HUNDREDS of thousands of Victorians with a medical condition that may make them unsafe drivers are going undetected by VicRoads and potentially putting other drivers at risk, a Fairfax Media investigation has revealed.
Critics have slammed the licensing authority's medical review process as chronically underfunded, unclear and inconsistent.
VicRoads data shows only a fraction of Victorians with some of the most common long-term medical conditions – including high-blood pressure, diabetes, anxiety and depression – have been referred for a medical review, which assesses whether their licences should be maintained, suspended, cancelled, or made conditional.
Meanwhile, more "visible" medical conditions, such as amputations, are reviewed in an apparently ad hoc way by VicRoads staff, sometimes against health experts' advice, raising procedural and equity issues.
An insider, who asked to remain anonymous, said the medical review department was chronically understaffed, and the often temporary administration and customer service staff have only limited knowledge of disabilities and the review process.
"If all Victorians with reportable medical conditions actually did what they are required to do and report[ed] their diagnosis to VicRoads, the department would collapse with the volume of case files," the insider said.
Under Victorian law, drivers are obliged to report any serious or chronic medical condition or disability that may impair their ability to drive safely. But health experts say there is widespread ignorance and sometimes deliberate avoidance of this legal requirement. Doctors can also be unwilling to dob-in patients, fearing it will damage trust.
Among 4.5 million Victorian licence holders on June 30, 2016, only 120,843 had been medically reviewed, according to VicRoads, with the most common conditions being hypertension, diabetes, muscular-skeletal disorders, depression/anxiety and epilepsy.
The prevalence of those diseases among the general population indicates the scale of potential under-reporting. About one in five people have uncontrolled hypertension, one in seven arthritis, and one in 19 diabetes, according to Australian Bureau of Statistics data. In any one year, about one in 10 people have anxiety and one in 20 depression, according to beyondblue.
"We suspect there is quite a bit of under-reporting," said Associate Professor Judith Charlton, acting director of the Monash University Accident Research Centre and the lead author of a major 2010 report on the influence of drivers' chronic illness on car crashes.
The report shows other conditions that elevate crash risk include sleep apnoea (up to 7.5 per cent of the population), cataracts (up to 5 per cent of the population), dementia and schizophrenia (1 per cent each).
While many drivers are unaware of their self-reporting obligations, Professor Charlton said, others made their own judgements about their impairment.
"Someone with mild arthritis might say it doesn't affect my driving, I'm fully able to compensate. That's why the level of under-reporting is very difficult to pin down."
Numerous drivers have come forward to Fairfax Media with allegations VicRoads' impairment assessment process is unfair, inconsistent and opaque.
Among them are four right-leg amputees. Two have never been formally medically reviewed, have unconditional automatic licences, and have continued to work, travel and lead full lives with unblemished driving records.
Two others were assessed by VicRoads-authorized occupational therapists as competent to drive conventional cars but that advice was ignored. Instead, officials issued licences specifying they must drive cars with transposed pedals, with severe impacts on their lives.
Former transport worker Ian has not worked since. Melbourne education consultant Jane Nicholls said her ability to travel and work interstate and overseas – where she has advised governments in Namibia and Indonesia – has been seriously constrained, as she is unable to hire cars.
Ms Nicholls is highly critical of VicRoads review process, alleging a range of officials, each claiming final authority, gave different accounts for their refusal to act on the OT's recommendation.
"One said I could hurt my back," Ms Nicholls said. "Another said when he had a broken ankle, he drove with his left foot in an unmodified car, but that was alright because it was only temporary so it wasn't dangerous. He said 'you'd be causing more danger, because you'd be doing it permanently'."
She gave up fighting when it was made clear she would have to go to court, she says, and the potential costs and further delay to getting back on the road were intolerable.
Two of the four amputees had their concerns about VicRoads' reviews taken up by former senator Ricky Muir as part of his interest in equitable road usage.
Melissa Noonan, chief executive of advocacy organisation Limbs 4 Life, is also critical of VicRoads seemingly erratic decisions, and the lack of clarity on what licensing assessments are based on, both in Victoria and interstate.
"I know some bilateral below knee [amputees] in Queensland who can drive buses. It's like, hang on a second, where do they draw the line? It's quite different for everyone."
One occupational therapist with over a decade's experience assessing drivers for licensing reviews criticises VicRoads discriminatory attitude to some impairments, and lack of respect for medical experts' recommendations.
"We're experts in the doing of activities, and ways to modify tasks to do them in different ways," said the OT, who asked to remain anonymous in case of VicRoads' reprisals.
"If an OT said there was a safe way to do this, and you'd conducted a complete OT driver assessment, your expert recommendation should be respected."
It is not the first time VicRoads review process has come under fire. Then Victorian Ombudsman George Brouwer was critical of its management and underfunding in his 123-page Investigation into VicRoads driver licensing arrangements in 2007.
A VicRoads spokeswoman said since then, the medical review department had improved its process and "delivered greater operational capacity," including the speedier processing of cases. Of its 23 medical review staff, only two were currently nursing-trained case managers, who oversaw 86,000 cases in 2015-16.
VicRoads did not answer questions about how many drivers had their licences restricted against the recommendation of health professionals, and pointed to its appeal process.
"We review each case individually to determine the outcome that is best for the safety of the individual and the community," said Robyn Seymour, director of vehicle and road use policy.
