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When determining whether to report a patient’s medical condition that may impair driving, physicians may have to weigh conflicting guidelines: a professional obligation to report and a legal requirement to maintain confidentiality, even in the face of danger to the public. Where obligated to report, physicians must do so.
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This duty exists even when reporting impaired drivers is not mandated by law. Physicians should explain to their patients this obligation to report. Departments of Motor Vehicles should be the final determiners of the inability to drive safely.
Defendant was driving or attempting to drive a vehicle in New Hampshire 2. While driving the vehicle, Defendant was under the inluence of any controlled drug Possible Defenses Allowed by Statute: None found Implied Consent for Drugs §265-A: 4: Yes Special Circumstances:
Physician reporting of demented drivers may have little effect on their driving, if the demented person does not comprehend the implications of loss of licensure. For demented patients, responsibility for driving cessation falls on other persons, such as the next-of-kin or legal guardian.
For a number of reasons, physicians should be restrained in reporting to authorities drivers with a mild or moderate increase in driving risk. First, this degree of added risk is on the same order as other conditions where reporting is not considered professionally or legally appropriate, e.g., benzodiazapine use.
Laws Concerning Disclosure of Impaired Drivers. Many states have enacted laws to address the problem of impaired drivers. Some of these laws mandate disclosure to motor vehicle authorities, while, in others, disclosure is voluntary. Some states require reporting for specific conditions but not for others [4].
Sometimes drivers act voluntarily in ways that make them unsafe, such as driving while intoxicated or exhausted. In these circumstances, we rightfully hold them responsible for injury or damage caused by their choices.
In other words, if informing driver’s licensing agencies (i.e., the Department of Motor Vehicles) about potentially dangerous drivers is not a legally sanctioned reason for breaching confidentiality, physicians may be unable to disclose.
Other states’ physician reporting laws are more permissive. Montana’s statute says that a “physician who diagnoses a physical or mental condition that, in the physician’s judgment, will significantly impair a person’s ability to safely operate a motor vehicle may voluntarily report [italics added]” the patient [11].
Oregon, for example, has broad regulations. Its laws require physicians ( especially primary care physicians) to report conditions that impair sensory, motor, and cognitive functioning to state authorities [5], and they provide comprehensive standards for determining when a driver is impaired.
The holder of the records may disclose information when the patient has communicated a serious threat of serious physical injury against a reasonably identifiable victim, the person with knowledge of the threat may disclose the threat to the potential victim or to any law enforcement officer, or both.
Jan. 1, 2005. Information from a clinical record may be released under the Mental Health Act when the patient has declared an intention to harm other persons.
A mental health professional has the duty to warn of or take reasonable precautions to provide protection from violent behavior only if the patient communicates an actual threat of physical violence by specific means and against a clearly identified or reasonably identifiable victim.
The duty to predict, warn of, or take reasonable precautions to provide protection from, violent behavior arises only when a client or other person has communicated to the licensee a specific, serious threat of physical violence against a specific, clearly identified or identifiable potential victim.
Behavioral health professional - client privilege does not extend when the professional has a duty to (1) inform victims and appropriate authorities that a client's condition indicates a clear and imminent danger to the client or others; or (2) to report information required by law.
Mental health professionals must make a reasonable effort to communicate, in timely manner, the threat to the victim and notify the law enforcement agency closest to the patient's or victim's residence and supply a requesting law enforcement agency with any information concerning the threat.
Immunity for mental health professionals for release of information via 36-504 or 36-509. A release of information via 36-504 or 36-509 shall, at the request of the patient, be reviewed by a member of his family or a guardian. Section provides for appeal procedures.
When a nurse encounters a patient who is likely to harm himself or another, the nurse may be torn between a call to prevent harm and the need to respect the patient's rights to confidentiality and autonomy. Ideally, the nurse would identify the danger area and advise the patient of the safest means of protecting self and others, and the patient would agree. But what if the patient doesn't agree? By warning others of the danger, the nurse is certain to breach patient confidentiality. Respect for patient confidentiality is one of the legal and ethical tenets of all health professionals. By detaining a patient against his or her will, the nurse may commit the tort of false imprisonment, which is also a crime in many jurisdictions. Furthermore, a clinician who disregards a patient's wishes may damage the clinician-patient relationship.
Respect for patient confidentiality is one of the legal and ethical tenets of all health professionals. By detaining a patient against his or her will, the nurse may commit the tort of false imprisonment, which is also a crime in many jurisdictions.
Most of the issues relate to patients who are impaired and therefore would be dangerous if they drove.
Recognizing the importance of this issue, the Federation of State Medical Boards (FSMB), which represents the nation’s 70 state and territorial medical licensing boards, adopted a formal position statement on the “Duty to Report” in April 2016, aimed at addressing the reporting and information-sharing and gap in health care by outlining the responsibility of physicians, hospitals and health organizations, insurers and the public to provide reports to state medical boards of information related to patient safety, physician impairment and professional misconduct.
The statutory limitations that impact state regulators, hospitals and others are also a prime cause for a lack of information-flow between law enforcement agencies and health care institutions – an issue that participants noted often causes public tension. Law enforcement investigators work under restrictive procedures that often require withholding information about criminal activities of health care practitioners for periods of time; when the information eventually becomes available publicly, the lack of active coordination and sharing with health care organizations may be criticized as a gap in public protection. Media reports of criminal activity in health care practitioners in recent years have frequently noted these communication gaps as an important issue beyond the crime itself.
Participants noted that in addition to legal and jurisdictional restrictions, many long-held institutional procedures may impact the flow and sharing of information. For example, many state medical boards share only what is categorized as public information, and this often does not include minor disciplinary measures, such as letters of reprimand. In Medicare investigations, no report is issued until there is a conviction; meanwhile much potentially important information is gathered. Hospitals may have various levels of “formal” and “informal” reporting of issues, and other institutions don’t have access to the results of “informal” reporting – despite the fact that this information, too, could be impactful. Other kinds of potentially useful data are also heavily restricted, including peer-review reports in hospitals and mental health records.
In addition, in smaller communities, health care workers may be reluctant to report the actions of their peers for fear of losing patient referrals or professional ostracization.
Common impediments to the flow of information are widespread statutory and legal restrictions imposed upon institutions. As an example, participants discussed state laws that restrict what kinds of information about disciplined physicians that medical boards can share across state lines. Similarly, federal institutions, such as the Veterans Health Administration, face legal limits to what kinds of information they may share outside the VA system. Similar restrictions apply to large databases, such as the National Practitioner Data Bank, as well as hospitals, insurers and other stakeholders in health care. Participants noted that an institution’s contractual agreements – common in hospitals, for example – may also restrict what information can be shared with others.
Participants noted that state medical societies and other associations with members who are health care practitioners are underutilized as potential partners in a more effective system of information-sharing and reporting. This is because such organizations have traditionally not played a strong role in disciplinary or regulatory matters, as their primary purpose is to advocate for their members. Still, participants noted that health practitioner associations have infrastructure, data, and other tools and resources that could help in an effort to better share information and encourage reporting at the front lines of patient care.
One of the most significant issues contributing to issues with information-sharing is a lack of integration and coordination between the vast databases being compiled by various stakeholder organizations in health care. Participants noted that much data exists that could be helpful in targeting issues in patient care, but more effort is needed to make this information more widely shared. Confidentiality and privacy concerns make this discussion complicated and contribute to a lack of greater reporting.