Extra case 2. 22 year old male university student admitted to hospital PC: prolonged grand mal seizure HPC Longstanding epilepsy well-controlled.

EPILEPSY, DRIVING AND CONFIDENTIALITY

Extra case 2

Presentation

22 year old male university student admitted to hospital

PC: prolonged grand mal seizure HPC Longstanding epilepsy well-controlled

for past 5 years (no seizures) No identifiable reason for this seizure Neurology review: recommends change in

anti-epileptic drug Rx; should not drive for > 3 months (until medication stabilises)

A few weeks later

Mother contacts GP son has started driving again

Makes appointment for her son to discuss situation with GP later that day

Discuss possible causes of Josh’s grand mal seizure

Epilepsy aberrant neuronal activity Can be genetic (eg. defective ion channel genes)

Brain repair following trauma/stroke Drugs/alcohol (including withdrawal) Dehydration Metabolic disorders (hypoglycaemia, hypoxia,

liver/kidney) Infection (eg. meningitis) Psychogenic seizure Tumour Syncope (but unlikely)

What are the guidelines in Queensland regarding

fitness to drive for people who have epilepsy?

Why may Josh continue to drive despite advice not to

do so?

Public safety Vs right to privacy

In relation to public safety there is, on the one hand, the community's right to be protected from persons driving on a public road who suffer from designated medical conditions such as epilepsy, to themselves, their passengers and all other users of the roadway.

On the other hand there is the patient's right to privacy but perhaps more importantly, the real likelihood that if a doctor is mandated to report then any patient may choose not to consult a doctor at all for fear of losing their driver's licence, thus posing, in my view, a greater risk or danger to not only themselves but their fellow passengers and to all other road users.

Why does a patient have a right to privacy

Part of a doctor’s duty of care to their patients is to maintain confidentiality.

If there is a breach of confidentiality and the patient can prove damages then the doctor can be sued for negligence.

The question then is: can a doctor be sued for negligence for losses incurred by a patient because they informed the transport department that their patient is unfit to drive?

What are Dr Smith’s ethical and legal

obligations regarding Josh’s driving?

Comment on Dr Smith’s obligation to respect

patient confidentiality.

Are doctors required to report patients who are medically unfit to drive?

Health professionals in Qld are not compelled to report medically unfit drivers to the department.

Reporting, however, is mandatory in NT and SA

Can a health professional be sued for a breach of

confidentiality? Health professionals are afforded

protection from liability for providing information in good faith about a person's medical fitness to hold, or continue to hold, a Queensland driver licence.

Jet’s Law

On the 1st of March 2006 and named "Jet's Law" in recognition of Jet Rowland, a little 22 month old boy who was killed in 2004 when a driver with epilepsy crashed into the car in which he was a passenger.

Under the relevant law, Queensland driver licence holders must promptly report to the Department of Transport and Main Roads any mental or physical incapacity (a medical Condition) that is likely to adversely affect their ability to drive.

History

Has ever been found unfit to drive a motor vehicle in the past, and the reasons;

Whether there is any history of epilepsy, syncope or other conditions of impaired consciousness including sleep disorders; neurological conditions; psychiatric disorders; problems arising from alcohol and/or drugs; diabetes;

hypertension and other cardiovascular conditions, especially ischaemic heart disease; locomotor disorders;

hearing or visual problems; Whether the person has a history of motor vehicle incidents; Whether they are taking medications which might affect driving

ability; The existence of other medical conditions which, when

combined, might exacerbate any road safety risks The nature of their current driving patterns and needs, for

example, how frequently they drive, for what purposes, over what distances, whether they travel at night, etc.

Perform and examination

Examination

Cardiovascular Lung sounds Liver size Neurological (Upper & lower limbs, vision

and hearing) Neuropsychological assessment (do an

MMS if indicated) Urinalysis (protein, glucose)

Doctor determines the patient is unfit to drive...

What do you tell the patient? Initial or isolated seizure (not necessarily a

diagnosis of epilepsy) – 6 months seizure free period before driving again

Recurrent seizure following seizure free period With precipitating cause (sleep deprivation or other

temporary illness) – 1 month Unknown cause – 3 months

Anticonvulsant withdrawal trial under consultant supervision – 3 months following completion of withdrawal

“Safe seizures” – those that occur at specific times of the day (eg upon waking) – a restricted licence can be applied for

If epilepsy has been diagnosed

New diagnosis – 6 months seizure free but can be reduced to 3 months if recommended fit to drive by an experienced consultant neurologist

History of uncontrolled seizures – 2 years seizure free

Seizures only whilst asleep – 12 months daytime seizure free period

Following surgery to prevent seizures – 12 months