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Number 309 January 2006

Every state has some form of medical advisory board (MAB) to help determine the fitness of individuals who have medical problems to drive. However, each MAB has its own set

of responsibilities that differ widely from State to State. Many cases reviewed by these boards are about older drivers. The importance of the boards increases as the

population ages. The National Highway Traffic Safety Administration (NHTSA) contracted with TransAnalytics, LLC, to accomplish two objectives: (1) to document the activities

of the MABs or medical review units in the 50 States and the District of Columbia with respect to determining fitness to drive; and (2) to determine which activities currently

applied by one or more jurisdictions deserve consideration as “recommended strategies,” and how to implement them.

Project staff enlisted the cooperation of the American Association of Motor Vehicle Administrators (AAMVA) to conduct a review of the driver licensing agencies in all 50 States

and the District of Columbia. This project solicited information about medical review practices. Each agency also mailed forms, guidelines, and statutes used in its medical

program operations, and participated in a follow-up telephone interview with the project principal investigator to clarify and expand the responses.

Based on information obtained from the three sources (assessments, documents, and interviews), project staff produced an 8- to 10-page description of each jurisdiction’s

procedures for dealing with drivers with suspected functional impairments and medical conditions. Respondents reviewed the information for their respective States for errors

or omissions. Staff also prepared extensive summary tables to simplify access to the information. AAMVA posted the results of this effort on its Web site at:

http://www.aamva.org/drivers/drv/ProblemDriversMedicalAdvisoryBoardPractices.asp.

Project staff identified 64 candidate “recommended strategies” from the review, sorted them into categories based on functional similarity, and arranged the categories into a

hierarchical outline. The resulting outline had four levels of detail, with four alternatives at each branching point. The relative value of each individual component was derived

from averaging weights assigned by representatives of State licensing agencies. AAMVA mailed ratings workbooks to medical review personnel in all 51 jurisdictions. Forty-five

jurisdictions returned completed workbooks. Averaged weights allowed components to be rank-ordered as candidates for inclusion in a model medical review program.

Project staff conducted a 11⁄2-day meeting with medical review staff from a subset of States and representatives from NHTSA and AAMVA to refine the concept of recommended

strategies and identify barriers to their implementation. Panelists discussed what constitutes recommended strategies among the 64 components rated in the Relative Value

Assessment (RVA) and what kinds of legislative and budgetary barriers could preclude implementation. Substantial agreement among participants was reached on a number of

points, including the following:

- Each jurisdiction should have an MAB staffed with physicians to provide advice to Department of Motor Vehicle (DMV) medical review department staff regarding licensees’

fitness to drive.

- The MAB should review individual cases for fitness-to-drive determinations and develop medical criteria and guidelines for licensing.

- The use of in-person and video interviews between MAB physicians and drivers under review to assist in making an initial fitness-to-drive determination should be explored.

- If MAB members cannot be employed as full-time DMV staff because of cost constraints, then they should serve as paid consultants to the DMV.

- Medical/functional guidelines should be used with consistency in treating drivers, but should not replace individual case review by MAB physicians for more complicated cases.

- Rules written for medical review of drivers should be incorporated in the Code of State Regulations, not in statutes, so that changes can be made quickly as new medical data

becomes available.

- National medical/functional model guidelines for driver licensing should be developed, and a national association of medical advisory boards should be created to develop

such guidelines for adoption by States.

- The AMA Physician’s Guide for Assessing and Counseling Older Drivers is a useful starting point for developing national guidelines.

- Drivers should be required to appear in person for license renewal when they reach a certain age, and the renewal cycle should be shortened based on driver age.

- Drivers should be required to self-report medical conditions for initial and renewal licensure.

- Physicians who perform medical evaluations on drivers of private vehicles (upon request of a DMV medical review unit) should be certified to determine eligibility.

Conclusions from the panel meeting and outcomes from the Relative Value Assessment exercise serve as the rationale for development of recommended strategies for the

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identification, regulation, and continuing safe mobility of drivers with medical conditions and functional impairments.

How To Order

For a copy of State of the Art Review of Medical Advisory Boards in States, write to the Office of Research and Technology, NHTSA, NTI-132, Washington DC 20590 or send a

fax to 202-366-7096, or download it from www.nhtsa.dot.gov. Jesse Blatt, Ph.D., was the contract manager.

TRAFFIC TECH is a publication to disseminate information about traffic safety programs, including evaluations, innovative programs, and new publications. Feel free to copy it as

you wish. If you would like to receive a copy, contact Patricia Ellison Potter, Ph.D., Editor, by fax at 202-366-7096, or e-mail at patricia.ellison-potter@nhtsa.dot.gov.

1200 New Jersey Avenue, SE, West Building, Washington, DC 20590 USA 1-888-327-4236 TTY:1-800-424-9153

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