MEETING WITH EXPERTS
Ranks 7, 10, and 23: Use of External Evaluation Procedures
Most jurisdictions begin their case reviews by requiring drivers to obtain a medical report from their treating physician to determine if the person is medically and mentally competent to drive. Some jurisdictions request further medical information from specialists, such as neurologists, and also request that certain laboratory tests be conducted, with the results submitted for review by MAB physicians. Finally, some jurisdictions request information from driver rehabilitation specialists about a person’s ability to drive safely before they will allow a person to be road-tested by a driver license examiner or will make a licensing determination. Results of the Relative Value Assessment and comments provided by meeting attendees are provided below for each of the four external evaluation procedures components and their subcomponents.
Examination by a personal physician received a weighting of 2.48, placing it first in importance among the four external evaluation components evaluated, and 7th in importance out of 64 when considering all components listed in the third column of the RVA. Comments provided by meeting participants regarding the usefulness of medical history data received by drivers’ personal physicians in making licensing determinations follow.
Meeting attendees agreed the medical history is criticalit provides valuable information to help the DMV make a licensing determination.
In some jurisdictions represented at the meeting, the doctor is asked to provide a response to indicate whether the person is medically and mentally competent to drive. If the doctor checks “no” the person does not drive. But sometimes physicians check “don’t know,” and request a drive test by the DMV or by a CDRS/OT. DMV administrative medical review people at the meeting said either the physician really does not know, or does not want to be the “bad guy” and “take the license away.” One attendee said they are going to take the “Don’t know, please road test” option off the medical history form, because it does not help with a determination of medical fitness to drive. One MAB physician in attendance said it is useful to have that check box on the form for the treating physician who really does not know if the person is medically fit to drive.
Meeting attendees agreed it is often valuable for MAB physicians to talk with treating physicians regarding a patient’s fitness to drive, especially when the treating physician is uncomfortable marking whether a person is fit to drive on the medical history form. The treating physician and the MAB physician each have information the other might not have (e.g., traffic records showing crashes, police reports, etc.).
Physicians also liked the policy described by one attendee, where if any restrictions other than corrective lenses were recommended by a treating physician, the driver would automatically be road-tested by the DMV. This way, the doctor would not seem to be the one that “took the license away” by stating the person was not medically fit to drive.
Sometimes it is difficult to get good medical information from treating physicians because drivers often switch doctorsthere is no doctor loyalty in metropolitan areas, some people do not even have a doctor, and some people with mental incapacities are able to hide their cognitive deficit well. If a treating physician does not see such individuals over several appointments with family input, the history just is not there. Particularly in these cases, an in-person or video interview with the driver, conducted by MAB physicians, can shed light on the magnitude of the problem. (In the RVA, in-person or video interviews were ranked 48/64. Comments about MAB physician interviews with customers are addressed later in this report).
Examination by a medical specialist was weighted 2.32, placing it second in importance of the four components comprising external evaluation procedures, and 10th out of 64 with respect to all components evaluated in the third column of the RVA. Meeting attendees in jurisdictions with MABs said their MAB physicians can request that a driver see a neurologist if more information is needed before a licensing determination can be recommended. The DMV can recommend such an evaluation, but it cannot “require” an evaluation (because it results in out-of-pocket expenses by the driver). However, if the drivers do not comply with the MAB request for an examination by a specialist, their driving privileges will be suspended until the requested information is received, rendering the “request” a “requirement.” One MAB physician said an examination by a medical specialist is medically appropriate, without even considering licensing. If a person has a medical condition such as a loss of consciousness, a medical specialist should conduct an evaluation to determine the cause and treatment, and recommend possible lifestyle changes. This should not be a difficult topic to get across to legislators who might balk at the DMV requiring independent evaluations that may require out-of-pocket expenses by drivers.
An evaluation by a driving rehabilitation specialist (e.g., OT or CDRS) or a driving school was weighted 1.68, placing it third in importance of the four components comprising external evaluation procedures, and 23rd of 64 with respect to all components evaluated in the third column of the RVA. Comments provided by meeting attendees regarding evaluations by a driver rehabilitation specialist in making licensing determinations follow.
Meeting attendees agreed this is an important component in making driver-licensing determinations. A multidisciplinary team is needed to make the right decisionan OT is a very integral part of that team. Treating physicians need to know there are specialists (OTs/CDRSs) who have the expertise to evaluate whether patients with medical conditions and functional impairments can drive safely. One MAB physician did not know, until taking DMV/MAB job, that there were such things as driver rehabilitation specialists.
One meeting attendee commented that if the treating physician marks “don’t know” to the question of whether the person is medically and cognitively fit to drive, the registered nurse on staff with the DMV medical unit sends drivers a notice that they must have an evaluation by a driver rehabilitation specialist, because if the drivers are not safe, the DMV does not want them in the car with an examiner. If drivers are able to go through the battery of tests and pass the specialist’s drive test, then they may attempt the DMV road test, and must pass the DMV test to maintain driving privileges.
One meeting attendee voiced concern about the out-of-pocket cost to drivers; however, in the jurisdictions where this practice is in place, that is of no concern to the DMVs. If drivers do not undergo the driver rehabilitation evaluation, they may not road test with the DMV and the driving privileges will be withdrawn.