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Ranks 3, 5, 9, and 19: Comprehensiveness of Criteria for Licensure –

  • Standards for Blackouts/Seizures/Losses of Consciousness (Component Z)
  • Standards for Vision (Component Y)
  • Standards for Medical Conditions Affecting Multiple Body Systems (Component AA)
  • Standards for Alcohol/Substance Abuse (Component AB)

    In the Relative Value Assessment exercise, the medical review component labeled comprehensiveness of criteria for licensure was rated as the most important of the 4 general components under policies governing medical review activities and the most important of the 16 components listed in the second column of the exercise. In fact, having standards for blackouts/seizures/losses of consciousness (weight=2.72); standards for vision (weight=2.67); standards for medical conditions affecting multiple body systems (weight=2.37); and standards for alcohol/substance abuse (weight=1.84) were ranked 3rd, 5th, 9th, and 19th in importance, respectively, out of 64.

    Standards for alcohol may have received lower ratings than standards for other medical conditions because, in at least one jurisdiction represented at the meeting, alcohol cases only come to the attention to the medical department after three DUI convictions. In several other jurisdictions represented at the meeting, alcohol cases go directly to the court system as opposed to the medical unit. In the majority of the jurisdictions represented at the meeting, alcohol school, substance-abuse counseling, and alcohol interlock requirements are automatic administrative requirements or court-ordered requirements; very few alcohol/substance abuse cases, if any, are considered by the MAB, with the exception of one jurisdiction.

    Meeting attendees were asked to focus the discussion on the following points:

    • For what medical conditions should there be standards for licensing?
    • How detailed should medical standards for licensing be?
    • Should National (Federal) standards be established, as opposed to having 51 different sets of State standards?

    The discussion of these points is summarized below. Areas of significant agreement among group members are noted.

    It was a consensus that it would be useful to have a regular way for MAB members in all jurisdictions to meet and exchange information. This group of MAB members should consist of medical professionals from each State, for the purpose of drafting a set of National guidelines for licensing drivers with medical conditions/functional impairments. The group should meet annually—potentially at meetings hosted by AAMVA—and update guidelines to keep them current with the state-of-the-art knowledge. The starting point for the National guidelines should be the AMA/NHTSA Physician’s Guide to Assessing and Counseling Older Drivers (Wang et al., 2003).

    A comment was made that unless the Federal Government promulgates National guidelines, States will not pay attention because there is never enough money or resources appropriated unless something is mandated.

    With respect to medical standards for alcohol/substance abuse cases, it was recommended by two physicians in attendance that “first-time offender” cases should be referred to the medical review department, based on the following statistics brought up during conversation:

    • These individuals have already driven drunk anywhere from 200 to 1,000 times before their first legal pick-up.
    • 80 to 85 percent of “first-time” DUI offenders have an alcohol dependency problem.
    • 1 out of 3 “first-time” offenders will recidivate.

    Administrative personnel said alcohol cases are followed up in their States (by the courts, Alcohol Commission, etc.), just not by the MAB/medical review department. One administrative medical review unit attendee remarked that having alcohol cases handled in the medical review department could result in almost no occupational licenses being issued in the State. This is because a medical review unit would use different criteria for licensing than the courts or the alcohol commission might. For example, a first-time offender would automatically qualify for an occupational license according to criteria used for licensing by the courts (by virtue of having no prior DUI arrests). The same individual may be denied a license according to criteria for medical fitness used by a medical unit (by virtue of being diagnosed as having a substance abuse problem).

    Regarding vision standards, two physicians in attendance pointed out many States require far visual acuity of 20/40 for licensure. However, recent studies indicate there may be no basis for that requirement. In two jurisdictions represented at the meeting, the requirement for a (non-CDL) driver to obtain a favorable vision statement before driving privileges could be continued was recently changed from 20/40 acuity to 20/70 acuity. In these two jurisdictions, the vision standard for licensing is not written in statute, but exists in guidelines/code.

    It was recommended that medical guidelines for licensing should remain as guidelines (or Code of State Regulations) and not become statutes, to allow for States to maintain their individual approaches to licensing drivers, but with a common thread. Medical guidelines for licensing, if kept as guidelines, can be updated within a week or two with new state-of-the-knowledge information, allowing the DMV to give drivers its best judgment, whereas statutes require changes in legislation that can take years.

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