Alexander DeLuca, M.D.
Fessing up to
doctor costs drinker his license -
|by Patrick Kerkstra, Philadelphia Inquirer, 8/6/2004 Originally posted 8/9/2004.. [www.doctordeluca.com/Library/PublicHealth/FessingUpToDocCostsLicense04.htm]|
Like most people, Keith Emerich thought he could tell a doctor anything.
So the 44-year-old print-shop pressman answered honestly when asked during an office visit whether he drank alcohol. Yes, he said, six to 10 Budweisers a day.
That candor cost Emerich, of Lebanon, Pa., his driver's license.
In a strict reading of a Pennsylvania law that requires physicians to report patients with conditions that might "impair the ability to control and safely operate" a vehicle, the doctor notified the Pennsylvania Department of Transportation of Emerich's appetite for brew.
With nothing more to go on than two check marks on a one-page questionnaire, PennDot revoked Emerich's license indefinitely.
Emerich thought it was a joke when the notice arrived in the mail last April Fool's Day. His driving record was pristine since a conviction for driving under the influence 23 years ago, and he said he does not mix drinking and driving.
"What I do in the privacy of my home is none of PennDot's business," said Emerich, who is appealing the agency's decision in Lebanon County Court. A ruling is expected within weeks.
Medical ethicists said the case presents a serious confidentiality issue, and a reason for patients to lie to their doctors about any alcohol and drug use.
They also point out the obvious: It does not necessarily follow that someone who consumes a six-pack a day drives under the influence.
"A man who has sex isn't a danger to drive - unless he's doing it in the car while he's on the road," said Norman Quist, publisher of the Journal of Clinical Ethics, a peer-reviewed quarterly. Taking Emerich's license has "got to be the wackiest application of a principle that I've ever heard of."
Pennsylvania is one of only six states - including New Jersey and Delaware - that require doctors to inform on patients who might be unfit to drive, typically due to such conditions as epilepsy or unstable diabetes. However, Pennsylvania's 28-year-old law goes further than the others by adding alcohol and drug abuse to the must-report list - without defining what constitutes abuse.
To encourage compliance, Pennsylvania guarantees doctors anonymity and immunity from patient lawsuits. If they fail to turn in dangerous drivers, the state is one of three nationwide that hold them liable for accident damages.
All told, each year, about 21,000 Pennsylvanians are reported to PennDot by doctors; 6,000 of them are relieved of their licenses. Last year, 230 were banned from the road because physicians notified the agency of alcohol or drug use.
In New Jersey, so few licenses are revoked for substance abuse that the state does not tally them, and those are taken away only on the recommendation of addiction counselors or police, according to the state Motor Vehicle Commission.
PennDot officials defend their state's tough standards, noting that drivers can get their licenses back if a doctor will vouch that they are fit to drive.
"We don't want to arbitrarily take someone's driving privilege away, but it is a privilege. And we have the authority to recall that privilege," said Joan Nissley, a PennDot spokeswoman. "Someone who has an alcohol or substance-abuse problem that would impair their driving ability would not be someone we want on the roads."
Peter J. Cohen, a doctor and lawyer who teaches substance-abuse law at Georgetown University in Washington, sees "a neat public policy question: Drinking a six-pack at night doesn't necessarily mean you are an alcoholic. But you could be. Everybody knows alcoholics can constitute a driving risk."
Pennsylvania lawmakers, he said, "decided to err on the side of safety."
In 1976, the legislature created the Medical Advisory Board, a volunteer panel of physicians and government officials who decided which conditions warranted the yanking of licenses. The board periodically reviews the guidelines, most recently last month; the alcohol category was again left unchanged.
Although the reporting net doubtless snares some hard-core alcoholics, others contend that their drinking does not meet the standard.
"I'm just a regular Joe Six-pack," Emerich said.
At six feet tall, 250 pounds, he is a big enough man to drink six Buds in two hours and keep his blood-alcohol level within the legal limit of 0.08 percent, by the National Highway Traffic Safety Administration's formula.
At a hearing here on July 29, Emerich testified that he did his drinking exclusively at night and on weekends, and that it had never caused him to pass out or miss a shift at work.
A toxicology report from his February visit to Good Samaritan Hospital showed that he was alcohol-free. Earlier that day, his family physician had detected an irregular heartbeat. That doctor, as well as those who subsequently examined Emerich at the hospital, advised him to cut back on beer for his heart's sake.
No one, he testified, suggested that he was not fit to drive or needed alcohol counseling.
PennDot, Emerich and his lawyer have not disclosed the names of the doctors involved. And the court records are sealed to protect the identity of the one who reported Emerich.
The one-page form had no written comments. There was a check at alcohol abuse, and one at yes in response to the question: "Do these conditions affect the patient's ability, from a medical standpoint only, to safely operate a motor vehicle?"
Edmund G. Howe calls it "a crapshoot."
"What one doc considers abuse might not seem as severe to another doc," said the editor-in-chief of the Journal of Clinical Ethics and a psychiatry professor at the Uniformed Services University at Bethesda, the U.S. military's medical school.
"I tend to think docs can't do two jobs and do them both well," Howe said. "They can't be adjuncts to the police force and at the same time form trusting relationships with patients."
Groups such as the American Medical Association have struggled to find the balance between public safety and patient confidentiality. The AMA advises doctors to report only drivers whose impairment poses "a clear risk to public safety" and to first discuss it with them.
Mothers Against Drunk Driving has not taken a position on mandatory reporting. The group's Pennsylvania treasurer, Nancy Oppedal, said there is merit in revoking licenses of diagnosed alcoholics, even if they do not have DUI convictions.
For Emerich, who is single and lives alone, four months without a car have had an impact. At the hearing, he said his Bud habit was all but gone, reduced to a six-pack a week, tops.
"I'm not saying that just to get my license back," he said afterward. "It's for my health."
Emerich hopes the judge returns his license. But if not, he said, he will install an ignition interlock (which requires a breath screening before operating the car), enter treatment, or do whatever else it takes to get back behind the wheel.
"It's a crazy law," he said. "But I can't have my dad drive me around forever."