Friday 06 November 2015
Environment response to Guernsey Press media query
Media Enquiry from Open Lines Column, Guernsey Press:
RIP Patient confidentiality
I understand that the general perception is that a person's medical details are a confidential matter and should not be divulged without the patient's approval, in which case the reader may wish to hear about the following experience which I think makes for a cautionary tale for the population at large.
Before we start, however, I hasten to point out that I have driven various vehicles on the strength of a Guernsey driving licence since 1965 with no blemish on the licence itself. Not so much as a parking ticket, so I flatter myself that this is not the outpouring of an ancient tearaway.
In March 2013 it was suggested that it was time for cataract surgery. At that time, and since there was no question that I couldn't read a number plate at 66/67 feet, with or without specs (Highway Code 581) and no suggestion since. Off we went then, right eye on 29 May 2013, and left eye on 5 November same year. In the process of so doing the surgeon indicated that there was atrophy (damage) to both eyes, mainly at the bottom end of the spectrum. Consequently we were referred to individual 'field tests' where small lights were fired from different angles and the patient presses a button when he/she sees them. The operators of these tests indicated that it was unwise to drive, and the surgeons advised to stop doing so, which I did.
On 24 June 2014 I was asked to undergo a 'binocular field test' which is done with both eyes open. Apparently this is an important one, and in a letter dated 25 June the surgeon wrote to say that the results were within prescribed limits. A copy of this last result was sent to my GP and on the data was handwritten a note saying 'Mr C to forward to the Licensing Authority'. This was the first intimation that this document was designed to go to the Environment Department. Until then I assumed that these tests were merely follow ups from the cataract surgery.
In view of the surgeon's comments in the letter dated 25 June, I phoned the practice (30 June) to confirm that I was now fit to drive. I was, and in the course of the same phone call, learned that someone at the practice had passed the information to the Licensing Authority without my knowledge on approval. I didn't do so.
I carried on driving without incident until September 2014, and without any further requests for field tests. The driving licence was due to be renewed on 1 November 2014, and in order to avoid the month's delay which had occurred on the previous renewal, submitted an application form on 23 September which included a form compiled by my GP.
On 25 September the Licensing Authority sent a letter revoking my driving licence. At the expense of repetition no new field tests were taken between June and September, so the data was exactly the same as that which was told to be within prescribed limits in June.
On 1 October I visited the practice and asked for written confirmation of the telephone conversation of 30 June. On the following day they rang to refuse with a suggestion that I spoke to the Licensing Department. I did so on 3 October and got an evasive response.
So now we come to the content of the GP's report of 22 September, which accompanied the application for a new driving licence. On this form the applicant is asked to authorise the GP to act by signing the form. A copy of the GP's comments were sent to me subsequently and confirmed that I had not signed the authorisation. As I see it, therefore, the passing over of the binocular field test in June, and the information contained in the GP's report, were out of order. When this last was taken up with the practice, I received a letter arguing that the practice was entitled to act as they did.
One further observation. At first sight and taking each appointment in isolation, some of them appear relatively harmless. However if they are looked at as a whole and in chronological order, it appears to add up to a systematic process of tipping off the Environment Department about medical details at the expense of the car driver.
Enter Guernsey Driveability
This is a slightly different issue, but is based up with the story outlined above. Early in the course of this saga it was suggested by both surgeon and GP that it might be helpful in an appeal, or in dealings with the Licensing Authority, to undergo a driving test with this organisation. It wasn't. An application form was submitted thereto on 27 June 2014, and a refusal was sent on 30 June, returning the registration fee. Apparently in order to carry out such a test it is necessary to obtain a temporary driving licence to drive on the public roads. And at this point in time is not forthcoming.
So we have a situation that the very people the applicant is in dispute with is in a position to obstruct the holding of such a test which could shed relevant light on the matter. It doesn't say a lot for the usefulness of Guernsey Driveability, at least as far as eyesight is concerned.
In the last year or so, I have had ample time to think all of this out, and have come to the following conclusions:
1. Within the limitations imposed by the structure of a motor vehicle from the front seat, my eyesight is no worse than it ever was, and can see as well as the average car driver. Notwithstanding a shortcoming in the eyes which is admitted. But this is largely downward, which doesn't seem to matter, as long as we can see where we are going.
2. The concept of patient confidentiality hasn't held ???? in this case. A figment of the imagination.
3. The results of the binocular field test (and there were three more after September 2014) are unreliable, and probably irrelevant.
4. If this is to be any meaning in a test by Guernsey Driveability, they should be enabled to carry out an assessment without a veto, or other interference, from the Licensing Authority.
Environment Department Response:
It should be noted that it is difficult to respond to the comments made in this letter without knowing the specifics of the particular case in question. At the time of responding the complainant was anonymous.
Whilst it would not, in any case, be appropriate to discuss an individual licence application in a public forum particularly when confidential medical information is involved the Department can say that in cases where applicants have to provide medical documentation as part of an application process they are referred directly to staff who deal specifically with medical cases and because of the sensitivities involved they are usually taken into a small interview room if it is considered necessary to discuss any issues of a potentially personal nature.
However the Department would like to draw attention to the fact that any licence holder has a responsibility to notify the Department of any medical condition or change in medical condition that may affect their ability to drive safely and failure to do so is an offence. Therefore the licence holder has a lawful obligation to advise the Department of the change in their health, particularly their eyesight. However, gleaned from the content of the letter the licence holder had obtained their previous licence, which was in use at this time, after providing a completed medical report. This would have been fully signed by all parties in order for the licence to be issued. When a licence holder signs a medical declaration they sign to authorise their Doctor, Specialist or Ophthalmologist to release confidential information to the Department if any matter affecting their ability to drive arises:
In connection with their application for a licence
During the period that a licence (if granted) is in force.
In these circumstances, as the licence holder had been granted the licence, it was entirely appropriate for the medical professionals (Doctor and Ophthalmologist) to submit medical information to the Department regarding a change in the licence holder's health. It should also be noted that it is un-lawful to drive with un-corrected or impaired/defective eyesight. With this in mind the Department would not have been able to issue a short term licence to allow a person with proven eyesight impairment which is insufficient to meet with safe driving standards to be able to undertake any type of on the road driving assessment.
The Department wishes it be acknowledged that any decisions regarding the status a driving licence entitlement is not taken lightly. In particular, the Department must always be sure that a licence holder is fit to hold their driving entitlement, as not to do so would be a failure in its 'duty of care'. This is not only for the sake of the individual, who if unfit will be more prone to be involved in or cause an accident, but also for the safety of the general public and, in particular, vulnerable road users.
Contact Information:
Karl Guille, Traffic and Transport Services Manager
Environment Department
Tel: 243400
