Am Fam Physician. 1999 Jan 1;59(1):199-200.
A 23-year-old woman with a history of a seizure disorder presented to the walk-in clinic, requesting antiepileptic medication. She said she had not been taking her antiseizure medication for more than one year because she did not have medical insurance. During that time, she had contacted an organization to seek help in obtaining medication, but her efforts were unsuccessful. She now had a new job with medical benefits and had come to the clinic to establish care a few weeks before this visit. At that time, she was not given antiseizure medication because her medical records had not yet arrived at the clinic.
The patient described herself as having a seizure once a month, with loss of consciousness and tonic-clonic movements. She also said she had daily seizures that did not generalize. Her medical records had arrived by the time I saw her. They confirmed her history and listed her previous antiepileptic medications. I wrote a new prescription for her, but before doing so, I asked if she was driving. She said that she had been driving all year. I asked if she was concerned about having a seizure while driving. “As a matter of fact,” she said, “I did have an accident during a seizure. I drove into a guardrail, but nobody was hurt.” And then she smiled as if to say I was crazy if I thought she was going to give up driving.
Driving is critical to life in American society. Without a driver's license, it is difficult to be mobile, to be employed and to be a full participant in all aspects of living. Our society recognizes the need for a driver's license and generally makes one available to everyone as long as they meet certain criteria. However, the young woman in the case presented here would face drastic legal consequences if she were to hurt someone while driving, by choosing to drive despite having uncontrolled seizures. The woman's physician may also face some legal concerns that he or she needs to address in a formal manner.
The laws in all 50 states restrict driver's licenses for persons with active seizures that are not controlled by medication and establish rules regarding when and how a license may be acquired. The usual requirements necessitate that a person be seizure-free for a specified period of time, commonly six months, but increasingly three months or more, and have a physician's statement confirming that the individual's seizures are controlled and that if the person is licensed to drive, he or she will not present an unreasonable risk to public safety.
Current laws commonly shield the physician from liability for statements given to the state, as long as the statement was made in good faith and with reasonable belief of its accuracy. In most states, there is a medical advisory board that reviews the individual's application for a driver's license and the physician's statement, and makes a decision whether to grant licensure. This decision may be appealed to a higher court within the state, usually a state court. As a general rule, if a person is seizure-free for the specified period and has a physician's statement supporting his or her driver's license application, a license will be granted.
Informing the state of a medical condition and complying with the state's requirements for driver's licensure not only serves to promote public safety, but also protects the individual in any subsequent litigation that may occur if he or she has a seizure while driving. As a general principle, this protection will apply as long as the person is following the licensing rules and has not been otherwise negligent in driving practices.
The young woman in this scenario is not only a risk to herself and to the public, but she may also face future civil liability and even criminal prosecution in the event that she has a car accident that injures someone. It is important that persons with epilepsy recognize that they can face dire consequences if they are driving without having informed their state's department of motor vehicles about their seizure condition.
In addition to the civil and criminal liabilities, insurance companies may refuse to cover persons with epilepsy for accidents that occur during a seizure if the company and the department of motor vehicles were not previously informed of their medical condition. The fact that this information was concealed will be used as evidence of willful and reckless negligence, particularly where the facts demonstrate the individual's failure to take medication for seizures.
Six states (California, Delaware, Nevada, New Jersey, Oregon and Pennsylvania) still require physicians to report patients who have seizures to the state, usually to the department of motor vehicles. While these statutes arguably do little to protect the public interest, they have been used to bring civil litigation against physicians who have not reported their patients to the department of motor vehicles, even in cases where patients are compliant and on medication.
One such case1 was later overturned by a higher court, which found that the failure to report could only result in the imposition of a fine and could not serve as the basis for a negligence lawsuit. However, in another state, a lawsuit was brought against the estate of a physician who did not report his patient to the state. In this case,2 the patient allegedly had a complex partial seizure while driving, resulting in a car accident that killed a family. If the physician in the case scenario presented here practices medicine in a state with a reporting statute, it would be prudent to obtain the regulations on reporting persons with seizures and do so accordingly.
It is the belief of many physicians and the position of the Epilepsy Foundation that such across-the-board reporting statutes are a detriment to public health because they encourage patients not to seek medical advice or consult with a physician when they have seizures. However, no evidence exists showing that the public is safer in a state with a reporting statute than in other jurisdictions. The Epilepsy Foundation supports individualized evaluations of ability to drive and self-reporting of a seizure condition to the department of motor vehicles, as well as reasonable restrictions (i.e., a three- to six-month seizure-free period and a review of the driver's license application by a medical advisory board) to promote public safety.
To prevent future liability exposure, many physicians who treat patients with seizures discuss with their patients the consequences of driving when seizures are not controlled and record that discussion in the patient's medical record. Some physicians have their patients sign the record to confirm that they have had the discussion and understand that they either should not drive or should disclose that they have a seizure condition when they apply for a driver's license. Some states also have statutes that permit physicians to voluntarily report patients whom they believe to be a threat to others. Physicians who report patients in “good faith” are protected by these statutes from litigation for violating patient confidentiality.
For additional information about driving and epilepsy, please contact the Epilepsy Foundation at 800-EFA-1000; Web site: http://www.efa.org.
1. Romero v Levine, Cal Ct App (4th Dist 1993).
2. Harden v Dalrymple, 883 F Supp 963 (D Md 1982).
Please send scenarios to Caroline Wellbery, MD, at email@example.com. Materials are edited to retain confidentiality.
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