Coroner's Finding: Hall, Robert Lloyd

Contributing factors

• driver with left absolute homonymous hemianopia failed to adequately scan to compensate for visual field loss
• driver not seeing cyclist on left side of road due to visual field defect and inadequate scanning
• insufficient assessment of driver's ability to maintain scanning during extended country driving on open speed limit roads
• inadequate attention to driver's poor insight into impact of visual condition on driving ability
• absence of appropriate conditions on driver's licence beyond annual medical review
• licensing authority's lack of full appreciation of grave risk presented by absolute homonymous hemianope to vulnerable road users such as cyclists

Coroner's recommendations

1. Request National Transport Commission and Austroads to amend Assessing Fitness to Drive to require occupational therapy practical driver assessment for hemianopes with visual field 90-110 degrees before conditional licence support by optometrist/ophthalmologist
2. Require OT practical driver assessments of absolute homonymous hemianopes to assess scanning during extended periods in varied driving conditions including rural roads and recommend appropriate conditions including rest breaks
3. Recognise in AFTD that occupational therapy practical driver assessment is the gold standard for assessing ability to compensate for absolute homonymous hemianopia and should determine what is permitted
4. Clarify in AFTD whether minimum horizontal extent of visual field exists below which absolute homonymous hemianope is unfit to hold any licence
5. Extend range of providers whose information licensing authority considers to include rehabilitation specialists and occupational therapists
6. Require licensing authority to impose conditions addressing high potential risk presented by absolute homonymous hemianope including: no alcohol or THC, no exceeding speed limit by 10km/h, not exceeding 100km/h, no mobile phone use, initially no night driving or towing, and requirement to drive only vehicles with Automatic Emergency Braking systems
7. Specify nature and extent of annual review requirement for absolute homonymous hemianope to include medical, vision and occupational therapy on-road reviews
8. Commission research into assessment of persons with absolute homonymous hemianopia and their scanning ability in extended duration high-speed country driving
9. Investigate potential use of driving simulators with eye and head movement monitoring for assessment purposes
10. Make representations to Australian Government for inclusion of complex vision/medical driving assessment by OTs on Medicare rebate table
11. If recommendations not adopted nationally, DIT to incorporate them within South Australia for conditional licences
12. Consider changes to legislation and DIT procedures to enable OT driver assessors to formally make licence recommendations alongside medical practitioners
13. Require OT practical driving assessment reports to be forwarded to DIT for consideration by licensing authority and to assist understanding of driver's insight into consequences of visual field loss