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At Your Service
Is There Duty to Report Impaired Drivers?
Psychiatric News
Volume 44 Number 5 page 21-21

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 elderly drivers?

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 minimum information.

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.

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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 available.

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 TheProgram@prms.com.

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