Should Doctors Be Responsible for Taking the Car Keys Away From Aging Patients?

Is there a magic age where someone is no longer capable of safely maintaining control behind the wheel? It seems to be a bit of a dubious question when phrased that way and a difficult one to answer. For many aging drivers – especially those living in rural or suburban areas – giving up the car keys is akin to giving up their independence.

But incidents involving elderly drivers are once again making headlines and forcing difficult questions like these to be asked.

Just over a month ago a 100-year-old man backed his car into a crowd of people outside an elementary school in Los Angeles, injuring 12 children and two adults. The accident has caused many to recall a tragic car crash from 2003 when an 86-year-old man killed 10 people and injured another 60 after driving through a street-side farmer’s market.

These accidents are just examples of car accidents involving older drivers, but they do raise the important questions of:

• When should older drivers have their driver’s licenses revoked?
• Who is responsible for taking away the keys: The driver’s family? The state licensing agency? The driver’s doctor?

The latter question is exactly what is at issue in a recent wrongful death case in California. In 2010, an 85-year-old woman drove her car into oncoming traffic, causing a car accident that took the life of her longtime boyfriend. But, it is not the elderly driver who is being sued by the deceased’s family; it’s her doctor.

The victim’s family believes that the woman’s doctor, who had been treating her for dementia for at least two years before the accident, should have taken steps to see that her driver’s license was revoked.

Are Doctors In Arizona Required To Report Medical Concerns To The Motor Vehicle Division (MVD)?

The case above raises questions as to whether doctors have an obligation to report diminished capacity to state licensing agencies and, if so, whether their obligation is supersedes providing confidential care to their patients. What falls within the scope of the doctor-patient relationship?

In 2010, at a National Transportation Safety Board hearing on aging drivers, a doctor who served on the Maryland Motor Vehicle Administration’s medical advisory board testified that in most states it is unclear whether doctors have a responsibility to report concerns about patients and their driving abilities. Dr. Carl Soderstrom noted that many doctors “[H]ave no idea at all whether they have any obligation… about reporting or talking to the DMV.”

In some states, such as California, regulations exist that require doctors to report patients with certain disorders to local health authorities, who then inform the state driver’s licensing agency. In California, doctors must report “disorders characterized by lapses of consciousness,” but what actually constitutes a reportable disorders leaves doctors substantial leeway in choosing whom and what to report.

Lawmakers argued that considerable discretion is needed – not only because doctors can be trusted to use their own clinical judgment based on the specific patient and specific circumstances – but also because stricter reporting regulations may actually deter elderly patients from seeking medical help if they believe their doctor could take away their driving privileges.

In Arizona there is no law that requires doctors must report concerns to the Motor Vehicle Division (MVD) of the Arizona Department of Transportation. In fact, according to Arizona’s state licensing agency, it is the responsibility of the driver to report his or her own medical condition.

Arizona’s self-reporting requirements do not mean, however, that doctors and others cannot voluntarily report concerns if they believe a driver is not fit to drive. The MVD’s website outlines how anyone – a doctor, family member or concerned citizen with direct knowledge – can report concerns about a driver’s ability to safely operate a vehicle. When the MVD receives confidential reports about a driver’s behavior it will contact the driver directly for a medical review.

Is It Medical Malpractice If A Doctor Doesn’t Report Concern About An Elderly Patient’s Ability To Drive?

Arizona law protects physicians who voluntarily report medical concerns about a driver in good faith. Such doctors are exempt from patient confidentiality restrictions and therefore immune from civil or criminal liability for making a report. So, while doctors in Arizona do not have a binding legal obligation to report concerns to the MVD, the question remains whether they are ethically obligated to do so.

Given the aging population (statistics suggest that by 2030, there will be more than 57 million drivers aged 65 or older) and the higher rate of car accidents among older drivers (drivers aged 75 or older have the highest risk of being in a fatal car accident), it is an important question that needs to be addressed.

Perhaps the best solution is for doctors with concerns about whether a patient is capable of driving to administer a few tests that will help gauge a patient’s fitness to remain behind the wheel. The American Medical Association (AMA) has recommended a set of tests that look specifically at a patient’s actual movement, strength and motor coordination. The doctor can then use the results of the tests to start a discussion on whether the aging driver should still be driving. Providing guidance to an elderly patient’s loved ones can also help with delicate conversations that many family members are hesitant to start with their older loved ones about driving safety.

While there is no binding, legal obligation for doctors in Arizona to stop older patients from getting behind the wheel, simple concerns for a patient’s safety may be enough to at least encourage starting a similar discussion with an aging driver.