Practising physicians are legally bound in Ontario to report medically unfit drivers, yet few of them do, finds a new study by the Institute for Clinical Evaluative Sciences (ICES).

Researchers at ICES took a look at those drivers who were admitted to Toronto's Sunnybrook Health Sciences Centre between 1996 and 2001 following a life-threatening auto or motorcycle accident. Sunnybrook is Canada's largest trauma centre.

Accident victims were assessed for three medical conditions that would warrant a physician's report to vehicle licensing authorities. These included alcohol abuse, cardiac conditions and neurological disorders.

Researchers then followed up using Ontario health databases to see if the admitted patients had been seen and reported by a doctor in their community. They also contacted the driver improvement office of the medical review section of the Ontario Ministry of Transportation to determine if the injured drivers had been given any driving restrictions, notifications or suspensions.

The findings included:

• Thirty-seven per cent of hospitalized drivers had a reportable condition.
• Eighty-five per cent of patients with a reportable condition had seen a doctor in the year before the crash, but only three per cent of these patients were reported to licensing authorities.
• Alcohol abuse was the top reportable condition, though only two per cent of cases were reported.
• Medically unfit drivers spent a total of 8,000 hospital days, which totalled $3 million in hospital costs.
• There were 53 deaths and 551 surgeries among medically unfit drivers.

According to ICES, medically unfit drivers kill more than 5,000 pedestrians annually worldwide. Yet in Ontario, less than 0.1 per cent of drivers in the province have their licences reviewed for medical conditions in any given year of the study.

"Restricting driving privileges is a difficult process for both physicians and patients," said Dr. Donald Redelmeier, lead author of the study, in a release. "However, our research suggests many missed opportunities to prevent serious crashes. There is widespread failure of physicians' duty to inform authorities despite mandatory laws."

The authors believe that many doctors fail to report their patients because they are torn between their duty to the patient and protecting society; they face confusion about what constitutes a severe impairment, limited office time, a lack of training, and the false belief that medically unfit drivers rarely visit doctors.

At the same time, the researchers acknowledge that a campaign to increase reporting rates among physicians could backfire, with medically unfit patients choosing to forgo doctor's visits.

They conclude that Ontario's mandatory reporting law is not working. The researchers suggest either reducing the regulations to decrease physicians' liability and bring more attention to driver testing, or expanding regulations to include the public's participation in reporting medically unfit drivers.

The ICES study was released Monday.