# Doctor-patient confidentiality not sacred says PennDot and five other states **URL:** \ **Category:** The BBQ Pit\ **Created:** [September 30, 2004, 7:17pm UTC](https://boards.straightdope.com/t/doctor-patient-confidentiality-not-sacred-says-penndot-and-five-other-states/266903 "2004-09-30T19:17:38Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![danceswithcats](https://avatars.discourse-cdn.com/v4/letter/d/9e8a1a/32.png) [@danceswithcats](https://boards.straightdope.com/u/danceswithcats)\ **Post date:** [September 30, 2004, 7:17pm UTC](https://boards.straightdope.com/t/doctor-patient-confidentiality-not-sacred-says-penndot-and-five-other-states/266903/1 "2004-09-30T19:17:38Z")
The story I heard on NPR this morning had me thinking I was nuts. A fellow in Lebanon, PA sought treatment for a heart murmur, and in the process told the doctor that he drinks a six-pack or better on a daily basis. [Shortly thereafter, PennDot advised him that his operator’s license had been suspended.](http://www.jointogether.org/sa/news/summaries/reader/0,1854,574238,00.html) He can get his license back, but only if he installs an ignition interlock, at a cost of $1000. Personally, I don’t care how much you drink, so long as your keys stay on the hook by the back door. No mention was made that this fellow was involved in an accident, or that he was tagged at a DUI checkpoint. Therefore, he broke no laws. What’s next? If your doctor thinks you might have a heart attack because you are 100 pounds overweight, do you need a device in your car to sense if you’ve just chowed down on a double bacon cheeseburger? [Here is a related article on the PA law.](http://www.jointogether.org/sa/news/summaries/reader/0,1854,573902,00.html) ---
**Author:** ![World\_Eater](https://avatars.discourse-cdn.com/v4/letter/w/f04885/32.png) [@World\_Eater](https://boards.straightdope.com/u/World_Eater)\ **Post date:** [September 30, 2004, 7:22pm UTC](https://boards.straightdope.com/t/doctor-patient-confidentiality-not-sacred-says-penndot-and-five-other-states/266903/2 "2004-09-30T19:22:11Z")
Wow that’s quite fucked up. ---
**Author:** ![wonky](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wonky/32/393_2.png) [@wonky](https://boards.straightdope.com/u/wonky)\ **Post date:** [September 30, 2004, 7:43pm UTC](https://boards.straightdope.com/t/doctor-patient-confidentiality-not-sacred-says-penndot-and-five-other-states/266903/3 "2004-09-30T19:43:57Z")
There was a thread in July about this, or a similar, [story](http://boards.straightdope.com/sdmb/showthread.php?t=266803&highlight=license+drink+doctor). ---
**Author:** ![tdn](https://avatars.discourse-cdn.com/v4/letter/t/94ad74/32.png) [@tdn](https://boards.straightdope.com/u/tdn)\ **Post date:** [September 30, 2004, 7:49pm UTC](https://boards.straightdope.com/t/doctor-patient-confidentiality-not-sacred-says-penndot-and-five-other-states/266903/4 "2004-09-30T19:49:47Z")
Umm… Isn’t that a violation of HIPAA regulations? Sure, PennDot has a right to look at the guy’s medical records, but not to make value judgements on them. ---
**Author:** ![danceswithcats](https://avatars.discourse-cdn.com/v4/letter/d/9e8a1a/32.png) [@danceswithcats](https://boards.straightdope.com/u/danceswithcats)\ **Post date:** [September 30, 2004, 8:05pm UTC](https://boards.straightdope.com/t/doctor-patient-confidentiality-not-sacred-says-penndot-and-five-other-states/266903/5 "2004-09-30T20:05:50Z")
> [@tdn](#): > > Umm… > > Isn’t that a violation of HIPAA regulations? > > Sure, PennDot has a right to look at the guy’s medical records, but not to make value judgements on them. I would think it a violation of HIPAA also. Things may have changed, but I don’t recall a physical for basic (Class C) licensure. I did need a physical prior to obtaining a CDL and DOT cert, but unless there was something _physically_ wrong with me such that I shouldn’t operate a Class A vehicle, my personal habits were below the radar. ---
**Author:** ![buttonjockey308](https://avatars.discourse-cdn.com/v4/letter/b/bcef8e/32.png) [@buttonjockey308](https://boards.straightdope.com/u/buttonjockey308)\ **Post date:** [September 30, 2004, 9:44pm UTC](https://boards.straightdope.com/t/doctor-patient-confidentiality-not-sacred-says-penndot-and-five-other-states/266903/6 "2004-09-30T21:44:47Z")
THAT, is seriously wrong. Like, Minority Report, Department of Pre-Crime kinda wrong. ---
**Author:** ![World\_Eater](https://avatars.discourse-cdn.com/v4/letter/w/f04885/32.png) [@World\_Eater](https://boards.straightdope.com/u/World_Eater)\ **Post date:** [September 30, 2004, 9:48pm UTC](https://boards.straightdope.com/t/doctor-patient-confidentiality-not-sacred-says-penndot-and-five-other-states/266903/7 "2004-09-30T21:48:51Z")
I read somewhere there’s a law on the books from 1960 where a doctor must report anything that could be harmful to the public. Don’t shoot the messenger please. ---
**Author:** ![Airman\_Doors\_USAF](https://avatars.discourse-cdn.com/v4/letter/a/e36b37/32.png) [@Airman\_Doors\_USAF](https://boards.straightdope.com/u/Airman_Doors_USAF)\ **Post date:** [September 30, 2004, 9:58pm UTC](https://boards.straightdope.com/t/doctor-patient-confidentiality-not-sacred-says-penndot-and-five-other-states/266903/8 "2004-09-30T21:58:35Z")
Remember, folks. Driving is a privilege, not a right. After nearly having my license revoked and being forced to pay around $3000 per ear for insurance for five years, I know that better than most. They can revoke your license for farting in your car really loud if they want to. This is well beyond something like that. This guy obviously had a health problem that necessitated a trip to the doctor, the doctor decided that the alcohol was a contributing factor and dimed him out. Would you all be getting on PENNDOT if this guy had a weakened blood vessel in his brain and was at high risk for aneurysm and the doctor told them? I think not. The doctor, and PENNDOT, did the right thing. Better he’s off the road before he has an alcohol-induced heart attack and kills someone else who has no idea. He’s being treated like a criminal? Hardly. He’s being treated like an adult who has a handicap that could kill others. At least he’s still allowed to exercise his privilege. ---
**Author:** ![Casey1505](https://avatars.discourse-cdn.com/v4/letter/c/dc4da7/32.png) [@Casey1505](https://boards.straightdope.com/u/Casey1505)\ **Post date:** [September 30, 2004, 10:06pm UTC](https://boards.straightdope.com/t/doctor-patient-confidentiality-not-sacred-says-penndot-and-five-other-states/266903/9 "2004-09-30T22:06:03Z")
He did break a law. If he drove drunk, he broke a law. Whether he got caught breaking that law ia something entirely diferent. > [@](#): > > Under Pennsylvania law, physicians are required to report drivers with medical conditions that could be potentially dangerous. Alcohol misuse is on the list of dangerous medical conditions. I have no problem with what the Doctor did, either. As far as your 100 lbs overweight and prone to heart attacks example, isn’t it his job to order you not to drive until the condition improves itself? ---
**Author:** ![SuaSponte](https://avatars.discourse-cdn.com/v4/letter/s/67e7ee/32.png) [@SuaSponte](https://boards.straightdope.com/u/SuaSponte)\ **Post date:** [September 30, 2004, 10:14pm UTC](https://boards.straightdope.com/t/doctor-patient-confidentiality-not-sacred-says-penndot-and-five-other-states/266903/10 "2004-09-30T22:14:18Z")
But **Airman Doors,** where the _connection_ between Emerich’s six-pack a day habit and his driving? For all we (and the doctor, and PennDOT) knows, Emerich downed his six-pack right before going to bed. He may well be a responsible alcoholic (and there are quite a few of them). Lord knows, there have been enough times when I drank six to ten beers in a day, and I’m sure you have as well. But what I and (presumably) you didn’t do is drive around town. There’s no crime - and no potential risk to others - in that. As for your “get him off the road before he has an alcohol-induced heart attack and kills someone else” argument, _mon frere,_ that is bunk. PennDOT will let him drive again if he gets an ignition interlock, which will test his BAC, not the strength of his heart. **Casey1505,** you are _assuming_ he drove drunk and therefore broke a law. There is no evidence of that. Sua ---
**Author:** ![Airman\_Doors\_USAF](https://avatars.discourse-cdn.com/v4/letter/a/e36b37/32.png) [@Airman\_Doors\_USAF](https://boards.straightdope.com/u/Airman_Doors_USAF)\ **Post date:** [September 30, 2004, 10:23pm UTC](https://boards.straightdope.com/t/doctor-patient-confidentiality-not-sacred-says-penndot-and-five-other-states/266903/11 "2004-09-30T22:23:37Z")
> [@SuaSponte](#): > > As for your “get him off the road before he has an alcohol-induced heart attack and kills someone else” argument, _mon frere,_ that is bunk. PennDOT will let him drive again if he gets an ignition interlock, which will test his BAC, not the strength of his heart. …which in turn will ensure that a) he’s not drunk when he gets on the road, b) he’s forced to cut down on his drinking if he wishes to exercise his privilege anytime he wants to, and c) that alcohol will not be a direct cause of anyone’s death. I think we should put blowers in ALL cars. God knows I’ve driven when I’ve been quite toasty, and the fact that I didn’t kill anyone doesn’t mean it was the right thing to do. I’m sure that the presumption of guilt argument will now rear its ugly head at that one, but if PENNDOT wants to make that a condition of driving I’m all for it, because it doesn’t presume guilt, instead it assures that a major hazard is mitigated. ---
**Author:** ![Casey1505](https://avatars.discourse-cdn.com/v4/letter/c/dc4da7/32.png) [@Casey1505](https://boards.straightdope.com/u/Casey1505)\ **Post date:** [September 30, 2004, 10:30pm UTC](https://boards.straightdope.com/t/doctor-patient-confidentiality-not-sacred-says-penndot-and-five-other-states/266903/12 "2004-09-30T22:30:10Z")
Yes, I was assuming. Correction noted. The connection is that the doctor feels that his heart trouble is a direct result of alcohol consumption. By installing the interlock, it may keep this guy off the sauce, or at least get him to cut back drastically, which sort of ensures that he follows the treatment program the doctor developed to aid with the heart flutters. It’s not like he’s being sent away to Marworth or Betty Ford or another treatment facility. If the interlock is considered a necessary part of his treatment, would it be covered under his insurance? I’m guessing that state employees have fantastic health insurance. Maybe that would take some of the sting out of the $1000. ---
**Author:** ![SuaSponte](https://avatars.discourse-cdn.com/v4/letter/s/67e7ee/32.png) [@SuaSponte](https://boards.straightdope.com/u/SuaSponte)\ **Post date:** [September 30, 2004, 11:32pm UTC](https://boards.straightdope.com/t/doctor-patient-confidentiality-not-sacred-says-penndot-and-five-other-states/266903/13 "2004-09-30T23:32:13Z")
> [@Casey1505](#): > > Yes, I was assuming. Correction noted. > > The connection is that the doctor feels that his heart trouble is a direct result of alcohol consumption. By installing the interlock, it may keep this guy off the sauce, or at least get him to cut back drastically, which sort of ensures that he follows the treatment program the doctor developed to aid with the heart flutters. It’s not like he’s being sent away to Marworth or Betty Ford or another treatment facility. You have another poor assumption. Having a heart flutter is not why this guy lost his license; the impairment reported by the doctor was his drinking habit. Even if it were, you got problems. First, the interlock is a pretty hit and miss “treatment” program (actually, it’s not a medical treatment at all). Treatments are generally designed to target the medical problem. This is a shotgun approach - and may very well miss the target - Emerich can keep drinking, just not when he’s driving. Second, do we really want the government to start forcing citizens into particular medical treatments? And no, the interlock will not be covered by insurance, as it is not a medical treatment. ---
**Author:** ![catsix](https://avatars.discourse-cdn.com/v4/letter/c/e19b73/32.png) [@catsix](https://boards.straightdope.com/u/catsix)\ **Post date:** [October 1, 2004, 12:00am UTC](https://boards.straightdope.com/t/doctor-patient-confidentiality-not-sacred-says-penndot-and-five-other-states/266903/14 "2004-10-01T00:00:40Z")
> [@](#): > > **Airman Doors** said: > I think we should put blowers in ALL cars. Even though the device may’ve been at fault in at least one accident because it requires a driver to breathe into it _while the car is in motion_? Let’s replace drunk driving with something just as bad, and hey, let’s make _everyone_ do it, instead of just having a few people who drive drunk. While you’re at it, why don’t we just stop producing cars that can ever go above 35 mph because speeders are dangerous? ---
**Author:** ![Random](https://avatars.discourse-cdn.com/v4/letter/r/57b2e6/32.png) [@Random](https://boards.straightdope.com/u/Random)\ **Post date:** [October 1, 2004, 12:03am UTC](https://boards.straightdope.com/t/doctor-patient-confidentiality-not-sacred-says-penndot-and-five-other-states/266903/15 "2004-10-01T00:03:59Z")
I think you’re all missing the main public policy downside of this rule. How many people in Pennsylvania who drink are going to admit this fact to their doctors in the future? Not many, I bet. That not only means that the docs may misdiagnose patients or prescribe drugs that have adverse reactions with alcohol, but could also mean that docs won’t know who to advise to seek treatment for alcoholism. That’s not a good thing. There’s times when I drink, sometimes to the point where I shouldn’t drive. Does that mean I should lose my license, even if I never actually get behind the wheel when drunk? ---
**Author:** ![Ferret\_Herder](https://avatars.discourse-cdn.com/v4/letter/f/e47774/32.png) [@Ferret\_Herder](https://boards.straightdope.com/u/Ferret_Herder)\ **Post date:** [October 1, 2004, 1:03am UTC](https://boards.straightdope.com/t/doctor-patient-confidentiality-not-sacred-says-penndot-and-five-other-states/266903/16 "2004-10-01T01:03:57Z")
> [@Airman Doors](#): > > I think we should put blowers in ALL cars. God knows I’ve driven when I’ve been quite toasty, and the fact that I didn’t kill anyone doesn’t mean it was the right thing to do. I’m sure that the presumption of guilt argument will now rear its ugly head at that one, but if PENNDOT wants to make that a condition of driving I’m all for it, because it doesn’t presume guilt, instead it assures that a major hazard is mitigated. You know, those blowers have to be blown while you’re driving as well, not just to start the car. There was a Pit thread here a while back about something like people getting in an accident while bent over and blowing for a minute or so into the nozzle. Or should people with asthma not drive, either? People are bad enough with eating, talking on the cell phone, changing the radio station; I don’t want everyone on the road hyperventilating into a tube lest their car engine shut down for failure to comply. I drink beer or wine most every night. Sometimes I drink enough that I shouldn’t be driving. Know what? I drink at **home** and don’t drive. If I go out with friends, I have a single drink and then sip soda the rest of the night. But if I told my doctor how much I drink when asked and then got my driver’s license taken away, I’d sue. Well, first I’d laugh, since I drive maybe once a month (yay for public transport), but then I’d sue. That is one hell of a HIPAA violation. The message to people in Pennsylvania is - lie to your doctors. Smoke a little pot? Better not tell. Drink? Don’t mention it. Time to pass up those opportunities to catch certain health ailments early, because who needs good health if you can’t get to work to pay those doctor bills anyway, right? ---
**Author:** ![TeaElle](https://avatars.discourse-cdn.com/v4/letter/t/8491ac/32.png) [@TeaElle](https://boards.straightdope.com/u/TeaElle)\ **Post date:** [October 1, 2004, 2:40am UTC](https://boards.straightdope.com/t/doctor-patient-confidentiality-not-sacred-says-penndot-and-five-other-states/266903/17 "2004-10-01T02:40:13Z")
> [@Random](#): > > I think you’re all missing the main public policy downside of this rule. How many people in Pennsylvania who drink are going to admit this fact to their doctors in the future? Does mandatory reporting stop people from being honest about seizures or narcoleptic episodes? ---
**Author:** ![Random](https://avatars.discourse-cdn.com/v4/letter/r/57b2e6/32.png) [@Random](https://boards.straightdope.com/u/Random)\ **Post date:** [October 1, 2004, 2:56am UTC](https://boards.straightdope.com/t/doctor-patient-confidentiality-not-sacred-says-penndot-and-five-other-states/266903/18 "2004-10-01T02:56:58Z")
Unfortunately, it probably does in some cases. There’s an important difference though. Unless someone is prepared to leave his epilepsy or sleep disorder untreated, he’s going to have to mention it to his doc. The beer drinker generally isn’t looking to have his beer drinking treated, and therefore will see no problem denying it to his doc. ---
**Author:** ![St.Urho](https://avatars.discourse-cdn.com/v4/letter/s/8e7dd6/32.png) [@St.Urho](https://boards.straightdope.com/u/St.Urho)\ **Post date:** [October 1, 2004, 3:49am UTC](https://boards.straightdope.com/t/doctor-patient-confidentiality-not-sacred-says-penndot-and-five-other-states/266903/19 "2004-10-01T03:49:47Z")
> [@tdn](#): > > Umm… > > Isn’t that a violation of HIPAA regulations? Actually, HIPAA allows disclosure of medical information as required by law. For example, in most jurisdictions doctors, nurses, and EMTs/Paramedics are mandatory reporters of child abuse and elder abuse. These disclosures are specifically allowed by HIPAA. St. Urho Paramedic ---
**Author:** ![St.Urho](https://avatars.discourse-cdn.com/v4/letter/s/8e7dd6/32.png) [@St.Urho](https://boards.straightdope.com/u/St.Urho)\ **Post date:** [October 1, 2004, 4:06am UTC](https://boards.straightdope.com/t/doctor-patient-confidentiality-not-sacred-says-penndot-and-five-other-states/266903/20 "2004-10-01T04:06:55Z")
Oh yeah, here’s the relevant part of the law, from this [Dept. of Health and Human Services pdf](http://www.hhs.gov/ocr/combinedregtext.pdf) > [@](#): > > _(b)Standard: uses and disclosures for public health activities. > (1)Permitted disclosures._ A covered entity may disclose protected health information for the public health activities and purposes described in this paragraph to: > \ > (ii)A public health authority or other appropriate government authority authorized by law to receive reports of child abuse or neglect; Also, > [@](#): > > _©Standard: disclosures about victims of abuse, neglect, or domestic violence. > (1) Permitted disclosures_ Except for reports of child abuse or neglect permitted by paragraph (b)(1)(ii) of this section, a covered entity may disclose protected health information about an individual whom the covered entity reasonably believes to be a victim of abuse, neglect, or domestic violence to a government authority, including a social service or protective services agency, authorized by law to receive reports of such abuse, neglect, or domestic violence: > (i) To the extent the disclosure is required by law and the disclosure complies with and is limited to the relevant requirements of such law; > (ii) If the individual agrees to the disclosure; or > (iii) To the extent the disclosre is expressly authorized by statute and regulation and: > (A) The covered entity, in the exercise of professional judgement, believes the disclosure is necessary to prevent serious harm to the individual or other potential victims Needless to say, there is much, much more. St. Urho [Next page](https://boards.straightdope.com/t/doctor-patient-confidentiality-not-sacred-says-penndot-and-five-other-states/266903.md?page=2)