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Old 02-12-08, 06:44 PM   #1
closetbiker
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unfit drivers

Researchers sound alarm over unfit drivers

One-third of those involved in serious crashes had medical conditions that should have kept them off the road, study finds



CAROLYN ABRAHAM

MEDICAL REPORTER

February 12, 2008


Hundreds of medically unfit drivers remain on the road in Canada, resulting in countless crashes and deaths because doctors are failing to report them, researchers have found.

Doctors in seven provinces are legally obliged to report to transport authorities patients with medical conditions that could compromise their ability to drive safely.

But a groundbreaking Ontario study has concluded that very few physicians comply with the law and the legislation needs urgent revamping.

Of 1,605 injured drivers admitted to Toronto's Sunnybrook Health Sciences Centre, Canada's largest trauma centre, between 1996 and 2001, researchers found 37 per cent had a reportable condition that made them potentially unfit to drive. But only 3 per cent had actually been reported to the licensing authorities of Ontario's Ministry of Transport.

"One-third of drivers involved in serious crashes were suffering from a chronic medical condition that contributed to the crashes," said Donald Redelmeier, a senior scientist with the Institute for Clinical and Evaluative Sciences in Toronto. "Almost all of them had seen a doctor in the previous year leading up to the crash, yet almost none of them had been reported.

"The extent of this under-reporting is really remarkable."

Dr. Redelmeier said 3,000 people die in crashes in Canada each year, and about one-third, or 1,000, of those deaths can be linked to medically unfit drivers. Yet, their study suggests, only a fraction of these drivers have ever been reported.

Statistics also show that for every 10 drivers killed in accidents, five passengers and two pedestrians also die.

It is pointless having a law on the books that is so widely flouted, Dr. Redelmeier said.

The study, released yesterday in the journal of Open Medicine, found drivers with reportable conditions were more likely to be older and male. Alcoholism was the most common underlying reportable condition, yet the least likely to be disclosed.

But researchers also found doctors had failed to report cardiac conditions, such as unstable angina, or strokes, as well as neurological disorders, such as dementia, seizures, or active psychiatric disorders.

The researchers acknowledged that "restricting drivers ... is no simple task" given the "cultural attitudes toward mobility, the political power of older people and the ambiguous definition of 'medically unfit.' "

Quebec and Nova Scotia leave it to doctors' discretion to report potentially unfit drivers. Alberta has no law on the issue. But this study is the first to review whether such a law, which was enacted about 40 years ago in Ontario, actually works to improve road safety.

"Some of my colleagues are family doctors. They are aware of how embarrassingly low the rates are for reporting ... but it's rarely talked about," said Dr. Redelmeier, who is also a professor of medicine at the University of Toronto.

He noted that doctors are not charged with taking away someone's licence, only sending a warning signal to ministry officials to trigger a separate review of their ability to drive.

The researchers also say doctors "may be disinclined to report patients" because they feel torn between advocating for their patients and protecting society. Some doctors may also worry that patients will not seek medical care if they suspect they could lose their driver's licence after a doctor's visit.

Yet the paper points out that the patient is most often the person disabled in a crash. The researchers reviewed the subjects' driving and medical records, including files from all visits to a doctor in the five years preceding the accidents.

The review did not include sleep disorders, hearing or vision problems and so researchers believe the study actually underestimates the extent of the problem.

No one at the College of Physicians and Surgeons of Ontario, the medical profession's regulatory and licensing body, was available to comment on the study yesterday. But spokesperson Kathryn Clarke, said "it's not something that's frequently a source of complaints."

Neither, she added, could she recall any doctor facing a disciplinary hearing for failing to report a potentially unfit driver in the 15 years she has been with the CPSO.

But in at least two cases that followed motor vehicle accidents, in 1992 and 1994, Ontario courts have found doctors liable for failing to report patients who were medically unfit drivers.

Dr. Redelmeier said lawmakers should consider expanding the law to oblige others, such as mechanics, vehicle insurers, or family members - and not just doctors - to report a medically unsafe driver.

At one time, for example, only pediatricians were obliged to report suspected cases of child abuse to authorities. But teachers, social workers and others in the community now also share that obligation.
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Old 02-12-08, 07:13 PM   #2
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Scary stuff.
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Old 02-12-08, 07:26 PM   #3
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No surprise there. People consider driving a right, not a priviledge, and haven't planned their cities out to offer alternatives. Not driving is seen as a loss of humanity.
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Old 02-12-08, 08:30 PM   #4
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... Not driving is seen as a loss of humanity.
Getting killed by an unfit motorist is sort of a loss of humanity, as well.

We need urban planning which interconnects sources and destinations with a network of 25-35mph roads on which neighborhood electric vehicles are legal. We also need the political will to stiffen the requirements to obtain and to retain a driver's license, which mandatory jail time for those who drive with a revoked license.
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Old 02-12-08, 10:22 PM   #5
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each year in BC there is a case of a cyclist that gets killed by one of these drivers. Still, these drivers kill other drivers and pedestrians that get killed by them too, so being on a bike is not being exposed to any more risk, but it just goes to show that to advocate for cyclists, sometimes we need to point out that driving needs closer scrutiny at least as much as cyclists need other things.
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Old 02-12-08, 10:28 PM   #6
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Well part of it is that people don't have the easy ability to NOT use their cars. Expand the transit network to all hours and reliable service with no waiting (coordinated timetables or frequent service, take your pick) and maybe some of the hesitation will diminish.
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Old 02-13-08, 08:53 AM   #7
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But you folks are talking "anti motoring..."
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Old 02-13-08, 10:28 AM   #8
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Anyone ever drive in Florida... now that is a scarry experience. Try the West Palm Beach to Miami side of the state. Those are the scarriest roads I've ever driven on. Drivers making left turns from the right lane crossing over 3 lanes of traffic without ever looking (or being able to bend their neck to move). I

Happy riding,
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Old 02-13-08, 11:40 AM   #9
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Good thing I don't drive or walk in Canada.
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Old 02-13-08, 01:46 PM   #10
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Well, I'm sure the US has at least an equal representation of alcoholism and cardiac conditions, but with the last 2 choices the good people of the US made as president I'd have to guess the US has a higher representation of active psychiatric disorders.

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Old 02-14-08, 02:18 PM   #11
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Combine these numbers with those driving SUVs (see post on their statistically abnormal participation in pedestrian fatalities) while potentially medically unfit?

Ouch!
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Old 02-14-08, 03:15 PM   #12
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Ummm... how is alcoholism a reason to pull someones license?

If they don't get behind the wheel when they've been drinking, who's business is it?
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Old 02-15-08, 07:31 AM   #13
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Combine these numbers with those driving SUVs (see post on their statistically abnormal participation in pedestrian fatalities) while potentially medically unfit?

Ouch!
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Ummm... how is alcoholism a reason to pull someones license?

If they don't get behind the wheel when they've been drinking, who's business is it?
Kar Kultur Bashing Advocates and Arrogant Health Nanny Advocates Bizness, dat's who!


Goes right along with the nightmarish "do-good advocacy" scheme about physicians reporting all their "potentially unfit" patients (a catch-all description that that could include any and all the advocates' perceived "unfit" untermensch in their medical cleansing dragnet) to the "authorities" to remove their means of livelihood.

Combine that with the schemers who see the boogyman behind the wheel of every motor vehicle and waddya get: The Brave New World of the Urban ÜberCyclist and/or Nanny State Ideologue.

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Old 02-15-08, 07:56 AM   #14
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Enforce existing laws and most of these problems go away. More bureaucracy to enforce more laws creates more confusion and wiggle room in the courthouse. Bigger government can't be good for anyone!
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Old 02-15-08, 08:03 AM   #15
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Kar Kultur Bashing Advocates and Arrogant Health Nanny Advocates Bizness, dat's who!


Goes right along with the nightmarish "do-good advocacy" scheme about physicians reporting all their "potentially unfit" patients (a catch-all description that that could include any and all the advocates' perceived "unfit" untermensch in their medical cleansing dragnet) to the "authorities" to remove their means of livelihood.

Combine that with the schemers who see the boogyman behind the wheel of every motor vehicle and waddya get: The Brave New Advocacy World of the Urban ÜberCyclist Ideologue.
A Nanny State, which I oppose as much as you, tries to protect me from myself.

A Daddy State, which I endorse to a limited degree, tries to protect me from others.

There is no absolute right to operate a motor vehicle -- only a privilege reserved for those who are physically, mentally, and emotionally qualified to do so safely without endangering innocent potential victims.
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Old 02-15-08, 08:39 AM   #16
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Ummm... how is alcoholism a reason to pull someones license?

If they don't get behind the wheel when they've been drinking, who's business is it?
I think the rationale behind is has to do with the recognition of alcoholism as a medical condition/disease. It's a disease that could impair your abilility to safely operate a motor vehicle. Before you say it, I realize that most alcoholics don't spend all their time drunk/in a state of impaired ability. Most narcoleptics don't spend all their time asleep, most epileptics don't spend all their time seizing and most heart patients don't spend all their time passing out from low blood pressure or an irregular heart rhythm.
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Old 02-15-08, 08:58 AM   #17
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I think the rationale behind is has to do with the recognition of alcoholism as a medical condition/disease.
As well as diabetes, high blood pressure, hardened arteries, hearing loss, obesity and who knows what else those healthy specimens might determine are medical conditions that might potentially impair these "unfit drivers"?

Presumably those in favor of a Daddy State equate all people with a "medical condition/disease" as a priori "unfit drivers", and are in favor of removing the drivers licenses of these "unfit drivers". Just in case, eh? All in the name of safety! Far more intrusive Nanny meddling than any MHL, eh Closetbiker?
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Old 02-15-08, 10:08 AM   #18
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Your right to swing your fists ends where my nose begins. Cars are a very big fist that needs unimpaired skills to control. I don't want to have to go to any more funerals of people who were slaughtered by someone who had no right being on the road in the first place, who honestly isn't going to have a very hard time living with themself.
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Old 02-15-08, 10:17 AM   #19
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OK iltb-2, how should society balance mobility freedom versus safety? How should we decide who gets to drive and who really should not?

I strongly favor treating a drunk driver as the perpetrator of a crime, rather than as a victim of alcoholism.

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Your right to swing your fists ends where my nose begins.
That says it all.
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Old 02-15-08, 10:24 AM   #20
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Community service for proficient, convicted car thieves--authorize them to steal cars on a list of people who need to be kept off the road.
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Old 02-15-08, 10:40 AM   #21
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OK iltb-2, how should society balance mobility freedom versus safety? How should we decide who gets to drive and who really should not?

I strongly favor treating a drunk driver as the perpetrator of a crime, rather than as a victim of alcoholism.

That says it all.
+1

As someone with family members who were drunks I have to agree with this 100%. Victim of a desease is much to convenient a crutch.
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Old 02-15-08, 10:49 AM   #22
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Nobody said alcoholism should be an excuse for drunk drivers, in fact the distinction was made.

So what do you want next--doctors informing your employers if you are not fit to work? Informing your insurance companies when testing indicates you have a high likelihood of some future congenital disease which will require extremely expensive treatment?

Naturally, this shows up in Canada. How much you wanna bet that any similar reporting law that ever hit bill stage in the US would be quickly and quietly quashed by AARP lobbying efforts?
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Old 02-15-08, 11:20 AM   #23
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and is it any wonder that the US leads all other first world countries in vehicle fatalities?
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Old 02-15-08, 11:22 AM   #24
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In the UK my father-in-law, at age 86, told his doctor that it was painful to turn his head to look over his shoulder. The doctor asked him to show how far he could turn his head, then asked him to hand over his driving licence.
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Old 02-15-08, 11:34 AM   #25
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Perhaps we should have mandatory retests every few years.


Would anyone be opposed to a disclaimer that bicycle riders are to be treated the same as other users of the public roadways? I am a firm believer that I deserve the rights of a vehicle on the roadway and that I also am responsible to the rules a regulations governing those vehicles.
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