All patients must have a driver after ESIs, facets, and mbb in my practice. If they insist on driving, we make them sign AMA.
I know this seems extreme, but my malpractice carrier advised that, if they get into an accident, and you have given them permission to drive, you are liable. If the patient injures third parties, you may well be personally liable, as your malpractice insurance extends only to your Dr./Patient relationship, NOT injuries to third parties. You are PERSONALLY liable in this instance.
Do you realize what you are doing here?
Having the patient sign an AMA form does nothing to protect you from the liability of a patient crashing into someone else. If you're truly worried your ESI patient (that didn't get local or sedation) is going to crash into someone else, they shouldn't get the chance to sign out AMA anymore than a drunk driver or sedated driver should get the chance to sign out AMA and still drive, high on versed/fentanyl or alcohol. AMA is a patient consenting to risk to themselves, not consenting to risk to others.
I agree, however, that lawyers and greedy sue-happy people have eff'd everything up to the point we have to make absurdly ridiculous requirements like this. (I know where you all are coming from).
Do you need a driver after getting dental work? No.
Do you need a driver after getting your ears pierced? No.
Do you need a driver after donating blood? No.
Do you need a driver after getting stitches? No.
Requiring a driver after a knee injection, trigger point, or SI joint is pointless, and makes no sense. Delayed vagal reaction? What the hell is that? You either vagal, or you don't.
If you truly believe in a "delayed vagal" reaction (whatever the hell that is) why is it safe for them to be at home alone
after they've been driven home?
What if their ride drops them off, then they still have a "delayed vagal" episode and drown in their pool, bathtub, or fall down the stairs?
Yet, lawyers will make absurd arguments in court and win, by confusing the crap out of juries of people who can't figure out how to get out of jury duty. So as a response, we make absurd rules to make ourselves feel better. Sad.
Here's what I think is reasonable, like others have mentioned:
1-Sedation or local in epidural space or nerve block affecting use of arms or legs- driver mandatory. No AMA option at all! Crashing and killing others after signing AMA isn't an option. Think of how crazy that is: documenting their risk then letting them drive
increases your liability, since you've documented their a danger in the road yet you still let them drive.
That's a lawyer's dream scenario! If they get behind the wheel with IV sedation on board, or motor block, the cops are called.
2-Other spinal injections, fluoro injections without nerve block or sedation, or epidural with local- have a policy such as driver strongly recommended or mandatory observation period afterwords, in office (ie 60 minutes). If there's no motor block or vagal response after one hour, it's not going to happen. Even anaphylaxis will occur within 20-30 min. "Delayed vagal" is made up. Don't even post such a thing online for the lawyers to latch onto to start using in court ("delayed vagal one hour later, three hours later, the next day, etc...)
3- Minor injections, such as trigger point, joint, there is absolutely no reason to require a driver. If there's no symptoms during or within 20 minutes after an injection, it's not going to happen. In fact, if I went to a doctor that required that, I'd never go back. Otherwise, any restaurant should require any patron that eats, to have a non-dining driver to take them home in case the customers have a delayed vomiting or choking episode after eating. Drivers required after every tetanus shot, or pneumovax vaccine... Drivers required for every wart or mole removal in the podiatry or derm offices...
It's absurd.