Treating Medically Impaired Drivers: Balancing Patient Confidentiality with Patient Public Safety.

Repurposed from The Scope, Third Quarter 2026

One of the most difficult decisions a patient under your care may face is whether, and when, to stop driving a motor vehicle. A patient with a long history of safe driving may later develop a physical or mental condition that makes operating a motor vehicle unsafe. Healthcare providers, including dental professionals, are often in the best position to identify these conditions and advise patients to limit or discontinue driving. 

Because the resulting loss of independence can be difficult to accept, some patients may refuse to follow their provider’s advice to discontinue driving. When this happens, providers often ask whether they are required — or permitted — to report a medically impaired patient to the New York State Department of Motor Vehicles (DMV) and whether failing to do so could expose them to liability for injuries caused to or by the patient. This article looks at some of the laws that answer these questions and provides guidance on reducing legal risks associated with treating medically impaired drivers.

The Provider's Role in DMV Licensing

While the DMV may deny, suspend, or revoke a driver’s license if there are reasonable grounds to believe that a licensed driver is not qualified to operate a motor vehicle,¹ the Commissioner of Motor Vehicles may not revoke or suspend a license arbitrarily or capriciously; there must be a reasonable basis for doing so, and the driver’s medical condition may be one such basis.²

The DMV obtains medical information from several sources. A healthcare provider’s role in the licensing process is usually limited to responding to DMV inquiries after the driver or another party, such as law enforcement, has notified the DMV of a medical condition. Healthcare providers are not mandatory reporters. As a result, a provider’s first contact with the DMV will likely be initiated by a patient or third party. 

The Health Insurance Portability and Accountability Act (HIPAA) and its related Privacy Rule, as well as New York State patient privacy laws, apply when providers are asked to disclose Protected Health Information (PHI) to the DMV about a patient’s medical condition. The general HIPAA non-disclosure rule³ and the minimum necessary standard⁴ are particularly relevant to these disclosures. The general nondisclosure rule requires covered healthcare providers not to disclose PHI to a third party without the patient’s consent. As a result, providers must obtain the patient’s written authorization before responding to any DMV request for PHI or filling out DMV forms at the patient’s request. 

The minimum necessary standard requires covered healthcare providers to limit disclosures of PHI to the minimum amount reasonably required to accomplish the intended purpose of the disclosure.⁵ Providers should be aware that the DMV may request more information than is necessary to assess the patient’s ability to safely operate a motor vehicle. For example, the DMV Physician’s Reporting Form asks the provider to describe the condition that he/she has treated or is currently treating.⁶ If the provider is treating the patient for multiple conditions, the provider should disclose only the condition that affects the patient’s ability to safely operate a motor vehicle. Providing more information than necessary will violate the minimum necessary standard.

When the Patient Refuses to Stop Driving

In some cases, a patient may refuse to report a medical condition to the DMV, refuse to authorize the provider to disclose information, and continue driving against medical advice. While providers may feel compelled to report the condition to protect both the patient and the public, disclosing medical information to the DMV without patient consent generally violates federal and New York patient confidentiality laws unless an exception applies. Two exceptions to the HIPAA Privacy Rule are often raised in this context: the “required by law” exception,⁷ and the “serious and imminent threat” exception.⁸

The "Required by Law" Exception

Providers often question whether they have a mandatory obligation to report patients with impaired driving to the DMV. If the answer is yes, the “required by law” exception would allow a provider to disclose PHI to the DMV without the patient’s consent. However, the “required by law” exception does not apply in New York because New York law does not impose a mandatory duty on providers to notify the DMV of patients driving when impaired. Although the DMV encourages providers to report medical conditions “in the interest of the health and safety of all highway users,”⁹ that guidance does not override federal or New York confidentiality requirements.

“Serious and Imminent Threat” — A Rare Exception

Although the “required by law” exception does not apply in New York, HIPAA’s “serious and imminent threat” exception may permit disclosure without patient consent in rare circumstances. It is important to note that this exception permits disclosure; it does not require it. Also, failure to disclose information under this exception will not, by itself, create liability for an injury caused by the impaired patient. 

The serious and imminent threat exception permits a provider to disclose PHI to the DMV without patient consent if, “consistent with applicable law and standards of ethical conduct,” the provider has a good-faith belief that disclosure is (1) “necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public” and (2) made to a “person or entity reasonably able to prevent or lessen the threat.”¹⁰ 

For the serious and imminent threat exception to apply, the existence of the medical condition alone is not enough. The provider must also have a good-faith basis to believe the patient’s operation of a motor vehicle poses a serious threat to the patient or the public, and the patient continues to drive despite the provider’s efforts to obtain voluntary compliance with the provider’s advice to stop driving. HIPAA presumes good faith when the belief is based on actual knowledge or on a credible representation by a person with apparent knowledge or authority.¹¹This presumption is important because it may protect providers who rely on information from the patient, a family member, or another credible source, even if the threat ultimately does not materialize. 

There are no reported cases applying this exception in the context of medically impaired drivers, and its application requires complex legal analysis. If the provider’s medical opinion is that the patient will cause personal injury to themself or others if the patient continues driving, and the patient refuses to stop driving, the provider should contact an attorney to determine whether reporting to the DMV without the patient’s consent is protected under the serious and imminent threat exception. 

The medical provider’s clinically informed opinion that the patient must discontinue driving to avoid harm to themself or others should be sufficient to establish that the threat is serious. The “imminent” element of the exception requires a more complex analysis. Courts grapple with the meaning of “imminent” because there is no bright-line rule for how close in time a threat must be. Whether a threat is imminent is decided on a case-by-case basis. 

The DMV Physician’s Reporting Form illustrates the distinction between a concern and a serious, imminent threat by asking the provider to select one of two medical opinions: either (1) the patient’s condition may affect safe operation, and the patient should be evaluated by the DMV, or (2) the patient’s condition prevents safe operation and driving privileges should be suspended.¹² This distinction matters. If the provider’s opinion is limited to the first option, patient consent should be obtained before submitting the form. The stronger basis for reporting without consent under the serious and imminent threat exception arises when the provider can support the second opinion — the provider’s medical opinion is that the patient’s current condition is so serious that immediate license suspension is required to protect the patient and the public. 

The final element of the serious and imminent threat exception is that the disclosure must be made to a person or entity reasonably able to prevent or lessen the threat. Because the DMV has legal authority to suspend or revoke a driver’s license, reporting to the DMV should satisfy this element. 

The exception also requires the provider to disclose PHI without consent only if the disclosure is consistent with applicable standards of ethical conduct.¹³ The American Medical Association Code of Medical Ethics Opinion 8.2 is consistent with the serious and imminent threat exception. It recognizes that caring for impaired drivers requires providers to “balance dual responsibilities to promote the welfare and confidentiality of the individual patient, and to protect public safety.”¹⁴ Consistent with the narrow serious and imminent threat exception, 

Opinion 8.2 implies that reporting to the DMV without consent should be a last resort. Before reporting, the provider should make every effort to encourage the patient to voluntarily discontinue driving, and documentation should include the provider’s concerns and the advice given to the patient.

Opinion 8.2 advises physicians to consider reporting to the DMV only when continued driving poses a “clear risk” to public safety or the patient’s wellbeing, and the patient ignores medical advice to stop driving. Before reporting, the provider should determine that the medical condition is clearly related to driving ability, speak with the patient about the risks, help the patient develop a plan to reduce those risks while preserving independence and dignity, and, with patient consent, involve family members in the discussion. The provider should also explain that reporting may become necessary if the patient continues to drive against medical advice.¹⁵

Liability to the General Public

Healthcare providers often worry about potential liability to patients and the public for accidents caused by medically impaired drivers under their care. New York recognizes a limited duty to third parties, but that duty is to warn the patient directly — not to warn the public or report the patient to the DMV. This is consistent with the absence of a mandatory DMV reporting obligation. 

The duty to third parties was introduced in 2015 in Davis v. South Nassau Communities Hospital. In Davis, the patient went to a hospital emergency department and received Dilaudid, an opioid pain medication, and Ativan, a benzodiazepine, both of which could impair driving. The providers did not warn the patient about side effects and discharged her approximately 90 minutes later. Shortly after discharge, she was involved in a motor vehicle accident with a bus, injuring the bus driver.

The bus driver sued the hospital and the emergency medicine physician group. The New York Court of Appeals held that when a medical provider administers medication that impairs, or could impair, a patient’s ability to safely operate a motor vehicle, the provider owes a duty to third parties to warn the patient of that danger.¹⁶ The Court emphasized that the duty is to warn the patient, not the public. 

The key takeaway from Davis is that providers should clearly warn patients when a medical condition or medication may impair driving ability. Those warnings should be documented in the medical record. Documentation that the provider gave a clear warning may help show that the provider satisfied the duty recognized in Davis and thereby reduce the risk of liability to third parties for the patient’s actions.

Risk Management Tips

To reduce the risk of liability while complying with privacy laws, providers should document the basis for any determination that a patient’s condition or medication impairs safe driving. Documentation should show that the provider advised the patient about the condition, explained how it affects driving ability, discussed the risks of continuing to drive, and advised the patient to discontinue driving. Providers should also document efforts to obtain the patient’s voluntary compliance and written authorization before making any disclosure to the DMV. 

In general, documentation should include:

• The basis for concluding that the patient’s medical condition(s) and/or medication(s) prevent safe operation of a motor vehicle. 

• The provider’s efforts to warn the patient and, with appropriate consent, the family that the patient should not drive because of the condition or medication side effects. 

• Records of telephone calls with the patient and/ or family about the patient’s medical condition, medication, and inability to drive safely. 

• Copies of any forms, letters, or other documents exchanged with the DMV. 

• Copies of the patient’s written authorization to release information. 

If the patient continues driving against medical advice, documentation should also include:

• The basis for the provider’s good-faith belief that the patient continued to drive against medical advice, including the name of any person who disclosed the information and their relationship to the patient. 

• Records of discussions and copies of written communications advising the patient that disclosure to the DMV may be necessary. 

• The provider’s efforts to obtain consent from the patient or legal representative to release information about the medical condition to the DMV.

Practical Takeaways

When treating medically impaired drivers, providers must balance patient and public safety with patient confidentiality. Providers should understand the limits of their role in the DMV license-review process, their obligations under HIPAA to obtain prior authorization and limit disclosures to only information related to the driving-impairing condition, and the narrow circumstances in which disclosure to the DMV without patient consent may be permitted.

As a practical matter, providers should clearly warn patients when a condition or medication may impair driving and thoroughly document those warnings. If the DMV requests information, or if a patient asks a provider to disclose information to the DMV, the provider should obtain written authorization from the patient. Because providers generally have no legal duty to voluntarily report a medically impaired driver to the DMV, and unauthorized disclosure may violate confidentiality laws, providers should seek legal advice before disclosing information to the DMV without the patient’s consent.

MLMIC policyholders can reach out to our healthcare attorneys for questions about treating medically impaired drivers, or any other healthcare law inquiries by calling (877) 426-9555 Monday-Friday, 8 a.m.-6 p.m. or by email here.

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Sources:

1. N.Y. Veh. & Traf. Law § 510. 

2. See 15 N.Y.C.R.R. Part 9 

3. 45 CFR § 164.502(a). 

4. 45 CFR § 164.502(b).

5. 45 CFR § 164.502(b). 

6. N.Y. DMV Form DS-6, Physician’s Reporting Form. https://dmv.ny.gov/forms/ds6.pdf (accessed Jul. 10, 2026).

7.  45 C.F.R. § 164.512(a). 

8.  45 C.F.R. § 164.512(j). 

9. See N.Y. DMV, Report a Medical Condition. https://dmv.ny.gov/driver-license/questions-about-medical-conditions (accessed Jul. 10, 2026) 10 45 C.F.R. § 164.512(j)(1)(i). 11 45 C.F.R. § 164.512(j)(4).

10.  45 C.F.R. § 164.512(j)(1)(i). 

11.  45 C.F.R. § 164.512(j)(4).

12.  N.Y. DMV Form DS-6, Physician’s Reporting Form. https://dmv.ny.gov/forms/ds6.pdf (accessed Jul. 10, 2026). 

13.  45 C.F.R. § 164.512(j)(1)(i). 

14. AMA Code of Medical Ethics Op. 8.2, , Impaired Drivers & Their Physicians

15. Id.

This document is for general purposes only and should not be construed as medical, dental or legal advice. This document is not comprehensive and does not cover all possible factual circumstances. Because the facts applicable to your situation may vary, or the laws applicable in your jurisdiction may differ, please contact your attorney or other professional advisors for any questions related to legal, medical, dental or professional obligations, the applicable state or federal laws or other professional questions.