title: Legal ramifications for physicians of patients who drive with hepatic encephalopathy.
abstract: OBJECTIVE
  Hepatic encephalopathy, a spectrum of neuropsychiatric abnormalities that can occur in patients with liver dysfunction, negatively affects driving performance, but no study has examined legal ramifications. We studied state requirements for reporting hepatic encephalopathy and investigated whether lawsuits have been completed against physicians or patients for motor vehicle accidents that were related to hepatic encephalopathy.
  
  
  METHODS
  We contacted motor vehicle departments from all 50 states and examined motor vehicle codes and legal databases to search for hepatic encephalopathy-related lawsuits.
  
  
  RESULTS
  Definitions of a medically impaired driver varied considerably. No state specifically mentioned hepatic encephalopathy or patients with advanced liver disease. Only 6 (12%) of the states had mandatory reporting laws for drivers who have medical impairment, and 25 of the remaining 44 states (57%) provided legal immunity to physicians for reporting such patients. The legal databases did not contain any cases against physicians for failure to warn against driving or diagnose hepatic encephalopathy that resulted in an accident. There were no lawsuits identified against an encephalopathic patient for causing a motor vehicle accident.
  
  
  CONCLUSIONS
  Only 6 states require physicians to report drivers with medical impairments. Hepatic encephalopathy is not specifically addressed in any state vehicle code. There are no completed lawsuits against physicians or patients for motor vehicle accidents associated with driving impairment from hepatic encephalopathy. In the absence of definitive laws, the onus of responsibility for identifying potentially hazardous drivers might still lie with the physician; physicians should carefully evaluate patients for driving abilities.
authors: Section of Hepatology, Loyola University Medical Center, Maywood, Illinois 60153, USA. stcohen@lumc.edu
authors: Stanley Martin
authors: SM
authors: Cohen
authors: Abraham
authors: A
authors: Kim
authors: Maria
authors: M
authors: Metropulos
authors: Joseph
authors: J
authors: Ahn
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control; D001334:Automobile Driving / Q000331:legislation & jurisprudence*; D006501:Hepatic Encephalopathy / Q000150:complications*; D006801:Humans; D016365:Liability, Legal; D019221:Mandatory Reporting; D010819:Physician's Role; D010820:Physicians / Q000331:legislation & jurisprudence*; D013219:State Government; D014481:United States