Inquest highlights lack of testing for older drivers with cognitive issues

Michael Hawkes knows how difficult it is to talk to an aging parent about their ability to drive or work.

"The whole last year of my relationship with him was kind of under a strain because I was constantly pushing,"Hawkes said of his father, who died on the job in the Fredericton area.

"It's time to retire, it's time to retire, it's time to retire."

There were also concerns about his father's ability to drive, so hethought if they could just take away his driver's licence,he'd have to retire.

But the son didn't know where to turn to start that process. Donald Hawkeshad a referral to meet with a geriatric specialist, but that appointment ended up being months too late.

The 78-year-old Fredericton man ended up being run over by a tractor-trailer in 2017 at the asphalt plant where he had worked for 60 seasons.

After a two-day inquest in Saint John last week, a coroner's jury ruled Hawkes's death was accidental. The five jurors made several recommendations, including better assessments of employees' fitness for work.

Michael Hawkes told the jury his father had been showing signs of dementia. In fact, his driving became such a concern in the months before his death that Michael Hawkes told his father that he could no longer drive his children around.

The official protocol if there is one for taking someone's licence in New Brunswick is difficult to find. Online searches of the government's website do not reveal any information or guidance .

The Department of Public Safety oversees the process.

Drivers of any age can lose their licence in a couple of ways, explained department spokesperson Geoffrey Downey.

"New Brunswick law requires medical practitioners, nurse practitioners and optometrists to report to the Registrar of Motor Vehicles any person who they suspect may be unsafe to operate a vehicle due to physical or mental conditions," he wrote in an emailed response.

Downey said the registrar also receives "confidential reports" from family members and from police officers who may have concerns after responding to collisions.

"The Registrar follows national standards for driver fitness and has an exhaustive process in place to review referrals," wrote Downey.

"We treat every referral case-by-case, and rely heavily on the advice of medical practitioners. Not every referral results in the restriction or revocation of a licence."

The process can include a road test for the person whose driving has been reported.

Family doctors play a role

Concerned family members can also go through a person's family doctor.

In fact, physicians have a duty to report concerns to Public Safety, said Dr. Will Stymiest, a family doctor in Fredericton.

Once raised, the department can suspend a person's driving privileges until a driving test determines whether they're fit to continue driving.

Stymiest said a person's cognitive or physical ability could be impaired by age or a medical condition, and some conversations are easier to have than others.

Onegroup includes those whose diagnosis "mandates exclusion," said Stymiest.That would include certain medicalconditions.

The second group is more "nuanced" and would include dementia, where the patient may not be completely aware of the extent of the problem. Stymiest said it's important to talk about the concerns early and try to have a family member or friend present.

In these cases, he drafts a "driving contract," where the patient signs an agreement that privileges should be taken away when their condition deteriorates.

"And when that day comes, I usually try to bring that piece of paper out and use that as a bit of ammunition to show the patient themselves that this was something that we agreed upon."

Loved ones can tip off docs

Stymiest said he welcomes family members to raise concerns about his patients. He knows they often don't want to be blamed for the loss of a person's licence and prefer that it be done by a family doctor.

"But that also runs the risk of ruining the physician-patient relationship, which can be pretty important, especially when we're dealing with things like dementia."

That's why such conversations are "universally difficult," Stymiest said, but necessary to prevent the person from hurting themselves or others.

"Operating a motor vehicle is a dangerous thing. And so certainly, I don't take my role lightly in these situations because of the loss of autonomy for the individual. I also need to balance that with the risk to the public."

Hawkes's son hopes for change

Michael Hawkes hopes his father's story gets people talking and gives them the added push to do something about a family member they're concerned about.

He said there's an inherent danger in keeping quiet for fear of offending someone's ego or their sense of self-worth.

In his father's case, he said, other family and friends were concerned, "but we all respected him so much that no one wanted to lean on him hard enough I felt like the heavy, like the bad cop. I was leaning hard that last six months because you could see it coming."

He hopes the province can develop a more formal process so that cases can be examined before people get hurt.

Perhaps, he suggested, there should be a mandatory and automatic evaluation for all drivers over a certain age. If there's a graduated system to initially get one's licence, perhaps there should be a similar testing regime at the other end an"ungraduation" system of sorts, he said.

The Canadian Association of Retired Personsalso supports the idea but believes the age should be young enough to avoid claims of "ageism," says the group's chief operating officer.

"It's got to start early enough so we're not assuming that just because a person is 70 or 75 or 80, that they're necessarily not able to drive anymore," said Bill VanGorder.

And he believes there should be a more uniform approach across the country for that age threshold and the criteria used to judge a person's fitness to drive.

So far, he said, no jurisdiction has been able to come up with an approach that satisfies all sides.

But if there's one thing that everyone agrees on, it's how important a driver's licence is to an older person.

VanGorder said it can be so much more than independence for an older driver. At a stage in life when people are losing vision and mobility, jobs and loved ones, it can represent more than a person's driving privileges.

"What doctors say to us is that taking a person's driver's licence away from them is one of the most impactful, worst things you can do to an older Canadian," said VanGorder.

For that reason, he said,doctors are often reluctant to be the one to set the ball in motion.

And families aren't always the most objective when it comes to judging a person's ability to drive.

"There really has to be some kind of medical intervention or testing to come to a conclusion that a person should not be driving any longer," he said.

"We don't want to have people who are unable to drive on the roads and being a danger to themselves and others, but we don't want a simple matter of age to determine whether or not a person is able to do that," said VanGorder.