The Elderly: Owning a car/counseling not to drive

[Scanner]

Hello. . .long time no see. I have been busy. I hope everyone here is doing well.

I recently had an unfortunate incident where an elderly patient (I am a chiropractor) struck and killed someone on a motorcycle and severely injuring his son on the other motorcycle. He was scheduled to be discharged on the day after the accident and luckily, from my standpoint, he was at maximum medical improvement under my care. However, I was worried from the get-go he was driving and I am seeing more and more geriatric patients as the populace ages and primary care is stretched thin.

So. . .a call to my malpractice carrier as a prevention and a couple days later, I am reading through a 246 document from the AMA on assessing and counseling the elderly driver and sifting through my State law (NJ) about my obligation(s), if any.

Anyway, one of the sections in there advises, when you do have to make a recommendation to not drive, based on all of the medications, pre-existing medical conditions, and examination findings is to "sell the patient the economic benefits" of giving up a car and then said there are websites you can refer them to.

I immediately thought of you guys and how you all scrutinize matters like this.

Are you aware of any simple, easy to read websites that explore "real costs" and hidden costs (ie: getting your butt sued, extra visits to the chiropractor) of owning a car?

I have a clean malpractice history for 15 years but this one shook me up enough to make my first call to my carrier.

DisneySteve, you are family medicine. . .your input is appreciated.

[LivingAlmostLarge]

It's called vehicular manslaughter and the old guy should be charged and on his record for life. Perhaps no jail time, but he should be made and example of and put in the papers.

How he can still drive while knowing he killed someone is beyond me. How his family can allow him to drive knowing he killed someone is beyond me. But I guess people have no personal responsibility at all even the elderly. Thought it was our "children" who didn't have it and aren't learning it. Turns out they can't learn it if the elderly don't have it either.

[EEinNJ]

This is one of those touchy questions that is much more complicated than money. Unless they're already hurting financially, an elderly person is not going to give up driving merely to save money. Driving means being self-reliant, independent, and not isolated. It means being able to go to the store, the doctor, visit friends and family. Usually there's a health issue or enough of a fender-bender that forces the issue. This sad story should be a real wake-up call.

[snafu]

Sad story for all those impacted. In our area seniors are required to have a form completed by their primary care physician and take driving tests every two years to renew their license. It's expensive but it assures some level of safety for the senior. A few weeks ago a middle aged woman suffered a heart attack while driving and her car landed inside a building. We survived and only one person in the room where the car halted had minor cuts and scrapes from shattering glass. You can be sitting at your desk and be struck by a car...who'd of thunk it

[Scanner]

LL,

Well, as I sift through the law, I realize there is an obligation on any doctor's part, if there is a suspected impairment to report him to DMV, who then initiates a letter to the licensee. But usually the physician will let the patient know he is notifying DMV, who then assigns the case to a medical advisory panel who renders a decision. Of course, the patient is going to be upset for reasons mentioned by EEinNJ.

At this point, he did not show for his visit today (understandably - this was yesterday this happened). I am not sure what my obligation is since I read about this in the newspaper and whether he has already self-restricted himself or not.

I am immune to a certain extent if I report him (and I am wrong) but now the damage has been done and don't think I don't feel bad about this. This could bite me in the butt, let alone I am sure an attorney would not let me ever take the stand because I tend to be the type with a guilty conscience. ("just sit there and look innocent, Scanner", lol). I would confess to the whole thing; I have that type of personality.

Whether I could make a call and tell them I became aware of an auto accident through the newspaper and tell them my findings, I am not sure.

Believe it or not, this is an emerging area of law for chiropractors as we gain more primary care responsibilities. I was planning to become DOT certified next month for examining truck drivers. The standards are more clear there vs. elderly and universal across the board and truckers do tend to doc-hop.

This is a complex subject, LL. . .it's not as simple as the Conservative vs. Liberal, responsibility/non-responsibility argument. It WAS motorcycles. . .and I have had near collisions with them that have scared the bajeezus out of me. . .so I don't really KNOW if it's his age. But he is frail. I was wondering why he was still driving.

I guess that's why the medical advisory panel decides.

I was hoping I could just talk to him today but he didn't show. Thanks anyway. I am not sure if he's been charged with a crime -in this or not. He did have "patchy primary care" next door (doctor left, not sure if new doc had assessed him) and thus the problem - doctors assuming the other doc had addressed the issue and no record access/communication.

[Scanner]

Within my scope of practice/area of expertise, BTW, I saw no reason he couldn't drive. Just on general examination, he seemed well, "frail" - he shuffled in his gait a bit, flexed posture, slow reflexes, bladder urgency - just "old" for lack of a scientific term. He could turn his neck both ways, even if his ROM was limited a bit.

I wasn't sure if DWE (Driving While Elderly) is a crime, even if it's not a good idea.

My father self-restricts himself to day time driving. Never had an accident in 76 years of life.

Sorry if this has drifted off topic, moderators.

Maybe I am just justifying, not sure.

[disneysteve]

an elderly person is not going to give up driving merely to save money.

I agree. Nobody is going to surrender his keys because it'll save him money. It has to be all about safety, and even then it is very, very difficult to get anyone to agree that it is time for them to stop driving.

I have enlisted the help of the patient's eye doctor, since there is a legal guideline for vision to drive. I have also referred patients to the local hospital that has a driving assessment program. If I can document a concrete reason why it isn't safe or legal for a person to drive, it is at least a bit easier than just telling them, "you should stop because I don't think it is safe."

I was planning to become DOT certified next month for examining truck drivers. The standards are more clear there vs. elderly and universal across the board and truckers do tend to doc-hop.

My partner and I are probably taking the certification course in September. We already do DOT/CDL physicals so we want to get certified and maintain that business. We're hopeful that a lot of docs won't bother getting certified and that will drive more business our way.

[Joan.of.the.Arch]

Keep in mind that newspapers don't always get the stories exactly right. It is possible your patient was not at fault despite any of his physical short-comings.