In
the United States of America, only the states of California, Delaware, Nevada,
New Jersey, Oregon, and Pennsylvania require physicians by law to report
persons with epilepsy. California mandates physicians report such patients to
the state health authorities. The health department then reports such persons
to the Department of Motor Vehicles (DMV). The DMV obtains information on the
person’s medical condition from the patient and from the physician. The DMV
decides if the license is revoked for a period of observation. If the person
remains seizure-free due to effective medications or because the epilepsy has
become inactive for 6-24 months the driving privilege can be reinstated. The
DMV makes this decision―not the physician!
If
the driving privilege is reinstated but then another seizure occurs it’s the
responsibility of the patient AND of
the physician to report this to the DMV for re-evaluation.
In
the 44 American states that do not have a mandatory physician-reporting law,
it’s up to the patient to voluntarily stop driving and to report to the DMV.
Emotional constraints and ethical challenges are rife: who wants to stop
driving if their livelihood depends on it and especially if there is a paucity
of public transportation in their area? Some of my own patients challenged me:
“Don’t send that report in, Doc. Are you going to pay my mortgage if I can’t
work at my driving job?
EPILEPSY ACTION, a website in the United Kingdom (England,
Scotland, Wales and Northern Ireland), advises people who have had a seizure of
any kind to stop driving and report their seizure-condition to the driving
agency. 1 In the UK, unlike in the United States, reporting is not
necessary “on the understanding if the seizures are nocturnal, i.e., the
seizures occur only during sleep. In nocturnal-type seizures in the United
States physicians in those six mandatory-reporting states still must report. But,
physicians may support driving for these people by stressing that their
seizures occur only during sleep and not while driving―nocturnal
epilepsy. Sleep lowers the
resistance on seizures in people with epilepsy.
If
one continues to drive in the UK they are breaking the law; significant financial
fines can be levied. Car insurance is unlikely to cover the person.
Personal
responsibility, ethical behavior and common sense are challenged; abiding by
the law often is abandoned as a part of our common humanity.
My
recent blog # 92 on this LanceFogan.com website
(Citizens Influence New York State Law:Driving with Epilepsy, March 26,
2018) reviews how a deadly driving accident occurred
during an apparent seizure in Brooklyn, NY in March, 2018. It led to a
mandatory physician-reporting law being introduced in the New York State
Legislature. If passed, New York would be the seventh American state making
mandatory physician reporting of epilepsy. More lives then could be protected.
1.
Epilepsy Action is a UK based charity providing
information, advice and support for people with epilepsy. The organisation was
founded in 1950 as the British Epilepsy Association and adopted Epilepsy Action
as its working name in 2002. Epilepsyaction.org.
