Physician Liability in Driving Accidents

Question: A diabetic driver (DD) strikes a pedestrian after losing control of his vehicle from insulin-induced hypoglycemia. Both the DD and the pedestrian were seriously injured. The DD was recently diagnosed, and his physician had started him on insulin, but did not warn of hypoglycemia. In addition, the DD suffers from coronary heart disease but was unaware this potentially can cause serious arrhythmias. Which of the following statements is best?

A. The DD can sue his doctor for failure to disclose the risk of insulin therapy.

B. The pedestrian can sue the DD’s doctor for failing to warn of hypoglycemia.

C. If the accident resulted from a cardiac arrhythmia rather than hypoglycemia, then the doctor will not be liable.

D. Statements A and B are correct.

E. Statements A, B, and C are correct.

Answer: E. A doctor is liable for negligent care only to his or her own patient. This duty of care grows out of the doctor-patient relationship, and is normally owed to the patient and no one else. However, in very limited circumstances, the duty may be extended to other individuals, so-called third parties, who may be family members or even total strangers.

Injured nonpatient third parties have successfully sued doctors for failing to warn their patients that certain medications can adversely affect their driving ability. There also may be liability for failing to warn about medical conditions, e.g., syncope, that can impact driving.

Thus, in the above hypothetical, statements A, B, and C are all correct choices.

Doctors are increasingly being sued when their patients injure others in auto accidents.

In McKenzie v. Hawaii Permanente Medical Group (47 P.3d 1209 [Haw. 2002]), a car suddenly veered across five lanes of traffic, striking an 11-year-old girl and crushing her against a cement planter. The driver alleged that the prescription medication Prazosin caused him to lose control of the car, and that the treating physician was negligent, first, in prescribing an inappropriate type and dose of medication, and second, in failing to warn of potential side effects that could affect driving ability.

The Hawaii Supreme Court emphasized that the risk of tort liability to an individual physician already discourages negligent prescribing. Therefore, a physician does not have a duty to third parties where the alleged negligence involves prescribing decisions – i.e., whether to prescribe medication at all, which medication to prescribe, and what dosage to use.

On the other hand, physicians have a duty to their patients to warn of potential adverse effects, and this responsibility should therefore extend to third parties. Thus, liability would attach to injuries of innocent third parties as a result of failing to warn of a medication’s effects on driving – unless a reasonable person could be expected to be aware of this risk without the warning.

Other court decisions are in support. The New Mexico Supreme Court ruled that a physician owes a duty to third parties injured by patients who had been injected with medications, such as narcotics, that are known to affect judgment and driving ability (Wilschinsky v. Medina, 108 N.M. 511 [1989]). However, that court later declined to extend a physician’s duty to nonpatients for prescription-involved situations, after considering the potential impact on malpractice litigation if a physician’s duty were to extend to the general public (Lester v. Hall, 126 N.M. 405 [1998]).

In addition, a Massachusetts superior court judge has ruled that a "special relationship" is deemed to exist between a doctor and an injured third party for public policy reasons. Foreseeability is one important factor in construing the existence of such a "special relationship." This would then translate into a legal duty of care, notwithstanding absence of the traditional doctor-patient relationship.

In that case (Arsenault v McConarty, 21 Mass. L. Rptr. 500 [2006]), a family practitioner had failed to warn his diabetic patient of the risk of diabetic drugs when operating a vehicle. Just 45 minutes after the patient’s discharge from the hospital, he developed hypoglycemia, losing consciousness and injuring a motorcyclist – who then sued the doctor.

A doctor also may be liable to third parties for failing to warn the patient of driving risks related to some underlying medical condition.

In Myers v. Quesenberry (193 Cal. Rptr. 733 [1983]), a California court held that the plaintiff, a third-party accident victim, had a cause of action against two doctors for negligently failing to warn their patient against driving in an uncontrolled diabetic condition that was complicated by a missed abortion. In Freese v. Lemmon (210 N.W.2d 576 [Iowa 1973]), the Iowa Supreme Court held that a physician must warn a patient with newly diagnosed seizure disorder about the risks of driving. In that case, a patient with history of a single seizure injured a woman when he suffered a second seizure while driving. A Massachusetts court has likewise ruled that a treating neurosurgeon whose patient with a brain tumor struck a plaintiff should be named a codefendant.

Not all courts have decided in this manner. In a recent departure, the Connecticut Supreme Court ruled in Jarmie v. Troncale (SC 18358 [Sept. 17, 2012]) that doctors are immune from third-party traffic accident lawsuits, as such litigation would detract from what’s best for the patient ("a physician’s desire to avoid lawsuits may result in far more restrictive advice than necessary for the patient’s well-being"). The defendant-gastroenterologist, Dr. Troncale, was treating a patient with hepatic encephalopathy and had not warned of the associated risk of driving.

Finally, there is the issue of the at-risk patient who insists on driving against medical advice. The doctor should spare no effort in trying to persuade such a patient to stop, even to the extent of notifying the motor licensing bureau.

According to the AMA Code of Medical Ethics (2.24 (3), 2010-2011 ed.), "Physicians should use their best judgment when determining when to report impairments that could limit a patient’s ability to drive safely. In situations where clear evidence of substantial driving impairment implies a strong threat to patient and public safety, and where the physician’s advice to discontinue driving privileges is ignored, it is desirable and ethical to notify the department of motor vehicles."

Dr. Tan is emeritus professor of medicine at the University of Hawaii. This article is meant to be educational and does not constitute medical, ethical, or legal advice. It is adapted from the author’s book, "Medical Malpractice: Understanding the Law, Managing the Risk" (2006). For additional information, readers may contact the author at [email protected].

Question: A diabetic driver (DD) strikes a pedestrian after losing control of his vehicle from insulin-induced hypoglycemia. Both the DD and the pedestrian were seriously injured. The DD was recently diagnosed, and his physician had started him on insulin, but did not warn of hypoglycemia. In addition, the DD suffers from coronary heart disease but was unaware this potentially can cause serious arrhythmias. Which of the following statements is best?

A. The DD can sue his doctor for failure to disclose the risk of insulin therapy.

B. The pedestrian can sue the DD’s doctor for failing to warn of hypoglycemia.

C. If the accident resulted from a cardiac arrhythmia rather than hypoglycemia, then the doctor will not be liable.

D. Statements A and B are correct.

E. Statements A, B, and C are correct.

Answer: E. A doctor is liable for negligent care only to his or her own patient. This duty of care grows out of the doctor-patient relationship, and is normally owed to the patient and no one else. However, in very limited circumstances, the duty may be extended to other individuals, so-called third parties, who may be family members or even total strangers.

Injured nonpatient third parties have successfully sued doctors for failing to warn their patients that certain medications can adversely affect their driving ability. There also may be liability for failing to warn about medical conditions, e.g., syncope, that can impact driving.

Thus, in the above hypothetical, statements A, B, and C are all correct choices.

Doctors are increasingly being sued when their patients injure others in auto accidents.

In McKenzie v. Hawaii Permanente Medical Group (47 P.3d 1209 [Haw. 2002]), a car suddenly veered across five lanes of traffic, striking an 11-year-old girl and crushing her against a cement planter. The driver alleged that the prescription medication Prazosin caused him to lose control of the car, and that the treating physician was negligent, first, in prescribing an inappropriate type and dose of medication, and second, in failing to warn of potential side effects that could affect driving ability.

The Hawaii Supreme Court emphasized that the risk of tort liability to an individual physician already discourages negligent prescribing. Therefore, a physician does not have a duty to third parties where the alleged negligence involves prescribing decisions – i.e., whether to prescribe medication at all, which medication to prescribe, and what dosage to use.

On the other hand, physicians have a duty to their patients to warn of potential adverse effects, and this responsibility should therefore extend to third parties. Thus, liability would attach to injuries of innocent third parties as a result of failing to warn of a medication’s effects on driving – unless a reasonable person could be expected to be aware of this risk without the warning.

Other court decisions are in support. The New Mexico Supreme Court ruled that a physician owes a duty to third parties injured by patients who had been injected with medications, such as narcotics, that are known to affect judgment and driving ability (Wilschinsky v. Medina, 108 N.M. 511 [1989]). However, that court later declined to extend a physician’s duty to nonpatients for prescription-involved situations, after considering the potential impact on malpractice litigation if a physician’s duty were to extend to the general public (Lester v. Hall, 126 N.M. 405 [1998]).

In addition, a Massachusetts superior court judge has ruled that a "special relationship" is deemed to exist between a doctor and an injured third party for public policy reasons. Foreseeability is one important factor in construing the existence of such a "special relationship." This would then translate into a legal duty of care, notwithstanding absence of the traditional doctor-patient relationship.

In that case (Arsenault v McConarty, 21 Mass. L. Rptr. 500 [2006]), a family practitioner had failed to warn his diabetic patient of the risk of diabetic drugs when operating a vehicle. Just 45 minutes after the patient’s discharge from the hospital, he developed hypoglycemia, losing consciousness and injuring a motorcyclist – who then sued the doctor.

A doctor also may be liable to third parties for failing to warn the patient of driving risks related to some underlying medical condition.

In Myers v. Quesenberry (193 Cal. Rptr. 733 [1983]), a California court held that the plaintiff, a third-party accident victim, had a cause of action against two doctors for negligently failing to warn their patient against driving in an uncontrolled diabetic condition that was complicated by a missed abortion. In Freese v. Lemmon (210 N.W.2d 576 [Iowa 1973]), the Iowa Supreme Court held that a physician must warn a patient with newly diagnosed seizure disorder about the risks of driving. In that case, a patient with history of a single seizure injured a woman when he suffered a second seizure while driving. A Massachusetts court has likewise ruled that a treating neurosurgeon whose patient with a brain tumor struck a plaintiff should be named a codefendant.

Not all courts have decided in this manner. In a recent departure, the Connecticut Supreme Court ruled in Jarmie v. Troncale (SC 18358 [Sept. 17, 2012]) that doctors are immune from third-party traffic accident lawsuits, as such litigation would detract from what’s best for the patient ("a physician’s desire to avoid lawsuits may result in far more restrictive advice than necessary for the patient’s well-being"). The defendant-gastroenterologist, Dr. Troncale, was treating a patient with hepatic encephalopathy and had not warned of the associated risk of driving.

Finally, there is the issue of the at-risk patient who insists on driving against medical advice. The doctor should spare no effort in trying to persuade such a patient to stop, even to the extent of notifying the motor licensing bureau.

According to the AMA Code of Medical Ethics (2.24 (3), 2010-2011 ed.), "Physicians should use their best judgment when determining when to report impairments that could limit a patient’s ability to drive safely. In situations where clear evidence of substantial driving impairment implies a strong threat to patient and public safety, and where the physician’s advice to discontinue driving privileges is ignored, it is desirable and ethical to notify the department of motor vehicles."

Dr. Tan is emeritus professor of medicine at the University of Hawaii. This article is meant to be educational and does not constitute medical, ethical, or legal advice. It is adapted from the author’s book, "Medical Malpractice: Understanding the Law, Managing the Risk" (2006). For additional information, readers may contact the author at [email protected].

Question: A diabetic driver (DD) strikes a pedestrian after losing control of his vehicle from insulin-induced hypoglycemia. Both the DD and the pedestrian were seriously injured. The DD was recently diagnosed, and his physician had started him on insulin, but did not warn of hypoglycemia. In addition, the DD suffers from coronary heart disease but was unaware this potentially can cause serious arrhythmias. Which of the following statements is best?

A. The DD can sue his doctor for failure to disclose the risk of insulin therapy.

B. The pedestrian can sue the DD’s doctor for failing to warn of hypoglycemia.

C. If the accident resulted from a cardiac arrhythmia rather than hypoglycemia, then the doctor will not be liable.

D. Statements A and B are correct.

E. Statements A, B, and C are correct.

Answer: E. A doctor is liable for negligent care only to his or her own patient. This duty of care grows out of the doctor-patient relationship, and is normally owed to the patient and no one else. However, in very limited circumstances, the duty may be extended to other individuals, so-called third parties, who may be family members or even total strangers.

Injured nonpatient third parties have successfully sued doctors for failing to warn their patients that certain medications can adversely affect their driving ability. There also may be liability for failing to warn about medical conditions, e.g., syncope, that can impact driving.

Thus, in the above hypothetical, statements A, B, and C are all correct choices.

Doctors are increasingly being sued when their patients injure others in auto accidents.

In McKenzie v. Hawaii Permanente Medical Group (47 P.3d 1209 [Haw. 2002]), a car suddenly veered across five lanes of traffic, striking an 11-year-old girl and crushing her against a cement planter. The driver alleged that the prescription medication Prazosin caused him to lose control of the car, and that the treating physician was negligent, first, in prescribing an inappropriate type and dose of medication, and second, in failing to warn of potential side effects that could affect driving ability.

The Hawaii Supreme Court emphasized that the risk of tort liability to an individual physician already discourages negligent prescribing. Therefore, a physician does not have a duty to third parties where the alleged negligence involves prescribing decisions – i.e., whether to prescribe medication at all, which medication to prescribe, and what dosage to use.

On the other hand, physicians have a duty to their patients to warn of potential adverse effects, and this responsibility should therefore extend to third parties. Thus, liability would attach to injuries of innocent third parties as a result of failing to warn of a medication’s effects on driving – unless a reasonable person could be expected to be aware of this risk without the warning.

Other court decisions are in support. The New Mexico Supreme Court ruled that a physician owes a duty to third parties injured by patients who had been injected with medications, such as narcotics, that are known to affect judgment and driving ability (Wilschinsky v. Medina, 108 N.M. 511 [1989]). However, that court later declined to extend a physician’s duty to nonpatients for prescription-involved situations, after considering the potential impact on malpractice litigation if a physician’s duty were to extend to the general public (Lester v. Hall, 126 N.M. 405 [1998]).

In addition, a Massachusetts superior court judge has ruled that a "special relationship" is deemed to exist between a doctor and an injured third party for public policy reasons. Foreseeability is one important factor in construing the existence of such a "special relationship." This would then translate into a legal duty of care, notwithstanding absence of the traditional doctor-patient relationship.

In that case (Arsenault v McConarty, 21 Mass. L. Rptr. 500 [2006]), a family practitioner had failed to warn his diabetic patient of the risk of diabetic drugs when operating a vehicle. Just 45 minutes after the patient’s discharge from the hospital, he developed hypoglycemia, losing consciousness and injuring a motorcyclist – who then sued the doctor.

A doctor also may be liable to third parties for failing to warn the patient of driving risks related to some underlying medical condition.

In Myers v. Quesenberry (193 Cal. Rptr. 733 [1983]), a California court held that the plaintiff, a third-party accident victim, had a cause of action against two doctors for negligently failing to warn their patient against driving in an uncontrolled diabetic condition that was complicated by a missed abortion. In Freese v. Lemmon (210 N.W.2d 576 [Iowa 1973]), the Iowa Supreme Court held that a physician must warn a patient with newly diagnosed seizure disorder about the risks of driving. In that case, a patient with history of a single seizure injured a woman when he suffered a second seizure while driving. A Massachusetts court has likewise ruled that a treating neurosurgeon whose patient with a brain tumor struck a plaintiff should be named a codefendant.

Not all courts have decided in this manner. In a recent departure, the Connecticut Supreme Court ruled in Jarmie v. Troncale (SC 18358 [Sept. 17, 2012]) that doctors are immune from third-party traffic accident lawsuits, as such litigation would detract from what’s best for the patient ("a physician’s desire to avoid lawsuits may result in far more restrictive advice than necessary for the patient’s well-being"). The defendant-gastroenterologist, Dr. Troncale, was treating a patient with hepatic encephalopathy and had not warned of the associated risk of driving.

Finally, there is the issue of the at-risk patient who insists on driving against medical advice. The doctor should spare no effort in trying to persuade such a patient to stop, even to the extent of notifying the motor licensing bureau.

According to the AMA Code of Medical Ethics (2.24 (3), 2010-2011 ed.), "Physicians should use their best judgment when determining when to report impairments that could limit a patient’s ability to drive safely. In situations where clear evidence of substantial driving impairment implies a strong threat to patient and public safety, and where the physician’s advice to discontinue driving privileges is ignored, it is desirable and ethical to notify the department of motor vehicles."

Dr. Tan is emeritus professor of medicine at the University of Hawaii. This article is meant to be educational and does not constitute medical, ethical, or legal advice. It is adapted from the author’s book, "Medical Malpractice: Understanding the Law, Managing the Risk" (2006). For additional information, readers may contact the author at [email protected].