Reporting LOC to DMV

[lockian]

Wondering what you'd do in this kind of situation. I thought I'd post here because neuro must deal with loss of consciousness a lot.

I have a patient with a history of multiple episodes of loss of consciousness, likely syncope due to physical and psychological stress. They were seen for this among other issues by pcp, neuro, and then myself, a psychiatrist. No one except myself and a triage nurse told them not to drive per the chart.

My state is not a mandatory physician reporting state, but patients are required to report to the DMV within 30 days about any episodes of "loss of voluntary control." Physicians may report but nothing compels them to report or not-report. I don't see any documentation that anyone has told the patient to do this, or that anyone helped them complete a form for the DMV - the form has a physician attestation section. I also saw them a couple times before realizing that a patient is supposed to report this to the DMV (I'm new-ish to the state). It's definitely been 30+ days since the first episode but less than 30 days since the last episode. I don't think the patient would've reported anything on their own, knowing them overall.

I feel bad and like I'm going to get in trouble for not getting on this sooner. And how should I even go about getting on this issue? I told them not to drive but not what they should do with regard to the DMV. Yes, other doctors did not seem to address it, but is they provided subpar care doesn't mean I won't be held to whatever is standard of care in this situation.

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[deathmerchant]

Unfortunately these laws are not well delineated and we don't have any consistent medical guidelines. It is state dependent and I would just follow the state law.
In most states you are not legally obligated to report but you Can report. You should definitely tell the patient and family to not drive And mention that in your notes. If you feel he is truly impaired and is still driving, I would ask the family to confirm and go ahead and report the patient after a warning. Or you can have them do a driving assessment at a Rehab and/or request a new drivers test at the DMV and if they pass they can drive.

In few states, I think reporting a patient is considered HIPAA violation, so check that before reporting.

Finally, if your states requires mandatory reporting, then there is no doubt about it. Just go ahead and report.

 

[xenotype]

Wondering what you'd do in this kind of situation. I thought I'd post here because neuro must deal with loss of consciousness a lot.

I have a patient with a history of multiple episodes of loss of consciousness, likely syncope due to physical and psychological stress. They were seen for this among other issues by pcp, neuro, and then myself, a psychiatrist. No one except myself and a triage nurse told them not to drive per the chart.

My state is not a mandatory physician reporting state, but patients are required to report to the DMV within 30 days about any episodes of "loss of voluntary control." Physicians may report but nothing compels them to report or not-report. I don't see any documentation that anyone has told the patient to do this, or that anyone helped them complete a form for the DMV - the form has a physician attestation section. I also saw them a couple times before realizing that a patient is supposed to report this to the DMV (I'm new-ish to the state). It's definitely been 30+ days since the first episode but less than 30 days since the last episode. I don't think the patient would've reported anything on their own, knowing them overall.

I feel bad and like I'm going to get in trouble for not getting on this sooner. And how should I even go about getting on this issue? I told them not to drive but not what they should do with regard to the DMV. Yes, other doctors did not seem to address it, but is they provided subpar care doesn't mean I won't be held to whatever is standard of care in this situation.

In most states you don't have to report. AES has a helpful state database that is extremely quick to search on duration and mandatory reporting. Medicolegally with any unexpected loss of consciousness you are obligated to tell the patient of the state law. With that said I don't think telling grandma with clear single vasovagal syncope in the bathroom or in the church pew is necessary. Additionally, nocturnal seizures are also an edge case.

 

[PecanPie1984]

Yes , reporting to the DMV in a non-mandatory dmv reporting state could be a hipaa violation
not much you can do except tell patient not to drive and document clearly in your notes and after visit summary

 

[neurolddoc]

My state is a non-reporting state. I tell people with loss of consciousness that it is my obligation to tell them the law and their obligation to follow the law.