Should My 99 Year-Old Stepfather Be Allowed To Drive?

Transcription

1 Should My 99 Year-Old Stepfather Be Allowed To Drive? Jerry and My Mom Michael G. Harris, OD, JD, MS Clinical Professor Emeritus UC Berkeley School Of Optometry Jerry s Vision & Health Concerns Jerry s Drivers License ARMD Best corrected VA: 20/70 OU Stone deaf Recovering from several broken bones CHF Difficulty with balance Jerry s Licensure History Previous license lapsed Unable to renew while recuperating from fall At CA DMV presented letters from eye & primary care doctors Received Drivers License w/o any testing Jerry s Licensure History Previous license lapsed Unable to renew while recuperating from fall At CA DMV presented letters from eye & primary care doctors Received Drivers License w/o any testing 1

2 Jerry s Driving History Never had a traffic violation Doesn t drive at night or on freeways Drives mainly to local stores and restaurants Had his first accident last year Should Jerry have been allowed to drive? How should optometrists deal with a patient like Jerry? Low Vision And Driving: A Dilemma For Patients And Doctors Visual tests do not completely evaluate functional driving ability Driving ability depends on other factors Driving laws vary from state to state Patient and public interest often conflict Low Vision And Driving: Legal And Ethical Issues Doctor s Legal Duties Reporting Unsafe Drivers Ethical Considerations State Licensing Standards Doctor s Legal Duties Doctor s Legal Duty To Warn Patient Warn patient Warn OTHERS? Maintain confidentiality Conditions creating risk of injury when driving Failure to warn can result in negligence 2

3 Liability To Others State Privacy Statutes & Reporting Unsafe Drivers Failure to warn of medical Rx side effects Negligent certification condition Reporting To State Motor Vehicle Agency Reporting rules vary among states Who can report potentially unsafe driver, and to whom? Immunity for reporting Doctor-patient confidentiality Doctor s Duty To Maintain Patient Confidentiality Common Law State Statutes and Reporting Laws Federal Statutes and Regulations Codes of Ethics Examples Of State Laws California Generally no disclosure of health care information without patient authorization Physician, spouse, or family member may report vision loss Immunity from liability for good faith reporting 3

4 Missouri Family members, law enforcement, social workers, therapists, psychologists, nurses, physicians, optometrists, and chiropractors are permitted to report Oregon Physician or health care provider required to report patient whose visual acuity or fields does not meet DMV standards State Physician Reporting State Physician Reporting: Legal Protection Counseling Counseling Older Drivers, Older 2nd Drivers ed Source: Source: AMA AMA Physician's Guide Guide to Assessing to Assessing and and Counseling Counseling Older Drivers, Older 2nd Drivers ed State Physician Reporting: Vision Report Forms State DMV makes final determination Some states shield doctors from liability State facts rather than opinions or conclusions HIPAA Disclosure permitted if necessary to prevent or lessen a serious and imminent threat to health or safety Doctor must act in good faith 4

5 HIPAA VS. STATE LAW Ethical Dilemmas HIPAA regulations generally preempt state law except where state law provides greater privacy protections HIPAA does not provide immunity from state law liability Case 1 Case 2 Patient George has retinitis pigmentosa Reduced visual fields and poor night vision George works as a clerk at K-Mart Concern he might make errors on the job Should you let George s boss know of his visual condition? Confidentiality vs. Boss s need to know George is a forklift operator in warehouse Warehouse has poor lighting Concern he could hurt himself or others Should you tell George s boss? Confidentiality vs. George s welfare Case 3 George also drives a school bus Concern he might have accident Should you tell someone? Confidentiality vs. danger to others Ethical Dilemma Resolution Identify principles involved Confidentiality vs. danger to patient and others Choose path that violates neither principle Choose most compelling principle and minimize effect of not choosing other 5

6 What Should The Doctor Do? Tell George and document in exam record Send certified letter to George Convince George to tell Involve George s wife or close relative Be advocate for George with his boss Tell state DMV Talk to local school district Worst-case Scenarios If you tell, patient could sue you If you don t tell, injured party could sue you You could be sanctioned by your state licensing board Ethicist "The Greater Good" State Driver Licensing Standards State Driver Licensing Visual Standards All states test visual acuity 40 states test visual fields 15 states test color vision 6 states test depth perception 3 states test eye coordination 0 states test contrast sensitivity Absolute Visual Acuity Minimum Counseling Older Drivers Source: AMA Counseling Physician's Older Guide Drivers to Assessing and Counseling Older Drivers Counseling Older Drivers, 2nd ed

7 State Visual Field Requirements Color Vision Testing Source: Peli, E, Visual Field Requirements in the USA Counseling Older Drivers, 2nd ed Source: AMA Physician's Guide to to Assessing and Counseling Older Drivers Counseling Counseling Older Older Drivers, Drivers 2nd ed Permissibility Of Bioptic Driving By State License Renewal Procedures For Older Drivers Source: Multiple Source: IALVS, Multiple sources Counseling 2013 sources Older Drivers Source: Insurance Institute for Highway Safety, Source: Insurance Institute for Highway Source: Insurance Highway Institute Loss Data for Institute Highway Safety, Highway Safety, Highway Loss Data Institute, 2013 Loss Data Institute Summary And Conclusions The End! Be familiar with federal and state laws Sound judgment using statutory and ethical standards Present findings and counsel your patient Document findings/recommendations in writing 7

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