Medical Fitness to Drive and a Voluntary State Reporting Law

AAA Foundation Study Finds Missouri Law on Medically Unfit Drivers is Model for Other States -Law to Identify and Remove Unsafe Drivers is Working
A Missouri state law designed to help families, doctors and law enforcement officials prevent unsafe motorists from continuing to drive is working effectively and should serve as a model for the nation, according to a comprehensive study released in October 2008 by the AAA Foundation. The law ensures licensing decisions are based on a person’s functional performance and medical fitness to drive safely – not their chronological age; although the study found that the average age of reported drivers was 80 years old.

Missouri’s voluntary reporting law allows concerned family members, police officers, physicians, license office staff and others to report potentially at-risk drivers for re-evaluation and possible license revocation if they are found to be medically unfit to drive.  In part, the law is in response to the efforts of the Suroff family of St. Louis, who lost their 21-year-old son, Jason, to a 92 year-old wrong-way driver with dementia.  Missouri is one of 44 states to allow voluntary reporting (six states have mandatory laws).

The findings from the evaluation of Missouri’s voluntary reporting law further reinforce the AAA Foundation’s consensus-based national license policy recommendations set forth earlier this year. The recommendations came out of a conference that brought together top transportation and health experts from federal and state governments, the insurance industry, medical professions, universities and advocates for the elderly:

• Increase educational efforts: Many stakeholders in driver safety are unaware of reporting mechanisms and how to identify medically-at-risk drivers.  Consistent education and training is needed for clinicians, licensing personnel and law enforcement to teach them about existing laws, regulations and proper procedures for reporting medically or functionally unfit drivers in their states.
• Promote civil immunity: As is done in Missouri, all states should enact laws that provide civil immunity for clinicians, law enforcement, licensing personnel, and others who report in good faith people they believe to be medically unfit to drive.
• Amplify the role of license office staff: Data suggest that trained license office staff can and do play a significant role in proactively identifying at-risk drivers during their interactions at the time of driver’s license and auto plate renewal.  There is also a need to increase the number of qualified people nationwide who can provide comprehensive driver testing and rehabilitation services.
• Establish and fund active Medical Advisory Boards (MABs): MABs should be in place to conduct individual case reviews and provide input on policy development.  Fourteen states lack any type of MAB, and most states that already have them should enhance them by providing greater incentives for physician participation.
• Promote mobility options for unlicensed drivers: Voluntary reporting procedures are an important component of the mobility continuum – not simply engines for de-licensing. Most individuals who can no longer safely drive choose to retire from driving without ever being reported. Some, however, drive past the point of safety and for these drivers, reporting may be necessary. Whether an unfit driver is reported or not, state driver licensing agencies are in a good position to support on-going mobility by referring individuals and families to alternative transportation resources in their communities. The AAA Foundation provides evidence-based information and guidance on how to remain mobile after individuals give up the keys.

The Missouri law does not specify age as a criterion for reporting. For instance, a 20-year-old with psychosis may be prevented from driving as could a 90-year-old with macular degeneration causing near blindness. Among older reported drivers, cognitive impairment due to dementia (e.g., Alzheimer’s disease) or other causes was the most prevalent medical condition, listed in records for half of the sample. Persons with dementia lose self-awareness over time and are at risk for continuing to drive when no longer reasonably capable of doing so.

Researchers found that most reported drivers voluntarily gave up their licenses or opted not to follow through with the appeal process, which involves submitting a physician’s statement within 30 days. Based on the health status of the reported driver and physician recommendations, state licensing officials can implement immediate license revocation or require on-road testing to certify ongoing fitness to drive. At the completion of the study, only 144 of 4,100 (3.5 percent) of reported drivers retained valid licenses. While crashes and other on-road incidents were important factors in these drivers (one third were involved in crashes within 0-6 months prior to being reported), subsequent crash data indicate that these individuals likely ceased to be active drivers.

Police officers were the most likely group to report a driver under this law, followed by license office staff. Together, these reports accounted for over half of all reports coming into the Missouri Department of Revenue in 2001-2005. Police-initiated reports were made typically in response to a crash or other on-road incident, indicating that public safety was already compromised. Relatively fewer reports were received from physicians and family members, those often in the best position to identify early warning signs of a driver fitness problem. This study concludes that enhanced reporting by non-police stakeholders could enhance public safety in the future. Procedural and educational initiatives to encourage reporting by physicians, family members, and healthcare professionals are crucial to recognizing at-risk drivers before a crash occurs.

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