07/05/2017

Health providers routinely care for patients whose ability to operate a motor vehicle is compromised by a physical or cognitive condition. To ensure the safety of all who share the roads, health professionals and caregivers are called upon to identify conditions that might compromise the driving abilities of patients and people under their care. As a result, health providers are often faced with the responsibility of deciding if they should report the unsafe driver to their state Department of Motor Vehicle (DMV).

When older drivers forego driving, they often lose their independence, compromise their ability to work, have difficulty maintaining social contacts, and limit their involvement in personal interest and community activities. These losses have a profound effect on the elderly in terms of emotional and physical well-being, quality of life and evaluation of self-worth.  Therefore, the health providers’ role often is pivotal in determining physical and mental conditions which may impair the patient’s ability to drive, which may lead to alternative transportation options.

 

 

According to the American Medical Association’s report “Impaired Drivers and Their Physicians”, health providers should “use their best judgment when determining when to report impairments that could limit a patient’s ability to drive. Initially, health providers should assess patients’ physical or mental impairments that might adversely affect driving abilities. Each case must be evaluated individually since not all impairments oblige a health provider to report.”

 

Also, not all health providers are in a position to evaluate the extent or effect of the impairment. Therefore, when making an evaluation, health providers should consider the following factors:

  1. Health providers must be able to identify and document the physical or mental impairment that clearly relates to the elderly’s ability to drive.
  2. The driver must pose a clear risk to public safety.
  3. Before reporting, the health provider should first have a tactful, but candid conversation with the patient and their family about the risks of driving based on the patient’s medical condition. From advised options and available alternative transportation material, if a workable plan can materialized, reporting may be unnecessary.
  4. In a situation where the driving impairment creates a threat to the patient and public safety, and the health provider’s advice is disregarded, then the health provider has an ethical obligation to notify the DMV.
  5. The health provider is obligated to report the patient’s medical condition that would compromise the safety of the driver, however, the determination of the patient’s license status is made by the state’s DMV.
  6. Health providers should explain to their patients their responsibility to report.
  7. The patient’s confidentiality should be protected by ensuring that only the information pertaining to driving impairment is reported.
  8. Health providers should work with their state medical societies to create statutes that uphold the best interests of patients and their community and safeguards should be in place to shield the health providers from liabilities when reporting an impaired driver in good faith. To view the latest National Highway Traffic Safety Administration (NHTSA) Medical Review Practices for Driver Licensing, click here.

A report to the relevant driver’s licensing authority may be a service to the patient as well as to the public. While loss of driving privileges is almost certainly an inconvenience and can even be detrimental to a patient’s well-being, the risk of injury or death to both the patient and third parties due to a medical impairment is too great a risk to ignore. Health providers should be aware of the options in their jurisdictions and keep the best interests of the patient—and the public—in mind.

Resources:

American Medical Association Code of Medical Ethics. https://www.ama-assn.org/

The Dear Rich Staff. (May 2013). When Do Physicians have to report Impaired Drivers? http://autolaws.blogspot.com/2013/05/when-do-physicians-have-to-report.html

National Highway Traffic Safety Administration. www.nhtsa.gov