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A hospice patient intends to drive while taking pain meds and a benzodiazepine. Am I liable under any circumstance for his actions, and how can I protect myself?
| Response from Carolyn Buppert, MSN, JD
Healthcare attorney, Boulder, Colorado
My Hospice Patient Wants to Drive, On Meds
What can a health professional do to protect against a lawsuit for negligence if a patient has a motor vehicle accident, injuring himself or others, while being given hospice medications and driving against medical advice? Here is the situation: A hospice patient regularly takes low doses of liquid lorazepam, 0.25 mg every 6 hours, as well as occasional 3.0-mg doses of morphine instant-release. He is on 3 L of continuous oxygen for his chronic obstructive pulmonary disease. He insists on driving his car and does so frequently.
Fitness to drive can be affected by many conditions -- poor vision or hearing, sleep deprivation, emotional upset, distractions such as texting or talking on a mobile phone -- as well as medications. Many clinicians are concerned about balancing the risk for accidents against the patient's freedom to drive.
At minimum, the clinician would need to inform the patient of the risk of driving while impaired, if the patient is impaired. Some patients on long-term medication for chronic pain are impaired, but that is not necessarily a given. To engage the patient in the discussion, it could be useful to help the patient take a test that would monitor his reaction time several hours after taking a dose of lorazepam, with or without the morphine. One such test is available online. No matter what a test of reaction time shows, the health professional still should inform the patient of the potential risk for driving impairment and should document the advice given.
If the work setting is an office or facility where the patient is being given a one-time dose of a medication that could impair reaction time, vision, or alertness (such as sedation for a procedure performed that day), then, in addition to a discussion about the risks associated with driving, the practice or facility should have a policy that requires patients to have someone else drive them home.
If, in the clinician's opinion, the patient is an imminent threat to self and others, and the patient insists on driving, then the professional has a responsibility to communicate the specifics to someone in a position to do something. This could be a relative, caretaker, the Department of Motor Vehicles, or the police. There is a HIPAA exception for such a communication.
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Cite this: Am I Liable for the Actions of an Impaired Patient? - Medscape - Oct 16, 2013.