Drunk drivers and medical and social injury.

Alcohol-related traffic injuries are a major cause of death, pain, and suffering and a major contributor to health care costs in the United States. We reviewed the medical and legal consequences of 252 motor vehicle accidents involving drivers admitted to St. Mary's Hospital between 1981 and 1985, with particular attention to patients with a blood alcohol concentration equal to or above the legally defined threshold for intoxication (100 mg per deciliter). There were 84 such patients, with a median blood alcohol level of 218.5 mg per deciliter. Few of these patients were referred either to alcoholism-rehabilitation programs or to the courts for prosecution. We conclude that both drunk drivers and the population at large are poorly served by current medical and legal practices. Because denial of reality and prevarication are hallmarks of alcoholism, we make two recommendations. First, in order to encourage physicians to refer all injured patients with high blood alcohol concentrations to detoxification and rehabilitation programs, injury to intoxicated drivers should be made a reportable condition. Second, prosecution for driving under the influence of alcohol should be made easier by simplifying the procedures for providing the courts with blood alcohol measurements obtained as part of normal clinical care. Physicians must act in the interest of their patients. The two recommended changes in current practice would help provide a firm framework within which physicians could advise patients about appropriate treatment for alcoholism. If such steps are not taken or are ineffective, vigorous legal action should be encouraged, because society has the right to demand that innocent people not be endangered by intoxicated people who drive motor vehicles.