For years, emergency room physicians knew something police suspected but couldn’t prove: Many people treated for injuries suffered in car accidents were legally drunk.
Blood and urine tests sometimes run on accident victims reveal the level of alcohol or drugs in their systems. Bound by doctor-patient confidentiality, physicians have remained silent about what these tests showed.
But a state law that took effect Jan. 1 permits physicians to breach that confidence and provide police the results of blood or urine tests conducted on emergency room patients. Now, hospitals are grappling with implementing the law, and there is some confusion about how to report such drivers and how aggressive to be about reporting.
Should doctors provide the information only when asked or actively offer it even when not questioned about it?
A local task force composed of hospital and law-enforcement officials hopes to settle those questions and is developing guidelines for implementing the law. At least one injured driver treated in a Chicago emergency room has been ticketed for driving while intoxicated.
Illinois is believed to be the second state, Oregon is the other, to permit physicians to volunteer the information to police without fear of being sued by a patient.
“This helps,” said Cmdr. Dennis Lesniak, who oversees the Chicago Police Department’s traffic section. “It’s another tool.”
Drivers who were not seriously injured might have been asked soon after a crash to take a breath test, the results of which might have been confirmed later by additional tests. For seriously injured patients, the priorities were different.
Paramedics quickly removed seriously injured victims from the scene and brought them to hospital emergency rooms. Police often could not interview them or administer a breath test, so drunken-driving tickets were not always issued to suspected intoxicated drivers. Those drivers might have been charged with other offenses related to the accident.
“It was almost like a sanctuary,” Lesniak said of the emergency room.
A one-year study by the Northwestern University Traffic Institute found that only 34 of the 332 known injured and impaired drivers treated at two suburban Chicago hospitals were charged with driving under the influence.
Some emergency room doctors applaud the law, but say they must learn how to apply it. If there is no police officer at the hospital, who should a doctor call with the blood-alcohol test results?
“It would be easier if we knew specifically. Do we call 911? The precinct they came from? The watch commander?” asked Dr. Leslie Zun, chairman of the emergency medicine department at Mt. Sinai Hospital.
An injured driver treated recently at Mt. Sinai was found to have a blood-alcohol level about twice the legal limit of .10. Physicians reported the information, and he was subsequently ticketed for driving under the influence.
“It was easy in this instance because the officer who had written all the tickets for violating other laws was still here (in the hospital) so I talked to him,” Zun said.
To help hospital employees, a 12-member task force assembled by the Metropolitan Chicago Healthcare Council is developing guidelines for hospitals.
The wording of the law is somewhat vague, leaving room for hospitals and physicians to decide how aggressively they will apply the law. It does not specify whether physicians must supply information when asked or must volunteer the test results even when police do not ask.
“Time will tell, and the courts may need to clarify that,” said Dr. Mark Moy, a member of the government affairs committee for the Illinois College of Emergency Physicians.
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Some emergency room physicians, used to shielding test results of such patients, might initially adopt a conservative approach to the law’s application.
“I think it’s going to take some time before we’re comfortable volunteering individual patient information on something like that, which physicians are not accustomed to doing,” said Dr. Cai Glushak, emergency medical services director at the University of Chicago and a physician in the emergency department.
Physicians do not always test motor vehicle accident victims for drugs and alcohol, Glushak said. Even under the new law, physicians would not do so just to provide such information to police.
Many doctors were long bothered by having to keep silent about blood-alcohol results. Two years ago, after a drunken driver came into the Mt. Sinai emergency room, a physician decided to do something.
Dr. Scott Plantz said that a driver brought into the emergency room had a blood-alcohol level more than four times the legal limit.
Plantz called the police.
The police ticketed the driver. The driver sued Plantz for violating physician-patient confidentiality.
Plantz, who at the time was also attending law school, said he felt obligated to report the information.
“I had learned there was a state law that physicians have a duty to report the commission of a crime,” he said. “I always thought drunken driving was a crime.”
He found that several years before he reported the blood-alcohol results of a Mt. Sinai patient, a nurse had taken a similar action, had been sued and lost. Attorneys involved in Plantz’s case decided they did not want to make the Mt. Sinai incident a test case, so the suit was dropped.
Plantz remained bothered by the problem and began lobbying to change the state law.
“Probable cause is never established in the field. No ticket is ever written, so injury protects you from conviction, which is very inappropriate,” Plantz said “These are the people causing the worst accidents, but they’re not getting arrested.”
Although Plantz said he is concerned whenever doctor-patient confidentiality is breached, there are exceptions. Doctors are required to report child abuse and may report drivers who have a medical condition that impairs their ability to drive.
“We feel that, yes, it’s a delicate balance, but in this case, we need to protect the individual and society,” said Dr. Sandra Olson, president of the Illinois State Medical Society and a neurologist.
Some studies show that injured intoxicated drivers who also are arrested seek treatment at much higher rates than those who are injured but not arrested.
With a grant from the Illinois Department of Transportation, the secretary of state’s office and researchers at the Northwestern Traffic Institute plan to develop a pilot program to encourage the emergency room reporting of impaired drivers. The researchers also plan to study the impact of the law at Mt. Sinai and several other area hospitals.
“Hopefully, we will increase the number of people who are charged with DUI when injured and impaired and, because they are charged, make it more likely they will seek alcohol and drug evaluation and treatment,” said Steve Kulm, project director for the grant in the DUI prevention unit of the secretary of state’s office.