More Information on the Duty to Report Lapses of Consciousness

Last month’s case dealing with the fatal automobile accident caused by a severely ill patient prompted several requests from Members for more information on their duty to report patients who should not be driving. A more in-depth description of the current statute and corresponding regulations should help physicians better understand their legal obligations.

California Health & Safety Code Section 103900 (formerly Section 410) requires every physician who has diagnosed a disorder characterized by lapses of consciousness in a patient, who is at least 14 years of age, to immediately report the name, date of birth, and address of the patient to the local health officer. The local health officer must then report the patient to the Department of Motor Vehicles.

Last year, new regulations related to Section 103900 were adopted in an attempt to clarify for physicians when they should report.

California Code of Regulations, beginning with Section 2800, describes “Disorders Characterized by Lapses of Consciousness” as those medical conditions that involve: (1) A loss of consciousness or a marked reduction of alertness or responsiveness to external stimuli; and (2) the inability to perform one or more activities of daily living; and (3) the impairment of the sensory motor functions used to operate a motor vehicle.

The regulations list “Activities of Daily Living” as “bathing, dressing, feeding oneself, brushing one’s teeth, and performing more complex tasks such as grocery shopping, cooking, management of personal finances, and operating a motor vehicle.”

According to the regulations, the term “Sensory Motor Functions” means “the ability to integrate seeing, hearing, smelling, feeling, and reacting with physical movement, such as depressing a brake pedal of the car to stop the car from entering an intersection with a green traffic light to avoid hitting a pedestrian crossing the street.”

The regulations also give examples of reportable medical conditions “that do not always, but may progress to the level of functional severity” to include “Alzheimer’s disease and related disorders, seizure disorders, brain disorders, narcolepsy, sleep apnea, and abnormal metabolic states, including hypo- and hyperglycemia associated with diabetes.”

The new regulations also explain when a physician need not report such conditions.

Those situations include patients whose sensory motor functions are impaired to the extent that the patient is “unable to ever operate a motor vehicle” or those patients who state to the physician that he or she does not drive and never intends to drive and the physician believes those statements to be true. The physician is also excused from reporting if he or she has previously reported the diagnosis and, since the report, believes the patient has not operated a motor vehicle. Finally, the physician is excused from reporting if there is documentation in the patient’s medical record that another physician or surgeon reported the diagnosis and, since that report, the physician believes the patient has not operated a motor vehicle.

One CAP Member commented that her patients get angry when she tells them she has to report their condition to the state. It may help to explain to patients that even after the health officer notifies the Department of Motor Vehicles, the patient still has the opportunity to explain to the DMV that he or she is capable of safely driving.

It also may help to relate to them the story of the patient whose automobile accident took the life of an unsuspecting young mother. . . .

Gordon Ownby is general counsel of CAP-MPT. For information on contacting your local health officer, call the California Conference of Local Health Officers, 916-654-0023 or write to gownby@cap-mpt.com.