Tuesday, August 7, 2012

Doctors can put brakes on driver's license

Posted: Sunday, February 19, 2012


The PennDOT form letter left Karen Moss confused. It stated that her driver’s license would be suspended because a doctor had declared her medically unfit to safely drive a car.
But when Moss, 67, a retired registered nurse, contacted her doctors for an explanation, they were just as confused, she said. Moss had no medical conditions they knew of that would impair her ability to drive, she said.
So she took action before the license suspension went into effect. She re-took the road test and provided more medical proof. PennDOT eventually deemed her medically fit to get behind the wheel.
“The trauma of not being able to defend myself and of having to retake the driving test was horrible,” Moss said. “I wondered at the time if there was a deranged person out there who was filing these reports for some warped reason.”
Three years later, the Perkasie resident still doesn’t know who filed the report or why. She never will.
In Pennsylvania, that information is legally protected. So are the report contents, including the medical condition cited as interfering with driving ability. That is, unless the driver files a formal appeal with the courts.
“You have no idea who your accuser is. You can’t do that in a court of law,” Moss said. “The worst is I can’t think why a doctor would think there was something wrong with me and they wouldn’t tell me.”
Moss isn’t alone in her criticism of Pennsylvania’s medical reporting system.
Other critics say it discourages patients from being candid with health care workers. They call the reporting requirement unconstitutional and overly broad, leaving it open to misinterpretation. They also say the system lacks adequate checks and balances by relying on the subjective opinion of someone who may have treated a person only once.
And doctors aren’t the only ones PennDOT listens to when it comes to medical reporting. Police officers also can recommend a special medical/driver examination if they suspect a driver has medical issues that compromise driving ability. Those reports are also legally protected.
The state transportation agency maintains that medical reporting is the most effective way to keep dangerous drivers off the road. PennDOT says research shows an extremely high rate of non-compliance in states with “self reporting” requirements for impaired drivers.
“They’re providing their professional opinion to us,” said Richard Kirkpatrick, PennDOT’s division manager for driver safety. “We’re relying on the judgments of the professionals to tell us what the condition of these people are.”
Pennsylvania is one of nine states that mandate health care providers report people with medical conditions or other impairments that could impact their driving ability. But the state is one of only four that include medical conditions other than those involving loss of consciousness or seizures.
Among the conditions that PennDOT says could interfere with driving ability: unstable diabetes, heart conditions, arthritis, chronic depression, substance addiction and “excessive aggressiveness.”
Each year, the Pennsylvania Department of Transportation receives about 22,000 new medical reports from health care providers; about half involve medical impairments significant enough to merit recalling a license, PennDOT safety administration spokeswoman Jan McKnight said. About half of the license recalls involve people under age 65.
The rest of the reports result in no further action, in license suspension or in restrictions, such as no night driving. In 2010, PennDOT issued about 7,000 restrictions on individual’s driving records and about 3,000 suspensions for non-compliance with requests for medical information, McKnight said.
CONFIDENTIALLY SPEAKING

PennDOT declined to provide copies of its special medical reporting forms covering 10 medical conditions that it believes can impair driving.
The agency also lets health care professionals use a general medical reporting form (called a DL-13) that lists 15 disorders and disabilities the agency believes impact driving ability. It allows doctors to include “other” conditions not listed.
The DL-13 form asks the health care professional whether the individual should lose driving privileges immediately or if PennDOT should conduct an investigation into “driving competency.” But PennDOT doesn’t require doctors to submit documentation nor does it routinely verify the information in the reports.
Patients diagnosed with seizure disorders can qualify for a medical waiver under certain circumstances, such as if the seizure is the result of a doctor-supervised medication withdrawal, dehydration or low sodium levels.
A seizure typically results in an automatic six-month driving suspension before a driver can seek reinstatement.
In 2010, 252 people who had their licenses revoked appealed PennDOT’s actions. At least 183 appeals were filed in the first 10 months of last year, McKnight said. The agency said it couldn’t provide information about how many appeals were reversed.
If a formal appeal is filed, the state is required to disclose the name of the health care provider who filed it, as well as the medical report, Falls defense attorney Ron Elgart said and PennDOT confirmed.
A 2000 study in the Society of General Internal Medicine journal found that the prospect of private health information being shared with a third party could result in a patient avoiding medical treatment.
The study also pointed out that most health conditions that impair driving ability do so gradually over time, meaning that the person doesn’t pose an immediate safety risk for other drivers.
PennDOT maintains that medical reporting doesn’t violate doctor-patient confidentiality, since doctors are required to report to police things like gunshot wounds, child abuse and sexually transmitted diseases.
The transportation agency also cites the American Medical Association’s ethics statement that a doctor may not reveal patient confidences or deficiencies he may observe, unless required by law or it is necessary to protect the public welfare.
But the American Medical Association, the Pennsylvania Medical Society, and the Pennsylvania Psychiatric Society joined in a “friend of the court” brief supporting a 2009 federal civil suit filed by a Bethlehem psychiatrist, Dr. David Behar, against PennDOT and the state secretary of transportation.
In his suit, Behar claims the mandatory medical reporting requirement violates federal law mandating confidentiality for drug and alcohol abuse patients and that the protocol for assessing drivers based solely on a submitted medical report without further investigation is unconstitutional.
Behar’s attorney, Alan Gold of Gold and Ferrante in Jenkintown, said his client’s main concern is that patients with chronic conditions would avoid medical treatment if they learned they could lose their driving privileges.
Gold maintains medical reporting requirements punish drivers for honesty, but not medical professionals who fail to report someone who fits its criteria. PennDOT confirmed that it wasn’t aware of any health care provider being penalized for failing to file a medical report or who file meritless reports.
“There are people who live in absolute fear to talk to their doctor,” Gold added. “The law is clear. They will not bring an action against a doctor (for not reporting), but they still say, ‘I’ve got to report it.’”
So far, the federal court has sided with PennDOT by dismissing the part of Behar’s suit that argues mandatory medical reporting is unconstitutional, Gold said.
But the court has yet to rule on the second part of the suit pertaining to the privacy protection of individuals in certain types of “federally funded” drug and alcohol treatment programs.
‘A STICKY WICKET’
St. Mary Medical Center cardiologist Dr. George Heyrich has filed medical reports with PennDOT, typically for patients who experience loss of consciousness or a medical condition where loss of consciousness can occur. He said he tells patients before filing the report.
For about half the patients, no obvious medical cause is found for a sudden loss of consciousness, Heyrich said. Some medical conditions that can lead to blackouts can be treated with medication or surgery, but may still require a driving “holiday period,” he added.
The patients who doctors tend to focus on for medical reporting are people at risk for recurrent blackouts, not a single one, Heyrich added.
Over his 20-year career, Dr. Joseph Kepko said he filed about a dozen medical reports with PennDOT and the agency never contacted him to verify the information or his signature.
Kepko, who retired from his Bensalem family practice last year, said he filed a medical report with PennDOT without first consulting the patient only once; in that case, the patient was in her 90s and her adult children made the request.
When PennDOT notified the woman she had to retake the road test to keep her license, she confronted Kepko, who confessed he turned her in.
“I asked her, could you live with yourself if you hit a school bus filled with children?” he added.
The woman agreed that she couldn’t, he said. She took the retest, failed, and lost her license.
Kepko was surprised that patients don’t have immediate access to the medical reports since patients are entitled to copies of their regular medical records.
“It doesn’t make sense,” he said. “They should have access.”
Dr. Neil Skolnik, associate director of Abington Memorial’s family medicine residency program, said the law is an opportunity for doctors and patients to discuss the sensitive topic of when to put away the car keys.
Skolnik, who has a family practice in Jenkintown, said he’s never had a patient request that he reverse another doctor’s medical report with PennDOT. He also doesn’t see the medical reporting requirement as hurting doctor-patient relationships.
“The alternative is not having the ability for the state to take licensure away is everyone drives regardless of ability or safety,” he said. “It doesn’t seem there is a confidentiality issue as long as the issue is handled responsibility and clearly.”
Abington Memorial neurologist Dr. Lee Harris, though, would like to see the mandatory medical reporting eliminated, saying it puts patients on the defensive.
“If a patient says that he had a seizure, I have to tell him that he can’t drive for six months,” he said. “I don’t want to promote dishonesty.”
Harris recalled how a patient with a seizure disorder threatened to sue him after he told her he was filing a medical report with PennDOT. But before PennDOT revoked her license, the patient had a seizure behind the wheel, which resulted in a car accident that killed another driver.
Harris also believes confusion exists over what is considered a reportable condition; for example, a patient with heart disease who faints is reportable, but an otherwise healthy person who faints after hearing bad news isn’t, he said.
“I think some doctors don’t understand the law,” he added.
Harris says he has reviewed medical records for patients who’ve challenge a suspension or revocation involving a seizure and found cases where doctors reported a single seizure as the reason a person should not drive. But a single seizure is not considered a seizure disorder without a brain wave test confirmation. Neurologists don’t recommend treatment for people who experience a standalone seizure.
Seizures can happen for many reasons and often the cause of a single seizure cannot be identified, Harris added. More than half of patients who experience a single seizure have normal follow-up testing.
“It’s just that — a fluke — but it’s still required they have to be reported to PennDOT,” he said. “This gets into a sticky wicket.”
One that Langhorne resident Dorothy DeBlasio finds herself stuck in. The 70-year-old said her six-month license suspension has turned into a tangle of red tape she is still trying to unravel.
A year ago this month, DeBlasio’s license was suspended after she experienced two seizures following a medication change. The new medication was the same one she was prescribed four years before and had a seizure. After doctors changed the drug the first time, she had no more seizures — until the medication was switched back.
Doctors changed her medication again and she has been seizure-free since, she said. Her neurologist and ophthalmologist both sent PennDOT the required paperwork declaring her medically fit to drive, she said.
But, first, PennDOT wants her to retake the road test. So far she has failed it twice. She plans to try a third time next month.
“It’s not six months, it’s a year,” she said. “It’s my independence they’re taking away.”

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