ACEP's policy on blood alcohol reporting laws
Susan Nedza, MD, FACEP
Chair, State Legislative Section
American College of Emergency Physicians
Clinical Faculty Member,
Christ Hospital
Elmhurst, IL
In January 1998, the American College of Emergency Physicians (ACEP) approved a new policy that supports alcohol testing by law enforcement officers of drivers involved in crashes that result in a fatality or serious injury. In making this policy, ACEP sought to make a significant impact on impaired driving, while considering all the ethical implications of this complex issue.
Every day, ACEP's more than 19,000 emergency physicians are on the front lines of America's social problems, including drivers. The public looks to us to provide guidance on how to appropriately address public health issues. We take this role seriously and are deeply concerned that we support measures that are beneficial to patients and the public, and that we don't support measures that, while well-intentioned, may actually do more harm instead of correcting the problems they were intended to resolve.
For example, some states have enacted laws that require mandatory reporting of domestic violence, but it has been determined that these laws may be detrimental to victims and may even put their lives at risk. And while mandatory and permissive reporting of impaired drivers by health care workers may sound like a good solution, it may be detrimental because it can prevent people from getting the treatment they need by violating the trust between physicians and patients.
ACEP's new policy on impaired driving goes beyond mandatory or permissive reporting of impaired drivers in that it advocates the leadership role of law enforcement officers in requesting alcohol tests and seeks to promote prosecution and conviction of drunk drivers. ACEP believes it is more effective for law enforcement officers who are at the scenes of accidents and know who the drivers are (and therefore know who should be tested) to take the lead in requesting alcohol tests. Alcohol testing for legal purposes is also different from alcohol testing for medical purposes, which is why having health care workers report blood alcohol levels done for medical purposes may not be effective in convicting impaired drivers, because the results may not stand up to legal scrutiny.
The policy states that mandatory reporting of patient alcohol concentration levels fundamentally conflicts with the appropriate role of physicians and can violate trust with patients. It reflects the ethical concerns of emergency physicians for patients who many not seek treatment when they need it for fear of being reported. It also reflects the belief of emergency physicians that permissive reporting of alcohol abuse can be harmful to people, in that judgments about whom to report would be based on subjective criteria, and reporting could be arbitrarily applied, which could be considered discriminatory. In addition, the new policy advocates ensuring that alcoholism treatment is covered by health care plans to the same extent as other medical conditions.
Several state legislatures, in response to public demand for stronger enforcement of impaired motorist laws, have enacted statutes to require or allow physicians to report alcohol concentrations of patients to law enforcement officials. In these states, it is clear that more people are being reported, but are the laws effective? Are more people being convicted and fewer people driving impaired? There's no evidence to show that any of these measures have affected the problem. ACEP strongly believes that any alcohol testing legislation must have a scientific basis and be carefully crafted to make sure the public and patients benefit from it and blood alcohol tests are done in a manner that will support the chain of evidence needed in court proceedings. To assess the effectiveness of new state laws, the National Highway Traffic Safety Administration is conducting a study to determine the efficacy of these type of reporting laws.
ACEP believes a broad-based effort is needed to confront the problem of impaired driving and that efforts should begin with enforcing the laws already on the books. Driving is a privilege, and all those who drive when they are impaired should lose that privilege. ACEP's new policy clarifies the role of the emergency physician as one of treating patients, not one of judging crimes or enforcing laws. It advocates promotion of efforts by emergency physicians and society to identify and arrange treatment for people who suffer from alcoholism.
Emergency physicians want to make it easier for law enforcement officers to enforce the law and take preventive steps to stop impaired driving by aggressively seeking to identify and intervene with people who are at risk of impaired driving, before they cause accidents. By preserving the bond of trust between patients and health care workers, emergency physicians can more effectively impact the problem of impaired driving and help people get the treatment they need.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content