DECEMBER 5, 2016 VOLUME 23 NUMBER 45
You might have wondered about this from time to time -- we have, too. If a patient really shouldn't be driving, is his or her doctor really able to write to the Motor Vehicle Division to report the patient's condition? Wouldn't that be a violation of the patient's privacy rights?
A recent California case says no -- the doctor is not liable for any breach of privacy, at least not under California law. The facts of that case are interesting, and instructive.
Mitch McIntyre (not his real name) was trying to establish that he was disabled, so that he could qualify for Social Security Disability payments. He visited several physicians over an almost ten-year period, but his primary care physician was Dr. Ann Kim. His diagnoses included diabetes and unspecified cognitive deficits.
During one office appointment, Mitch told Dr. Kim that he needed to renew his commercial driver's license. He told her that he had applied to drive a school bus, and asked if she would "sign off" on his medical certification.
Over previous years, while he was working as a bus driver, Mitch had complained to Dr. Kim and other physicians that he didn't want to "babysit" his passengers. He had confessed to his physicians that he didn't always follow the routes specified by his employer -- he preferred his own routes. On one occasion, he acknowledged, he had taken a group of children from San Diego, California, to Tijuana, Mexico -- though that was not their actual destination.
But when Mitch told Dr. Kim that he was about to start driving school buses, that was too much for her. She called Mitch, told him that she wouldn't be signing his medical certification form, and added that, in fact, she was considering sending a letter to alert the California DMV to her concerns about his impulsivity and poor judgment. Mitch told her that he did not want her communicating with the DMV at all, and that he did not agree with her reporting her concerns.
Dr. Kim thought about her dilemma for several weeks, and then wrote a letter to DMV. Her letter reported that Mitch "is functionally illiterate, lacks the capacity to set limits on himself and fails to understand the consequences of his behavior." She added that Mitch's problems appear to be "the result of mild congenital or developmental brain damage that has not only affected his cognitive skills but more importantly has impaired his judgment, impulse control, insight, forethought and ability to introspect."
Mitch's commercial and regular driver's licenses were suspended almost immediately after the DMV received Dr. Kim's letter. His employment was suspended, and he was ordered to get his licenses reinstated if he wanted to continue to drive buses. He managed to get his regular license restored quickly, but it took him three months to get his commercial license reinstated -- though he did manage to do so. Because he failed to meet his employer's deadline, however, he lost his bus-driving job.
Mitch then sued Dr. Kim and her employer, alleging that she had violated state privacy laws and the federal HIPAA (Health Insurance Portability and Accountability Act) law by disclosing his medical information to DMV. The defendants moved to dismiss Mitch's complaint, arguing that they were permitted to give such information to the Department of Motor Vehicles. While the trial court did not immediately dismiss, it ultimately threw out Mitch's case after he had put on evidence at his trial; the defendants were not even required to put on any case.
Mitch appealed to the California Court of Appeals, which affirmed the trial judge's dismissal. Applying California's version of the privacy laws, the appellate judges ruled that Dr. Kim's disclosure was specifically authorized to report her concerns about Mitch's ability to drive. According to the appellate court, California has a policy of encouraging people (including but not limited to physicians) to report the possibility of unsafe driving -- and that supported Dr. Kim's authority to disclose medical information for the limited purpose of calling Mitch's ability to drive into question. McNair v. City and County of San Francisco, November 22, 2016.
Mitch and Dr. Kim, of course, were operating under California's state law -- and the national HIPAA rules. As the court acknowledged in its opinion, HIPAA does not give Mitch (or any other individual) any right to bring a breach-of-confidentiality suit against a medical provider. That means that state law will be the most important consideration in addressing similar claims.
Arizona has law that seems like it would resolve a dispute similar to Mitch's (if it had been subject to Arizona law, that is). Arizona Revised Statutes section 28-3005 spells out that:
Notwithstanding the physician-patient, nurse-patient or psychologist-client confidentiality relationship, a physician, registered nurse practitioner or psychologist may voluntarily report a patient to the department who has a medical or psychological condition that in the opinion of the physician, registered nurse practitioner or psychologist could significantly impair the person's ability to safely operate a motor vehicle.
In fact, the Arizona Motor Vehicle Division has a web page devoted to the forms and procedures for physicians -- and any regular citizens -- to report unsafe drivers or concerns about anyone's ability to drive. Physicians are encouraged to use the form on the MVD website; other concerned citizens can download a form to make their own reports, as well.