Q. I'm an early career psychiatrist. I recently read about a physician's
being held liable for the harm his patient, who was an impaired driver, caused
to a third party. Should I make it a practice to report patients in treatment
for substance or alcohol abuse or who are on certain medications? What about
A. As a general rule, physicians are not held liable for the actions
of their patients except in cases of serious, imminent harm to identifiable
victims, in which case most states require the physician to take some form of
action to warn or otherwise protect the victims. However, with regard to
patients who are or may be impaired drivers, the obligation to take action
becomes less clear-cut.
In one specific instance, the duty to report is clear. If you see your
obviously impaired patient drive away despite your best efforts to make other
arrangements for leaving your office, then you may alert the authorities in
the interest of public safety. Remember, of course, to disclose only the
Most cases, however, are not as straightforward as the above; so the
general advice, which is in keeping with risk management's primary and
secondary goals of providing appropriate patient care and minimizing
liability, is as follows:
Unless your state mandates immediate reporting of a specific diagnosis,
your first duty as the treating physician is to address any clinical reasons a
patient might be impaired. For example, an elderly patient with vision or
hearing loss may need referrals to see an appropriate specialist to possibly
correct those problems. Furthermore, your clinical judgment may dictate
changes in treatment approach, medications, dosages, or some combination
thereof. If you have already made a report, you can subsequently continue with
the process of addressing the patient's clinical needs.
Next, as an extension of the informed consent process, you are charged with
advising, educating, and/or warning the patient regarding his or her
impairment and documenting the same. Counseling the patient includes not only
warnings about safety and your possible duty to report, but also information
about adverse reactions to medication or combinations of medications.
Regardless of your state law, you may still be exposed to claims of
breaches of confidentiality should you report a patient as an impaired driver.
Therefore, you may need to seek additional guidance from your state medical
association, your malpractice liability carrier, or personal counsel when
deciding how to improve safety for patients and others and whether reporting
is the best option for a given set of circumstances.
The Psychiatrists' Program (the Program) will be located at booth #1202 in
the Exhibit Hall of the Moscone Center at APA's 2009 annual meeting in San
Francisco. PRMS, the manager of the Program, will have risk managers and
insurance underwriting specialists present to provide individualized insurance
information and risk management advice for psychiatrists. Complimentary risk
management articles and information about future seminars will also be
As a thank you, Program participants will receive a copy of "My Risk
Management Plan," a workbook to help psychiatrists develop their own
risk management plan. Participants will also receive a complimentary"
For Participants Only" customer resource guide.
PRMS risk management staff will be presenting at the following sessions in
the Moscone Center:
While at the meeting, be sure to check the meeting schedule for last-minute
changes to times or locations.
This column is provided by Professional Risk Management Services,
manager of the Psychiatrists' Program, for the benefit of APA members. More
information about the Program is available by visiting<www.psychprogram.com>;
calling (800) 245-3333, ext. 389; or sending an e-mail to