Indiana Supreme Court: DO NOT DRIVE!

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lobelsteve

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Legal & Regulatory

Physician May Be Held Liable for Car Accident for Failing to Instruct Patient Not to Drive

A physician who had treated an individual involved in a head-on automobile collision may be held liable for not doing more to prevent his patient from driving following an Indiana Supreme Court’s ruling that reversed summary judgment in his favor. The Indiana Supreme Court held that several questions of material fact precluded making a summary judgment on the case, including the need to determine exactly when the statute of limitations began to run. At the scene of the accident, the physician’s patient allegedly said that she was not supposed to drive because of her medical condition. It came to light that the county prosecutor was in possession of an undated letter written to him by the physician, which said that his patient had several medical conditions that, combined with medications she had been prescribed, may have contributed to the accident. In reversing summary judgment in favor of the defendant, the supreme court said that the date the statute of limitations began to run on the injured party’s claim could not be ascertained based on the available evidence and that more evidence was needed to establish a causal relationship between the physician’s treatment of the patient and the collision. The physician originally sought summary judgment on the basis that the claim was barred by the medical malpractice statute of limitations, and the court initially held that this limitations period applied because the claim had been filed in compliance with the state’s medical malpractice act. The physician argued that the limitations period began to run on November 21, 2006, the last time he saw the patient, while the injured party argued that the period began to run on November 27, 2006, the date of the collision. The court noted a third possible date—when the physician wrote to the county prosecuting attorney’s office. The physician argued that there was no evidence indicating that his failure to warn the patient not to drive could have been a proximate cause of the accident, because the patient may have ignored his advice and because the patient’s choice to drive was not a superseding cause of the accident. The court said that the physician’s contentions rested on uncertain facts and inferences that could not be determined in summary judgment, thus reversing the summary judgment in favor of the physician.

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http://www.ncbi.nlm.nih.gov/pubmed/24076302
http://www.oregon.gov/ODOT/DMV/docs/at-risk/attachmenta.pdf
MED> 120, or Repeated THC/ETOH & Opioids = http://www.odot.state.or.us/forms/dmv/7230.pdf

Accid Anal Prev. 2013 Sep 8;60C:205-210. doi: 10.1016/j.aap.2013.09.001. [Epub ahead of print]
Drug use and fatal motor vehicle crashes: A case-control study.
Li G, Brady JE, Chen Q.
Source
Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, USA; Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 West 168th Street, New York, NY, USA. Electronic address: [email protected].
Abstract
Drugged driving is a serious safety concern, but its role in motor vehicle crashes has not been adequately studied. Using a case-control design, the authors assessed the association between drug use and fatal crash risk. Cases (n=737) were drivers who were involved in fatal motor vehicle crashes in the continental United States during specific time periods in 2007, and controls (n=7719) were participants of the 2007 National Roadside Survey of Alcohol and Drug Use by Drivers. Overall, 31.9% of the cases and 13.7% of the controls tested positive for at least one non-alcohol drug. The estimated odds ratios of fatal crash involvement associated with specific drug categories were 1.83 [95% confidence interval (CI): 1.39, 2.39] for marijuana, 3.03 (95% CI: 2.00, 4.48) for narcotics, 3.57 (95% CI: 2.63, 4.76) for stimulants, and 4.83 (95% CI: 3.18, 7.21) for depressants. Drivers who tested positive for both alcohol and drugs were at substantially heightened risk relative to those using neither alcohol nor drugs (Odds Ratio=23.24; 95% CI: 17.79, 30.28). These results indicate that drug use is associated with a significantly increased risk of fatal crash involvement, particularly when used in combination with alcohol.
 
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Doesn't change the risk. Hopefully, you aren't coprescribing.
 
While we have always had this as a part of our opioid agreement, now we are specifically warning and documenting the warning.
 
While we have always had this as a part of our opioid agreement, now we are specifically warning and documenting the warning.

1+ my treatment agreements changed today.
 
Legal & Regulatory

Physician May Be Held Liable for Car Accident for Failing to Instruct Patient Not to Drive

A physician who had treated an individual involved in a head-on automobile collision may be held liable for not doing more to prevent his patient from driving following an Indiana Supreme Court’s ruling that reversed summary judgment in his favor. The Indiana Supreme Court held that several questions of material fact precluded making a summary judgment on the case, including the need to determine exactly when the statute of limitations began to run. At the scene of the accident, the physician’s patient allegedly said that she was not supposed to drive because of her medical condition. It came to light that the county prosecutor was in possession of an undated letter written to him by the physician, which said that his patient had several medical conditions that, combined with medications she had been prescribed, may have contributed to the accident. In reversing summary judgment in favor of the defendant, the supreme court said that the date the statute of limitations began to run on the injured party’s claim could not be ascertained based on the available evidence and that more evidence was needed to establish a causal relationship between the physician’s treatment of the patient and the collision. The physician originally sought summary judgment on the basis that the claim was barred by the medical malpractice statute of limitations, and the court initially held that this limitations period applied because the claim had been filed in compliance with the state’s medical malpractice act. The physician argued that the limitations period began to run on November 21, 2006, the last time he saw the patient, while the injured party argued that the period began to run on November 27, 2006, the date of the collision. The court noted a third possible date—when the physician wrote to the county prosecuting attorney’s office. The physician argued that there was no evidence indicating that his failure to warn the patient not to drive could have been a proximate cause of the accident, because the patient may have ignored his advice and because the patient’s choice to drive was not a superseding cause of the accident. The court said that the physician’s contentions rested on uncertain facts and inferences that could not be determined in summary judgment, thus reversing the summary judgment in favor of the physician.

Can you post the original link, please?
 
No drinking, driving, operating heavy machinery while on opioids. No signing or agreeing to contracts while on opioid pain medication. I review this with pts and document it.

But what about long acting agents? Are patients never allowed to drive, etc.? What about gabapentin, etc? A good amount of pts have adverse effects which can affect driving.

What procedures do pts require a chauffeur for? Can they argue a TPI caused an accident?
 
While we have always had this as a part of our opioid agreement, now we are specifically warning and documenting the warning.
Algos:

How are you documenting this in your opioid agreement?

When I had mentioned this line item to an attorney friend of mine, they stated that listing it in my opioid contract was not advised.

What are your thoughts considering the Indiana case?
 
Algos:

How are you documenting this in your opioid agreement?

When I had mentioned this line item to an attorney friend of mine, they stated that listing it in my opioid contract was not advised.

What are your thoughts considering the Indiana case?

Would want a reason that it should not be in the Dr/Pt agreement.

That's where mine is as it explains risks and benefits of treatment. Also explains the rules of the clinic.
 
I put it in mine. "Please refrain from driving while on these medications."

I have used use of opioids to prohibit driving.. The patients would rather give up driving than give up their meds....
 
My thoughts in the IN csse are that the Supreme Court has declared open season on physicians regarding any perceived deficit in informed consent. Physician recommends a vitamin but does not disclose all known side effects then they become culpable. Same for prescribing any drug- the only safe way is to not prescribe any drug nor perform any procedure because informed consent now will require exhaustive disclosure ...too much for most medical practices. Indiana just became a goldmine for lawyers and a very poor place to practice medicine. We list not driving or operating heavy machinery if impairment from these drugs is present. Now we are adding a specific warning.
 
It's a good way to stop prescribing.

If a patient insists on driving, you cannot legally prescribe. If it happens in my state, that's what I may be forced to do.

Eventually tho some lawyer will sue a pain doctor for NOT prescribing, as it violates their patients rights somehow......
 
Bump....

I am curious to hear a bit more about how people are addressing the driving issue with opioids (and other medications). I am thinking about adding this to our opioid agreement. I have similar questions to PainApplicant1 above: Are you telling patients no driving at all, no driving for the first 4-6 hours after taking a short acting medication? What about people on long-acting preparations? Are you carrying this over to muscle relaxers, gaba/pregaba, etc. Tramadol? I feel like driving issues around medications were hardly ever addressed during training and would like to get a better idea of what people are doing.
 
It's a good way to stop prescribing.

If a patient insists on driving, you cannot legally prescribe. If it happens in my state, that's what I may be forced to do.

Eventually tho some lawyer will sue a pain doctor for NOT prescribing, as it violates their patients rights somehow......
Which is why I document, maybe even more on those to whom I don't prescribe to and why, for that possibility.
 
Indiana just became a goldmine for lawyers and a very poor place to practice medicine. .


you mean, beside the fact that most places in indiana have some of the highest reimbursements in the country? i can think of worse places to practice pain medicine.
 
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