Pennsylvania Requires Docs to Report Patient Drinking

Medical ethicists say that a Pennsylvania law requiring doctors to report patients who drink to the state Department of Transportation (PennDot) breaches physician-patient confidentiality, the Philadelphia Inquirer reported Aug. 8.

Pennsylvania is one of six states with a law that requires physicians to report patients with conditions that could "impair the ability to control and safely operate" a vehicle. But Pennsylvania law goes one step further by including alcohol and drug misuse without defining "misuse."

For example, Keith Emerich, 44, of Lebanon County, told his physician that he drank six to 10 beers a day. A few days later, the print-shop pressman received notification that his driver's license would be revoked indefinitely.

"What I do in the privacy of my home is none of PennDot's business," said Emerich, who is appealing the agency's decision.

Medical ethicists said the law gives patients a reason to lie to their doctors about alcohol and other drug use. The law also assumes that a person would drive while 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 a driver's license has got to be the wackiest application of a principle that I've ever heard of."

Under the program, doctors are guaranteed anonymity and immunity from patient lawsuits. Physicians who fail to report patients who misuse alcohol and other drugs, on the other hand, could be held liable.

According to state statistics, doctors report about 21,000 Pennsylvanians to PennDot each year. Of that number, 6,000 have had their driver's licenses revoked. Last year, 230 licenses were revoked because of alcohol or other drug use.

PennDot officials defend the law. "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."

But Edmund Howe, editor-in-chief of the Journal of Clinical Ethics and a psychiatry professor at the Uniformed Services University at Bethesda, Md., the U.S. military's medical school, calls the law "a crapshoot."

"What one doc considers abuse might not seem as severe to another doc," said Howe. "I tend to think docs can't do two jobs and do them both well. They can't be adjuncts to the police force and at the same time form trusting relationships with patients."

The American Medical Association advises doctors to only report patients whose impairment poses "a clear risk to public safety" and to discuss the case with them first.