A dilemma
 

So I caught this guy through the ER. Diabetic, younger than me, drove an RV from Florida to the West coast. Had planned to fly back, but when he went to the airport, they would not let him on the plane. He was out of his head with overwhelming infection, blood sugar of 650 in full on ketoacidosis. That is where your blood has so much sugar in it, it starts forming ketones. Your body does not have a good way to get rid of ketones, so they get out through your lungs. This makes your breath smell like nail polish remover, close enough to booze to make you seem drunk. His vision is poor enough that he had to have the consent for surgery read to him.

This was on Christmas. He still has both legs and is alive, supposed to go home tomorrow. Thing is, he almost certainly went directly to the airport after he dropped off the RV, and was too sick to ride on a plane. He had to have been out of his head driving the RV for a while, days maybe.

My dilemma: Do I send a letter to the Florida DMV and tell them about this guy?

Is there a peer review group you could share this with other ER docs/ medical professionals and get feedback there?

The FL DMV could care less about this. Nothing will be done.

HIPA ramifications? Only asking cuz I don’t know.

Tell them what exactly?

That he shouldn't have been driving then or that he shouldn't be driving now?

Is there any way to prove definitively that he was in an impaired condition while behind the wheel in FL?

Legit question because I have no idea how rapidly the condition progresses.

Incorrect. Tobra is a health care professional and has an ethical responsibility to report it to the appropriate governing body if the individual’s health can harm others.

Example, an ophthalmologist or optometrist, the primary care provider must submit a report to DMV with concerns regarding visual impairments that do not meet the acuity threshold and field standards. In other words, if you can’t see, they are supposed to report you, or could face disciplinary action.

Someone with a blood sugar level of 650 is going to be very dangerous behind the wheel.

Tobra’s professional society likely has ethical standards which require him to report it, no doubt he already knows that. I’m sure he is encouraging a debate in medical ethics.

The American Medical Association’s Code of Medical Ethics explicitly acknowledges that physicians have a responsibility “to recognize impairments in patients’ driving ability that pose a strong threat to public safety and which ultimately may need to be reported to the Department of Motor Vehicles”

I say do what you feel is the right thing to do.

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Frankly, I have no idea what your ethical or legal responsibilities are, but your hospital will have a staff attorney who does. You absolutely should find out who is responsible for advising your group and get their advice.

This hits close to home for me right now.

The Tobra Man!

I don't see how you could not report this. But as you already know that doesn't mean anything will be done about it however at the very least it will be on the record.

I'd report it. Won't he be the coroner's problem soon at that level? Sorry to be crass but I'm a type 1 diabetic. Taking insulin a few times a day isn't that hard.

I wrote the letter before I posted this. I don't think sending it to the other doctor is really adequate, even if I thought they would respond appropriately. As stated above, there is no question what to do. This is something a lot of folks who frequent this place will have to confront eventually, for themselves or a family member. When is it time to lose the car keys?

Paul, I think the Florida DMV will do something, but it will probably be pretty ineffectual.

My best friend had this from her Diabetes. She went COMPLETELY INSANE and was institutionalized.

I VOTE YES.

Yes you should report this- but who do you report it to?
Florida DMV. They can't do anything until he gets back to Florida. Heck, even if they revoke his license tomorrow- he is still going to drive home.
I think you also need to report this to the local authorities. I would hate to see him injure himself or someone else on his drive home.
Ethics can be a *****.
gary

I had to deal with this and my now 85 year old mother a few years ago. It was time when I knew I couldn't live with the guilt when she mowed down a kid in a crosswalk or got lost on a 20 degree day and froze to death. She has pretty advanced dementia now but we took the keys away before it was really bad. She still *****es about it 4 years later.

I have seen cases that bartenders are held accountable when they let an intoxicated individual drive home- and something bad happens.
Could physicians be held to the same standards?
gary

As a doctor don't you have a responsibility to inform the DMV?

Not long before my mother's passing, she lived with me. She was in what I believe the early stages of dimension or Alzheimer's. It was bad enough I removed the stove from her apartment before I brough her to my house.

One day I came out of my house to find her car parked on the sidewalk. I wanted to take her driver's license but didn't want to be the bad guy, so I took her to her physician. In private I explained to the physician what was going on. Physician ran a few tests and revoked her driving privileges on the spot.

Even if FLDMV does nothing you fulfilled your obligation to society. It's the right thing to do.

This looks like a good answer to me, Tob.

I think you have to get your attorney there involved.

Of course, document everything.

I would think your patient's family and/or friend(s) would be of some help too, but of course your patient would have to be supportive of that effort.

Seems like he just needs to get healthy again and get a plane ride home and after that it's up to his support system there to help.

PS - I voted for the 3rd option.....