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From: Brian Symonds   <[log in to unmask]>
 
There has been so much on this list recently that it is hard to find the time
to comment, however, K's recent experience re his driver's licence, and a
lawyer's response begs some comment.
 
In British Columbia, any examination requested by the Superintendent of Motor
Vehicles (SMV) who has licensing authority, has to be signed by the patient
before it is sent to the SMV. It is not clear to me how most doctors would
respond to a request "out of the blue" for medical information about a
patient. My understanding is that the SMV has legal authority to request such
a report, but I don't know if that has been tested in court or not. Usually a
family doctor would inform the patient that a report has been requested, and
I at least would have the patient in for an exam, and make them aware of what
I was putting in a report. If told not to send it, I would have to get a
legal opinion as to whether or not I was legally bound to even without the
patients consent. The patient's lawyer and the government's lawyer and my
lawyer would then have to battle it out in court. Was the family doctors
report a new report, or one that had previously been sent in as part of a
previous driver's examination report?
 
Doctors are legally obliged to keep copies of reports and information about
patients on their chart, and I would think that K could make an appointment
to see the doctor, and at that time request his chart to read. If the doctor
refused, my understanding is that the doctor would be legally liable unless
the doctor could prove to a court that there was some information on the
chart, that unless kept confidential, would be seriously detrimental to K's
health. I believe K's lawyer would have greater success getting access to the
doctor's report from K's chart than through the governmental agency, and
could obtain if necessary a court order to have access to the chart, or a
complete copy of the chart.
 
My understanding also is that a doctor cannot discharge or fire a patient
from their practice without the patients consent. So if your doctor tells you
that they no longer wish to see you as a patient, and that you should find
another doctor, they are still responsible for your care until you see
another doctor and that doctor formally assumes your care by notifying the
previous doctor of the transfer of care (usually by asking for a copy of the
person's previous records). Thus, if K still wishes to see the doctor who did
up the medical report, he cannot refuse to see K, and if he does refuse, K
should tell him that if he does not see K, K will call up the College of
Physicians and Surgeons of that Province and log a complaint and ask for a
review. It is uncertain what the College would do in such a circumstance, but
I would be surprized if they did not direct the doctor to continue seeing K
until K finds another doctor who is to K's satisfaction. Most people would
not want to go on seeing a doctor who does not want to look after them for
whatever reason, but these types of situations sometimes develop in small
towns where there are a limited number of doctors, and people cannot easily
find another doctor who is willing to assume their care. It would be of
interest to ask the doctor why they no longer wish to look after K. If they
feel that K might be angry with them for their part in all this trouble, and
if in fact K is not angry, they may be agreeable to continuing on with K's
care if K has been happy with their service over the years.
 
In British Columbia, and I believe across Canada, doctors are legally obliged
to report patients who have medical conditions that may make it dangerous for
them to drive. This includes people with seizure disorders, alcoholics, those
at risk for strokes, heart attacks or irregular heart beatrs, people who are
developing dementias, and so on. I don't know if this has been challenged in
court, and whether or not it applies only to people seen in a doctor's office
or at the hospital. I presume that outside of a doctor's normal work,
doctor's are expected to act as any other citizen in reporting dangerous or
potentially dangerous behaviour. I do not know for sure if any doctors have
been charged for not reporting dangerous behaviour in or out of the office,
although I believe there was a case of a doctor charged a few years ago in
Ontario.
 
I believe that the laws governing access to information provided to motor
vehicle licensing bodies are in place to protect people (such as doctors)
from abuse by the people who are being reported, and thus to encourage them
to report information for the public good. This is similar to the intent of
programs like Crime Stoppers where you can report information (and even get
rewarded) and stay anonymous. Doctors and their families and of course all
sorts of other people have be shot and threatened about all sorts of things,
and this generally makes people reluctant to get involved. Since motor
vehicle accidents kill a lot of people, and since many are thought to be
preventable, the government and society are understandably politically
sensitive to the prevention of needless accidents. However, everyone
recognizes that the good of society has to be balanced with the good of the
individuals in it. It is easy for me to be philosophical about what happened
to K, but I don't know how I would have reacted had it happened to me.
Telling people that they can no longer drive ranks right up there with
disclosing news of untreatable cancer in terms of how emotionally laden these
issues are. I personally have been threatened by people whom I have told that
they cannot drive and that I was reporting them to the Motor Vehicle Branch,
and I have had people leave my medical practice over this. And I have
reported someone (an alcoholic) to the motor vehicle branch, who was not my
patient, whom I'd never seen behind a wheel, but whom I knew on reliable
authority was drinking and driving in the morning in a neighbourhood where
there were school children walking. This circumstance is of course different
from K's, but I think the principal is the same. This individual had been
confronted by othersm and still continued to drive until I reported him to
the Motor Vehicle Branch, without telling them (I believed at the time that
this person would have believed that his wife had given me the information
and would have taken out his anger on her and I did not tell him that I
reported him). Should he have had the right to know that it was me that
reported him? I don't know.
 
The phrase, "We are afraid that one day...." in the excerpt from the letter
to the Motor Vehicle licensing body suggests to me at least that whoever sent
in the letter was not acting maliciously, but rather in a well intended
albeit misinformed way. We see this happening in other circumstances as well,
eg, someone swatting their kid in public and being reported for child abuse.
These instances have to be balanced with the opposite side of the coin, ie,
no one in society reporting life threatening incidences, eg, drunk drivers,
the child who died from starvation in Nova Scotia that no one reported, child
and person abuse that goes unreported, etc. It is unfortunately not clear why
the Motor Vehicle Branch acted as they did. It is possible that upon
receiving the information, that they pulled out the last medical report they
had on K, looked at the medications, thought "holy cow, K should be dead",
and suspended his licence, or they may have asked the last doctor who had
sent them a medical report to send another report, and that was the report
that had the incorrect dose of medication, and acted on that, or, the
incorrect dose of the medication may have had nothing to do with their
decision, and they may have suspended K's licence for some other reason. They
may have acted hastily, or they may have acted upon false information. The
only way I know of to try to get them to review their process would be to ask
K's Member of the Legislative Assembly to ask whichever government minister
is responsible for that department to conduct a review of their procedures,
something that might or might not happen (it never hurts to complain to your
MLA or the Minister of Transport or the Prime Minister, they are sensitive to
political pressure, and are always looking for something to make themselves
look good, or avoid looking bad). Only a lawyer could tell K if a legal
action could bring the same thing about.
 
As for K, I would hope that he has faith that the majority of his fellow
citizens are not malicious, and though well intentioned, may be misinformed
about Parkinson's. It would be very easy to direct anger and frustration at
whoever it was. Lawyers might well like to sink their teeth into all the
legal issues that are unclear about what happened, but would the expense, and
time, and aggravation for everyone best serve K and society, if this is
indeed the case? However, how can K redress this issue? K can speak to his MP
and ask for an investigation asnoted above. Will the Motor Vehicle Licensing
agency agree to send a letter to the complaintants outlining the outcome of
their complaint, and directing them to get more information about the stages
of Parkinson's? Can K go to a newspaper or TV station, and try to create some
publicity about Parkinson's, to try to better inform the average citizen
about the disease, and how it affects people, and how doctors and the Motor
Vehicle Licensing people decide who can drive and who can't? There certainly
are people with Parinkson's who get to the point where they can't drive. Our
family was fortunate. My father voluntarily gave up his driver's licence when
he felt it was unsafe for him to drive, and our family, and in particular my
mother did not have to go through the trauma of having the licence taken away
involuntarily. Others on this list may have other ideas.
 
I will read with interest the other comments that come on the list about K
and these events. Parkinson's seems so unfair, it makes me angry when other
indignities are added to it. But it is good to reward those who try to make
society safe for us all, even if the reward turns out to be a big helping of
information about Parkinson's, and the Motor Vehicle people having to take
time to examine their processes of how they suspend an individual's licence!