Nobody disputes that 85-year-old Lorraine Sullivan steered her Toyota Corolla into oncoming traffic, causing a crash that killed her longtime boyfriend, who was in the front passenger seat.
But she is not the one in a Santa Ana courtroom this week facing a wrongful death lawsuit for the 2010 accident.
Her doctor is.
Dr. Arthur Daigneault, who practices near the retirement community of Laguna Woods Village and caters to the elderly, is being sued by the family of William Powers. The internist had been treating Sullivan for dementia in the two years before the crash. At issue is whether he should have initiated a process to take away her driver's license — and whether by not doing so he bears some responsibility for the death.
The case casts a spotlight on a problem that will grow more common as the population ages and doctors see more dementia and other conditions related to old age, such as slowed reflexes, lack of alertness and diseases that can trigger lapses of consciousness. At what point do doctors have a responsibility to notify authorities that their patients may pose a threat on the road?
By 2030, the number of U.S. drivers older than 65 is expected to reach 57 million, nearly double the number in 2007. According to a federal report that year, drivers 75 and older have the highest chances among all age groups of being involved in a fatal crash, based on miles driven.
One of the most dramatic reminders of those risks came in 2003, when an 86-year-old man drove his Buick through the Santa Monica Farmers Market, killing 10 people and injuring more than 60. Last week, a 100-year-old man backed into a crowd in front of a south Los Angeles elementary school and injured two adults and 12 children.
During National Transportation Safety Board hearings on the issue of aging drivers in 2010, Dr. Carl Soderstrom of the Medical Advisory Board of the Maryland Motor Vehicle Administration testified that doctors in many states "have no idea at all whether they have any obligation … about reporting or talking to the DMV."
Some advocates for the elderly are grappling with how to guide doctors, patients and their families, because in the early stages of Alzheimer's and other diseases, a person may seem perfectly capable of driving safely — or at least as safely as many younger people on the road.
"This underscores the need for more discussion about this subject," said Jean Dickinson, spokeswoman for the Alzheimer's Assn. in Los Angeles, which has recently launched a "dementia and driving" resource center on its website.
A driver's license has always been a ticket to freedom, and losing it can be devastating, especially in freeway-centric cultures like California, where public transportation has notoriously limited reach.
California law requires doctors to look out for patients with "disorders characterized by lapses of consciousness" and report them to local health authorities, who in turn notify the Department of Motor Vehicles. The law states that such conditions may include Alzheimer's disease and related ailments but lets doctors use their clinical judgment as to whether a patient is too impaired to drive.
As the Orange County case illustrates, a doctor's responsibilities can be open to interpretation. The lawsuit went to the jury Wednesday. Such legal cases are rare.
In December 2007, court records show, Sullivan told Daigneault, her longtime doctor, that she had memory loss. Tests showed a slight decline over the next year, and in June 2009, he prescribed an Alzheimer's drug. When she complained that her memory was still worsening, he switched her to another dementia drug.
The last time he saw her was in May 2010, two weeks before the accident. He didn't consider her memory problems serious enough to report, according to the doctor's deposition.
Sullivan's daughter, Mary Bestgen, testified this week that apart from occasional forgetfulness, her mother was the same capable person she always remembered. Though they saw each weekly, Bestgen said she had no idea that her mother had ever been diagnosed with dementia or put on medications for it.
Craig Powers and Andrea Wooldridge, the plaintiffs in the case, forced their 90-year-old father to give up driving in early 2010 but did not express any concern about Sullivan or letting him ride with her, according to court filings.
In an interview, they said that Sullivan was intensely private and managed to hide her dementia.. "My dad did occasionally tell me, 'Lorraine is confused about what day it is,' " Wooldridge said.
The couple had been together since the late 1970s, when they met at a dance. He was a salesman, and she was a court clerk. Both divorcees, they bought a condominium together in 1995 in what is now known as Laguna Woods Village, a gated community of about 9,000 senior citizens. Powers enjoyed the golf courses.
His last game was May 26, 2010. The next morning, Sullivan drove him to a nearby Costco. They filled the back seat with groceries and headed home. Less than a mile away, Sullivan made an errant left turn, and a black Mercedes smashed into the passenger door.
Sullivan suffered a head injury. Powers suffered a broken pelvis and lung damage, among other injuries. He survived for six weeks.
Wooldridge said she hopes the case will prevent accidents by taking drivers with dementia off the road: "We want to set a precedent so doctors take this seriously."
As of 2011, seven states had mandatory reporting requirements for doctors who believe a driver is impaired. At least a couple of states have loosened their rules in recent years, and some people have expressed concerns that senior citizens might avoid getting crucial medical care if they viewed their doctors as adversaries who could take away their licenses.
In any case, it is clear that reporting by doctors is relatively rare. Families often intervene first and take away the keys, or a driver fails to pass periodic written and vision tests that some states mandate for senior citizens. California requires drivers older than 70 to renew their licenses in person.
As of December 2011, there were 92,000 people older than 80 licensed to drive in California — up from 77,000 in 1999. Last fiscal year, the DMV took away 26,428 licenses for medical reasons. Officials were unable to provide a breakdown by age or medical problem. The state is home to an estimated 600,000 people with Alzheimer's disease.
In a deposition, Daigneault estimated that he reported 10 patients for impairments over the last five years.
"This is an important issue and the doctors take it seriously," his lawyer, Michael Trotter, said, adding that "it's an issue that is not black and white."
Trotter argued in court that there was no evidence that dementia played a role in the 2010 accident or that the DMV would have stripped Sullivan of her license even if she had been reported.
Sullivan, now 88, has not driven since the accident.