For many individuals, having a driver’s license allows them the freedom to travel to whatever place they choose at whatever time they choose. To the elderly and disabled, a driver’s license may be the only way he/she can get out of the house and retain a sense of independence and autonomy. The surrender of a driver’s license may force an individual to acknowledge that he or she is no longer an active part of society.
Many times it is the physician who initiates the conversation regarding a patient’s driving habits and whether or when a person should surrender his/her driver’s license. This is a difficult topic to address, particularly when there is a risk of damaging the patient-physician relationship, violating patient confidentiality, and potentially losing patients.
The Motor Vehicle Law requires physicians to report every person over fifteen years of age who the physician diagnoses as having certain conditions that interfere with the driver’s ability to control and safely operate a motor vehicle to the Pennsylvania Department of Transportation (PennDOT). Conditions that MUST be reported include visual deficiency with acuity of less than 20/70 (with correction); epilepsy; any other conditions in the opinion of the examining physician is likely to interfere with the patient’s ability to control and drive safely a motor vehicle.
Driving impairment reports must be made within ten days of the diagnosis. The report must include the full name, address, and date of birth of the patient. PennDOT further requests that the report includes the condition that prompted the report and any specific information about the condition. The report must be made in writing either in a letter or on PennDOT’s initial reporting form (DL-13).
The report of the physician remains confidential and is solely used by the PennDOT to determine the competency of any person to operate a motor vehicle in Pennsylvania. The health care provider’s duty to report supersedes patient-physician confidentiality. No report shall be used as evidence in any civil or criminal trial, except in any proceeding related to the determination of incompetence.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Standards for Privacy of Individually Identifiable health Information (“Privacy Rule”) permit health care providers to disclose protected health information without individual authorization as required by law.
However, there may be specific confidentiality obligations that may preclude physicians from complying with the driving impairment reporting requirements in certain cases. These include patients receiving mental health or drug and alcohol treatment. In these cases, the physician should consult his attorney or risk management department.
The Motor Vehicle Law requires PennDOT to limit use of the reports to determinations as to whether the reported individual is qualified to be licensed. If PennDOT takes adverse action as a result of a report and the reported individual appeals to the courts, however, the reported individual generally will be able to obtain the report through discovery. (PennDOT advises that court appeals are infrequent.) Health care providers who make required reports to PennDOT are immune from liability. The failure by a health care provider to make required reports to PennDOT may result in civil or criminal liability.
Physicians have a duty to warn their patients that their medical condition and possibly medication side effects may impair their ability to drive safely. If the physician believes that the patient’s driving is unsafe and cannot be made safe by medical treatment or adaptive devices, he/she should recommend that the patient surrender his/her driver’s license. Failure to appropriately warn a driving impaired patient can put the physician at risk of civil liability if the patient is injured in an accident caused by the impairment.
The physician should document conversations, recommendations, and any referrals for further testing in the patient’s chart. Good documentation will provide evidence of your efforts to assess and maintain your patient’s driving safety.