MEETING WITH EXPERTS
Ranks 4, 12, and 24: Physician Reporting Responsibilities and Protections
Physician reporting responsibilities and protections ranked 4th out of the 16 components in the second column of the RVA, with a weighting of 7.62. Looking at the four components within this area, protection from tort action/immunity for reporting received the highest weighting (2.70), which places it 4th in order of importance when considering all 64 components. The component with the second highest weighting of the four in this area is reporting that is mandated by law for specified medical conditions (weight=2.17), which places it 12th out of 64 in order of importance. Confidentiality of reports followed with a weight of 1.61, placing it 24th out of 64 in order of importance. Sanctions for failure to report received the lowest weight of the four components in this area (weight=1.15), and placed 44th in order of importance when considering all 64 components in column 3.
Mandatory physician reporting is controversial. Although mandatory reporting is not favored by physicians, most of the administrative medical staff at the meeting thought this would be extremely helpful to DMVs for identifying drivers with medical conditions and functional impairments. Mandatory reporting would be particularly helpful because many people lie about medical conditions on the license renewal form, and because family members are often reluctant to report their loved ones.
Physicians in the meeting stated that treating physicians should counsel their patients about driving, and only report those who do not comply with driving recommendations or medical treatments. Physicians are concerned that mandatory reporting laws will result in drivers not getting needed medical treatment for fear of losing their licenses, and will result in compromised health (and more unsafe drivers on the road).
A physician in the meeting said mandatory reporting results in the public perception that the DMV is there to take away licenses instead of trying to help people maintain their safe driving ability. Instead, the treating physician should perform some functional tests in the office, and then refer the driver for remediation of functional abilities or retraining, and get the MAB involved for a review of the situation if there is no improvement.
Another argument against mandatory reporting is that people living in small communities and in rural areas will get reported in high numbers if reporting is mandatory, because they are the ones who have repeat appointments with the same doctors and have good relationships with their physicians. Drivers in metropolitan areas who have no doctor loyalty will not get reported. So, many who should be reported will not get reported, and those with a good patient-physician relationship who may respond well to physician counseling will have that relationship tainted if reporting were mandatory.
All physicians in this meeting (and several of the administrative attendees) responded that physician reporting should be voluntary. To make voluntary reporting effective, physicians in the meeting stated there should be a policy and funding set aside for the DMV to talk to the medical boards and committees in the State to educate the physicians about reporting requirements, the relationship between medical conditions/functional ability and safe driving ability, and how to counsel patients to adjust driving habits or seek alternative transportation. Patient and physician education limit the number of reports going into the DMV to those where DMV intervention is needed to effect a change in driving behavior (i.e., patients whom the physician knows will dismiss their advice). In the RVA, physician education by the DMV was ranked 46/62, as discussed earlier.
Physicians in the meeting said the AMA/NHTSA Guide provides Current Procedural Terminology (CPT) codes physicians can use to bill for counselingphysicians may spend an extra 15 minutes counseling a driver about driving if they will be compensated for their time. Physicians will be more likely to spend time learning about medical conditions and driving if they know they will receive CME credits for their education.
If mandatory reporting would burden a medical unit, it was suggested that reporting could be limited to conditions so severe and uncontrollable that driving safely is impossible (Oregon’s new law). This eliminates temporary impairments or reporting by diagnosis, as it is not the medical condition that causes the report to be required, but how that condition affects driving safety. In other words, the diagnosis of a particular disease would not in itself be cause to report; but if that disease has progressed to the point where safe driving is compromised by severe and uncontrollable cognitive, physical or visual impairments, this would constitute cause to report.
There was high agreement by all meeting attendees that physicians who report (either by law or voluntarily) should be protected from tort action (provided with immunity from legal action) by their patients. Even when guaranteed immunity, physicians in the meeting said their colleagues often do not report because they do not want to deal with all the extra paperwork that the DMV will require them to complete, coupled with the fact that they do not want to be bothered by the patient’s relatives who invariably call the office asking how the physician could have done such a thing.
Confidentiality of reporting is controversial. Some attendees thought drivers should have a right to “know their accuser.” Others thought confidentiality would increase the volume of voluntary reports by physicians as well as concerned family members.