Q.

We have a client who caused a dangerous situation while driving.  While driving on an interstate highway at 70 mph her hood flew open.  She then stopped in the middle lane and stayed there until helped by another driver. Needless to say, she presented great danger to herself and others.  We are aware the client abuses Vicadin.   There is no proof this was the result of her mental disability or the Vicadin abuse.

Our staff expressed concern they may have a responsibility to report this occurrence to the State of Washington, Department of Motor Vehicles, so they may review her driving capability.  

Do mental health providers have a responsibility to report such an occurrence to the DMV? 

Are we released from the risk of breach of confidentiality if we report this incident to the DMV?"

A.

As I understand it from our conversation, you have no reason to believe that the client's driving was influenced by Vicadin or her mental disability.  Further, you believe that it was reasonable for the client to stop on the highway in response to the hood flying open because she could not see with the hood in the up position.  Your concern centers around the fact that the client did not move from the stopped position until a passing motorist came to her aid.  Nonetheless, you have no reason to believe that this action was influenced by her mental disability or by Vicadin. 

Under the circumstances, I think it is unlikely that you have a responsibility to report to any agency.  If at some point you have reason to believe that the client presents a threat to public safety you may have such a duty.  Nonetheless, I suggest that you review your specific state statutes on the duty to warn or protect and a physician's duty to report to the state highway safety administration.  You should also review federal confidentiality regulations and the privacy provisions of the Federal Health Insurance Portability Act, specifically 45 CFR section 164.512 (j).