DMV reporting of unsafe driving

[queenjulie, RN]

Got a dilemma: I am a nursing risk manager at a family practice. PA at our office has a patient who is refusing all treatment for what are probably multiple (now old) strokes. Has fairly serious motor deficits, but can walk and talk.

Pt is a professional truck driver. She STRONGLY recommended he stop driving. He told her absolutely not; his next license inspection isn't for a couple more years and he plans to continue driving a tractor-trailer at least until then. Refused all meds and PT/OT. She wants to report him to DMV and have them evaluate him now, but is worried about violating his rights. Any thoughts? Our other experienced providers have only had this happen when someone came in asking whether they need license re-evaluation, not someone refusing it. 

I know HIPAA has an exception for reporting a public health issue, but all my research shows that driving is a really underregulated area and there's very little law around it with regard to patient privacy versus road safety. 

[NRSKarenRN, BSN, RN]

Not a HIPAA issue.   Here are PA regulations for medical reporting unsafe driving conditions:
 

Quote

A physician does not have a duty to control his patient’s driving by reporting a physical condition to the Department of Transportation or to protect third persons from injuries sustained from unforeseeable accidents.

The Vehicle Code only requires physicians to provide medical information regarding the conditions of certain licensed drivers to the Commonwealth so it can determine if operating privileges should be revoked, and does not authorize a private cause of action based upon physician’s failure to report a driver’s condition to Department of Transportation.

Quote

 

§ 83.5. Other physical and medical standards.

 (b)  Disqualification on provider’s recommendation. A person who has any of the following conditions will not be qualified to drive if, in the opinion of the provider, the condition is likely to impair the ability to control and safely operate a motor vehicle:

   (1)  Loss of a joint or extremity as a functional defect or limitation.

   (2)  Impairment of the use of a joint or extremity as a functional defect or limitation.

     (I)   The provider should inform the patient of the prohibition against driving due to the functional impairment.

     (ii)   The provider shall inform the Department in writing of the impairment if the condition has lasted or is expected to last longer than 90 days.

   (3)  Rheumatic, arthritic, orthopedic, muscular, vascular or neuromuscular disease.

     (I)   The provider should inform the patient of the prohibition against driving due to the functional impairment.

     (ii)   The provider shall inform the Department in writing of the impairment if the condition has lasted or is expected to last longer than 90 days

 

Check your states regulations and submit medical reporting form if required.

Hardest thing I had to do was have my Dad's PCP report his dementia to PA DOT and have license revoked as UNSAFE to determine driving speed when I last drove with him.

Having a diesel mechanic son with DOT tractor trailer license and grandfather who was Philly to NY professional trucker:  Reporting medical information puts onus on the STATE to determine operating privileges.  When impairment reported, most truckers required to take retake tractor-trailer driving test; some pass with restrictions or assistive devices, others denied.

[JKL33]

If you're worried about risk, I would say it is risky to strongly recommend someone stop doing something because the activity is a danger to self and others, and then not use available reporting mechanisms. This is not a HIPAA issue.

If the PA is a DOT provider, she knows whether he would meet the qualifications for certification in his current condition. This should help with her decision-making.

As far as I can tell he is NOT authorized to continue to drive and is in fact prohibited from doing so if his deficits would disqualify him, whether his certificate is still good or not. 

https://www7.fmcsa.dot.gov/faq/my-medical-certificate-still-valid-am-I-prohibited-operating-cmv-if-I-have-medical-cond

[beachynurse, ASN, BSN]

Virginia Law is different, anyone can report medical concerns. It also addresses medical provider reporting. This is directly from the Medical Review section of the DMV website. It also discusses confidentiality of the reporting.

Report Submissions:

"Any resident of Virginia can be reported to the DMV as having one of the qualifying medical conditions that require MRS review. Oftentimes customers will self-report their conditions; however, anybody has the option to send in a report when they have a driver safety concern." 

Confidentiality

"Virginia law prohibits DMV from releasing information on the source or reason for the report submitted by a relative or medical professional treating the driver. Information on the source of other reports may be released if requested."

 

"DMV relies strongly on information provided by physicians, law enforcement, judges, relatives and other reliable sources to help identify drivers who may be unable to safely operate a motor vehicle.

If the driver is reported by a relative or healthcare provider, VA. Code § 46.2-322 prohibits DMV from releasing information on the source of the report concerning the person's ability to drive safely."