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Hepatic encephalopathy (HE) is marked by neuropsychiatric abnormalities in cirrhotic patients, ranging from overt confusion to subclinical manifestations. Even minimal hepatic encephalopathy has been associated with poor driving skills and high numbers of traffic violations (JW Gastroenterol Dec 4 2009 and JW Gastroenterol Oct 5 2007). However, legal ramifications for physicians of patients who have HE and drive have not been evaluated.
To investigate this issue, researchers examined each state's motor vehicle laws and relevant databases for references to physician reporting requirements of potentially impaired patients with overt or minimal HE, or any specific mention of patients with HE in definitions of medical impairment. In addition, th…