MEETING WITH EXPERTS
Ranks 14, 16, and 28: Extent of DMV Evaluation Procedures (for Re-Exam Drivers) -
DMV evaluation procedures received a weighting of 6.75, placing them second in importance of the four case review procedures evaluated, and 6th out of 16 with respect to the components evaluated in the middle column of the RVA. When a person enters the medical review program, the DMV may:
The results of the RVA and comments provided by meeting attendees for these subcomponents are described below.
Regarding DMV examinations, one attendee said her jurisdiction just added in September 2003 the requirement that whenever drivers are reexamined they must take the knowledge and driving tests. This has reduced reexaminations they administer by approximately 50 percent. People surrender their licenses because they do not want to take the knowledge test. An attendee from another jurisdiction commented that the knowledge test is included for reexamination customers who demonstrate serious cognitive impairment. These customers generally do not even attempt the knowledge test.
One attendee said whenever they require testing for medical reasons, a separate group of examiners (the more experienced ones) are assigned to conduct the road test. Another attendee said they use the same road test course for reexamination drivers as for initial licensees, but they are not looking for the same things when someone is missing an arm versus missing a leg. The examiner still asks questions but the driver is not scored the way a 16-year-old driver is, and drivers are not scored equally depending on the disability. The special drive tests are not scored at all, as far as a particular score passing or not. In the special drive test, the objective is to discover the driver’s limitations whether the driver can deal with traffic in a 25-mph zone, a 30-mph zone, etc. That driver will be restricted from driving according to the limitations determined by the drive test. Several attendees said when drivers are issued geographically restricted licenses, they must return to the DMV for periodic evaluations during the license cycle to make sure their functional ability has not declined further. In one jurisdiction, an attendee said customers with mild dementia may be allowed to continue to drive, but they must take and pass multiple road tests given over the course of a two-or three-week period, because dementia patients have good days and bad days, and passing one single test is not indicative of their ability to drive safely. They must also be reexamined by taking drive tests at 3- or 6-month intervals as recommended by the MAB. Meeting attendees agreed it would be a good, best-practice recommendation to require patients with dementia to take and pass multiple road tests to keep their licenses.
Regarding DMV requests for and review of medical history, meeting attendees agreed medical history is critical in making licensing determinations. If people do not go to doctors and fail to get the forms completed, they do not drive. With regard to requiring medical reports on a periodic basis for progressive medical conditions, one jurisdiction said because of legislative and budget cuts, its medical review staff was reduced from 10 people to 2 people, so they had to stop the monitoring cycles already in place. In one jurisdiction represented at the meeting, a doctor's certification is required at the age of 70; the DMV will not renew the license without it.
One administrative attendee said they have received complaints from physicians about the complexity and length of time it takes to complete the DMV medical history forms. This jurisdiction has tried to find a middle ground and included Yes/No check boxes, but that seems simplistic compared to other States’ forms, which require thought and provide a lot of valuable information. One solution may be to have physicians profile patients using the Functional Ability Profiles. One jurisdiction said although its form seems lengthy, the physician only needs to fill out one page per medical condition that affects the person (e.g., a physician need only complete the cardiovascular page unless the person has other medical conditions).
Physicians in attendance said the science of medicine cannot be reduced to check boxes, arguing that “If we are looking for a quality program, we do need a full administrative and medical piece. I don't think we can reduce medicine to a one-page form.” One administrative attendee said in her jurisdiction, the medical review unit is staffed only with clerical staff, who have difficulty understanding how to interpret information provided by physicians. Clerical staff just want to know the ultimate answerwhether the person should be licensed or not. The point was also made that it is important to have physicians available to a DMV medical unit to review medical history forms. Administrative people in a medical unit cannot be trained on all aspects of all medical conditions.
Functional screening was considered twice in the RVA, once as a renewal procedure to identify at-risk drivers, and once as a DMV evaluation procedure during case review of individuals during reexamination. Functional screening received a higher value as a tool to identify potentially at-risk drivers (weight = 1.72, rank = 21/64) than as a case management procedure for drivers already identified as having a potential problem (weight = 1.42, rank = 28/64).
Although not falling within the top 32 components evaluated in the RVA, comments by attendees regarding the utility of conducting driver interviews instead of just paper reviews deserves mention. In the initial survey, it was found that only 5 jurisdictions currently hold interviews between drivers and MAB physicians. During the meeting, attendees voiced amazement that video conferencing could be implemented. Currently, in most jurisdictions, drivers going to a hearing to dispute a DMV decision (the only time in these jurisdictions there are in-person interviews) must drive to a central office location -- and these are the people who potentially should not be driving at all, so they must find a ride. As a result of current practice, many drivers just give up their licenses. Interviews may have been rated low in the RVA, because respondents could not get beyond considering the barriers to implementing them (even though the instructions for the exercise emphasized that weightings were not to consider feasibility). Meeting attendees liked the idea of in-person or video interviews to help make the initial licensing decision (as opposed to appealing the decision).