Driving the long and bumpy road of life with diabetes can be challenging in so many ways, including what happens behind the wheel of an automobile. That's the focus of today's special edition of our weekly advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and educator Wil Dubois.Ask-DMine_button

April is actually National Distracted Driving Awareness Month, with the big focus on cell phone use while driving, but our minds went to other distractions that could impair driving ability...

Note that we've written about this issue here at the 'Mine before, including a post in which Mike shared his own story of going low while driving, one on police training, and a column on driver's ed with diabetes.

{Got your own questions? Email us at AskDMine@diabetesmine.com}

 

Natalie, type 1 from Connecticut, asks: What do you think about the diabetic who got convicted of murder after he had a hypo that caused a car crash which killed a little girl?

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Wil@Ask D'Mine answers: If he had been convicted of murder, I would have said that it was a medio-legal lynching. But, in fact, high school science teacher David Alan Herman was charged with second-degree manslaughter. It's an important distinction, as murder—by definition—is a planned crime; while manslaughter is a crime in which your actions took a life, even though that was not your intent.

Still, he's basically going to the big house for four years because he had a hypo.

This is no small thing. Even the authorities admit that it's "unusual" to make someone criminally liable for a crash caused by a medical condition. So that begs the question: Why did they? Because, they claim, Herman had a history of poor control of his diabetes.

Wow. That's a crime now? I'm sorry Mister Smith, your A1C has risen to nine-point-seven. You're going down. Bailiff, take the patient away.

We need to talk about this, but before we begin to theorize, analyze, rant, rave, and ridicule, I want to insert one somber note. I need to remind all of you that, regardless of "fault," an 11-year old girl is dead. Mowed down in her own front yard by Herman's Toyota Prius. She died in front of her mother, a mother who will never be able to clear her head of her daughter's screams.

As a parent, I can't imagine anything worse, and my heart goes out to her family. But as a citizen, I have to wonder... does sending this driver to prison serve justice? And what kind of precedent does this set?

It's a VERY tricky subject because of course people do need to be held accountable for their own choices and actions — including being responsible with their own disease care. But we also need to consider how the barriers to the medicines and gear we need to keep our blood sugars in line come into play... especially at a time when health insurance companies (and even the federal government) are increasingly limiting our access to good therapy. Are we now expected to be held to stricter standards? If a lack of access to care plays a role in a tragedy like this, shouldn't the health plans share the liability?

But I've gotten ahead of myself. Just what the heck really happened? What are the facts of the case? Well, I'm embarrassed to admit that I didn't have time to do anything more than read the mainstream media reports. If those facts are wrong, so are some of my assumptions. And one of the problems I faced when trying to understand the facts is that the press accounts of the sentencing throw around phrases like "diabetic episode," and "diabetic coma," using them interchangeably. Hell, I don't even know if the guy is a type 1 or type 2. All I know is that he takes insulin.

But while I'm assuming that what we are talking about here was a low blood sugar, therdriver's license diabetese's no disputing that David Alan Herman, person with diabetes on insulin, lost control of his car, ran the little girl over in her front yard, killing her, and crashed into her house. He made no attempt to flee the scene. He told investigators he was "diligent" in checking his blood sugar and taking his insulin and had no idea what had happened. In fact, no charges were brought against him until four months after the tragedy.

Then, when charges were finally brought against him, the prosecution made some interesting claims. Theysaid he had a history of ignoring his doctor's orders. They said he had a history of mismanaging his diabetes. He was accused of lying to authorities about his "diligence" in taking care of his diabetes. The district attorney even called Herman "a good liar," and claimed that in 2007 he passed out while driving, narrowly missed a jogger, and crashed into a tree. Citing more evidence of poor diabetes control, the authorities claim that shortly after the tragic crash, Herman went to his doctor to have his head stitched up following a fall from another "diabetic episode," and several days later he went lights-out at the Spirit Mountain Casino. Is this a pattern of poor control? Or is he over-medicated? Or did he suffer an undiagnosed concussion in the first crash?

The cash that killed the child happened in April 2013. Investigators reported that Herman's last refill of test strips was that past December, for 100 strips, and they claim he should have used 500 if he tested like his doctor ordered. Does that mean he wasn't testing as often as he should? Maybe. Or maybe he scored some samples. Or bought some Wal-Mart strips because they were cheaper than his copay.

The powers-that-be also talked to Herman's ex-wife, who said he was "irresponsible" about his diabetes throughout their marriage. She also said he had a gambling problem. And that he wore mismatched socks. OK, I made that last one up.

Still, this case is built around his doc, backed up by the patient's Ex, saying he's a "bad" diabetic. Uh. Imagine that. Are these the best sources of information? Ex-wives have been known to suffer from residual venom, and a doc in a case like this might be concerned about his license and be eager to paint the patient in a bad light.

So we need to ask, as he's accused of ignoring them, just what were his doctor's orders? Were they clear? Did the patient understand them? Was the therapy appropriate for his condition? Was he able to get the medicines and supplies the doctor ordered? Did he ever have any diabetes education, and if so, was it given in an appropriate manner for his intellectual and educational levels? He's a science teacher, so we can assume he's not an idiot. But still, plenty of smart people with diabetes never get any good education about their condition. Did he really have good care, or did he get 10 minutes of "do what I tell you to do" every three months?

I doubt we'll ever know, but these are the kinds of questions that need to be asked in cases like this. I can think of a lot of extenuating circumstances that would make a tragedy like this not his fault, and I think that authorities need to be sure that they have looked at each before pressing charges against a person with diabetes who's involved in this type of accident.

But let's assume, just for the sake of argument, that this guy is the poster boy for noncompliance. Let's pretend his doc is the best diabetes doc on the planet, he's got the CDE of the Year on his team, and he has low-cost health insurance that covers him like a United States Senator. Let's assume he has affordable access to the best medicines and tools made. If all of that were true, and he still just ignored his diabetes, would he then be criminally liable for his actions?

Yes. Hell, yes. ID-Driver On Key think that in those circumstances, he should be held accountable. Because if you have a disease, and you have access to care and tools and medicines, and you choose not to use them, then I think you should be held responsible for the consequences of that choice. In fact, IF it were true that he had access to all he needed, and chose not to use those resources, then he's no better than a drunk driver.

In fact, you can make a good case for comparing resource-rich noncompliant diabetics with drunk drivers. Both alcoholism and diabetes are diseases. No one chooses to get either one. It's a matter of fate and genes. But the alcoholic can choose to drink and drive, or not to drink and drive. This element of choice in the setting of a disease has increasingly led states to charge drunk drivers who kill someone with charges similar to those brought against Herman; and although it varies from state to state, the time served if convicted is similar. By the same token, the person with diabetes who has access to care can choose to try to control his or her blood sugar or ignore it.

The problem with this view is that I know the cold, hard facts: Very few people with diabetes actually have access to good care, good medicines, and good tools. I don't know if Mr. Herman had this access or not. But as a general rule I think that until our culture advances to the point where we give people the tools they need to stay healthy, we need to mitigate some of the personal blame for tragedies like these.

Society can't have it both ways.

That's what I think, anyway.

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

 
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This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.