Filling-out forms is a necessary part of the practice of medicine, and failure to perform this seemingly secretarial task may lead to dire consequences. I was retained as an emergency medicine consultant in a case involving a Type-1 diabetic who preferred to keep himself in “tight control” resulting in his blood sugar rarely going very high but also resulting in his suffering recurrent episodes of hypoglycemia associated with lapses of consciousness. In California, when a patient presents to an Emergency Department (ED) after having suffered a lapse of consciousness, that event must be reported to the County Health Department via a form. That information will then be forwarded to the DMV by the Heath Department.
Specifically, California Health & Safety Code §103900 requires that a report be immediately submitted to the local health officer, in written form, of every patient 14-years of age or older, who is “…diagnosed as having a case of a disorder characterized by lapses of consciousness.” California Code of Regulations Currentness (CCR) §2806 defines Disorders Characterized by Lapses of Consciousness to be conditions that involve:
- A Loss of consciousness or a marked reduction of alertness or responsiveness to external stimuli; and
- The inability to perform one or more activities of daily living; and
- The impairment of the sensory motor functions used to operate a motor vehicle.
Examples of medical conditions that do not always, but can, progress to the level of functional severity described above include: Alzheimer’s disease and related disorders, seizure disorders, brain tumors, narcolepsy, sleep apnea, and abnormal metabolic states including hypo- and hyperglycemia associated with diabetes. Note that the patient need not have suffered a loss of consciousness, as with a seizure, but only a lapse of consciousness, which would have caused an altered mental state sufficient to render that person incapable of safely operating a motor vehicle.
Regarding the case in which I was involved, the diabetic individual had a hypoglycemic event followed by a brief seizure, was taken to an ED, and the emergency physician filled-out the requisite form. However, the patient’s primary care physician wrote a letter to the DMV stating that the problem had been dealt with and that the patient was now safe to drive; so, the DMV did not suspend his license. Two months later, the diabetic had another hypoglycemic episode characterized by a severely altered level of consciousness (“lapse” of consciousness) but not a complete loss of consciousness. He was, again, taken to an ED, but the emergency physician on this occasion felt that he did not have a duty to fill-out the requisite form because the patient had not demonstrated a complete loss of consciousness. The DMV was not made aware of the event, and no restriction of driving privileges ensued. 18 months later, the diabetic had a hypoglycemic event while driving, crossed the road, crashed into another vehicle head-on, and caused a severe traumatic brain injury to the young woman driving that other vehicle.
The difference between “lapse” and “loss” may seem like esoteric semantics, but it is not. For want of the understanding of the meaning of the law, a form was not filled-out. For want of that form, a person continued to drive who should not have been driving. The result was a tragic event that ruined a young woman’s life. The case settled for almost 9 million dollars, and the emergency physician who failed to fill-out the form and send it to the County Health Department was assessed his share of that total.