HE, esld, TIPPS, seizures and now driv... - British Liver Trust

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HE, esld, TIPPS, seizures and now driving again

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My ex ( who I have cared for since his diagnosis 4 yrs ago as he has nobody else), has esld due to alcohol. His licence was revoked by DVLA two years ago due to his alcohol dependancy and they have now just gone and given him his licence back!!! He has bought a car and is on public roads. Problem is, he has become SO abusive towards me and my little girl that we are now scared of him and im just about ready to walk away. I have watched him have seizures, three cardiac arrests, many episodes of both upper and lower GI bleeds and always supported him without judgement. I cannot reason with him at all and he has turned very nasty indeed. I have played hell with the DVLA and I have also told the police, as im sure his insurance wouldn't be valid for starters. If he kills anyone I will be heartbroken. Anyone else been in this situation?

11 Replies

Has your ex ever been diagnosed with having HE (hepatic encephalopathy)?

What can sometimes happen is that someone can lose their license for say, drink-driving. During this time he may continue to drink, unaware of the medical damage he is causing.

Once the liver becomes seriously damaged, things start to go wrong at the End-stage liver disease stage. The symptoms of being short-tempered, abusive, being nasty are signs of HE.

Do you happen to share the same medical practice as your ex? I ask this as in the eyes of the DVLA and even the police, you might be coming across as being just a disgruntled ex and not being taken seriously. It would be hard for the likes of the DVLA or the police to act upon your word as you aren’t medically qualified to make that diagnosis.

I think you should speak with your GP. Your doctor might be aware of your past relationship issues and be able to offer you some advice. If this doctor was the same as your ex, then he/she has a duty of care towards you both. They would be able to write and inform the DVLA of both yours and their concerns, as this may well have an impact on the well being of his/her patient, and the general public. Even if you now have a different GP, still tell your GP and they, in turn, could send an email to your ex’s GP who will most likely call him in for a consultation.

A copy of this email could then be given to your local constabulary, purely for their information.

I think Katie (AyrshireK) might be able to advise you further on this.

Good luck

Richard

Thank you.

Yes we still have the same GP so I’ll seriously consider that.

His last hospital admission was only January gone; due to alcoholic binge episode resulted in him having HE bad enough to lose ‘ capacity’. It was the police who drove him to hospital, as I had to give them the keys to do a welfare check on him ( id come off a ventilator and still had covid pneumonia). Im hoping the police will look at their notes on that occasion, as I did mention it, and realise that my worries are valid.

Ive never been scared of him before but this has simply disgusted me-more the DVLA if im honest, but also to him as he must have lied if they DID send him a medical questionnaire

I'd agree, this needs raising with his GP - it's a crazy situation that notifying DVLA has to be done by the patient, however, the GP can go over the patient's head in certain circumstances.

Is your ex driving whilst under the influence of alcohol? If you ever know that he is doing that then phone 999 and report anonymously - police get numerous reports of individuals who are drinking and driving and do respond. They'll need car details, number plate and area/direction of travel. A drink drive conviction would see him banned.

DVLA notification by drivers or healthcare professionals

Applicants and licence holders have a legal duty to:

notify DVLA of any injury or illness that would have a likely impact on safe driving ability (except some short-term conditions that are unlikely to continue beyond three months, as set out in this guide)

respond fully and accurately to any requests for information from either DVLA or healthcare professionals

comply with the requirements of the issued licence, including any periodic medical reviews indicated by DVLA

They should also adhere, with ongoing consideration of fitness to drive, to prescribed medical treatment, and to monitor and manage the condition and any adaptations.

Doctors and other healthcare professionals should:

advise the individual on the impact of their medical condition for safe driving ability

advise the individual on their legal requirement to notify DVLA of any relevant condition

treat, manage and monitor the individual’s condition with ongoing consideration of their fitness to drive notify DVLA when fitness to drive requires notification but an individual cannot or will not notify DVLA themselves

Of course, this last obligation on professionals may pose a challenge to issues of consent and the relationship between patient and healthcare professional. The General Medical Council (GMC) and the General Optical Council (GOC) offer guidance on this which is summarised below.

In law it is the duty of the licence holder or applicant to notify DVLA of any medical condition that may affect safe driving. This notification by people with licences issued by DVLA (because they live in England, Scotland or Wales) may be done via GOV.UK – see Medical conditions, disabilities and driving.

For people with licences issued by the Driver and Vehicle Agency in Northern Ireland, the options for direct notification are given on the NI Direct page: How to tell DVA about a medical condition.

Circumstances may arise in which a person cannot or will not notify DVLA. It may be necessary for a doctor, optometrist or other healthcare professional to consider notifying DVLA under such circumstances if there is concern for road safety, which would be for both the individual and the wider public.

The General Medical Council (GMC) and the General Optical Council (GOC) offer clear guidance about notifying DVLA when the person cannot or will not exercise their own legal duty to do so.

The GMC guidelines 2017 (reproduced with permission) state:

1.In our guidance Confidentiality: good practice in handling patient information we say:

1.Trust is an essential part of the doctor-patient relationship and confidentiality is central to this. Patients may avoid seeking medical help, or may under-report symptoms, if they think that their personal information will be disclosed by doctors without consent, or without the chance to have some control over the timing or amount of information shared.

60.Doctors owe a duty of confidentiality to their patients, but they also have a wider duty to protect and promote the health of patients and the public.

62.You should ask for a patient’s consent to disclose information for the protection of others unless it is not safe or practicable to do so, or the information is required by law. You should consider any reasons given for refusal.

64.If it is not practicable to seek consent, and in exceptional cases where a patient has refused consent, disclosing personal information may be justified in the public interest if failure to do so may expose others to a risk of death or serious harm. The benefits to an individual or to society of the disclosure must outweigh both the patient’s and the public interest in keeping the information confidential.

68.If you consider that failure to disclose the information would leave individuals or society exposed to a risk so serious that it outweighs patients’ and the public interest in maintaining confidentiality, you should disclose relevant information promptly to an appropriate person or authority. You should inform the patient before disclosing the information, if it is practicable and safe to do so, even if you intend to disclose without their consent.

About this guidance

2.Doctors owe a duty of confidentiality to their patients, but they also have a wider duty to protect and promote the health of patients and the public. This explanatory guidance sets out the steps doctors should take if a patient’s failure or refusal to stop driving exposes others to a risk of death or serious harm.

Fitness to drive: doctors’ and patients’ responsibilities

3.The Driver and Vehicle Licensing Agency (DVLA) in England, Scotland and Wales and the Driver and Vehicle Agency (DVA) in Northern Ireland are legally responsible for deciding if a person is medically unfit to drive. This means they need to know if a person holding a driving licence has a condition or is undergoing treatment that may now, or in the future, affect their safety as a driver.

4.The driver is legally responsible for telling the DVLA or DVA about any such condition or treatment. Doctors should therefore alert patients to conditions and treatments that might affect their ability to drive and remind them of their duty to tell the appropriate agency. Doctors may, however, need to make a decision about whether to disclose relevant information without consent to the DVLA or DVA in the public interest if a patient is unfit to drive but continues to do so.

Assessing a patient’s fitness to drive

5.When diagnosing a patient’s condition, or providing or arranging treatment, you should consider whether the condition or treatment may affect their ability to drive safely. You should:

refer to the DVLA’s guidance Assessing fitness to drive – a guide for medical professionals, which includes information about disorders and conditions that can impair a patient’s fitness to drive

seek the advice of an experienced colleague or the DVLA’s or DVA’s medical adviser if you are not sure whether a condition or treatment might affect a patient’s fitness to drive.

Reporting concerns to the DVLA or DVA

6.If a patient has a condition or is undergoing treatment that could impair their fitness to drive, you should:

a. explain this to the patient and tell them that they have a legal duty to inform the DVLA or DVA

b. tell the patient that you may be obliged to disclose relevant medical information about them, in confidence, to the DVLA or DVA if they continue to drive when they are not fit to do so

c. make a note of any advice you have given to a patient about their fitness to drive in their medical record.

7.If a patient is incapable of understanding this advice – for example, because of dementia – you should inform the DVLA or DVA as soon as practicable.

8.If a patient refuses to accept the diagnosis, or the effect of the condition or treatment on their ability to drive, you can suggest that they seek a second opinion, and help arrange for them to do so. You should advise the patient not to drive in the meantime. As long as the patient agrees, you may discuss your concerns with their relatives, friends or carers.

9.If you become aware that a patient is continuing to drive when they may not be fit to do so, you should make every reasonable effort to persuade them to stop. If you do not manage to persuade the patient to stop driving, or you discover that they are continuing to drive against your advice, you should consider whether the patient’s refusal to stop driving leaves others exposed to a risk of death or serious harm. If you believe that it does, you should contact the DVLA or DVA promptly and disclose any relevant medical information, in confidence, to the medical adviser.

10.Before contacting the DVLA or DVA, you should try to inform the patient of your intention to disclose personal information. If the patient objects to the disclosure, you should consider any reasons they give for objecting. If you decide to contact the DVLA or DVA, you should tell your patient in writing once you have done so, and make a note on the patient’s record.

Responding to requests for information from the DVLA or the DVA

11.If you agree to prepare a report or complete or sign a document to assist the DVLA’s or the DVA’s assessment of a patient’s fitness to drive, you should do so without unreasonable delay.

See the full guidance on the GMC website: Confidentiality: patients’ fitness to drive and reporting concerns to the DVLA or DVA.

The GOC offers similar guidance, available in full at its website under the confidentiality section of its General Optical Council Standards (use the subsection on ‘disclosing confidential information about patients with or without consent’).

This guidance includes the following (reproduced with permission of GOC):

Disclosing information with consent

Where you are not sharing information with other healthcare professionals for the purpose of providing (or supporting the provision of) direct care to a patient, you should always try to get your patient’s explicit consent to disclose sensitive information about them, unless any of the following apply:

a. obtaining consent would defeat the purpose of the disclosure (for example, where there would be a risk of harm to others; where detection of a serious crime would be obstructed); or

b. you have already made the decision to disclose information in the public interest and obtaining consent would be meaningless or tokenistic; or

c. the patient is not able to give consent as a result of disability, illness or injury. A patient’s ability to give consent is referred to as their ‘capacity’ to consent. For more information on capacity, including what to do if a patient lacks capacity, see our consent guidance.

Where your patient provides you with explicit consent to disclose confidential information about them, you must ensure that they know what they are consenting to (see Standards 2 and 3 of the Standards of Practice, and our consent guidance) and that they are clear what information is going to be disclosed, why it is being disclosed and to which person or authority. Where you are relying on implied consent (see paragraph 10 above), patients should not be surprised to learn how their information is used; if the information would be used in ways that patients would not reasonably expect, you should seek explicit consent for this from the patient.

It is important to remember that patients with the capacity to consent have the right to make their own decisions and to refuse consent, even where you or others may consider the decision to be ill-advised. If a patient makes a decision contrary to clinical advice, you should document this in the patient records so that it is clear to all involved in that patient’s care.

Disclosing information without consent

If a patient does not provide you with explicit consent to disclose confidential information about them, and if you cannot rely on implied consent, there may still be circumstances in which you may pass the information on to an appropriate authority, such as where it is in the public interest, or where there is a legal requirement for you to do so.

Notification can be provided by healthcare professionals in the above circumstances, in confidence:

medadviser@dvla.gov.uk

Telephone: 01792 782337

Medical Business Support

D7 West

DVLA

Swansea

SA6 7JL

How DVLA responds to notification and applies the medical standards

Once DVLA is notified of a medical condition and obtains consent, it will make medical enquiries as required.

The Secretary of State (in practice, DVLA) is unable to make a licensing decision until all the relevant medical information is available and has been considered. Exceptions to this do exist, specifically DVLA’s ability to revoke a licence immediately in the interests of road safety and without detailed enquiry if individual case circumstances dictate this.

DVLA’s medical enquiries procedure is generally a two-stage process:

Information on the medical condition is sought from the licence holder or applicant, either by paper questionnaire or online

Information is sought from relevant healthcare professionals, either by questionnaire or provision of medical notes.

In some circumstances DVLA will require independent review by a DVLA-appointed doctor or optician/optometrist. Depending on individual circumstances, a licence applicant may also require a driving assessment and/or appraisal.

He certainly shouldn't be driving if he has or recently had a HE diagnosis plus alcohol problems alone are a illness listed on the DVLA notifiable list.

LOOK AFTER YOURSELF AND YOUR LITTLE ONE - ANY ABUSE IN A RELATIONSHIP (ILLNESS RELATED OR NOT) SHOULD NOT BE TOLERATED. THIS IS DOMESTIC ABUSE AND YOU AND YOUR LITTLE ONE SHOULDN'T PUT UP WITH IT.

Best wishes,

Katie

Well done Katie, what a fantastic reply.

Great wasnt it.

He went through all the DVLA medicals two years ago and his licence was revoked. Im really stunned that they just gave him his licence back without another medical first.

I am amazed too ! I sold my husbands car.

Good luck to you. You are in a horrible situation and l hope it's not too long before you find a way out. He is wasting his life but that doesn't mean you have to have yours wasted by his behaviour too. Look after yourself.

Laura xx

Thank you soooo much for that information. I should be his lasting piwer of attirney in two weeks once its registered, so I can definately speak to his GP directly then. However, im so stressed, and been put on tablets for depression, raising a child on my iwn, just lost my job due to long covid- that i will probably see my go about me and explain his behaviour as a main contributory factor for the stress.

Sorry about all the typos!!

I have nothing useful to add, just wanted to say I'm so sorry you're having to deal with all this and sending you best wishes.

Thank you

Yes I've been through exactly the same with my husband, the nastiness and violent outbursts and was terrified, he too was drink driving, untill i rang the police and reported him, i gave them the car registration make and model, and within an hour they had found him still in the car which was parked up by now, he had put the back seats flat and was lying down in the back with a large box of cider, they arrested him and he lost his licence for 2yrs and had a hefty fine, im sure if i hadn't reported him he could have killed some innocent person and of course himself, i got out of the relationship for my own sanity in the end, i do still help him from time to time as he has no one else and i feel sorry for him.

Take care julie x

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