2.4 Medical Advisory Boards

Overall Effectiveness Concerns: This countermeasure is widely used; however, there are no known studies evaluating the crash relevant effects of MABs.

Thirty-two States have medical advisory boards to assist the licensing agencies in evaluating people with medical conditions or functional limitations that may affect their ability to drive (Lococo, Stutts, et al., 2017). MABs generally make policy recommendations on what licensing actions are appropriate for people with specific medical conditions or functional limitations. In 2016 and 2017, NHTSA published a series of reports on the analysis of the MAB implementation practices. These reports document the medical review structures and processes of all States and include case studies for several States. Most State MABs review individual cases, though this activity varies widely; 5 States reported that their MABs reviewed 1,000 cases or more in 2012 while another 7 reviewed 10 or fewer cases (Lococo, Stutts, et al., 2017).

MABs should play key roles as the links among health care professionals, licensing agencies, law enforcement, and the public. They should take the lead in defining how  medical conditions and functional impairments affect driving; defining medical assessment and oversight standards; improving awareness and training for healthcare providers, law enforcement, and the public; advising health care professionals how drivers can compensate for certain medical conditions or functional impairments; and reviewing individual cases. AAA has developed its list of best practices and recommendations for MABs based on the NHTSA- AAMVA study findings (AAA, 2004). The National Transportation Safety Board has made similar recommendations (NTSB, 2004). In June 2005 NHTSA released a summary of recommended strategies for MABs and national medical guidelines for driving, prepared in collaboration with AAMVA (Lococo & Staplin, 2005).

As noted above, NHTSA and AAMVA produced a guide in September 2009, “Driver Fitness Medical Guidelines” designed to provide guidance to licensing agencies in making decisions about a person’s fitness for driving (NHTSA, 2009). These guidelines, as well as NHTSA’s Physician’s Guide to Assessing and Counseling Older Drivers (Wang et al., 2003; Carr et al., 2010), can be used to provide guidance to MABs as they define how  medical conditions and functional impairments affect driving and what steps can be taken to compensate for any limitations noted due to relevant conditions and limitations.

Use: Thirty-two States report having MABs or a formal liaison with other offices that functions as MABs (Lococo, Stutts, et al., 2017).

Effectiveness: There are no known studies evaluating the effects of MABs. Maryland’s MAB reviewed over 500 individual cases in 2004 and recommended license suspension for about two-thirds of the cases.[1]

NHTSA performed a detailed examination of driver review practices across the country to identify the strengths and weaknesses of the different implementations. The 51 agencies were grouped into four categories based on two criteria:

• presence of a State MAB or similar liaison with a State health department and
• availability of in-house medical professionals to review license referral cases (Lococo et al., 2016).

Seven States were selected for detailed analysis of their MAB practice—Maine, North Carolina, Texas, Wisconsin, Ohio, Washington, and Oregon. These States were surveyed on the structure and operation of their driver review programs, which included information on sources for medical referrals, activities of the MAB, and the type of medical information collected from the drivers. States without MABs or in-house physicians were found to rely on the assessments of drivers’ physicians and licensing tests. Driver appeals to licensing decisions in these States were found to be the lowest. States with MABs relied on the medical standards that were in place; these generally also had legal immunity granted to physicians, which resulted in high physician referrals.

Case studies of driver referrals from 6 of the States (all except for North Carolina) were performed in 2012. A random sample of 500 drivers referred for initial medical were selected from each State (Lococo, Sifrit, et al., 2017). Many were referrals by the driver (self-referral), physicians, licensing agency staff, or LEOs. The States varied in terms of the licensing outcomes. Overall, the majority of cases (99%) including all types of referrals in both Oregon and Texas resulted in changes in licensing status. While overall changes in licensing status were lower in the 4 remaining States (ranging from 76 to 88%), the majority of physician referrals (ranging from 90 to 97%) resulted in licensing status changes. The authors concluded that the identification of the source of referrals has implications for educational countermeasures to increase number and quality of referrals. One example discussed is the participation of LEOs in NHTSA’s 4-hour Older Driver Law Enforcement Course (see www.iadlest.org/training/older-driver-law-enforcement-training) to increase identification of driving impairment signs.

Costs: MABs are comprised of physicians and other health care professionals together with appropriate administrative staff. Costs will be minimal for a MAB whose activities are limited to policy recommendations. Costs for a MAB that evaluates individual cases will depend on the caseload. The presence of a MAB and/or in-house medical staff may not always result in higher overall costs (Lococo et al., 2016).

Time to implement: States probably will need at least a year to establish and staff a MAB, depending on what duties the MAB undertakes. States likely can expand the functions of an existing MAB in 6 months.

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