The ABCDF's of the DMV and Medically Impaired Driver.

Mardy recently emailed me with a question about driving priviledges in a case she's involved with related to the DMV and driving priviledges.  This is a very complicated area, as it is a melding of medical and legal, so it's extremely difficult for the public and the providers involved to navigate through.  I'll do my best to answer and then perhaps we can find others who can contribute from their perspectives. Mardy wrote:

I'm sending this question out to you hoping you'll post it and a response on Lumigrate.  You've written so informatively on Lumigrate over the past year almost about many of the different components and situations related to driving -- everything from simply 'stop signs' to a five day piece in January about the aging driver. 

I've recently had about five conversations about driving and what's entailed in a person or their team assessing driving safety and making the extremely big step to undo driving privileges.  I've been trying my best to educate everyone involved verbally but it would really be best if they had something from you that is succinct (as that's your style!) about the typical process for when someone has a medical impairment.  For those tuning in to read this, Karen's not only got about 20 years experience overall on me and about 10 more just on the Earth experience, but you'll notice in her signature she has important initials after her name, CDRS.  Very hard to come by.  She expects me to kneel and curtsy when I see her.  So far I don't have to kiss her car keys but I bet she might have me do that next! 

All kidding aside, I wish everyone were like the exemplary people I haven known who say 'I know it's time for me to stop driving' and they go into DMV and surrender their license and get an identification card and start having others drive them.  By the way, I really love Karen's suggestion in one of your previous writings here at Lumigrate about paying it forward and giving rides to the elderly when you're younger so you'll feel it's your time to receive when it's time to stop driving.  My father was the complete opposite and only after he was totally compromised physically, which coincided with his license expiring though I had gotten the MD to fill out a Dept of Revenue form from his state at the time he was hospitalized and clearly incapable of driving, just to protect myself and the medical team. 

As a therapist with the ability to know safe and unsafe driving we are all responsible to some extent; in some states neighbors have been held responsible in lawsuits that went up through the supreme court level, for not having contacted DMV about a concerning driver.  And despite over 10 years of AMA and NTSB collaborating on education to physicians, they are remarkably unaware and if they are aware it's very cumbersome and quite frankly, gets ignored due to lack of time. This will be of tremendous benefit to the consumers and providers who know about Lumigrate and I hope people look down and hit that PRINT button or Email button and get this information to anyone they might be able to help and share the information with.

I'm going to simplify this and give a few scenarios and ask you to comment:

1) The most typical of all.  A person who is over 50 is diagnosed with macular deneration. Can the optometrist or ophthalmologist ascertain enough about vision related to driving performance?  Are they only looking at the visual acuity and do they always factor in the other things such as cognition and physical abilities that go into driving?

2)  It's easy to start writing and base this on 'age' but I want to clarify that some people at all ages are having so much difficulty with cognition or  physical coordination they're not as capable for the challenges of driving as someone in their 80s or 90s who happen to have particularly ideal physical and mental well-being.  So let's just say a person has decreasing physical and/or cognitive abilities such as from a neurological disease or condition.  At what point should they have a driving assessment? 

3) If it's something that's typically 'progressive', meaning it gets worse with time, when are reassessments suggested or required?

4) What if they have a reversal in their condition after they've lost or surrendered their privileges; what is the route for getting privileges back? 

5) Let me further complicate things: What if they had a driving assessment which said they were observed to be driving safely and then had an incident which lead to their losing their license based on points. (This could be a crash or a DUI.)

K, here goes.  The first question looks easy but really is not.  The typical optometrist or ophthalmologist will look at visual field loss as well as visual acuity.  Remember that macular degeneration, if not caught in time, will present with central visual field loss, which increases as the disease progresses.  You cannot always count on the eye specialist to relate that to driving. (You may have better luck with a functional optometrist, especially one who has worked with a driving specialist in the past.) They should be able to tell you what the standard is related to minimum visual field for driving in your state.

This is a time when you will need to be proactive in asking questions if you are a driver and want to continue driving safely.  Additionally, you cannot expect them to realistically assess your physical and/or cognitive abilities related to driving.  This may be better done by your family doctor.  Or better yet, have a formal driving evaluation done by a driver rehabilitation specialist who is trained to put all these pieces together to assess your safety.  I would certainly recommend getting the driving evaluation as a baseline of your abilities now so you can realistically plan for your future.

The person who demonstrates decreasing physical and/or cognitive abilities should have a formal assessment of driving safety sooner rather than later.  As in the previous question, this will allow you to realistically plan for your future.  It is fact that at some point we will all face loss of driving privileges secondary to our inability to be safe behind the wheel.  By knowing where we are today in that time line we can make changes gradually either in how or where we drive or start planning how we will get around when we no longer drive.

If we are diagnosed with a progressive illness or disease, AND we have been assessed for current driving safety, you can expect that the driver evaluator will want to do a reassessment in 6-12 months.  Depending on your diagnosis, it may be as soon as 3 months.

I am so glad you asked this last question.  What if your driving privilege has been cancelled and your condition reverses so you are getting better?

You will definitely need to go through your physician to start the process toward getting your driving privilege back. 

• (S)he should refer you to a driver rehab specialist for an evaluation if you are fortunate enough to live in an area with such specialists available. 
• A special Rehab Driving Permit will allow you to do the on-street portion of the evaluation. 
• If all agree that you are now safe to drive, the doctor must fill out a special form that is sent to the DMV stating that you are now safe to drive and asking that you be re-tested by the DMV to obtain your license. 
• You will need to pass the written test, the eye  test and the behind the wheel test just like you did when you first got your license. 
• Some states may ask you to pay a reinstatement fee in addition to the cost of the license.
• The doctor or drivers license office may ask that you be re-tested within a specific period of time to be sure that you are still safe.

Did you notice that the common thread here is the referral to and being tested by the driver rehab specialist?  These are the people who are specifically trained to assess your safety behind the wheel.  As one of those people, I can assure you that our goal is to keep you driving safely for as long as possible.

I hope this sufficiently answers your questions about how to 'Keep the Rubber Side Down' ~~ Karen