Elderly lady dies from injuries suffered in a head on car crash after her driver’s licence was wrongly reinstated despite numerous doctors expressing concern about her ability to drive.

Inquest dates: 4 & 5 August 2016 (delivered on 21 December 2016) Coroner: James McDougall Place: Southport Date of death: 18 July 2013

Issues for Consideration

  • Concerns that Ms Capps’ licence should not have been reinstated by Dr Brian Purtle.
  • Whether a number of underlying medical conditions made the deceased unfit to drive as per the advice of previous medical examinations.

Factual Summary

Ruth Capps, aged 75, died at the Gold Coast Hospital (GCH) at 7:00pm on 18 July 2013 as a result of injuries sustained in a car accident at Mudgeeraba at approximately 10:00am. She had a history of debilitating medical conditions.

She presented to the GCH for prolonged periods in 2011 and 2012 following a number of falls. During this time, a number of medical consultants assessed that Ms Capps was not fit to drive due to her limited mobility and slow reaction times. Her licence was subsequently cancelled on the 27 February 2012 by the Medical Unit of the DTMR.

Seven days prior to the fatal crash, Ms Capps’ licence was reinstated after she was provided with medical clearance by Dr Brian Purtle from the Mudgeeraba Medical Centre.

Evidence

Evidence by Senior Constable Jenny Lowe and Senor Constable Steve Paris, Forensic Crash Unit

  • Ms Capps, while mentally sound, was clearly very physically frail. Her family and friends were of the opinion that she should not have been driving. She was nonetheless provided with a medical certificate suggesting that she was fit to drive by Dr Purtle.
  • Based upon this investigation and the evidence of her friends, the FCU had grave doubts as to Ms Capps’ ability to drive a motor vehicle safely at the time she had her licence renewed. This is particularly so considering Ms Capps’ propensity to fall asleep and her frail physical condition.
  • Conditions should have been added to Ms Capps’ licence.

Evidence by Dr Ian Home, Clinical Forensic Medical Officer

  • Based upon the findings of the Occupational Driving Assessment, Ms Capps was not fit to hold a driver’s licence, particularly as she did not undergo a further on-road driving assessment.
  • Dr Home reiterated the importance that a medical practitioner considers the cumulative effect a person’s medical conditions on their ability to drive a car safely. For this to be effective, the medical practitioner would need to have a very good understanding and knowledge of a person’s medical history.
  • There was no evidence to suggest that Dr Purtle sourced, or made any attempt to source, Ms Capps’ previous medical records from Health Choice Medical Centre.

Evidence provided by Dr Brian Purtle

  • Despite not having consulted with Ms Capps in 7 years, Dr Purtle did not source her recent medical records from the Health Choice Medical Centre or local hospitals. He acknowledged that the only information he had of Ms Capps’ previous medical history was from his own recollection and Ms Capp’s self-reporting.
  • On 1 July 2013, Dr Purtle signed a Medical Certificate for Motor Vehicle Driver for Ms Capps after he assessed her as fit to drive. He claims that she was no longer taking opiate medication, her balance was apparently good, and she was said to be dancing twice a week.
  • When asked during the inquest as to what information he had in July 2013, which enabled him to effectively assess Ms Capps’ fitness to drive, that he did not have in November 2012, Dr Purtle stated that he had “noticed a significant improvement in her overall physical health and she’d come off her analgesics”. He claimed that Ms Capps’ mobility had improved “significantly” in the three months prior to her death.

Conclusions

  • Ms Capps was not fit to hold a Queensland driver’s licence.
  • She was frail, had limited mobility, suffered from a number of significant medical conditions, some of which were degenerative, and had recently undertaken an Occupational Therapy Driving Assessment, which had deemed her unfit to drive.
  • Dr Purtle’s assessment of Ms Capps’ fitness to drive fell below the standard of care reasonably expected of a medical practitioner in the circumstances. Dr Purtle did not make any attempt to avail himself of her very relevant recent medical history.
  • According to the Coroner, Dr Purtle “did not demonstrate any insight into his conduct and failings,” maintaining that he would still have signed the Medical Certificate for Motor Vehicle Driver form had he been aware of Ms Capps’ recent medical history.Despite this, Dr Purtle was not referred to the Medical Board, due to the Coroner’s hope that Dr Purtle would reflect on the circumstances and behave differently in the future.
  • It could not be said with certainty that Ruth Capps died and people were injured as a direct consequence of Dr Purtle’s inadequate assessment.

Recommendations

  • Medical Certificate for drivers over 75 years of age be amended to require that doctors test a person’s movement, which should include:
    • Moving feet from brake to accelerator;
    • Able to move the head to look left, right and over both shoulders; and
    • Reaction times, particularly the ability to make the right choice when there is an emergent situation
  • The requirement that any driver over the age of 75 years who is applying for their licence following a previous cancellation, undergo an occupational driving test that particularly focusses on reaction times and the ability to respond in an emergent situation.
  • Review of processes and policies in place in relation to medical reporting by DTMR. DTMR have commenced implementing these changes.

Chronology of Events

November 2005 - April 2012

Ms Capps attended the Health Choice Medical Centre to see Dr Sachin Gupta regarding insomnia, osteoarthritis, peptic ulcer disease as well as other general, intermittent ailments.

She also consulted Dr Charulata Shah at the same practice seeking regular treatment for a number of conditions including Type II diabetes, restless leg syndrome, osteoarthritis, recurrent falls and sleep apnoea.

12.11.2011 Admitted to GCH following a fall, which had caused her to injure her ankle. Records noted a history of increasing falls over the past 12 months.
16.11.2011 Discharged from GCH.
29.11.2011

Admitted to GCH following two falls in the same day. She was unable to explain why or how she had fallen. Ms Capps suffered right hip, right ankle and lower back pain. Assessed as being of high fall risk after having 6 falls in 12 months.

Medical Consultant, Dr Das, suggested that Ms Capps not drive due to her unsteadiness. Dr Das recommended that Ms Capps undergo a fitness driver assessment.

23.12.2011 Three of Ms Capps’ friends attended the Mudgeeraba Police Station to report their concerns as to her medical fitness to drive.
09.01.2012 Three of Ms Capps’ friends attended the Mudgeeraba Police Station to report their concerns as to her medical fitness to drive.
13.01.2012

Senior Constable David Borrowdale of Mudgeeraba Police Station completed a Medical Show Cause report to the Department of Transport and Main Roads (DTMR). Officer Borrowdale attended to speak to Ms Capps and she stated that whilst she had been advised by doctors not to drive, she intended to continue to do so.

As a result of his concerns held about Ms Capps’ driving ability, Senior Constable Borrowdale referred the matter to the medical unit of DTMR.

25.01.2012 DTMR sent a letter to Ms Capps stating that they proposed to cancel her licence and requested a Medical Certificate for Motor Vehicle Driver confirming her fitness to drive. She failed to produce her licence or a medical certificate.
February 2012 Dr James Fink reviewed Ms Capps as an outpatient in the Robina Hospital. He assessed her as “at risk” for driving due to poor mobility and slow reactions. Dr Fink suggested that Ms Capps undergo a driving test.
23.02.2012 Ms Capps attended on Dr Shah (Health Choice Medical Centre) to request a medical certificate attesting to her fitness to drive. Dr Shah refused, stating that she would need to undertake a driving test before she could issue the certificate.
27.02.2012 Ms Capps’ driver’s licence was cancelled.
29.02.2012 Ms Capps attended on Dr Shah again, requesting a medical certificate. Dr Shah noted that Ms Capps had difficulty walking and a delayed response time.
08.03.2012 Dr Fink wrote to Dr Shah. Ms Capps had attended on Dr Fink for the purposes of getting a licence. Dr Fink noted that he had told Ms Capps that, despite the fact that she was mentally capable, she was physically stow and unsteady and needed to undergo a test of her motor skills before she could drive again.
15.03.2012 Optometrist, Dr Alan Ming, conducted an eye assessment on Ms Capps to assess her fitness to drive. Ms Capps was extremely tired and falling asleep during their 9:00am examination.
23.03.2012 Ms Capps attended on Dr Shah for a referral to a private occupational driving assessment.
30.03.2012 Ms Capps underwent an Occupational Therapy Driving Assessment with Occupational Therapist, Ms Michelle Palmada. Ms Palmada concluded that Ms Capps’ condition did impact on her ability to drive safely. She recommended that Ms Capps discontinue driving and surrender her licence.
18.04.2012 Ms Capps attended upon Dr Shah to discuss the findings of the occupational driving assessment. Dr Shah confirmed that she agreed with Ms Palmada’s findings. Ms Capps was unhappy with the outcome and ceased attending the Health Choice Medical Centre.
26.11.2012 Ms Capps commenced attending Dr Brian Purtle at the Mudgeeraba Medical Centre (‘the Centre’). Between November 2012 and 1 July 2013, Ms Capps attended appointments at the Centre on around 20 occasions.
04.12.2012 Ms Capps presented to Robina Hospital Emergency Department after a fall which resulted in a laceration and haematomas above her right eye.
28.12.2012

Attendance with Dr Andrew Hayes at the Centre. Following x-rays and testing, Ms Capps was revealed to have a mild crush fracture, osteopenia in the femoral neck and age deterioration of the spine.

She was prescribed analgesics by Dr Purtle to treat pain in consultations in February, March, April, May and June.

18.04.2013 Ms Capps attended a different medical practice and saw Dr Sanjeev Kumar. She requested hat Dr Kumar sign a Medical Certificate for Motor Vehicle Driver. Dr Kumar refused.
01.07.2013 Ms Capps attended upon Dr Purtle for the purpose of obtaining a Medical Fitness to Drive Certificate. Dr Purtle granted this, with a condition that Ms Capps wear glasses while driving.
11.07.2013 Ms Capps’ licence was reinstated.
18.07.2013
1000 Hours

Ms Capps was involved in a collision while driving along Mudgeeraba Road, Mudgeeraba.

Ms Capps was seen to drift onto the wrong side of the road whilst driving southbound, before colliding with the front of a maxi taxi travelling northbound.

1120 Hours Senior Constable Lowe attended the scene with Senior Constable Paris. It had not been raining at the time of the incident. The road was sealed and in good condition. There were no obstructions or debris on the roadway. No tyre friction marks were located in relation to the incident.
1900 Hours Ms Capps sustained serious injuries and was pronounced deceased at the Gold Coast Hospital.
Post-mortem revealed that the death was as a result of multiple injuries which combined to directly cause Ms Capps’ death. The injuries included multiple fractured rips causing a contusion of the left lung, haemorrhage and escape of air into the left chest cavity, tear of the aorta in the chest, abdominal injury with laceration and bruising of the spleen and fractures of the femurs and right wrist.