Medical Review Practices for Driver Licensing: Volume 1: A Case Study of Guidelines and Processes in Seven U.S. States
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Medical Review Practices for Driver Licensing: Volume 1: A Case Study of Guidelines and Processes in Seven U.S. States

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      This report is the first of three examining driver medical review practices in the United States and how they fulfilled the basic functions of identifying, assessing, and rendering licensing decisions on medically at-risk drivers. The aim was not to identify an optimal medical review method, but rather to document strengths and weaknesses of a variety of approaches. This report presents the methods used to group the diverse medical review practices across the 51 driver licensing agencies into four broad medical review structures, describes selection of States for case study, and identifies strengths and weaknesses associated with each of the four medical review structures. The classification scheme was based on (1) whether a State had a Medical Advisory Board (MAB); and (2) whether inhouse medical professionals performed case review. The seven States for case study were: Maine and North Carolina (States with MABs and medical professionals on the licensing agency case review staffs [MAB & MP]); Texas and Wisconsin (States with MABs and where administrative staff perform case reviews [MAB & Admin]); Ohio and Washington (States with no MABs and where administrative staffs perform case reviews [Admin Only]); and Oregon (no MAB but with medical professionals on the licensing agency case review staff [MP Only]). We contacted each case study State and followed up with telephone interviews and e-mail queries where more information was needed. Although programs within targeted medical review structures varied considerably, each allowed the State to determine whether a driver flagged as potentially medically unfit posed an unacceptable crash risk. Preliminary data from the case study States suggests that having an MAB, and/or having medical professionals on the case review staff, may convey some advantages to the driver medical review process with respect to identifying at-risk drivers, and the assessment of referred drivers. The four case study States with MABs and the MP Only State had more comprehensive medical guidelines in place, and were the only States among those in the case study that provided legal immunity to physicians who voluntarily reported an at-risk driver. Both measures may encourage physician referrals. The two Admin Only States relied heavily on the opinion of the driver’s physician regarding fitness to drive, as well as testing carried out at local licensing offices. In contrast, States with MABs were more likely to base licensing decisions on whether medical standards were met. Practices in the MP Only State were a hybrid of the two. States with MABs and/or medical professionals on their staffs also generally had a broader range of licensing options available. However, appeals were lowest in the two Admin Only States. Finally, having medical professionals on staff, or having paid MABs perform reviews, was not always associated with a higher overall cost per case, although the lowest cost was found for one of the Admin Only States.
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