EDITORIAL

The Physician's Responsibility for Epileptic Drivers Richard L. Masland, M D

In ten states (California, Connecticut, Delaware, Illinois, Indiana, Montana, Nevada, New Jersey, New Mexico, and Oregon), physicians are required by law to report to the department of motor vehicles the names of patients with epilepsy. In some states this requirement is specific for epilepsy. In others it refers to any condition associated with recurrent lapses of consciousness. Physicians have been held legally and financially responsible for accidents caused by patients whom they failed to report [51. The rationale for this legislation is obvious. The automobile is a dangerous piece of equipment, requiring uninterrupted control. There are many proved instances in which an epileptic driver has caused a fatal accident. The accident rate of known epileptic drivers is almost twice that of the general population 181 (Table). Most important, there are repeated surveys to document that because of the S O cial, psychological, and economic pressures involved, persons with epilepsy do not report their illness. A very large proportion are driving illegally [4, 6, 71. The physician is the only person in a position to know who has epilepsy. The precedent for the reporting of illness in order to protect the health of others is now esrablished in the parallel instance of infectious disease. However, close inspection reveals that the situation is not so simple. Although there are many instances of fatal accidents caused by epilepsy, they represent a small fraction of the total toll (estimates range from 0.1 to 1.2% of all accidents [3]). If one really wishes to reduce the horrible toll of death on the highways, other, far more direct and profitable measures could be taken.' Although the accident record for epileptic drivers T h e Commission for the Conuol of Epilepsy and Its Consequences [I] estimates that highway deaths in the United States (approximately 46,000 per year) could be reduced by 28,000 through four readily applicable measures: (1) enforcement of 5 5 mph speed limits; (2) mandatory crash helmets for motorcyclists; (3) mandatory seat belts or other passenger restraints for automobiles; and (4) suict control of drunken driving.

is in general elevated, the degree of personal responsibility of the individual is a more important determinant of driving performance than is whether or not he has epilepsy. In fact, epileptic women drivers have fewer accidents than do nonepileptic men [2] (Figure). Thus, the data scarcely support the need for drastic social action and discrimination. At issue, then, is the extent to which a physician's ability to serve as a physician is destroyed by the requirement that he serve as a policeman. The mandatory reporting laws represent a serious infringement on the right of the individual to privacy in personal affairs. Because of unwillingness to be reported, the patient may deny himself the treatment he needs to make it safe for him to drive. Data regarding the efficacy of mandatory reporting laws are conflicting. In California, which has a mandatory reporting law, it has been estimated that about threequarters of the epileptic patients of driving age are known to the Department of Motor Vehicles. Of those known, 32% had reported themselves, but 45% had been reported by a physician 181. Only 10% were reported by private physicians, the rest by emergency room and clinic physicians. O n the other hand, in New Mexico, only 290 of an estimated 2,000 epileptic persons of driving age have been reported. Clearly, in that state, physicians have been

Accident Rates of Driueivers with Medical Conditions

Accidents per Million Miles Disease

Rated

Controle

Epilepsy Diabetes Cerebrovascular disease

16.0

15.5 14.6

8.2 8.7 9.0

.Nonepileptic drivers matched for age. Source: From Waller [ B ] . Reprinted, by permission, from the New England Journal of Medicine 2 73 : 14 13, 1965.

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From the Department ofNeurology, Columbia University College of Physicians and Surgeons, and the Neurological Institute, New York, NY.

Address reprint requests to Dr Masland, 118 E Hamilton Ave, Englewood, NJ 07631.

0364-5134/78/0004-0601$01,25 @ 1978 by Richard L. Masland 485

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ment. The patient should be notified in writing, and the notification should be recorded in the patient's record in order for the physician to be relieved of any responsibility should an accident occur. There are data to indicate that physicians are currently being negligent of their duty to advise their patients about driving restrictions 161. Possibly the best guarantee against further efforts to force the physician into the role of informer will derive from greater efforts on his part to educate his patients regarding their obligations to protect the lives of others.

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Comparison of accidnt nates by age and sexfar all licensed Wclshingtondrivers andfor drivers with an epilepsy license resttiction. (Prom Plan for a Nationwide Action on Epilepsy

[ I 1.)

either neglectful of or resistant to their obligation under the law. The Commissioo for the Control of Epilepsy and Its Consequences [l] suggests an alternative solution based on the thesis that the primary responsibility for reporting must reside with the afflicted individual, but that this individual needs to be informed of his responsibilities. The Commission recommends that physicians should be required to notify all patients subject to lapses of consciousness of their obligation to report themselves to the motor vehicle depart-

References 1. The Commission for the Control of Epilepsy and Its Conse-

quences: Plan for a Nationwide Action on Epilepsy. DHEW Publication No. (NIH) 78-312, 1978 2. Crancer A Jr, McMurray L Accident and violation rates of Washington's medically restricted drivers. JAMA 205:75-78, 1968 3. Herner B, Smedby B, et al: Sudden illness as a cause of motor vehicle accidents. Br J Ind Med 23:37-41, 1966 4. Maxwell RDH, Leyshon GE Epilepsy and driving. Br Med J 3:12-13, 1971 5. The MccoOey Case (editorial). Bull Acad Med NJ 1017,1964 6. Quqlieri CE: Physician's responsibility for epileptic's compliance with motor vehicle laws. Legal Med 5:8aa-8bb, 1977 7. Van der L u g PJM:Epilepsy and traffic accidents. Epilepsia 16~747-751, 1975 8. W d e r JA: Chronic medical conditions and tr&c safety. N E d J Med 273:1413-1419, 1965

486 Annals of Neurology Vol 4 No 6 December 1978

The physician's responsibility for epileptic drivers.

EDITORIAL The Physician's Responsibility for Epileptic Drivers Richard L. Masland, M D In ten states (California, Connecticut, Delaware, Illinois, I...
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