Epilepsy Foundation

Recently, in California, our Legislative Body passed a Bill that would allow physicians the discretion to report seizure activity to the DMV. It has been a right of our Physicians but fear of reprisal should there be an accident involving an epileptic has often deterred many doctors from not reporting. The law would have legally covered these physicians who make a conscious decision that may be otherwise be mandated or guided in fear. But due to a fight over the State budget Gov. Schwarzenegger vetoed every Bill on his desk despite their causes.
Seizures come in many forms. Febrile seizures will occur in over an average of 86% of Americans. These are isolated incidents that obviously do not need to be reported. But fears prevail and many doctors will report to the DMV. I've been through the DMV's public safety process. As soon as the topic of seizures are raised these officers do not understand the difference between isolated events, controlled seizure activity or Grand Mal. The presumption is that they're is just one type. It is solely not the resposibility of these officers however.
As advocates we must push for more training in the areas involoving epilepsy. With progress and time more and more successes of control over seizure activity has increased. Post surgical treatment depsite its success leaves the stigma of a "damaged brain." Stigma's that can only be erased through an active training program facilitated through the Foundation.
Second, as California goes, so does the Nation. We must not allow this Bill to disappear or lose its way. If we get this to move forward it just may set an example for the rest of the Nation. When Physicians need to determine whether to report or not. Knowing that they are protected should they not report will be more likely to occur in favor of not reporting a seizure. More significantly, those who do have a seizure and otherwise might not seek medical attention because of fears of being reported. Now will seek the help that they might otherwise have opted not to.
If your a Californian call your Representative. If you are an advocate anywhere else call your representative. The opportunity to be change is now and the timing couldn't be better.

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Tags: DMV, choice, physician, reporting, seizure

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Comment by Christine Fisher on April 21, 2009 at 3:44am
Hi Joseph - Looks like this went unopposed because it was well written without anything snuck into it. Very good to see. I didn't even know about it. I'll be sure to refer my neuro to it on my next visit. Thanks very much for posting it in its entirety, and don't worry - I'll be making a call. - Chris
Comment by Joseph Castanon on April 21, 2009 at 1:16am
Hey Christine thanks for asking. Here it is: SB 1394 (LOWENTHAL) passed February 2008. Below isa summary. It went unopposed.






SENATE TRANSPORTATION & HOUSING COMMITTEE BILL NO: SB 1394
SENATOR ALAN LOWENTHAL, CHAIRMAN AUTHOR: lowenthal
VERSION: 2/21/08
Analysis by: Jennifer Gress FISCAL: yes
Hearing date: March 25, 2008



SUBJECT:

Lapses of consciousness

DESCRIPTION:

This bill refines the circumstances under which a physician is
required to report a patient who has suffered a lapse of
consciousness to the Department of Motor Vehicles (DMV) for a
reexamination.

ANALYSIS:

Existing law specifically requires every physician to "report
immediately to the local health officer, in writing, the name,
date of birth, and address of every patient at least 14 years of
age or older whom the physician has diagnosed as having a
disorder characterized by lapses of consciousness." The health
officer is then required to provide this information to the DMV.

After this information is submitted to DMV, DMV is required to
conduct vision, written, and behind-the-wheel driving tests and
hold an administrative hearing. Based on information obtained
through the examination process, DMV may suspend, revoke, or
restrict the license of any person diagnosed with a lapse of
consciousness disorder.

The reports submitted by physicians assist DMV in making its
finding, and the information is required to "be kept
confidential and used solely for the purpose of determining the
eligibility of any person to operate a motor vehicle on the
highways of the state." In that regard, the following ailments
are conditions that DMV considers lapse of consciousness
disorders: Alzheimer's disease and related disorders, seizure,
brain tumors, narcolepsy, sleep apnea, epilepsy, and abnormal
metabolic states, including hypo and hyperglycemia conditions
associated with diabetes.





SB 1394 (LOWENTHAL) Page 2




This bill :

Requires that a physician, when reporting a patient who has
experienced a lapse of consciousness, report to DMV rather
than the local health officer as required under existing law.

Requires that, rather than a physician reporting every patient
who the physician has diagnosed as having a disorder
characterized by lapses of consciousness, a physician report a
patient under the following circumstances:

o The physician has diagnosed the patient with
Alzheimer's disease or another dementia disorder;
o The physician has diagnosed the patient as
suffering from a single lapse of consciousness within
the previous six months , if that patient has been
diagnosed with a disorder characterized by lapses of
consciousness, and the physician believes that the
risk of recurrence is sufficient to pose a threat to
public safety; or
o The physician has diagnosed the patient as
previously suffering multiple lapses of consciousness ,
if that patient has been diagnosed with a disorder
characterized by lapses of consciousness if
substantial medical evidence exists to suggest a
recurrence of a lapse of consciousness or if the
condition adversely affects the patient's ability to
operate a motor vehicle.

Specifies that a physician is not required to make a report
under the following conditions:

o The physician has made a report in the
previous six months and the patient's condition has
not substantially changed;
o The patient's condition was initially
diagnosed by another physician within the previous six
months, the subsequent physician has knowledge that
the prior physician either determined that a report
was not required or made a report to DMV, and the
condition has not substantially changed in a manner
that may adversely affect the patient's ability to
drive;
o The physician making the initial diagnosis
determines that the disorder can and likely will be
controlled and stabilized within 30 days of the




SB 1394 (LOWENTHAL) Page 3




initial diagnosis and that the patient's condition
during the 30-day period does not pose an undue risk
to public safety.

Deletes the requirement that DMV conduct a behind-the-wheel
driving test as part of every reexamination and instead
requires a driving test only for those patients who a
physician has voluntarily reported because the physician
"reasonably and in good faith" believes that reporting the
patient will serve the public interest, including for
conditions that are not required to be reported pursuant to
DMV regulation. For patients reported under other
circumstances, the bill permits DMV to conduct a driving test
at its discretion.

Allows DMV to provide report data for the purpose of a "bona
fide research project, if the data is solely provided by the
department in anonymous form."

Requires DMV to develop, by July 1, 2009, a reporting form
that physicians may use to report patients to DMV.

Requires DMV, in cooperation with the state Department of
Public Health, to adopt regulations by January 1, 2010 that
define disorders characterized by recurrent lapses of
consciousness, list circumstances that do not require
reporting of a patient, and describe circumstances that shall
not require reporting a patient because the patient is unable
to ever operate a vehicle or is unlikely to represent a
danger.

COMMENTS:

1.Purpose . The author contends that the mandatory reporting
requirement of patients who experience lapses of consciousness
can adversely affect the long-held confidential nature of the
patient-physician relationship. He further asserts that the
potential disclosure of sensitive information can cause
patients to be less forthcoming to physicians, which may
result in inaccurate or inadequate diagnosis and treatment of
the condition. Lastly, he argues that there are many persons
who suffer only a single episode of a lapse of consciousness
or who have a condition that is easily controlled that do not
pose a threat to public safety. By refining the circumstances
under which physicians are required to report patients who
experience a lapse of consciousness, this bill provides a




SB 1394 (LOWENTHAL) Page 4




balance between public safety and patient-physician
confidentiality.

2.Effects of mandatory reporting . The author provides
evaluation studies that examined some of the impacts of
mandatory physician reporting. In comparing patient reporting
of seizure disorders (whereby the patients, rather than the
physicians, are required to report their condition to the DMV)
to mandatory physician reporting, a study of 158 patients with
epilepsy found that under patient reporting, 96 percent of
patients would inform their physician of a breakthrough
seizure and 56 percent would report to the DMV. When
contrasted with physician reporting of patients' seizure
disorders, only 72 percent of patients would inform their
physician of a breakthrough seizure. These results suggest
that a policy whereby physicians would be required to report
their patients to DMV could lead patients to under report
seizure activity to their physicians. Another study regarding
the reporting of epileptic drivers revealed that only 25
percent to 28 percent of epileptic drivers experiencing a
seizure reported the episode to their physician because of
fear of being reported to the licensing authorities.
Furthermore, a substantial number of patients admitted that
they would continue to drive if their licenses were revoked.
A study of physicians' reporting behavior found that about 58
percent of physicians did not hesitate to report patients
medically unfit to drive, but that almost 60 percent felt that
the physician-patient relationship is negatively affected by
reporting. As a result of mandatory reporting laws, epileptic
patients may fail to obtain appropriate care for their
condition, which may inadvertently increase their risk to
experience a collision.

3.Behind-the-wheel driving test . Existing law requires that DMV
conduct vision, written, and behind-the-wheel driving tests of
drivers reported to it by a physician for a lapse of
consciousness disorder. This bill requires only those drivers
referred voluntarily by a physician who "reasonably and in
good faith believes that reporting the patient will serve the
public interest" to be subject to vision, written, and
behind-the-wheel driving tests. For drivers reported under
other circumstances, the bill only requires DMV to make an
assessment based on "the evaluation and assessment provided by
the reporting physician and surgeon and the factors
enumerated" in regulation. DMV's regulations regarding the
factors to consider when assessing whether the driving




SB 1394 (LOWENTHAL) Page 5




privileges of a person with disorders characterized by lapses
of consciousness should be suspended, revoked, or restricted
do not involve vision, written, or behind-the-wheel driving
tests. In 2000, the Legislature passed SB 335 (Hayden),
Chapter 985, which established, until January 1, 2011, the
requirement that DMV reexamine drivers referred to it by law
enforcement officers, health professionals, or family members
by administering vision, written, and behind-the-wheel driving
tests. One accident that prompted the passage of SB 335
occurred when an 85-year-old man hit and killed a police
officer in Lodi. The police officer had earlier requested
that DMV reexamine the man's driving ability. After receiving
reports from his doctor and interviewing him over the
telephone, DMV did not revoke or suspend the 85-year-old man's
driver's license. Shortly thereafter, the police officer that
had requested the reexamination was struck and killed by the
very man the officer had previously referred to DMV for
reexamination, which at the time did not involve a
behind-the-wheel driving test. To protect public safety by
ensuring that those drivers who are reexamined are subject to
a thorough process, the author or committee may wish to
consider an amendment that would specifically require a
vision, written, and behind-the-wheel driving test as part of
the reexamination process.

4.License restrictions . Under current law, DMV may suspend,
revoke, or restrict, subject to terms and conditions, the
driving privileges of those reexamined because of a lapse of
consciousness disorder. This bill only allows DMV to suspend
or revoke a license. There may be situations when DMV may
wish only to restrict a license and require as a condition of
the license some modification to the vehicle or to driving
behavior that would allow the driver to compensate for
whatever deficiency is identified during the reexamination
process. The author or committee may wish to consider an
amendment that would, in addition to suspending or revoking a
license, allow DMV to place restrictions on a license.

5.Operative date . This bill would go into effect January 1,
2009. Given that this bill requires DMV to develop a
reporting form for physicians by July 1, 2009 and to develop
and adopt new regulations for administering the provisions of
this bill by January 1, 2010, the author or committee may wish
to consider an amendment that would make Section 12818 as
amended by this bill (related to the requirement that DMV
reexamine patients) and Section 13010 as added by this bill




SB 1394 (LOWENTHAL) Page 6




(related to the requirement that physicians report patients to
DMV) operative on January 1, 2010.


RELATED LEGISLATION

SB 212 (Lowenthal, 2006) was a nearly identical measure. Vetoed
by the Governor.


POSITIONS: (Communicated to the Committee before noon on
Wednesday, March 19,
2008)

SUPPORT: Epilepsy California (sponsor)

OPPOSED: None received.
Comment by Christine Fisher on April 20, 2009 at 3:42pm
You didn't mention the name or number of the bill. Please add it.

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