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DOT HS 812 402April 2017Medical Review PracticesFor Driver LicensingVolume 3: Guidelines and ProcessesIn the United States
DISCLAIMERThis publication is distributed by the U.S. Department of Transportation, NationalHighway Traffic Safety Administration, in the interest of information exchange.The opinions, findings and conclusions expressed in this publication are those ofthe authors and not necessarily those of the Department of Transportation or theNational Highway Traffic Safety Administration. The United States Governmentassumes no liability for its contents or use thereof. If trade or manufacturers’names are mentioned, it is only because they are considered essential to the objectof the publication and should not be construed as an endorsement. The UnitedStates Government does not endorse products or manufacturers.Suggested APA Format Citation:Lococo, K. H., Stutts, J., Sifrit, K. J., & Staplin, L. (2017, April). Medical review practices fordriver licensing, Volume 3: Guidelines and processes in the United States (Report No.DOT HS 812 402). Washington, DC: National Highway Traffic Safety Administration.
Technical Report Documentation Page1. Report No.2. Government Accession No.3. Recipient's Catalog No.DOT HS 812 4024. Title and Subtitle5. Report DateApril 2017Medical Review Practices for Driver Licensing6. Performing Organization CodeVolume 3: Guidelines and Processes in the United States7. Authors8. Performing Organization Report No.Kathy H. Lococo, Kathy J. Sifrit, Jane Stutts, and Loren Staplin9. Performing Organization Name and Address10. Work Unit No. (TRAIS)TransAnalytics, LLC336 West Broad StreetQuakertown, PA 1895111. Contract or Grant No.Contract No. DTNH22-09-D00135,Task Order No. 0812. Sponsoring Agency Name and Address13. Type of Report and Period CoveredNational Highway Traffic Safety Administration1200 New Jersey Avenue, SEWashington, DC 20590Final Report14. Sponsoring Agency Code15. Supplementary NotesDr. Kathy Sifrit was the NHTSA Task Order Manager on this project.16. AbstractThis is the third of three reports examining driver medical review practices in the United States and howthey fulfill the basic functions of identifying, assessing, and rendering licensing decisions on medically orfunctionally at-risk drivers. This volume updates the information presented in 2003 (Summary of MedicalAdvisory Board Practices in the United States). Medical Review/Driver Reexamination Department staff in49 of the 51 State driver licensing agencies plus the District of Columbia responded to a survey designed togather information about the driver medical review structure and processes in their jurisdictions. The firstsection of this report presents a 5- to 10-page narrative for each jurisdiction describing the organization ofthe medical review program; mechanisms used to identify drivers with medical conditions and functionalimpairments; procedures and medical guidelines used to evaluate drivers for fitness to drive; medical reviewand reexamination outcomes; appeals processes; availability of counseling and public information andeducation; outreach to law enforcement, medical professionals and others who may have concerns about amedically or functionally impaired driver; and administrative issues such as training of employees, and costsassociated with medical review/reexamination. Following the State-by-State summaries, tables compare andcontrast States’ responses to each survey question. This updated information may serve as a reference toState driver licensing agencies when updating their own guidelines, practices, and outreach to those whomay refer drivers for medical review, by showing what works in other jurisdictions; and may promotepractices that maintain public safety while allowing for personal mobility.17. Key Words18. Distribution StatementDriver licensing, driver medical review,driver reexamination, medical advisoryboard, functional impairment, medicalcondition, license restrictionNo restrictions. This document is available to the publicthrough the National Technical Information Service,www.ntis.gov19. Security Classif. (of this report)UnclassifiedForm DOT F 1700.7 (8-72)20. Security Classif. (of this page)Unclassified21. No. of Pages650Reproduction of completed page authorizedi22. Price
AcknowledgementsThe authors wish to thank the administrators in each participating State licensing agency for theirsupport of this work, and for tasking completion of our survey with the appropriate medicalreview personnel. We are sincerely grateful to each of the survey respondents listed below fortheir time and effort, including responding to the survey questions and collaborating with otherdepartments when necessary; updating the narratives describing their programs; providing copiesof forms, standards, and guidelines for our review; and responding to our repeated inquiries toclarify information. We would not have been able to complete this project successfully withouttheir kind assistance.StateRespondent oradoConnecticutDelawareDistrict of waKansasKentuckyLouisianaMaineDiane WoodruffNichole ThamKaren MillsKarla CochranWesley GooTed TrujilloSusan ArchambaultTana LyonsLucinda BabersWilliam R. HendersonJohn HawkinsJohn LovstedtChris KiyoshiMichael J. MayerMelissa LechnerDebra CarneyMichele ChavezJana SanchezPaige PaxtonThea FickettMarylandCarl A. Soderstrom, M.D.MassachusettsSteve EvansDriver License ManagerDriver Services ManagerSpecial Assistant to the DirectorManager Driver ControlLicensing Operations Division Deputy DirectorOperations Director, Driver Control SectionMotor Vehicle Division ManagerAssistant Manager/Hearing OfficerDirector, DC DMVHuman Services AdministratorDeputy General CounselHighway Safety ManagerMedical/Driver Records Unit Supervisor, Driver ServicesDirector of Driver ServicesCDL Program DirectorCompliance OfficerPublic Service Administrator IIAdministrative Section SupervisorCDL PDPS Helpdesk ManagerMedical Review CoordinatorChief, Medical Advisory Board; Maryland Motor VehicleAdministrationDirector, Medical AffairsMichiganJohn GregurichRamona PutnamSenior Driver AnalystDirector (Traffic Safety kaLois CheeseboroWendell J. WrightRuss QuinnMichele SnowbergerLea KinnisonDriver Services CoordinatorDirector, Driver Records DivisionCDL CoordinatorRecords and Driver Control Bureau ChiefDriver License Managerii
StateRespondent NameNevadaNew HampshireWayne BahmillerJeff OberdankNew JerseyGina M. SineNew MexicoNew YorkNorth Carolina--Donna LewisLinda BriggsTitleManagement AnalystSupervisor, Driver LicensingManager, Driver Review Bureau, Compliance & SafetyDivision--Chief driver improvement examinerSupervising driver improvement examiner------North DakotaOhioCassondra AufenthieJoyce BlantonMedical CoordinatorCustomer Service ManagerOklahomaMike BaileySenior Medical Officer for the Driver Compliance Divisionof the Oklahoma Department of Public SafetyOregonPennsylvaniaRhode IslandSouth CarolinaSouth est VirginiaLisa WalligKurt MyersMichael KinchPearl ArdisJane SchrankGerry CrownoverRaquel AtesDebbie DargerMichael A. SmithMillicent FordJudy GroezingerRoxana DoveSteven PazynskiMatthew BrelieDebbie TrojovskyMedical Programs CoordinatorDeputy Secretary, Driver and Vehicle ServicesChief of Operator ControlSupervisor, SCDMV Driver ImprovementProgram Director, SD DPS Driver Licensing ProgramStaff Attorney, Manager Driver ImprovementAnalystManager, DPS Driver License DivisionDirector of OperationsDriver Services DirectorAdministrator, Driver RecordsMedical Coordinator for Driver ServicesMedical Review & Fitness Unit SupervisorMedical Review & Fitness Unit Team LeaderDriver Services, Program ManagerWisconsinWyomingiii
Table of ContentsIntroduction . 1Methods . 2Results: State Summaries . 4Alabama . 4Alaska . 10Arizona. 19Arkansas . 26California . 30Colorado . 41Connecticut . 46Delaware . 61District of Columbia . 70Florida . 75Georgia . 85Hawaii . 90Idaho . 96Illinois . 102Indiana. 114Iowa. 120Kansas . 130Kentucky . 138Louisiana . 146Maine . 155Maryland . 165Massachusetts . 180Michigan . 192Minnesota. 198Mississippi . 205Missouri . 211Montana . 219Nebraska . 226Nevada . 231New Hampshire . 238New Jersey . 244iv
New Mexico . 252New York . 257North Carolina . 264North Dakota . 276Ohio. 282Oklahoma . 290Oregon. 301Pennsylvania . 319Rhode Island . 327South Carolina . 332South Dakota. 341Tennessee . 347Texas . 353Utah . 372Vermont . 380Virginia . 385Washington . 398West Virginia . 409Wisconsin. 416Wyoming. 433Results: Survey Responses by State . 440Q6. Does your State currently have a Medical Review or Medical Advisory Board(MAB) or formal liaison with another office, department, or division that functionsas a MAB (e.g., a State Health Office)? . 440Q7. In which of the following activities does the MAB participate? . 443Q8. How many MAB positions are there? . 448Q8a. How many of these positions are presently filled? . 448Q9. Is the MAB divided into committees or subcommittees? . 448Q9a. If “Yes,” please explain (e.g., how many committees and how many members oneach?) . 448Q10. What medical specialties are represented by the MAB members? . 451Q10a. List any other medical specialties represented by the MAB that are not listed above. 451Q10b. If there are other members of the MAB who are not physicians, please describethem here . 451Q11. What is the employment of the MAB physicians? . 454v
Q12. If Board physicians are NOT employed by the licensing agency (i.e., if they areconsultants), who are they employed by? . 454Q13. If MAB members are paid consultants to the licensing agency, describecompensation . 454Q14. When the MAB reviews individual cases referred by the licensing agency medicalcase review staff, how are fitness to drive recommendations determined (orrecommendations for further testing)? . 458Q15. How many individual cases referred by licensing agency case review staff did theMAB review in 2012? . 458Q16. What types of cases are generally referred to the MAB for review? . 458Q18. If the MAB reviews cases appealing the agency’s licensing decision, how manyappeal cases did the MAB review in 2012? . 458Q17. What types of dispositions may the MAB recommend?. 469Q19. Are MAB members immune from legal (tort) action? . 471Q20. Are records and deliberations of the MAB confidential? . 471Q21. Are MAB members’ identities public or do they remain anonymous? . 471Q22. Which best describes the individuals within the licensing agency who perform casereview of drivers referred for medical review or reexamination? (NOTE: this isindividuals other than any MAB your State may have). . 473Q23. Are there any medical professionals (physicians or nurses) on the licensing agencycase review staff? (NOTE, again, this is separate from any MAB your State mayhave). . 476Q24. What is the composition of the licensing agency staff who provide case review ofdrivers referred for medical review or reexamination? Check all that apply, andenter the number of individuals in each category, where applicable. If physicians,please also list their medical specialties. (NOTE: this is separate from any MAByou may have). . 478Q25. What are the circumstances under which a driver may be required to undergomedical review/reexamination (examination by treating physician, and/or DMVtesting)? . 482Q26. In 2012, how many drivers were referred to the licensing agency for MedicalReview or re-evaluation of fitness to drive? (These are initial referrals/letters ofconcern by law enforcement, physicians, family, friends, other concerned citizens,DMV counter personnel who observe signs of impairment by drivers undergoingrenewal, etc.). . 491Q27. How many cases that were already under periodic review, did the licensingagency’s Medical Review Department review in 2012? . 491Q28. What were the sources of the initial non-alcohol-related referrals/letters of concernin 2012, and what percentage of the total number of these referrals does each sourcerepresent? . 497vi
Q29. Are first-time applicants for a passenger vehicle driver’s license required (by Statestatute or law) to have a physical exam performed by a physician or other medicalpractitioner (apart from whether a driver license examiner observes signs ofimpairment or a driver self-reports a medical condition)?. 506Q30. Are driver license applicants required to respond to either written or verbalquestions about medical conditions? . 506Q31. Are physicians required by law to report drivers to the licensing agency who havemedical conditions or functional impairments that could affect their ability to drivesafely? . 509Q31a. Describe the conditions or situations that physicians are required to report:. 509Q31b. If a physician fails to report a driver with a medical condition, as required, andthen the patient is involved in a crash, can the physician be held liable as aproximate cause of a crash resulting in death, injury, or property damage caused bythe patient? . 509Q31c. If a physician fails to report a driver with a medical condition, as required, can thephysician be convicted of a summary criminal offense? . 509Q32. For physicians who report drivers to the licensing agency (either by law or on avolunteer basis), are reports confidential? . 513Q33. Are physicians who report drivers in good faith (either by law or on a volunteerbasis) immune from legal action by their patients? . 513Q34. Does the licensing agency accept reports from individuals who do not provide theirname (i.e., anonymous referrals)? . 517Q35. Are certain drivers and/or their reporting sources interviewed or investigated beforethe licensing agency opens a case for medical review or reexamination (toauthenticate the need for a medical review or reexamination and/or to rule outmalicious intent in reporting)? . 517Q36. Are all drivers undergoing initial Medical Review/reexamination required to submita medical report completed by their treating physicians and/or a vision reportcompleted by their vision specialist to the licensing agency as a part of the MedicalReview Process? . 526Q36a. If the answer to Question # 36 is “No,” please describe the circumstances underwhich a driver would not be required to comply with this step in the MedicalReview/reexamination process. . 526Q37. Which of the following types of guidelines/medical standards does your State applyfor licensing drivers of passenger vehicles? Remember, this survey concerns driversof passenger vehicles only (includes cars, vans, and pick-up trucks only); it doesNOT include commercial motor vehicle drivers or school buses or other for-hirepassenger transport. 530Q38. When a driver must provide a medical form from his or her treating physician, whatopinions does the licensing agency request the driver’s treating physician to provideon the form? . 532vii
Q39. When licensing agency case reviewers or medical review board physicians areevaluating medical information provided by a driver’s physician (forms requestedfor completion by the DMV), what do the case reviewers or physicians considerwhen making a licensing determination? . 535Q40. Do drivers undergo in-person screening of physical and cognitive abilities as part ofa medical review/re-examination (apart from the standard DMV vision, knowledge,and road tests)? . 539Q40a. Describe who conducts these tests. . 539Q40b. Describe the kinds of tests and how they are administered. . 539Q41. Is there a method or process used by the Medical Review department to prioritizeparticularly risky cases (i.e., a “triage system”) so they are processed first or morequickly than less risky cases? . 543Q41a. If “Yes” to Question 41, describe the procedures when a particularly risky driver isreferred to the licensing agency for medical review/reexamination. . 543Q42. Are there situations where a potentially high-risk driver’s license is suspended,revoked, or cancelled immediately (upon receipt of a referral for medicalreview/reexamination), pending the outcome of the medical review process? . 543Q42a. If “Yes” to Question # 42, please describe the types of situations where apotentially high-risk driver’s license would be suspended, revoked, or cancelledimmediately. 543Q43. Which bests describes the on-road test given to drivers undergoing medicalreview/re-examination, when a licensing agency road test is required? (Check 1response). . 552Q44. Which best describes the driver license examiners who conduct reexamination testsfor drivers undergoing medical review/reexamination, and their training forconducting reexaminations?. 552Q45. Are home-area tests sometimes offered to drivers undergoing MedicalReview/reexamination, to determine whether a driver can navigate safely in afamiliar area near home, and to determine whether a limited license can be issued?. 556Q45a. If “Yes” to Question 45, describe the circumstances under which a home-area testis given, the qualifications of the driver license examiners who conduct home-areatests, and the approximate number of home-area tests given in a 1-year period. . 556Q46. Are some drivers required to undergo evaluation by a driver evaluation specialist(e.g., Occupational Therapist or driver rehabilitation specialist outside of thelicensing agency) to obtain this specialist’s opinion regarding fitness to drive,before a licensing decision will be made? . 561Q56. Does your licensing agency either refer drivers to driver rehabilitation specialists(DRSs) for remediation of driving problems (may include driver training for use ofadaptive equipment and how to compensate for impairing conditions) or educatedrivers about how driver rehabilitation specialists may help remediate drivingproblems (and provide a list of DRSs in the area)? . 561viii
Q47. Under what circumstances might a reported driver’s license besuspended/revoked/denied/cancelled? . 566Q48. What are the potential outcomes of referrals for medical review/reexamination (i.e.,outcomes the licensing agency applies after driver interviews/investigations, reviewof any required medical reports and/or any required testing)? (Outcomes 1 through4, of 17 listed outcomes) . 571Q48 (Cont’d). What are the potential outcomes of referrals for medicalreview/reexamination (i.e., outcomes the licensing agency applies after driverinterviews/investigations, review of any required medical reports and/or anyrequired testing)? (Outcomes 5 through 9, of 17 listed outcomes) . 574Q48 (Cont’d). What are the potential outcomes of referrals for medicalreview/reexamination (i.e., outcomes the licensing agency applies after driverinterviews/investigations, review of any required medical reports and/or anyrequired testing)? (Outcomes 10 through 14, of 17 listed outcomes) . 577Q48 (Cont’d). What are the potential outcomes of referrals for medicalreview/reexamination (i.e., outcomes the licensing agency applies after driverinterviews/investigations, review of any required medical reports and/or anyrequired testing)? (Outcomes 15 through 17, of 17 listed outcomes) . 580Q49. With the understanding that the Licensing Authority has the final authority formaking a licensing determination, on what basis are licensing decisions generallymade? (Check all that apply). If many apply and there is a hierarchy, rate each inorder of priority in the medical review
Tennessee Gerry Crownover Staff Attorney, Manager Driver Improvement Texas Raquel Ates Analyst Utah Debbie Darger Manager, DPS Driver License Division Vermont Michael A. Smith Director of Operations Virginia Millicent Ford Driver Services Director Washington Judy Groezinger Administrator, Driver Records
