DriveABLE On-Road Evaluation (DORE) is an on-road evaluation which consists of a standardized road course developed through scientific research to reveal competence-defining driving errors.

Professional driving assessors trained and certified by DriveABLE administer the on‐road evaluation on special road courses designed to test and reveal driving errors associated with cognitive decline. Minor handling errors and bad driving habits are not part of the scoring; only errors related to cognitive abilities are scored.

The DORE is conducted in a dual‐brake vehicle, as that is the safest environment for both the driver and the driving examiner, in the event of unsafe driving due to cognitive impairment.

The DORE provides drivers who do not pass the in‐office assessment with a secondary opportunity to demonstrate their continued fitness to drive.

If DriveABLE has you listed as your patient’s physician and your patient does not pass the DCAT, you will receive a notification that your patient is required to undergo a DORE. The notification is for information purposes only; you do not need to take any action at that time.

When your patient has completed the DriveABLE assessment, a copy of the final report will be sent to the OSMV and to the physician listed on your patient’s OSMV file.

Unlike in most other jurisdictions, in British Columbia, the OSMV pays for a patient’s DCAT and DORE, when those assessments are requested by the OSMV.  If you provide medical information indicating a measurable cognitive improvement in a patient who has previously failed a DCAT and/or a DORE, the OSMV will authorize a second DORE, but your patient will be responsible for the cost of that assessment.

Note: If a physician other than yourself is named on your patient’s OSMV file, you will not automatically be sent these results. To enquire about results (or for any other driver fitness questions), you can phone a dedicated OSMV line in Victoria that is just for medical professionals: 250-953-8612.

Here are the possible final results and your recommended actions:

Note: If your patient’s DCAT or DORE score falls within the ‘normal’ or ‘borderline normal’ range, they will not receive any communication from the OSMV. It is recommended you relay these results to your patient. To confirm the OSMV fitness to drive determination, your patient can call the OSMV toll-free at 1-855-387-7747.

DCAT results

The DCAT score represents the ability to predict your patient’s outcome of an on-road assessment. Following are possible scores on a final report:

When you receive a DCAT report from DriveABLE, review the results. If your patient’s score falls within the ‘impaired’ range, recommend they cease driving.  They will receive a letter from the OSMV offering them a DORE, but unless their DCAT score is at the low end of the ‘impaired’ range, recommend against them taking a DORE, as the likelihood of them passing is not high. If your patient uses their driver’s licence as photo ID, advise them that they can get a free BC Identification Card from any ICBC Driver Licensing Office, or from the Service BC office in towns that do not have an ICBC Driver Licensing Office.

DORE results

DORE scoring is based on the type and severity of cognitive driving errors the patient makes:

When you receive a DORE report from DriveABLE, review the results. If your patient’s score falls within the ‘impaired’ range, recommend they do not drive. Your patient will receive a letter from OSMV informing them of their decision to cancel their driver’s license, plus a follow-up letter from ICBC cancelling their license, but this can take several weeks.  If your patient uses their driver’s license as photo ID, advise them that they can get a free BC Identification Card from any ICBC Driver Licensing Office, or from the Service BC office in towns that do not have an ICBC Driver Licensing Office.

Related links:

OSMV Driver Medical Fitness:   pssg.gov.bc.ca/osmv/medical-fitness/index.htm

DriveABLE Information Guide:  pssg.gov.bc.ca/osmv/shareddocs/infoguide-driveable.pdf

DriveABLE public information line:   1-888-475-4666

DriveABLE.com

Important: Physicians can be held legally liable for not reporting if they could have reasonably foreseen that the patient’s medical condition could lead to a motor vehicle crash. All provinces protect the physician from litigation if they report in good faith.

BC Motor Vehicle Act: Mandatory Reporting, Protection, & Confidentiality Section 230

(1) This section applies to every legally qualified and registered psychologist, optometrist and medical practitioner who has a patient 16 years of age or older who

(a) in their opinion has a medical condition that makes it dangerous to the patient or to the public for the patient to drive a motor vehicle, and

(b) continues to drive a motor vehicle after being warned of the danger by the psychologist, optometrist or medical practitioner.

(2) Every psychologist, optometrist and medical practitioner referred to in subsection (1) must report to the superintendent the name, address and medical condition of a patient referred to in subsection (1).

(3) No action for damages lies or may be brought against a psychologist, an optometrist or a medical practitioner for making a report under this section, unless the psychologist, optometrist or medical practitioner made the report falsely and maliciously.

If you, as a physician, have questions about this, you can phone an OSMV hotline in Victoria which is just for medical professionals: 250-953-8612.