Medical Review Protocols

This countermeasure involves the use of medical review protocols by licensing agencies to evaluate people with medical conditions or functional limitations that could affect their ability to drive safely. The medical review may be performed by an MAB or by in-house medical professionals. Medical review protocols are designed to inform what licensing actions are appropriate for people with specific medical conditions or functional impairments. In 2017 NHTSA published a series of reports on studies outlining the operational benefits of medical review practices. A summary of the studies is available as a Traffic Tech report (NHTSA, 2017).

More than half of the States have MABs or in-house medical professionals that assist 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 implementation of driver medical review protocols. 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 seven reviewed 10 or fewer cases (Lococo, Stutts, et al., 2017).

In 2005 NHTSA released a summary of recommended strategies for MABs and national medical guidelines for driving, prepared in collaboration with AAMVA (Lococo & Staplin, 2005). MABs should play a Key Role in each State as the link between health care professionals, licensing agencies, law enforcement, and the public. They should take the lead in defining how various medical conditions and functional impairments affect driving by defining medical assessment and oversight standards, improving awareness and training for healthcare providers, law enforcement, and the public, advising health care professionals on how drivers can compensate for certain medical conditions or functional impairments, and reviewing individual cases.

NHTSA and AAMVA produced a guide in September 2009, Driver Fitness Medical Guidelines, designed to provide guidance to licensing agencies in making decisions about an individual’s fitness for driving (NHTSA, 2009). These guidelines, as well as the American Geriatrics Society Clinician’s Guide to Assessing and Counseling Older Drivers (Pomidor, 2019), can provide guidance to MABs as they define how various 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:

More than half of the States report currently having an MAB or a formal liaison with another office that functions as an MAB (Lococo, Stutts, et al., 2017).

Effectiveness:

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).

Lococo, Stutts, et al. (2017) presented the descriptions of driver review practices among the 51 driver licensing agencies.

Seven States were selected for detailed analysis of their medical review 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 with MABs relied on the medical standards that were in place; these generally also granted legal immunity to physicians, which resulted in high physician referrals. States without an MAB or in-house physician were found to rely on the assessments of the driver’s physician and licensing tests. Driver appeals of licensing decisions in these States were found to be the lowest.

Lococo et al. (2016) reviewed the licensing outcomes of 4 of these States that had data readily available. They found that greater than 90% of referrals in the 3 States with an MAB or medical professional on staff resulted in a licensing action compared to less than half of the referrals in States without an MAB. This indicates that the MAB/medical professional model may help identify at-risk drivers. The authors concluded that having an MAB or medical professional on the case review staff offered some benefits to the medical review process, most notably providing access to medical expertise when needed.

Cost:

MABs are comprised of physicians and other health care professionals together with appropriate administrative staff. Costs will be minimal for an MAB whose activities are limited to policy recommendations. Costs for an MAB that evaluates individual cases will depend on the caseload. The presence of an MAB 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 an 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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