Impact of a mandatory physician reporting system for cardiac patients potentially unfit to drive

CONTEXT: Sudden cardiac incapacitation of a driver may lead to the death or serious injury of passengers or bystanders. This has raised public safety concerns and has led to the creation of legislation to protect the public. Some jurisdictions in Canada and the United States have introduced mandator y physician reporting of patients who may be unfit to drive for medical rea sons. The impact on motor vehicle accident (MVA)-related morbidity and mort ality of mandatory physician reporting for at-risk cardiac patients is unkn own. OBJECTIVE: To determine the impact of mandatory physician reporting legisla tion (for cardiac patients) in Ontario (population 10.3 million) on MVA-rel ated morbidity and mortality. DATA SOURCES: Reporting data were obtained from the Ontario Ministry of Tra nsportation. Incidence and prevalence data were taken from Ontario Ministry of Health sources and from the literature (MEDLINE), Data for modelling we re taken from the literature (MEDLINE) and from the Canadian Cardiovascular Society's Consensus Conference document on cardiac illness and fitness to drive. DATA EXTRACTION: Licence suspension data (correlated with medical illness) were taken directly from government documents. These were then applied to a 'risk of harm' formula used to calculate the risk posed to bystanders and passengers by the suspended patients if they had continued to drive. Canadi an licence suspension guidelines were then reviewed in conjunction with car diac disease incidence and prevalence data to arrive at the number of patie nts who should have been suspended. Physician compliance with the legislati on was then calculated, along with the potential impact on MVA-related morb idity and mortality in the scenario of 100% physician compliance. STUDY SELECTION: All Ontario drivers who had licence suspensions in 1996 fo r reasons of cardiac disease were included in the analysis. DATA SYNTHESIS: Nine hundred and ninety-four licences were suspended for ca rdiac reasons in 1996, compared with an estimated 72,407 that should have b een suspended if Canadian guidelines had been followed (1.4%). Less than on e death or serious injury was avoided as a result of the legislation (from the 'risk of harm' formula). If all drivers with cardiac illness had been s uspended from driving, up to 29.2 such events could potentially have been a voided. However, only 13 of 929 (1.4%) road fatalities in Ontario in 1996 w ere attributed to a driver with a medical illness. CONCLUSIONS: Mandatory physician reporting of patients with cardiac illness has a negligible impact on MVA-related morbidity and mortality.