Denise Thomas, case manager at Medical Protection, shares a recent case relating to a disclosure to the DVLA without patient consent.
Dr A, a GP, telephoned the Medical Protection medicolegal advice line to speak to an expert about a challenging situation.
Mr F had attended a consultation with Dr A to discuss substance misuse and alcohol addiction. Mr F informed Dr A that he consumed over 50 units of alcohol per week and had an addiction to cocaine. Mr F held a driving licence to operate a heavy goods vehicle (HGV), in addition to his category B licence to drive a car. Dr A discussed his concerns with Mr F regarding his health and the importance of reducing his weekly alcohol intake, as well as addressing Mr F’s addiction to cocaine. With his consent, Dr A referred Mr F to the local drug and alcohol service to receive advice and treatment for his addiction issues.
In the meantime, Dr A advised Mr F to stop driving until he had received treatment from the drug and alcohol service and had reduced his alcohol intake and drug use. Dr A also advised the patient to inform the DVLA of his drug and alcohol addiction. Mr F refused, informing Dr A that this would result in his licence being revoked and would affect his livelihood as an HGV driver.
Dr A was unsure what to do in this situation and sought advice from Medical Protection.
Expert advice
Dr A spoke to a case manager who had dealt with a variety of medicolegal queries for a number of years at Medical Protection.
She advised Dr A in accordance with the GMC guidance on Confidentiality: patients' fitness to drive and reporting concerns to the DVLA or DVA.1 This guidance states that although doctors have a duty of confidentiality to a patient, there is a wider duty to protect others from a risk of serious harm. As the DVLA in the UK (the DVA in Northern Ireland) has a legal duty to decide whether an individual is medically fit to drive, they need to know if a person holding a licence has a condition or is undergoing treatment that may affect their safety as a driver.
The case manager further advised Dr A that the patient had a legal duty to inform the DVLA once a medical professional has determined they have a condition that could impair their fitness to drive, after a review of the DVLA’s guidance Assessing fitness to drive – a guide for medical professionals.2If the patient refuses to notify the DVLA, Dr A should inform Mr F that Dr A himself may have an obligation to do so, if he feels others are at risk of death or serious harm.
If Mr F remained dissatisfied, she informed Dr A that he could offer Mr F a second opinion, as long as he agreed not to drive in the meantime. The case manager also advised Dr A that he could offer to have a discussion with friends or family members of Mr F with his consent, if this would be helpful. Due to the impact the disclosure would have on Mr F, she recommended that Dr A seek advice from one of the DVLA’s medical examiners anonymously in the first instance, to confirm that the patient’s condition(s) did indeed meet the threshold for disclosure.
If Mr F still refused to stop driving, either before or after obtaining a second opinion, and if Dr A felt the patient’s ability to drive safely was still impaired and could expose others to a risk of death or serious harm, the case manager advised Dr A that he should make a disclosure of the relevant information to the DVLA in confidence. Before contacting the DVLA to make this disclosure, DT advised Dr A that he should attempt to contact the patient to inform him of his intention to disclose, if this is practicable. Once a disclosure has been made, Dr A should inform the patient in writing. Any decision made to either disclose or not to disclose the information should be clearly documented in the medical records.
If Dr A had concerns that Mr F posed an immediate risk to the public, the case manager advised that Dr A should consider calling the police in order to safeguard the public.
To contact Medical Protection with your own query, please contact our 24/7 helpline on 0800 561 9090.
References
1 Gmc-uk.org. (2019). Patients' fitness to drive and reporting concerns to the DVLA or DVA. [online] Available at: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/confidentiality---patients-fitness-to-drive-and-reporting-concerns-to-the-dvla-or-dva/patients-fitness-to-drive-and-reporting-concerns-to-the-dvla-or-dva [Accessed 6 Aug. 2019].
2 GOV.UK. (2019). Assessing fitness to drive: a guide for medical professionals. [online] Available at: https://www.gov.uk/government/publications/assessing-fitness-to-drive-a-guide-for-medical-professionals [Accessed 6 Aug. 2019].
Published as From the advice line - driving force in our print publication, Practice Matters.