Alberta doctors should be required by law to report medically unfit drivers to the Registrar of Motor Vehicles, a judge says in a scathing fatality inquiry report into the death of an 11-year-old girl killed when a man with a history of seizures plowed his truck into a St. Paul school.

More than four years after the crash that killed Megan Wolitski and seriously injured two other girls, one of whom later died, provincial court Judge Karl Wilberg wrote that the deaths and injuries should not have happened.

"[T]he evidence heard from the inquiry made it clear that the deaths and injuries in question were avoidable. They took place ... from a longstanding institutional failure to take action against a known danger."

Alberta is currently one of three provinces that does not require such reporting from doctors. The fatality report was released publicly on Thursday, after a three-day inquiry last fall.

On Oct. 25, 2012, Richard Benson had a seizure while driving his minivan and crashed into the basement level classroom of Racette School in St. Paul, about 200 kilometres northeast of Edmonton.

Wolitski suffered catastrophic injuries and died the next day.

Maddie Guitard, 11, remained in a vegetative state after the crash and died last year at the age of 15. A third girl, Angelina Luce, suffered a permanent brain injury.

Ten years earlier, Benson had suffered a permanent head injury himself that caused him to have seizures. Benson never self-reported his medical problems when applying for a driver's licence and vehicle insurance. His family also didn't report their concerns about his driving.

But the judge noted Benson had repeated contact with the medical system between the time of his injury and the fatal crash.

Richard Benson was sentenced to jail and received a lifetime driving ban. "The evidence was distressingly clear that, in spite of all the obvious warning signs, the persons who could take action didn't," the report stated.

But requiring physicians to report unfit drivers is not enough, the judge wrote. They also need the diagnostic tools, technological infrastructure, and compensation to ensure that information is passed along in a timely and efficient way.

Rules confusing for physicians

In his report, the judge untangled the various rules that currently regulate doctors' reporting duties.

The code of ethics from the Canadian Medical Association compels doctors to pass on patients' health information to third parties if it could help prevent significant harm to others.

Meanwhile, the Traffic Safety Act does not compel physicians to report, but does provide them with anonymity if they decide to do so. But the Alberta College of Physicians and Surgeons has in the past said the duty to report is discretionary.

11-year-old Megan Wolitski was killed after a minivan came through the wall of her school. (Les Miskolzie) "There was a lack of accurate information and widespread confusion over the duties of physicians in Alberta," Wilberg wrote "This resulted in the failure to report a driver who was a danger to the public."

He noted that some doctors might not report unfit drivers because they're unaware that ethical guidelines compel them to do so.

The judge recommended the use of a standardized test to determine driver fitness, and said doctors should be paid for completing the assessment and report.

Transportation Minister Brian Mason said it's too early to know if the government will implement any changes to the Traffic Safety Act.

"We'll be consulting with some of our partners in traffic safety as well as in (the) health (department)," Mason said. "But it's just too early to give you a definitive answer as to where we're going to land."

Guilty pleas to criminal negligence

Benson pleaded guilty in 2013 to one count of criminal negligence causing death and two counts of criminal negligence causing bodily harm. He was sentenced to two years less a day in jail and was prohibited from driving for life.

By the following year, he had been placed in a mental-health ward under strict observation by doctors.

Dr. Lyle Mittelsteadt, with the Alberta Medical Association, said doctors would likely support the judge's recommendation if the rules were clear.

"There needs to be clear criteria for people with chronic medical conditions as to when it's mandatory to report," he said.

"The vast majority of patients are fully capable of driving safely at the time they're first diagnosed with a chronic medical condition but there are instances where in the advancement of that condition, they may not be safe to drive anymore. When are the criteria for reporting? That needs to be clear."