New Mandatory and Discretionary Reporting of Substance Use to the Ontario Ministry of Transportation
Aug 16, 2018
Tagged implications for practice, MTO, reporting
Recently, the Ontario Ministry of Transportation (MTO) issued new amendments to the Highway Traffic Act (HTA) that include both mandatory and discretionary reporting guidelines for certain healthcare professionals. As of July 1st, 2018, it is mandatory for physicians and nurse practitioners to report certain high-risk medical conditions, functional impairments, and visual impairments, including substance use disorders (excluding caffeine and nicotine).
Under Ontario Legislation 340/94, s. 14.1 (3), an applicant for or holder of a driver’s license must not "...be addicted to the use of alcohol or a drug to an extent likely to significantly interfere with his or her ability to drive a motor vehicle safely."
These new reporting guidelines may prove to be challenging for practitioners and affect the retention of patients to care. A potential premature termination of the clinical relationship by the patient, as a result of a report to MTO, also presents a conflict between providing adequate and ethical care and fulfilling a legal mandate. This will likely require practitioners to place more emphasis on building relationships and therapeutic alliances with patients, as well as providing appropriate encouragement to commit to treatment. Practitioners are also urged to connect patients to resources in the community as soon as possible, if there is a concern with ongoing compliance.
The Medical Condition Report form has been adapted to reflect the new reporting requirements. The form is used for both mandatory and discretionary reports.
In completing this form, practitioners will find terminology that may be difficult to interpret, creating a challenge to accurately reflect a patient’s condition. Phrases on the form such as uncontrolled substance use disorder and non-compliant with treatment are sufficiently problematic and create uncertainties on how best to represent the complicated contexts patients experience as they move through treatment. Also, there is little direction, clear guidelines or an explanation of purpose around discretionary reporting at this time. While MTO is acknowledging that a discretionary report may not necessarily lead to a license suspension, it is unknown as to what the current process of investigation would entail and any potential negative outcomes for the patient that would result.
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