Doctors Can Decide Who Rules the Road

Dr. Melvin Kirschner remembers the time two years ago when a female patient of his became disoriented while driving and crashed into several cars parked along a suburban Los Angeles street.

The middle-aged woman, a diabetic who had experienced a sudden drop in blood sugar, insisted the incident was a one-time occurrence, a transitory physical lapse.

Kirschner was sympathetic. Nonetheless, because of an explicit--but largely unknown--provision in state law, the Van Nuys family practitioner was required to report the incident to local health authorities, which led to the suspension of the woman’s driver’s license.

Every physician and surgeon must immediately report the name, address and date of birth of any person diagnosed as having a disorder characterized by a lapse of consciousness. As one doctor warned a patient recently: “Never even mention the word ‘disoriented’ to your doctor unless you really are and you’re prepared for trouble with the DMV.”

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According to the state Department of Motor Vehicles, about 25,000 Californians will lose the privilege to drive this year because of medical conditions reported by their doctors, including lapses of consciousness, dizziness, dementia, seizures and physiological or mental lapses brought on by drug use.

“The law is very explicit,” said Marlene Harrison, program director at the Center for Aging Research and Evaluation at the Granada Hills Community Hospital. If someone is judged by a doctor to be medically unfit to drive, she said, that person has to be turned in.

Though state guidelines vary with the specific medical condition, the process is triggered when a doctor notifies the city or county health department, said Edan Nossoff, a DMV spokesman. Notification, he said, can also come from law enforcement or relatives.

Once the DMV is contacted by health authorities, the driver is mailed a notice to appear for a hearing with DMV officials, who may require that the driver’s exam be taken again or that the subject provide a medical evaluation.

In half the cases, DMV officials say, this will result in the suspension or revocation of a driver’s license. And once their licenses are taken, people may not get them back for months or years, depending on the nature of the illness.

Those who can provide medical evidence that their condition has been brought under control can reapply for a license. Still, the DMV has the authority to subject them to periodic progress checks.

Physicians understand that they are obliged by law to report a patient with a potentially dangerous medical condition. But some acknowledge that the decision to report is not easy, especially if it appears that the condition was temporary.

The question is particularly emotional, they say, in the Los Angeles area, where independence hinges on mobility.

Willingness to report--particularly when a person has suffered from a less-serious ailment--can also depend on what type of physician is doing the treating, one doctor said.

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“Neurologists are very rigid when it comes to reporting,” said one family doctor from the San Fernando Valley. “But family practitioners, who have a better understanding of family dynamics, tend to be more humanistic.”

Doctors have to balance their responsibility to be an advocate for their patient with responsibility for public health and safety, said another San Fernando Valley physician. “And for some doctors, the decision to call the authorities can be a difficult one.”

There are physicians who will skip the official report if they see the problem addressed by the family, one doctor said. “Basically [family members] go ahead and quietly sell Uncle Joe’s car to make certain he’s not a hazard.”

But DMV officials have no tolerance for doctors who take shortcuts, even for conditions that the driver or doctor may regard as minor.

All doctors who know a driver suffered a mental lapse are obligated to report it, said William Madison, a DMV spokesman. “If a case came to light where they didn’t, it would be reported to the state medical board as a violation of state law.”

Although opinions on individual cases differ, all agree that the state must remove dangerous drivers from the road.

“For every doctor, there’s a time when the duty to the public safety outweighs his duty to the patient,” Kirschner said.