Mandatory Physician Reporting Bill in Colo: A Doctor's Opinion

[lindsayschu2]

Last week, there was an item in the news in Colo about a bill being proposed that required doctors to report all patients with lapses in consciousness to the DMV, where of course, they all then lose their licenses. The bill language is super vague and doesn't include any timeframes or nocturnal only seizures or any qualifications at all. I had some significant problems yesterday and spoke to the dr on call this morning, and took the opportunity (much to his delight I'm sure) to ask him his opinion on it. Here is what he said: "It's horrible. It turns doctors into policemen. The net effect will be, that seizure patients will no longer report seizures to their doctors, they will be undertreated, and there will be even more people driving at risk of having seizures. This must be lobbied against." Anyway, I thought I would share!

 

[kirsten]

I think your doctor is absolutely right. Just to clarify simply:
-it is important that we don't drive when there is a risk of daytime seizures
-it is important that the laws about seizures and driving are comprehensive and precise
-requiring doctors to police their patients, on the other hand, changes their role and requires them to go against the very foundations of their practices (to first do no harm.)

In a sense, doctors already face this problem when they are required to report gunshot victims, test for alcohol and drug abuse after car accidents, and work with medical aids which have the sole motive of profit-making. I am optimistic, when looking at so many doctors' refusal to participate in these three issues, that they will continue to do the same regarding this new bill, if it's passed.

 

[kirsten]

You know, after some thought, I think this proposal is prejudiced. If they want doctors to report seizures but not alcoholism, drug addiction, non-epileptic seizures, patients taking mind altering medications, and other illnesses that get in the way of driving safely, they're discriminating against epilepsy patients.

 

[lindsayschu2]

I agree Kirsten, and it's far beyond epilepsy too, extending to anyone who has fainted from diabetes or any other cause. Doctors would be shoveling over names of all kinds of patients to the DMV. As our law is stated, it is automatic cancellation, then the patient can appeal--but imagine how long the appeals process would take when the law first takes effect? Drs would essentially hand over the names of every patient who EVER had a complex partial/grand mal, plus every other disease that applies, and thousands of patients who hadn't had seizures in years would have to wade through a clogged system to await a lengthy appeal. This doctor said "Any crackpot can introduce a bill"--he didnt think it would pass, but who knows.

 

[niceguyVZ]

Is it also mandatory in California? Cause the neuro doctor already saw me once and he said i have seizures but i haven't gotten nothing in the mail about my license being cancelled?

 

[Cint]

You know, after some thought, I think this proposal is prejudiced. If they want doctors to report seizures but not alcoholism, drug addiction, non-epileptic seizures, patients taking mind altering medications, and other illnesses that get in the way of driving safely, they're discriminating against epilepsy patients.

I've Been Saying That for YEARS!!!!!!!! HOW MANY GET TO DRIVE AFTER DRINKING TOO MUCH? Anyway, I live in Colorado and don't drive 'cause I did have a seizure while driving and hit a brick wall, literally. Thank god no one was injured.

But then on the other hand, what about cases like this?:

Several years ago, here in the Denver area, a young mother with E did wipe out a family of 5. She was told by her Dr. not to drive.

http://abcnews.go.com/US/colorado-woman-kills-family-seizures-blame/story?id=16564021

 

[kirsten]

I was lucky enough to find an article obliquely related to this in a book I'm reading had been printed online. Here is some of it. It's by Randy Cohen, an ethicist for the NY Times:

"Q: I am a physician in a trauma center that does not check accident victims for alcohol and drugs. If a driver were intoxicated, insurance would not cover medical costs. However, not knowing blood-alcohol levels may have adverse medical consequences. Should we check even if it means added financial burdens, suboptimal care or exposure to criminal charges?

- Anonymous, New York

A: A doctor is pledged to do what is in the patient's best interest medically. So check blood-alcohol levels, but do not disclose this information - neither to cops nor to insurance companies - without the patient's consent.

The American Medical Association's confidentiality policy is meant to protect individual patients, not to promote public health, aid law enforcement or reduce insurance rates. Of course, varying state statutes can create conflicts between what is legal and what is ethical, putting the doctor in an awkward position.

Fortunately, even aggressive disclosure laws often allow some discretion. Some doctors, for example, regard a medical chart as a guideline for continued care: anything not directly pertinent need not be recorded. From this perspective, a knowledge of blood-alcohol level that is vital for immediate treatment may not be germane to future care and can be omitted." www.nytimes.com/top/features/magazi...atch=exact&query=DRUNKEN+AND+RECKLESS+DRIVING

 

[kirsten]

I've Been Saying That for YEARS!!!!!!!! HOW MANY GET TO DRIVE AFTER DRINKING TOO MUCH? Anyway, I live in Colorado and don't drive 'cause I did have a seizure while driving and hit a brick wall, literally. Thank god no one was injured.

But then on the other hand, what about cases like this?:

Several years ago, here in the Denver area, a young mother with E did wipe out a family of 5. She was told by her Dr. not to drive.

http://abcnews.go.com/US/colorado-woman-kills-family-seizures-blame/story?id=16564021

It's a really tough question, Cint. On the one hand, patients wouldn't tell their doctors about their illnesses and would receive substandard care as a result. On the other hand, if a patient is likely to endanger the lives of others, who do we say is responsible for preventing it? There are excellent points to support both sides. If confidentiality is cast aside in medicine, it must follow that it must be cast aside by psychologists and lawyers as well. Society as a whole would decline. I think that ultimately there is a lot of responsibility that falls on our own shoulders and we tend to underestimate others' capacity to manage their own accountability.

 

[lindsayschu2]

Yes my son was practically foaming at the mouth on my behalf about how discriminatory this is against seizure patients (but his political dial is set a little high in the best of circumstances ;-)) In the end, we as patients are responsible for our own actions, and should be legally liable for what we do and don't do. Throwing doctors in jail for not tattle taling is ridiculous, and it sets a precedent as you all point out for which there is no limit. Doctors could be required to inform employers that someone is doing drugs if they have hazardous jobs for example (ridiculous, surely, but where's the line?)

 

[Cint]

I agree Kirsten, and it's far beyond epilepsy too, extending to anyone who has fainted from diabetes or any other cause. Doctors would be shoveling over names of all kinds of patients to the DMV. As our law is stated, it is automatic cancellation, then the patient can appeal--but imagine how long the appeals process would take when the law first takes effect? Drs would essentially hand over the names of every patient who EVER had a complex partial/grand mal, plus every other disease that applies, and thousands of patients who hadn't had seizures in years would have to wade through a clogged system to await a lengthy appeal. This doctor said "Any crackpot can introduce a bill"--he didnt think it would pass, but who knows.

Well actually, the accident I was referring to in my last post was from diabetes. When I finally was able to speak to the EMT on the way to the hospital, I told him I also have Diabetes and had taken my insulin, but because I had to be somewhere because it was Xmas Eve, I forgot to eat. Therefore, my blood sugar had plummeted and when the EMT tested it on the way to the ER, it was 38. So the ER Dr. stated on the report that the accident was due to a diabetic seizure, not an epilepsy seizure. But then my neuro doesn't agree. Can't wait to see my endocrinologist in 10 days and ask his opinion. I don't think he will want to report every time my glucose falls below 70, will he?

 

[lindsayschu2]

Here's a look at mandatory reporting rules in the US and the world:
http://en.wikipedia.org/wiki/Epilepsy_and_driving

There are only 6 states in the US that have this rule, and I assume it's because, while most clearly believe driving with active seizures is a VERY BAD IDEA, making doctors liable is also a bad idea. I hope that Colo follows suit. I found the rules in other countries to be really interesting--a lot say that if you've ever had a seizure in your life you can't ever drive. Remind me not to live there.

 

[lindsayschu2]

Well actually, the accident I was referring to in my last post was from diabetes. When I finally was able to speak to the EMT on the way to the hospital, I told him I also have Diabetes and had taken my insulin, but because I had to be somewhere because it was Xmas Eve, I forgot to eat. Therefore, my blood sugar had plummeted and when the EMT tested it on the way to the ER, it was 38. So the ER Dr. stated on the report that the accident was due to a diabetic seizure, not an epilepsy seizure. But then my neuro doesn't agree. Can't wait to see my endocrinologist in 10 days and ask his opinion. I don't think he will want to report every time my glucose falls below 70, will he?

Cint I'm holding out hope this bill doesn't pass at all! Colo is a pretty reasonable, middle-of-the-road state. I hope not--I only have nocturnal complex partials and myclonics (no daytime CPs in 7 years), and haven't had a grand mal in 17 years--all I have while awake is simple partials but under this bill my license would be gone too.

 

[Cint]

Cint I'm holding out hope this bill doesn't pass at all! Colo is a pretty reasonable, middle-of-the-road state. I hope not--I only have nocturnal complex partials and myclonics (no daytime CPs in 7 years), and haven't had a grand mal in 17 years--all I have while awake is simple partials but under this bill my license would be gone too.

I hope not..... I don't think they would. We will all have to go and protest if they do!!

 

[N Sperlo]

It needs to be left up to the doctor. If he says to not drive for six months, that is on you. If you chose to go against his will, then you take full responsibility.
The doctors don't need to police their patients. I am just fine to drive, and driving is a big part of my life. I am happy with the laws in my state.

 

[kirsten]

Here's a look at mandatory reporting rules in the US and the world:
http://en.wikipedia.org/wiki/Epilepsy_and_driving

I had no idea there were laws about epilepsy and driving in my own country! I've gone through three neurologists in my life and none have ever asked about or mentioned driving to me. Maybe the law just isn't enforced here.