NOTE: This project is a continuation of Evaluating Drivers Licensed with Medical Conditions in Utah, 1992-1996, which was completed in June 1999 (DOT HS 809 023, available from the National Technical Information Service, Springfield, Virginia 22161). In order that this report be comprehensible as a stand-alone document, some of the introductory and explanatory materials from that report are repeated here. The Executive Summary from the first report is included here as Appendix C.
Driver license agencies, as regulatory entities, have the responsibility of developing and enforcing policies that protect public safety, while balancing the risks of licensing drivers who have physical or mental impairments. Utah is not unique in the development and implementation of a licensing program for drivers with medical conditions; most states have specific policies related to physical and mental function and driving . The rationale for such programs is that certain diseases or conditions could impair driving ability and, therefore, drivers with medical conditions should be subject to a more rigorous screening process so that they do not jeopardize others on the roads . Any such program, however, must be applied in a careful and reasonable fashion; note that it is unlawful for any State or local government under the Americans with Disabilities Act to discriminate against a qualified person with disabilities on the basis of those disabilities.
Because of the demographic shift in the age of our population , and the higher prevalence of chronic medical conditions in elderly persons, it is increasingly important to evaluate the effects of these existing programs and to assure that they are protective of public safety as is their intent. The number of drivers in these programs will only increase in future years and modifications resulting from such analyses, can provide future benefit.
The Utah Driver License Division implemented a program in 1979 to license drivers with medical conditions. In 1981, the Utah Driver License Division Medical Advisory Board (a physician advisory group) redesigned the written standards of the program that describe the physical, mental and emotional capabilities appropriate for various types of driving. The intent of the board was to create a program that improved public safety while imposing on drivers the fewest possible restrictions consistent with that goal.
The program uses a general questionnaire to screen all license applicants within the state to identify medical conditions related to the applicant's physical, mental and emotional health. Applicants who report a medical condition when completing the questionnaire are placed into one (or more) of twelve broad categories of medical diagnoses. These are termed functional ability categories by the program and are listed in Table 1. In this report, the terms functional ability category and medical condition are used interchangeably to refer to these 12 categories:
Table 1: Functional ability categories
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Applicants identifying themselves on the questionnaire as having a medical condition are evaluated for the potential impact of their medical condition on their ability to drive a motor vehicle. Based upon the results of the questionnaire, an applicant may have a driver license immediately issued, or the applicant may be required to complete a more extensive health history form. An applicant identified as having a medical condition may be required to provide documentation by a health care provider to verify his or her functional ability level before a license will be issued. Applicants are then rated on their ability to drive by being placed into one of 12 classifications. These are termed by the program, somewhat confusingly, as functional ability levels. Scaling is done by a medical professional according to detailed guidelines provided by the program. A copy of the State of Utah Functional Ability in Driving: Guidelines and Standards for Health Care Professionals is located in Appendix A. Copies of the general screening questionnaire and the corresponding forms that are completed by health care professionals are located in Appendix B. The functional ability level assignment signifies various constraints and restrictions on driver license privileges. Driving privileges are increasingly more restricted at numerically higher levels. Depending upon the functional ability category (medical condition) and functional ability level (1 – 12), an applicant who has a medical condition may receive full (unrestricted) or restricted driving privileges, or the license application may be denied. Specifics of restrictions for a given functional ability level are not totally consistent between different functional ability categories (medical conditions). However, the restrictions associated with functional ability levels can roughly be summarized as described in Table 2.
Table 2. Relationship of Functional Ability Profiles to Driving Risk/Responsibility or Limitation
| Functional
Ability Profile Level |
Driving Risk/Responsibility, License Class or Limitations |
1-2 |
Irrelevant for private drivers. 1 is used for commercial drivers and 2 is for drivers with a history of a medical problem which is now resolved. No restrictions on driving privileges or licensing periods. |
3-5 |
No restrictions on driving privileges; licensing periods are shortened. |
| 6 | Driving with speed limitations |
| 7 | Driving with speed and area limitations |
8 |
Driving with speed, area and time of day limitations |
9 |
Driving accompanied by licensed driver with limitations of speed and/or area and/or time of day limitations as recommended by health care professional |
10 |
Special driving limitations recommended by health care professional not covered above |
11 |
Under evaluation – may or may not drive, according to circumstances as determined by director, with medical advice as appropriate |
12 |
No driving |
The major product of this program, then, is the imposition of driving restrictions on individuals who have medical conditions and whose medical conditions, after evaluation, appear to adversely affect the ability to drive a motor vehicle. The restrictions are applied by placement in functional ability levels. (Applicants who disagree with the level assigned by their health care provider may contest the level and have it reviewed by the Utah Driver License Medical Advisory Board.)
The Utah Crash Outcome Data Evaluation System (CODES) was created in 1992 at the University of Utah School of Medicine through a successful competitive funding application from the National Highway Traffic Safety Administration (NHTSA). Utah was one of the initial seven CODES states that used probabilistic linking techniques to link computerized data from motor vehicle crashes with those from several health care related data sets including emergency medical services and hospital inpatient and emergency department databases. The initial objective of CODES was to measure the effectiveness of safety belts and motorcycle helmets . Since its creation, Utah CODES has linked and analyzed state crash, ambulance, hospital inpatient and outpatient data in part or entirely for the years 1991 - 1997.
Utah CODES has become an integral partner with the Utah Department of Public Safety, the Utah Department of Health and the Utah Department of Transportation in injury control efforts related to traffic safety in the state. Analysis of the linked data sets has identified the medical and resulting financial outcomes for injuries caused by crashes. Utah specific data have been used to analyze the effects of pending legislative issues and to support changes that would be of benefit to public health and safety (e.g., implementation of a primary seatbelt law and graduated licensing program for teens). Because program staff have the capability and experience in probabilistic linkage and analytical techniques, Utah CODES possessed expertise to perform the necessary linkages in order to evaluate the existing program of licensing drivers with medical conditions.
Several agencies approached Utah CODES about evaluating the medical conditions licensing program in the state. According to the Department of Public Safety, the program is controversial; many drivers feel the program is unwarranted while others feel the standards set forth are so lenient as to compromise public safety. Utah's medical conditions program and the associated guidelines have been regarded as one of the more effective such programs in the country. Ufortunately research in this area is sparse. Consequently, both the Utah Medical Advisory Board and the Utah Driver License Division were interested in evaluating the effects of the program. Because of the applicability of the research to public policy, Utah CODES was funded to evaluate the effect of the existing system. The project was funded by NHTSA with the support of the Utah Driver License Division in the Utah Department of Public Safety and the Utah Department of Transportation.