6 States Mandate Physicians to Report Medically Impaired Drivers—Only Oregon, Pennsylvania Requires to Report Vision Impairment

Only the 6 states—California, Delaware, Nevada, New Jersey, Oregon, and Pennsylvania—required physicians to report medically impaired drivers, according to new research. From there, only 2 states required physicians to report vision impairment: Oregon and Pennsylvania.

Physicians in the 6 states had specific mandatory conditions to report:

• California: Conditions with lapses of consciousness.
• Delawares: Loss of consciousness due to a disease of the central system.
• Nevada: Epilepsy.
• New Jersey: Recurrent convulsive seizures, recurrent periods of unconsciousness, impaired or loss of motor coordination due to conditions like epilepsy.
• Oregon: Severe, uncontrollable functional or cognitive impairments, such as vision impairment, strength, peripheral sensation, reaction time, memory, and loss of consciousness.
• Pennsylvania: Disorders related to lapses of consciousness, as well as mental or physical disabilities including vision impairment, seizure disorder, unstable diabetes, cardiovascular conditions, drugs, or suicidality.

The national cross-sectional survey study, led by Elaine M. Train, MD, from Shiley Eye Institute at the University of California in San Diego, collected data in November 2022 on mandatory and voluntary reporting, anonymous reporting, medical conditions that require reporting, availability of reporting instructions, confidentially of reports, and legal immunity for physicians. The findings were presented at the 127th American Academy of Ophthalmology (AAO) 2023 from November 3 – 6 in San Francisco.

To collect data, the investigators first reviewed all 50 US states’ department of motor vehicle (DMV), then surveyed a DMV staff from each state via phone, and after reviewed every state’s vehicle legal codes, and finally cross-referenced the data and analyzed using descriptive statistics.

For the 6 states, reporting instructions are only available on the DMV website in California, New Jersey, Oregon, and Pennsylvania, but not Delaware or Nevada. Over half (66%) of the states had available reporting instructions on DMV websites but 34% did not.

Also, Nevada and Oregon both had no time frame for their mandated reporting, while California had to report in 14 days, Delaware in 1 week, New Jersey in 24 hours, and Pennsylvania in 10 days. California, Nevada, or Pennsylvania did not mention any penalty for not reporting, while physicians in Delaware will receive a fine of $5-50, physicians in New Jersey will receive a fine of $50 per violation, and physicians in Pennsylvania could be convicted of a summary criminal offense.

Many state DMVs did not accept anonymous reports—only 6% accepted this, but 94% did not. Three states allowed anonymous reports, and 7 states allowed physician reports to be confidential without exception. Only 60% of physicians were protected from legal liability from people, while 40% of physicians were not.

“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,” wrote Lee Black, writer from the AMA Journal of Ethics. “So, if they follow their professional obligation to report patients (pursuant to detailed guidelines), doctors may face civil and criminal liability for unauthorized disclosure under some state laws.”

The investigators concluded by writing that they would like to incorporate the research into graduate medical education curricula across several medical specialties, including internal medicine, emergency medicine, neurology, and ophthalmology.

“We hope our findings will encourage physicians to study the policies of their respective states and increase their awareness of reporting issues surrounding confidentially and legal liability,” the investigators wrote.

References

1. ^{Tran, E and Lee, J. Physician Reporting of Medically Impaired Drivers: Caveats to Confidentiality and Legal Immunity Across 50 U.S. States. American Academy of Ophthalmology. November 3, 2023.}
2. ^{Black, Lee. Physicians' Legal Responsibility to Report Impaired Drivers. AMA Journal of Ethics. https://journalofethics.ama-assn.org/article/physicians-legal-responsibility-report-impaired-drivers/2008-06. Accessed November 17, 2023.}