Transcript File - Temple University Hospital Foot and Ankle Surgical

Restrictions with respect to driving in a cast or immobilization device?
Restrictions with respect to lower extremity disability?
State
US State Driving Laws Relevant to Podiatric Physicians
Laura E. Sansosti, DPMa, Timothy Greene, DPMa, Michael Berger, DPMa, Todd Hasenstein, DPMa,
and Andrew J. Meyr, DPM FACFASb
Restrictions with respect to drivers with diabetes?
Physician reporting and physician liability with respect to
potentially impaired patient driving?
More information can be found at:
ALABAMA
-No specific regulations identified with respect to a cast or immobilization device.
-The Medical Examination Report asks specifically about “sensorimotor function”, “strength and endurance”, “range of motion”, “maneuvering skills”, “use of arm(s) and leg(s)”, and any history of “surgery”.
-Alabama Administrative Code (Chapter 760-x-20) details medical standards for driver licensing with respect to “conditions affecting musculoskeletal function”. Conditions specifically mentioned include
“rheumatoid arthritis, osteoarthritis, osteomyelitis and osteoposrosis” as it relates to “functional ability including reduced range of motion, pain, stiffness, and reduced mobility”.
-Applicants are specifically asked about diabetes on the driver’s license application form. If present, then it is likely the applicant will have to undergo a medical examination.
Renewing applicants are not asked any medical questions.
-The Medical Examination Report specifically asks if the patient is on insulin and if the patient has been hospitalized for any complications of diabetes within the past year.
-Alabama Administrative Code (Chapter 760-x-20) details medical standards for driver licensing with respect to diabetes. With respect to the lower extremity, it specifically states
that “there is no neuropathy or other complication which interferes with safe driving, as assessed by a physician or determined through a driving evaluation”.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, but may provide information to the state licensing agency. Physicians
may be asked to swear an affidavit. Reports may not be filed anonymously.
-Physicians are immune from civil and criminal liability with respect to reporting of drivers as long as “acting in good faith without negligence or malicious intent”.
-Alabama DMV Home: http://dps.alabama.gov/Home/wfContent.aspx?ID=30&PLH1=plhHome-DriverLicense
-Alabama Driver’s Manual: http://www.alea.gov/Documents/Manuals/DriverLicenseManual.pdf
-Alabama Administrative Code: http://www.alabamaadministrativecode.state.al.us/docs/alea/760-X-20.pdf
ALASKA
-No specific regulations identified with respect to a cast or immobilization device.
-Applicants are required to answer questions about any physical disability that could impair their ability to operate a motor vehicle including “do you have any physical impairments?” and “within the last 5 years
have you suffered from…health problems that might impair your driving?”. If present, then the department may require a physician’s statement before issuing a license. Alaska does not have an independent
medical advisory board.
-A licensee who suffers the permanent loss of a foot or leg must report this to the licensing agency, and it is likely they will have to take a reexamination.
-The Medical Examination Form is very general and asks if any “neurological or neuromuscular disease” or “impaired motor function…may affect the safe operation of a motor vehicle”. It also asks if a
“prostheses would be necessary to ensure the safe operation of a motor vehicle”.
Applicants are not specifically asked about diabetes on the application form. The Medical Examination Form specifically asks about diabetes, but nothing specific about
neuropathy or the lower extremity in this respect.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, but may provide information to the state licensing agency. Reports
may not be filed anonymously although it may be treated with confidentiality.
-Physicians are not immune from civil liability or for damages arising out of an accident caused by the condition with respect to reporting.
-Alaska DMV Home: http://doa.alaska.gov/dmv/akol/
-Alaska License Application: http://doa.alaska.gov/dmv/forms/pdfs/478form.pdf
-Alaska Driver’s Manual: http://doa.alaska.gov/dmv/dlmanual/dlman.pdf
-Alaska Medical Form: http://doa.alaska.gov/dmv/forms/pdfs/468.pdf?_ga=1.175093986.1576534206.1457279504
-Alaska Administrative Code: http://www.legis.state.ak.us/basis/aac.asp#2.90.440
-Alaska List of Moving Violations: http://courts.alaska.gov/specproj/version-a.pdf
ARIZONA
-No specific regulations identified with respect to a cast or immobilization device.
-Applicants are asked if they have any medical condition that might affect their ability to safely operate a motor vehicle: “Do you have a physical condition…. that could affect your ability to safely operate a motor
vehicle?” If present, then it is possible they will have to have a medical examination report completed by their physician. The Medical Examination Form specifically asks about “missing or impaired hand, arm,
foot, leg, finger, toe”.
-Drivers are also required to self-report any new medical conditions.
Applicants are not specifically asked about diabetes on the application form. The Medical Examination Form specifically asks about “diabetes” and “missing or impaired hand,
arm, foot, leg, finger, toe”.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, but may provide information to the state licensing agency. Reports
must be written. Reports may not be filed anonymously.
-Physicians are immune from civil and criminal liability with respect to reporting of drivers.
-Arizona DMV Home: https://www.azdot.gov/home
-Arizona License Application: https://www.azdot.gov/docs/default-source/mvd-forms-pubs/40-5122.pdf?sfvrsn=11
-Arizona Driver’s Manual: https://www.azdot.gov/docs/default-source/mvd-forms-pubs/99-0117.pdf?sfvrsn=0
-Arizona Driver’s Medical Form 1: http://azdot.gov/docs/default-source/mvd-forms-pubs/40-1501.pdf
-Arizona Driver’s Medical Form 2: https://www.azdot.gov/docs/default-source/mvd-forms-pubs/40-1504a.pdf?sfvrsn=0
-Arizona Administrative Code: http://apps.azsos.gov/public_services/Title_17/17-04.pdf
ARKANSAS
-No specific restrictions or regulations identified with respect to a cast or immobilization device.
-Applicants are not asked any questions about medical conditions.
-For commercial drivers, Arkansas utilizes the Federal Commercial Medical Examination Report which specifically asks drivers about “bone, joint, muscle or nerve problems”, “Have you ever had a broken
bone?”, and “Have you ever spent a night in the hospital?”. It specifically asks physicians to grade “extremities/joints” and “gait” as either “normal” or abnormal”.
Applicants are not asked any questions about medical conditions. For commercial drivers, Arkansas utilizes the Federal Commercial Medical Examination Report which
specifically asks drivers about “diabetes or blood sugar problems” and “Have you ever spent a night in the hospital?”. It specifically asks physicians to grade the “neurological
system including reflexes” as either “normal” or abnormal”.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, but may provide information to the state licensing agency.
-There is no statutory immunity from civil or criminal liability with respect to reporting potentially unsafe drivers.
-Arkansas DMV: http://www.dfa.arkansas.gov/offices/motorVehicle/Pages/default.aspx
-Arkansas Driver’s manual: https://static.ark.org/eeuploads/asp/dl_study_guide_vol_1_edition_6_august_2011.pdf
-Federal Commercial Drivers medical form: https://www.fmcsa.dot.gov/sites/fmcsa.dot.gov/files/docs/Medical-Examination-Report-(MER)Form-MCSA-5875.pdf
-Arkansas Administrative Code: http://www.sos.arkansas.gov/rules_and_regs/index.php/rules/search/new
-Arkansas List of Moving Violations: https://www.arkansashighways.com/act300/AR%20Motor%20Veh%2011E.pdf
CALIFORNIA
-No specific regulations identified with respect to a cast or immobilization device.
-Applicants are required to complete a section on the application that asks questions about medical conditions: “In the last 5 years have you experienced any medical conditions that affects your ability to operate a
motor vehicle safely?”. If present, then it is possible they will have to undergo a medical examination.
-The Medical Examination Form specifically asks about “muscular disease”, “any permanent impairment”, and “loss of lower extremity motor control”.
-California has specific physical and mental evaluation guidelines: https://www.dmv.ca.gov/portal/dmv/?1dmy&urile=wcm:path:/dmv_content_en/dmv/dl/driversafety/pm_guidelines
-We also found in a FAQ section: “Q: Should temporary conditions, such as a broken bone, be reported? A: Temporary conditions that do affect your ability to safely operative a motor vehicle, a broken right leg
for example, do not need to be reported; however, you should not drive until it is safe to do so.”
-Applicants are specifically asked about diabetes on the application form. If present, then it is possible they will have to undergo a medical examination. The Medical Examination
Form specifically asks about diabetes including “slowed reactions”, “weakness or fatigue”, and “nervous system disease”.
-California also has a specific handout entitled “Diabetes and Driving”: https://www.dmv.ca.gov/portal/wcm/connect/f0987278-2f6d-4f05-af659a78a8244882/ffdl40.pdf?MOD=AJPERES
-Physicians are not required to report drivers with medical conditions that could affect driving ability, with the exception of disorders characterized by lapses of
consciousness. Physicians must report these. Reports are confidential.
-Physicians are immune from civil and criminal liability with respect to reporting of drivers.
-California DMV: https://www.dmv.ca.gov/portal/dmv
-California License Application: https://www.dmv.ca.gov/portal/wcm/connect/bb16ade8-ef21-4400-85a05811783eda1f/dl44sample.pdf?MOD=AJPERES&CONVERT_TO=url&CACHEID=bb16ade8-ef21-4400-85a0-5811783eda1f
-California driver’s handbook: https://www.dmv.ca.gov/web/eng_pdf/dl600.pdf
-California driver’s medical form: https://www.dmv.ca.gov/portal/wcm/connect/f92586ac-be7a-456b-af31b35acc029982/ds326.pdf?MOD=AJPERES
-California Vehicle Code: http://leginfo.legislature.ca.gov/faces/codesTOCSelected.xhtml?tocCode=VEH&tocTitle=+Vehicle+Code+-+VEH
-California List of Moving Violations: https://dmv.ca.gov/portal/dmv/detail/dl/vioptct
COLORADO
-No specific regulations identified with respect to a cast or immobilization device.
-Applicants are required to answer questions about medical conditions when completing the application. If present, then it is possible they will have to undergo a medical examination.
-The Colorado Confidential Medical/Eye Examination Report specifically asks about “extremities” as being “normal” or “abnormal”. Physicians are asked if “authorization of driving privilege is medically
prudent”, and can recommend a road test or a rehab permit.
-In their Colorado Driving Handbook, however, it does state that “even little problems like…a sore leg can affect your driving. Check with your doctor if you think your health condition could affect your driving”.
Applicants are required to answer questions about medical conditions when completing the application including diabetes. The Colorado Confidential Medical/Eye Examination
Report specifically asks about “diabetes” as being “normal” or “abnormal”.
-We identified no information stating that physicians were required to report drivers with medical conditions that could affect driving ability, but that physicians could
provide information if they had any concerns.
-Physicians are immune from civil and criminal liability with respect to reporting of drivers.
-Colorado DMV: https://www.colorado.gov/dmv
-Colorado driver’s handbook: https://www.colorado.gov/pacific/sites/default/files/DR2337.pdf
-Colorado driver’s medical form:
http://www.leg.state.co.us/clics/clics2008a/commsumm.nsf/b4a3962433b52fa787256e5f00670a71/2ed8c71f953968af8725740200738020/$FILE
/080304%20Attach%20B.pdf
-Colorado Revised Statues: http://tornado.state.co.us/gov_dir/leg_dir/olls/2013TitlePrintouts/CRS%20Title%2042%20(2013).pdf
CONNECTICUT
-A representative of the Connecticut DMV informed us that it was unlawful to utilize a device on either leg that impairs the ability to drive an automobile, but we were unable to correlate this with a
specific statute within their vehicle code.
-Applicants self report problems and must sign a medical certification statement that they do not have any health problems or conditions preventing them from driving safely “I hereby certify that I do not have any
health or vision problems that prevent me from driving safely”. If checking yes, then it is possible they will have to undergo a formal medical evaluation.
-This report asks drivers if they have any history of “muscular disease” and “missing or impaired hand, arm, foot, leg, finger, toe”. It asks physicians specifically if there is “loss or impairment of leg, foot, toe,
hand, finger; perceptible limp, deformities, atrophy, weakness, paralysis, clubbing, edema, hypotonia; Insufficient mobility and strength in lower limb to operate pedals properly; asymmetric deep tendon reflexes,
sensory or positional abnormalities, abnormal patellar and Babinski’s reflexes; ataxia; previous surgery; limitation of motion or tenderness”.
-In the Connecticut Driver’s Manual it states “even little problems like….a sore leg can affect your driving. If you are not feeling well and need to go somewhere, let someone else drive.”
-Applicansts self report problems and must sign a medical certification statement that they do not have any health problems or conditions preventing them from driving safely. If
checking yes, then it is likely they will have to submit a medical report. There is a separate Diabetes Medical Report that specifically asks if there is “significant sensorimotor or
autonomic neuropathy” and “has amputation been necessary”.
-Physicians may submit a written, signed report to the agency about potentially unsafe drivers. Anonymous reports are not accepted and these reports are not confidential.
P.A. 75-577 added a provision to the statues that says “physician’s failure to report constitutes an infraction”. We contacted the state to get clarification on this, but
were unsuccessful.
-Physicians are immune from civil liability with respect to reporting of drivers.
-Connecticut DMV: http://www.ct.gov/dmv/site/default.asp
-Connecticut License Application: http://www.ct.gov/dmv/lib/dmv/r-229.pdf
-Connecticut driver’s manual: http://www.ct.gov/dmv/lib/dmv/20/29/r12eng.pdf
-Connecticut driver’s general medical form: http://www.ct.gov/dmv/LIB/dmv/20/29/R-323.pdf
-Connecticut diabetes medical form: http://www.ct.gov/dmv/LIB/dmv/20/29/P-142D.pdf
-General Statutes of Connecticut and DMV Vehicle Code: https://www.cga.ct.gov/2011/pub/title14.htm
-Connecticut List of Moving Violations: https://www.jud.ct.gov/Publications/Infractions/infractions.pdf
DELAWARE
-No specific regulations identified with respect to a cast or immobilization device.
-Applicants are required to complete a section on the application that asks questions about medical conditions. If present, then it is possible they will have to undergo a medical examination.
-The Medical Report of Physician’s Findings specifically asks about “spastic, amputations or ankylosed joints”, “prosthetic devices used for driving”, “joint ataxia, paralysis or weakness”, and “other deformities or
abnormalities”.
-In their Delaware Driver Manual it states that “even little problems like…a sore leg can affect your driving. Check with your doctor if you think your health condition could affect your driving”.
Applicants are required to complete a section on the application that asks questions about medical conditions. If present, then it is possible they will have to undergo a medical
examination. The Medical Report of Physician’s Findings specifically asks about diabetes, but nothing related to the lower extremity.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, with the exception of disorders characterized by lapses of
consciousness. Physicians must report these within one week. Anonymous reports are not accepted but reports are kept confidential.
-
-Delaware DMV: http://www.dmv.de.gov/
-Delaware driver manual: http://www.dmv.de.gov/forms/driver_serv_forms/pdfs/dr_frm_manual.pdf
-Delaware driver’s medical form: https://www.dmv.de.gov/forms/driver_serv_forms/pdfs/dr_frm_mv346.pdf
-Delaware Administrative Code, Title 21: http://delcode.delaware.gov/title21/
DISTRICT OF COLUMBIA
-No specific regulations identified with respect to a cast or immobilization device.
-Applicants are required to complete a section on the application that asks questions about medical conditions: “do you have any other mental of physical conditions that would impair your ability to driver?”. If
present, then it is possible they will have to undergo a medical examination.
-The Medical/Eye Report only generally asks about “other mental and physical conditions”.
-Applicants are specifically asked about diabetes on the application form “In the past 5 years have you been treated for insulin dependent diabetes?”. If present, then it is possible
they will have to undergo a medical examination. The Medical/Eye Report only specifically asks if the patient is an “insulin dependent diabetic”.
-Drivers that develop diabetes are required to report the condition to the licensing agency.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, but may submit a report which can be done anonymously.
-There is no statutory immunity from civil or criminal liability with respect to reporting potentially unsafe drivers.
-DC DMV: http://dmv.dc.gov/
-DC License Application: http://dmv.dc.gov/sites/default/files/dc/sites/dmv/publication/attachments/DMVLR4%20Rev%2008-10-2015.pdf
-DC driving manual: http://dmv.dc.gov/sites/default/files/dc/sites/dmv/publication/attachments/dltest.pdf
-DC driver’s medical/eye report: http://dmv.dc.gov/sites/default/files/dc/sites/dmv/publication/attachments/Medical_Eye_Report.pdf
-DC Vehicle municipal regulations: http://www.dcregs.dc.gov/Gateway/TitleHome.aspx?TitleNumber=18
-DC List of Moving Violations: http://www.lefande.com/COLLATERAL2012.pdf
FLORIDA
-No specific regulations identified with respect to a cast or immobilization device. Although the corresponding author of this investigation was once cited for driving without a seat beat.
-Applicants for a driver’s license must list all physical or mental problems that might affect driving. Some drivers might need to undergo medical evaluation although it is not clear which ones.
-The Medical Report only generally asks physicians about “any limitation of motion, weakness, spasticity or paralysis” and it might “interfere with patient’s driving”.
Applicants for a driver’s license must list all physical or mental problems that might affect driving. Some drivers might need to undergo medical evaluation although it is not clear
which ones. The Medical Report specifically asks about diabetes, but nothing about lower extremity manifestations.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, but may choose to submit the medical reporting form. These reports
are confidential and the agency does not accept anonymous reports.
-Physicians are immune from civil and criminal liability with respect to reporting of drivers.
-Florida DMV: http://www.dmv.org/fl-florida/
-Florida driver handbook: http://www.flhsmv.gov/handbooks/englishdriverhandbook.pdf
-Florida driver’s medical form: https://tampaduiattorney.files.wordpress.com/2013/09/dhsmv-form-medical-report.pdf
-Florida medical reporting form: https://www.flhsmv.gov/forms/72190.pdf
-Florida Statutes: http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0300-0399/0322/0322.html
GEORGIA
-No specific regulations identified with respect to a cast or immobilization device.
-Applicants are asked about any history of “musculoskeletal performance”. If present, it is possible that applicant may have to undergo a medical examination.
-The Medical Examination Form specifically asks about the presence of “physical impairments”, “orthopedic, musculoskeletal, bone, joint or muscle problems or diseases”, “limitation of motion”, “stiff or flail
joints”, “spastic or paralyzed muscles”, need for “orthopedic appliances or supports” and generally any “orthopedic or musculoskeletal findings which could affect patient’s ability to safely operate a motor
vehicle”.
-Applicants are not specifically asked about diabetes on the application form.
-The Medical Examination Form specifically asks the presence of diabetes but no lower extremity manifestations.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, but may choose to do so. Anonymous reports are accepted.
-Physicians are immune from civil and criminal liability with respect to reporting of drivers.
-Georgia DDS: http://www.dds.ga.gov/
-Georgia Drivers Manual: http://www.eregulations.com/wp-content/uploads/2015/06/15GADM_LR.pdf
-Georgia driver’s license application: http://www.dds.ga.gov/docs/forms/mailinrenewal.pdf
-Georgia medical examination report: http://www.dds.ga.gov/docs/forms/ds-287.pdf
-Georgia moving violations: http://www.dds.ga.gov/rules/rules.aspx?chap=375-3-3&rule=375-3-3-.01&head=375-3
-Georgia Code: https://dps.georgia.gov/georgias-traffic-laws and http://www.dds.ga.gov/rules/index.aspx
HAWAII
-No specific regulations identified with respect to a cast or immobilization device.
-Applicants are asked general medical questions on the application including “have you lost physical control”, “has your ability to drive been impaired”, and specifically about “neurologic, orthopedic/arthritic
conditions”. If present, then it is possible the applicant will have to undergo a medical examination.
-The Medical Examination Form generally asks about “physical or neurological impairment”, and specifically about “an amputation or skeletal defect that can interfere with driving ability”, “use of an artificial
limb”, “any paralysis, joint stiffness, reduced physical dexterity, or limitation of motion”. It specifically asks “is this person capable of safe driving?”.
-The Hawaii Driver’s Manual has a nice section on restricted licenses detailing situations of “major surgery, amputation, diminished reflexes”, etc.
-Applicants are specifically asked about diabetes on the application form. If present, then it is possible the applicant will have to undergo a medical examination.
-The Medical Examination Form specifically asks the presence of diabetes but no lower extremity manifestations.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, but may choose to do so.
-There is no specific immunity from civil and criminal liability with respect to reporting of drivers.
-Hawaii DMV: http://www.honolulu.gov/csd.html
-Hawaii Driver’s Manual: http://hidot.hawaii.gov/highways/files/2015/11/mvso-HawaiiDrivers-Manual09.2015.pdf
-Hawaii driver’s license application: https://www.honolulu.gov/rep/site/csd/onlineforms/csddlapplicationform.pdf
-Hawaii medical report form: http://hidot.hawaii.gov/highways/files/2013/01/mvso-Medical-Report-Form.pdf
-Hawaii Vehicle Code: http://codes.lp.findlaw.com/histatutes/1/17/291C and http://codes.lp.findlaw.com/histatutes/1/17/287
IDAHO
-No specific regulations identified with respect to a cast or immobilization device.
-Idaho utilizes a paperless application, but applicants are asked by the examiner “is your ability to operate a motor vehicle affected by any physical condition which brings about momentary or prolonged lapses of
consciousness or control?” and “do you want a permanent disability on your license?”. Applicants you answer in the affirmative may have to undergo a formal medical evaluation.
-The Idaho Certificate of Medical Examination generally asks about “disease or injury that will affect the applicant’s ability to operative a motor vehicle on public highways”.
-Applicants are not specifically asked about diabetes during the applicant or renewal process.
-The Idaho Certificate of Medical Examination generally asks about “disease or injury that will affect the applicant’s ability to operative a motor vehicle on public highways”, but
also nothing specifically about diabetes.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, but may choose to do so.
-Physicians are immune from civil and criminal liability with respect to reporting of drivers.
-Idaho DMV: http://www.itd.idaho.gov/dmv/
-Idaho Driver’s Manual: https://itd.idaho.gov/dmv/driverservices/documents/driver_manual.pdf
-Idaho moving violations: https://itd.idaho.gov/dmv/driverservices/ds_viol.html
-Idaho vehicle code: https://legislature.idaho.gov/idstat/Title49/T49.htm
-We were unable to obtain the drivers license application or medical examination report online, and the Idaho DMV would not fax us a copy.
ILLINOIS
-No specific regulations identified with respect to a cast or immobilization device.
-The Illinois Driver’s License Application specifically asks “do you have any condition that might cause a temporary loss of consciousness?”, “do you have any mental or physical condition that might interfere
with safe driving?”, and “do you use any drugs, including prescription medication, or alcohol to an extent that they impair your driving ability?”. If yes, then it is possible that the applicant will have to undergo a
medical examination.
-The Medical Examination Form generally asks about the presence of “musculoskeletal” conditions.
-Applicants are not specifically asked about diabetes on the application.
-The Medical Examination Form generally asks about the presence of “diabetes”.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, but may choose to do so. Anonymous reports are not accepted, but
reports are kept confidential.
-Patients, on the other hand, are required to report any medical condition that could cause “loss of consciousness or any loss of ability to safely operate a motor vehicle”
within 10 days of being aware of the condition.
-Physicians are immune from civil and criminal liability with respect to reporting of drivers.
-Illinois DMV: http://www.cyberdriveillinois.com/
-Illinois Rules of the Road: https://www.cyberdriveillinois.com/publications/pdf_publications/dsd_a112.pdf
-Illinois Medical Report form: https://www.cyberdriveillinois.com/publications/pdf_publications/dsd_dc163.pdf
-Illinois Vehicle Code: http://www.ilga.gov/legislation/ilcs/ilcs2.asp?ChapterID=49
INDIANA
-No specific regulations identified with respect to a cast or immobilization device.
-Indiana has a paperless application where examiners ask applicants “are you subject to fainting spells or seizures of any kind?” and “have you had or do you presently have a physical, mental or hearing disability
which MAY adversely affect of impair your ability to operate a motor vehicle safely?”. If present, then it is possible the applicant would have to undergo a medical examination.
-The Physician’s Certificate of Medical Impairment only asks about medical conditions that cause fainting spells or seizures.
-Applicants are not specifically asked about diabetes during the application process.
-The Physician’s Certificate of Medical Impairment does not reference diabetes.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, but may choose to do so. Anonymous reports are not accepted.
-Physicians are immune from liability with respect to reporting of drivers.
-Ind. Code Ann. § 16-40-1-2 (2013).
-Indiana BMV: http://www.in.gov/bmv/index.htm
-Indiana Driver’s Manual: http://publicsafety.ohio.gov/links/hsy7607.pdf
-Indiana Physician’s Certificate of Medical Impairment: https://forms.in.gov/download.aspx?id=10260
-Indiana Vehicle Code: http://iga.in.gov/legislative/laws/2015/ic/titles/009/
IOWA
-No specific regulations identified with respect to a cast or immobilization device.
-We were unable to access the specific driver’s license application or medical evaluation form for Iowa.
-Applicants are not specifically asked about diabetes according to the ADA.
-We were unable to access the specific driver’s license application or medical evaluation form for Iowa.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, but may choose to do so. Anonymous reports are not accepted but are
kept confidential.
-Physicians are immune from civil and criminal liability with respect to reporting of drivers.
-Iowa DOT: http://www.iowadot.gov/index.html#/services
-Iowa Driver’s Manual: http://www.iowadot.gov/mvd/driverslicense/dlmanual/dlmanual.pdf
-Iowa list of moving violations: www.publications.iowa.gov/11391/1/Compendium_2011.pdf
-Iowa Vehicle Code: https://coolice.legis.iowa.gov/Cool-ICE/default.asp?Category=billinfo&Service=IowaCode&input=321
KANSAS
-No specific regulations identified with respect to a cast or immobilization device.
-The driver’s license application form specifically asks “do you have any physical or mental disabilities that could make it difficult to operative a motor vehicle safely?”.
-The Kansas Medical Evaluation form specifically asks about “amputations/missing extremities/prosthesis” and “other orthopedic impairments”.
-The Kansas Driving Handbook additionally states that “Driving is a complex skill. Many health problems…. even little problems like…. a sore leg can affect your driving. If you are not feeling well and need to
go somewhere, let someone else drive.” It also uniquely says that “Your foot should be able to pivot smoothly from brake to accelerator while the heel is kept on the floor.”
-Applicants are not specifically asked about diabetes on the application form.
-The Kansas Medical Evaluation form specifically asks about the presence of “diabetes”, but nothing specifically with respect to lower extremity manifestations.
-Physicians are not required to report drivers with medical conditions that could affect driving ability with the exception of epilepsy, but may choose to do so. Anonymous
reports are not accepted.
-Physicians are immune from civil liability with respect to reporting of drivers.
-Kansas Department of Revenue: http://www.ksrevenue.org/vehicle.html
-Kansas Driving Handbook: http://www.ksrevenue.org/pdf/dlhb.pdf
-Kansas driver’s license application form: http://www.ksrevenue.org/pdf/demi1.pdf
-Kansas Medical Evaluation form: http://www.ksrevenue.org/pdf/dv124.pdf
-Kansas list of moving violations:
http://www.kslegislature.org/li_2012/b2011_12/statute/008_000_0000_chapter/008_021_0000_article/008_021_0018_section/008_021_0018_k/
-Kansas vehicle code: http://www.kslegislature.org/li_2014/b2013_14/statute/008_000_0000_chapter/
KENTUCKY
-No specific regulations identified with respect to a cast or immobilization device.
-We were unable to access the Kentucky driver’s license application, but the Medical Review Board Affidavit specifically references “mental or physical disability that makes it unsafe to drive” including “sensorimotor deficits”, “rheumatoid arthritis”, and “muscular diseases or disorders”. The Kentucky Medical Examination form asks about the diagnosis and symptoms related to the presence of “musculoskeletal”,
“neurological” and “endocrine” conditions. It also asks if any controlled substances are prescribed.
-The Kentucky Driver’s Manual states “Any health problem can affect your driving – Even minor problems like….a sore leg can also affect driving.”
-We were unable to access the Kentucky driver’s license application, but the Medical Review Board Affidavit specifically references “mental or physical disability that makes it
unsafe to drive” including “diabetes” and specifically mentions “diabetic neuropathy or other complication which interferes with safe driving”. The Kentucky Medical
Evaluation form asks about the presence of “endocrine” conditions, but not specifically diabetes.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, but may choose to do so.
-Physicians are immune from civil and criminal liability with respect to reporting of drivers.
-Kentucky MVL: http://transportation.ky.gov/motor-vehicle-licensing/Pages/default.aspx
-Kentucky Driver Manual: http://www.kentuckystatepolice.org/pdf/2012_ky_drivers_manual_op.pdf
-Kentucky Driver’s License Application form: http://transportation.ky.gov/Organizational-Resources/Forms/TC%2094-30.pdf
-Kentucky Medical Review Board Affidavit: https://docjt.ky.gov/legal/documents/MedicalReviewofOL.pdf
-Kentucky list of moving violations: Found in Driver’s Manual.
-Kentucky vehicle code: http://www.lrc.ky.gov/statutes/chapter.aspx?id=38038
LOUISIANA
-No specific regulations identified with respect to a cast or immobilization device.
-The driver’s license application form specifically asks “do you currently have a physical or mental condition which could impair your ability to operate a motor vehicle safely?” and “have you ever experienced any
loss of consciousness other than normal sleep?”. The applicant also asks the examiner to look for physical infirmities including “missing extremities” and “stiffness”. If present, it is possible that the applicant will
have to undergo a medical examination.
-The Medical Evaluation Form specifically asks “any past surgical procedures”, “amputation or skeletal deficits”, “stiff or frail joints”, “spastic or paralyzed muscles”, and “any orthopedic appliances or supports”.
-Louisiana can place a variety of specific restrictions on a driver’s license if a person has a “physical handicap”, but they don’t explicitly define what this is. For example, a patient with a prosthetic limb may not be
able to drive without it, but they are not specifically restricted from driving because of it. These license restrictions may include use of only automatic transmission vehicles, left sided accelerator pedals, mechanical
turn signals, use hand controls, speed restrictions, scheduled medical assessments, etc.
-Applicants are not specifically asked about diabetes on the application form.
-The Medical Evaluation Form specifically asks about the importance of “diabetes” but no specific questions about lower extremity manifestations.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, but may choose to do so.
-Physicians are immune from civil and criminal liability with respect to reporting of drivers.
-Louisiana OMV: http://omv.dps.state.la.us/
-Louisiana Drivers Manual: http://usdriving.net/drivers-manual/louisiana-driver-manual.pdf
-Louisiana Medical Examination Form: http://coes.latech.edu/crest/forms/driver-rehabilitation/la%20omv%20medical%20examination.pdf
-Louisiana vehicle code: http://coes.latech.edu/crest/forms/driver-rehabilitation/la%20omv%20medical%20examination.pdf
-Recommended reading:
http://web01.dps.louisiana.gov/omv1.nsf/58c968bd569b099986256cdc000806eb/10564241920020fc862564ae005125e9?OpenDocument
MAINE
-Yes. “Driving may need to be temporarily prohibited due to an immobilizing cast…if it impedes safe operation of a motor vehicle” (29 Department of the Secretary of State; 250 Bureau of Motor Vehicles;
Chapter 3 Physical, emotional and mental competence to operate a motor vehicle).
-Applicants are asked if they have any medical conditions including “limb amputation”. If present, then it is possible the applicant will have to undergo a medical examination.
-The Driver Medical Evaluation form asks physicians to fill out a functional ability profile (link provided). This includes a section on “neurological and related musculoskeletal conditions”.
-The Maine Motorists Handbook additionally states that “Any health problem can affect your driving…. even a sore leg can affect your driving. If you are not up to par, let someone else drive.”
-Applicants are asked if they have any medical conditions including “diabetes”. If present, then it is possible the applicant will have to undergo a medical examination.
-The Driver Medical Evaluation form asks physicians to fill out a functional ability profile (link provided). This includes a section on diabetes.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, but may choose to do so. Anonymous reports are not accepted.
-Physicians are immune from civil and criminal liability with respect to reporting of drivers.
-Maine BMV: http://www.maine.gov/sos/bmv/
-Maine Motorist Handbook: https://www1.maine.gov/sos/bmv/licenses/motoristhandbook.pdf
-Maine Driver’s License Application form: http://www.maine.gov/sos/bmv/forms/MVE%20-%2064.pdf
-Maine Medical Evaluation Form: http://www.maine.gov/sos/bmv/forms/CR24.pdf
-Maine Functional Profile: www.maine.gov/sos/cec/rules/29/250/250c003.doc
-Maine vehicle code: http://legislature.maine.gov/legis/statutes/29-A/title29-Ach0sec0.html
MARYLAND
-No specific regulations identified with respect to a cast or immobilization device.
-Applicants are asked if they have been diagnosed with “any physical or mental disability, other than vision, which may affect your driving”. If present, then it is possible they will have to undergo a formal medical
evaluation.
-The Maryland Physician Referral form specifically asks physicians about the presence of “loss of limbs”.
-Applicants are asked if they have been diagnosed with “any physical or mental disability, other than vision, which may affect your driving”. If present, then it is possible they will
have to undergo a formal medical evaluation. It does not specifically ask about diabetes.
- The Maryland Physician Referral form specifically asks physicians about the presence of “diabetes requiring insulin” but nothing specifically about lower extremity
manifestations of diabetes.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, but may choose to do so. Anonymous reports are accepted.
-Physicians are immune from civil and criminal liability with respect to reporting of drivers.
-Maryland MVA: http://www.mva.maryland.gov/
-Maryland Driver’s Manual: http://www.mva.maryland.gov/_resources/docs/DL-002.pdf
-Maryland Health Questionnaire: http://www.mva.maryland.gov/_resources/docs/DC-001.pdf
-Maryland Physician Referral form: http://www.mva.maryland.gov/_resources/docs/DC-220.pdf
-Maryland list of moving violations: http://www.courts.state.md.us/district/forms/criminal/dccr090.pdf
-Maryland vehicle code: http://law.justia.com/codes/maryland/2010/transportation/title-21
MASSACHUSETTS
-No specific regulations identified with respect to a cast or immobilization device.
-Applicants are asked if they have any “cognitive, neurologic, physical, or any other impairment that may affect your functional ability to operate a motor vehicle safely” and “are you currently taking any
medication that may affect your ability to safely operate a motor vehicle”. If present, then it is possible they will have to undergo a formal medical examination.
-The Medical Evaluation form does not specifically ask about anything directly related to the lower extremity.
-Applicants are asked if they have any “cognitive, neurologic, physical, or any other impairment that may affect your functional ability to operate a motor vehicle safely” and “are
you currently taking any medication that may affect your ability to safely operate a motor vehicle”. Applicants are not specifically asked about the presence of diabetes. If present,
then it is possible they will have to undergo a formal medical examination.
-The Medical Evaluation form does not specifically ask about anything directly related to diabetes or lower extremity manifestations of diabetes.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, but may choose to do so.
-Physicians are immune from civil and criminal liability with respect to reporting of drivers.
-Massachusetts RMV: http://www.massrmv.com/rmv/dmanual/Drivers_Manual.pdf
-Massachusetts Drivers Handbook: http://www.massrmv.com/rmv/dmanual/Drivers_Manual.pdf
Report: http://www.ncdot.gov/download/dmv/DL78MedicalReportForm.pdf
-Massachusetts Driver’s License application: http://www.massrmv.com/rmv/forms/21042.pdf
-Massachusetts Medical Evaluation form: https://www.massrmv.com/rmv/forms/20221.pdf
-Massachusetts reporting requirements: http://www.massrmv.com/rmv/medical/reporting.htm
-Massachusetts list of moving violations: http://www.mass.gov/courts/docs/courts-and-judges/courts/district-court/citable-civil-motor-vehicleoffenses.pdf
-Massachusetts vehicle code: https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXIV/Chapter90
MICHIGAN
-No specific regulations identified with respect to a cast or immobilization device.
-Applicants are asked “have you had a medical condition which affects your ability to drive”. If present, then it is possible the applicant will have to undergo a formal medical evaluation.
-The Physician’s Statement of Examination does not ask physicians about specific diagnoses, but asks the physician to list them. It asks about the performance of functional tests including “rapid pace walk” and
“manual test of motor strength”.
-Applicants are asked “have you had a medical condition which affects your ability to drive”. If present, then it is possible the applicant will have to undergo a formal medical
evaluation. It does not specifically ask about diabetes.
-The Physician’s Statement of Examination does not ask physicians about specific diagnoses, but asks the physician to list them.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, but may choose to do so. Anonymous reports are not accepted.
-Physicians are immune from civil and criminal liability with respect to reporting of drivers.
-Michigan SOS: https://www.michigan.gov/sos/0,4670,7-127-1627---,00.html
-Michigan What Every Driver Must Know: https://www.michigan.gov/documents/wedmk_16312_7.pdf
-Michigan Driver’s License Application: http://internationalcenter.umich.edu/events/DriverLicenseAppl.pdf
-Michigan Physician’s Statement of Examination: https://www.michigan.gov/documents/DI-4P_16784_7.PDF
-Michigan list of moving violations: https://www.michigan.gov/documents/OffenseCode_73877_7.pdf
-Michigan vehicle code: http://www.legislature.mi.gov/documents/mcl/pdf/mcl-act-300-of-1949.pdf
MINNESOTA
-No specific regulations identified with respect to a cast or immobilization device.
-Applicants are asked questions about any existing medical conditions. If present, then it is possible they will have to undergo a formal medical examination.
-Applicants are asked questions about any existing medical conditions. If present, then it is possible they will have to undergo a formal medical examination. This includes a
specific question about the presence of diabetes.
-Insulin dependent diabetics are required to report their condition within 30 days of their diagnosis. The Insulin-Treated Diabetes Mellitus Report asks if the patient can exercise
reasonable and ordinary control over a motor vehicle.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, but may choose to do so. Anonymous reports are not accepted.
-Physicians are immune from civil and criminal liability with respect to reporting of drivers.
-Minnesota DVS: https://dps.mn.gov/divisions/dvs/Pages/default.aspx
-Minnesota Driver’s Manual: https://dps.mn.gov/divisions/dvs/forms-documents/Documents/Minnesota_Drivers_Manual.pdf
-Minnesota Insulin-Treated Diabetes Mellitus Report: https://dps.mn.gov/divisions/dvs/forms-documents/documents/dl_diabeticreport.pdf
-Minnesota Medical Conditions and your Driver’s License brochure: https://dps.mn.gov/divisions/dvs/formsdocuments/Documents/MedicalConditions_and_YourLicense.pdf
-Minnesota moving violations and vehicle code: https://www.revisor.mn.gov/statutes/?id=169
-https://www.revisor.mn.gov/statutes/?id=171&format=pdf
Specifically pages 45 (examination based on physical/mental illness), 48 (physician reporting), and 41 (license restrictions).
MISSISSIPPI
-No specific regulations identified with respect to a cast or immobilization device.
-Applicants are not asked any specific medical questions on the application form.
-The Physical Evaluation Form very generally asks physicians to describe any “medical condition that would prevent this patient from operating a motor vehicle safely”.
the same general question but does give physicians the option of putting an indicator of a medical condition on the license including “difficulty in walking”.
-Applicants are not specifically asked about diabetes on the application form.
-The Physical Evaluation Form does not specifically ask about the presence of diabetes. Neither does the Confidential Physician’s Report but it does give physicians the option of
putting an indicator of a medical condition on the license including “diabetes with other coma”.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, but may choose to do so. The physician’s form is confidential.
-We were unable to find any specific information on physician immunity with respect to reporting of drivers.
-Mississippi DMV: https://www.ms.gov/hp/drivers/license/Main.do
-Mississippi Drivers Manual: http://www.dps.state.ms.us/wp-content/uploads/2012/06/Driver-License-Manual-Jan-2012.pdf
-Mississippi Driver’s License Application form: http://www.dps.state.ms.us/wp-content/uploads/15-and-16-year-old-APPLICATION-FORMISSISSIPPI-DRIVER.pdf
-Mississippi Diabetes Certification form: http://www.dps.state.ms.us/wp-content/uploads/2011/12/DE16DiabetesForm.pdf
-Mississippi vehicle code: http://www.sos.ms.gov/ACProposed/00019396b.pdf
aResident,
Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, Pennsylvania
bAssociate Professor and Residency Program Director, Department of Podiatric Surgery, Temple University School of Podiatric Medicine and Temple University Hospital, Philadelphia, Pennsylvania ([email protected])*
*Please don’t hesitate to contact AJM with any questions/concerns. He’s happy to provide you with a .pdf of this poster if you email him.
Statement of Purpose and Literature Review
Results
The effect of lower extremity pathology and surgical
intervention on automobile driving function has been
a topic of contemporary interest in the orthopedic
literature. Several authors have published general
guidelines and produced original data on the return to
safe driving following lower extremity surgery [1-4].
Others have specifically studied the effect of chronic
musculoskeletal lower extremity pathology, the use of
immobilization devices, the effect of major limb
amputation, and the general effects of diabetes and
hypoglycemia on driving outcomes [5-8].
Our group has previously studied the effect of
diabetes, diabetic sensorimotor neuropathy and
diabetic foot disease on driving outcomes [9], as well
as the effect of lower extremity immobilization in a
surgical shoe and walking boot on driving
performance [10].
Does the state have specific regulations with respect to driving in a lower extremity cast or with a foot/ankle
immobilization device? Does the state have any regulations with respect to drivers with acute or chronic lower
extremity pathology/disability or those who have had foot/ankle surgery?
Full state-specific results are displayed in the admittedly large Table. We found that most states had no explicit or
specific regulations with respect to driving in a lower extremity cast, with lower extremity immobilization devices, or
following foot/ankle surgery. Connecticut, Maine, and Vermont were the only states we identified where we found
any specific mention of driving with a cast or limiting device, and even these were somewhat vague at best and we
were unable to correlate these with a specific state statute.
Twelve states (Colorado, Connecticut, Delaware, Kansas, Kentucky, Maine, Montana, New Jersey, New
Mexico, South Dakota, Tennessee, and Washington) had Driver’s Manuals containing a general statement along the
lines of “Driving is a complex skill. Any health problem can affect your driving…. even a sore leg. If you are not
feeling well and need to go somewhere, let someone else drive”. Delaware additionally encouraged drivers to
“Check with doctor if you think your health condition could affect your driving.” And Kansas uniquely stated in their
Driver’s Manual: “Your foot should be able to pivot smoothly from brake to accelerator while the heel is kept on the
floor.”
The initial and renewal driver’s license application forms of most states at least generally asked about “any
physical or mental conditions that could affect your ability to safely operative a motor vehicle”. We identified only
Arkansas, Mississippi, New Hampshire and Rhode Island that did not ask any specific health related questions on
their driver’s license applications. A few states further specifically asked on the application questions relating to the
presence of “musculoskeletal conditions”, “any permanent impairment”, or “amputation” which could affect driving.
If answering yes to any question about health or medical conditions that could affect driving, applicants were then
generally required to undergo a specific medical evaluation, and most states had a specific medical evaluation form
for physicians to complete and return. These forms were variable, but usually included questions and sections on at
least “musculoskeletal conditions” and “neuromuscular conditions”. The exact wording of questions on the
applications and medical evaluation forms is provided in the Table. Pennsylvania was the only state we identified
that required a formal medical examination of all new drivers applying for a learner’s permit. And interestingly on
this topic of formal medical evaluation, we also came across a website promoting helping find “driver friendly”
doctors for physical examinations [http://dotphysicaldoctor.com/].
However, we found that there were two broad concepts to keep in mind when attempting to address this first set of
questions. First, we spoke to one police officer in Virginia who stated that although there were often no specific state
regulations about driving with lower extremity restrictions or impairment, they could always potentially cite a driver
for “not driving under reasonable or ordinary conditions” if they were looking for something, and that it would be
very easy to demonstrate driver “negligence” in these situations. We found that most states had very vague and
subjective definitions for “careless”, “reckless” and “negligent” driving. For example, the state of Nebraska defines
negligent driving as “indifferent, offhand, neglectful”, careless driving as “inattentive, forgetful, inconsiderate”,
reckless driving as “rash, heedless, dangerous” and willful reckless driving as “deliberate and intentional”
[http://www.dmv.nebraska.gov/frd/pts.html]. Although none of these specifically refer to driving in a cast or brace,
we do not believe it would be a stretch to imagine someone making this argument.
Second, the use of narcotic pain medications while driving, which are commonly prescribed by physicians in the
perioperative period and in the treatment of chronic conditions, could lead to a driving under the influence charge in
most states.
The objective of this investigation was to
organize and summarize the individual US
state laws and regulations with respect to
driving that might be related to patients
presenting for care with podiatric physicians.
Methodology
We collected data from the 50 US states (and District of Columbia) attempting to
answer the following questions with respect to:
-Does the state have specific regulations with respect to driving in a lower
extremity cast or with a foot/ankle immobilization device?
-Does the state have any regulations with respect to drivers with acute or chronic
lower extremity pathology/disability or those who have had foot/ankle surgery?
-Does the state have any regulations with respect to drivers with diabetes?
-Does the state have regulations with respect to physician reporting of potentially
impaired patient driving?
-Where can foot and ankle surgeons from the state find more information?
The focus of our investigation was with respect to non-commercial driving
regulations. We first went directly to the websites of the respective state governments
and departments of motor vehicles to review the information available online. This
specifically included searches of driver’s manuals (which often summarize state driving
laws), initial and renewal license application forms, physician medical evaluation forms,
lists of moving violations, and state administrative statutes (often referred to as “vehicle
code”). In addition to manually reading this material, when possible, we also performed
electronic searches of the documents for the following terms: “ankle”, “foot”, “toe”,
“leg”, “cast”, “brace”, “device”, “diabetes”, “neuropathy”, “fracture”, “amputation”,
“surgery” and “injury”. If answers were not directly supplied within these searches, the
information was not clear, or we had any remaining questions, then we directly
contacted the individual state departments of motor vehicles and police departments via
telephone and email in order to answer the above questions.
We also found two additional websites to be useful in data collection and would
recommend them to interested physicians. The first is the website of the American
Diabetes Association which has subsection dealing with drivers with diabetes
[http://www.diabetes.org/living-with-diabetes/know-yourrights/discrimination/drivers-licenses/drivers-license-laws-by-state.html]. This
includes a state-by-state analysis of regulations interestingly written from the
perspective of patient’s rights and preventing discrimination against diabetic drivers.
The second is an online, searchable database of state laws [http://law.justia.com].
We believe it is important to note that the authors of this paper are neither current nor
aspiring lawyers, judges, law enforcement agents, nor government personnel. The
intention of this review is promote general awareness and give physicians a resource to
further inquire about more information. It is not intended as and should not be taken as
medical or legal advice. We make no warranties or guarantees about the accuracy,
completeness or adequacy of the information contained here.
References
[1] Marecek GS Schafer MF Driving after orthopedic surgery J Am Acad Orthop Surg 2013; 21(11): 696-706
[2] Goodwin D Baecher N Pitta M Letzelter J Marcel J Argintar E Driving after orthopedic surgery Orthopedics 2013; 36(6): 469-74
[3] Holt G Kay M McGrory R Kumar CS Emergency brake response time after first metatarsal osteotomy J Bone Joint Surg Am 2008; 90(8): 1660-4
[4] Egol KA Sheikhazadeh A Mogatederi S Barnett A Koval AJ Lower-extremity function for driving an automobile after operative treatment of ankle fracture J Bone
Joint Surg Am 2003; 85-A(7): 1185-9
[5] Talusan PG Miller CP Save AV Reach JS Jr Driving reaction times in patients with foot and ankle pathology before and after image-guided injection: pain relief without
improved function Foot Ankle Spec 2015; 8(2): 107-11
[6] Tremblay MA Corriveau H Boissy P et al Effects of orthopaedic immobilization of the right lower limb on driving performance: an experimental study during simulated
driving by healthy volunteers J Bone Joint Surg Am 2009; 91(12): 2860-6
[7] Meikle B Devlin M Pauley T Driving pedal reaction times after right transtibial amputations Arch Phys Med Rehabil 2006 Mar; 87(3): 390-4
[8] American Diabetes Association Lorber D Anderson J Arent S J D Frier BM Greene MA Griffin JW Jr Gross G Hathaway K Hirsch I Kohrman DB Marrero DG
Songer TJ Yatvin AL Diabetes and Driving Diabetes Care 2012 Jan Jan; 35 Suppl 1: S81-6
[9] Spiess KE Sansosti LE Meyr AJ The Temple Diabetic Driving Studies: Summary Findings Presented in oral and poster format at this conference Pending peer-review
publication
[10] Sansosti LE Rocha AM Lawrence MW Meyr AJ The effect of lower extremity immobilization devices on emergency brake response driving outcomes Presented in
oral and poster format at this conference Pending peer-review publication
[11] Driver Fitness Medical Guidelines PDF available at:
http://www google com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwiH14jv1vzLAhXGtYMKHSDMChsQFggcMAA&url=http%3A%
2F%2Fwww nhtsa gov%2FDOT%2FNHTSA%2FTraffic%2520Injury%2520Control%2FArticles%2FAssociated%2520Files%2F811210 pdf&usg=AFQjCNHNx5chSk2UbP
yIaD0AyFUoZa1cWA&sig2=Er2P7IsbBjgXbzOlCEgf0Q
Does the state have any regulations with respect to drivers with diabetes?
Again, the initial and renewal driver’s license application forms of most states at least generally asked about “any
physical or mental conditions that could affect your ability to safely operate a motor vehicle”. Some states
specifically asked about the presence of diabetes on these applications, while others did so on the specific medical
evaluation forms. Kentucky, Indiana, Iowa, Massachusetts, Michigan, Montana, Nevada, New Hampshire, New
Jersey, Oregon, Rhode Island, South Dakota and Wyoming were states we identified that did not specifically ask
about the presence of diabetes on either the license application or medical evaluation forms. Most medical evaluation
forms asked physicians questions about diabetes as it primarily related to the potential for hypoglycemic events, loss
of consciousness and seizures. It was less common for these forms to ask questions about potential lower extremity
manifestations of diabetes including lower extremity neuropathy, wounds or amputations. With that being said,
however, Alabama, Connecticut, Kentucky, Tennessee, Oregon, Washington and Wisconsin specifically asked
about the presence of lower extremity neuropathy on the medical evaluation form. And Oklahoma uniquely had a
requirement that drivers with diabetes requiring insulin keep “foot, fruit or candy within reach of the driver”.
Does the state have regulations with respect to physician reporting of potentially impaired patient driving?
Most states do not require physicians to report their patients with potentially impaired driving function, but had
processes in place to allow them to do so if they chose. Exceptions to this were Pennsylvania and Oregon. We
encourage physicians in these states to carefully review these specific regulations. In Pennsylvania, physicians “must
report to PennDOT individuals whom they have diagnosed as having a condition that could impair their ability to
drive safely”. In Oregon, physicians are required to report drivers with “cognitive or functional impairments that
affect ability to safely operate motor vehicles.” In Utah physicians are not required to report drivers to the state but
“physicians who care for patients with physical impairments that may affect their driving safety, whether defined by
published guidelines and standards or not, are responsible for making available to their patients without reservation
their recommendations and appropropriate information related to driving safety and responsibility.” In Connecticut,
P.A. 75-577 states that “physician’s failure to report constitutes an infraction”, but also that physicians are not required
to report. This topic of physician reporting has been addressed in the medical literature as it relates to elderly drivers.
Most states granted statutory civil and criminal immunity to physicians with respect to reporting of (or lack of
reporting of) potentially impaired drivers. States we identified that do not specifically grant immunity include
Alaska, Arkansas, the District of Columbia, Nevada, New Hampshire, New Jersey, New Mexico, New York,
South Dakota, Texas, Virginia and Washington. We were unable to find specific information with respect to
immunity for Delaware, Mississippi and Wyoming.
MISSOURI
-No specific regulations identified with respect to a cast or immobilization device.
-Applicants are asked medical questions, but nothing specific to the lower extremity or musculoskeletal conditions. If present, then it is possible they will have to undergo a formal medical examination.
-The Physician’s Statement form specifically asks about the presence of “arthritis”, “uses cane or walker”, “difficulty transferring”, “paralysis –leg”, “prosthesis or brace – leg”, “restricted or weakness-leg”,
“history of falls” and “loss of limb”.
-Applicants are asked medical questions, but nothing specific about diabetes.
-The Physician’s Statement form specifically asks about the presence of “diabetes” and if the applicant takes insulin, but nothing more specific than that.
-Physicians are not required to report drivers with medical conditions that could affect driving ability with the exception of epilepsy, but may choose to do so. Anonymous
reports are not accepted but the physician’s report is kept confidential.
-Physicians are immune from civil liability with respect to reporting of drivers.
-Missouri DOR: http://dor.mo.gov/drivers/
-Missouri Driver Guide: www.dor.mo.gov/forms/Driver_Guide.pdf
-Missouri Driver’s License Application form: www.dor.mo.gov/forms/4317.pdf
-Missouri Physician’s Statement: www.dor.mo.gov/forms/1528.pdf
-Missouri list of moving violations: www.dor.mo.gov/forms/899.pdf
-Missouri revised statutes: http://www.moga.mo.gov/mostatutes/ChaptersIndex/chaptIndex304.html
-Section 302 of the MO Vehicle code, particularly sections 291 and 301.
MONTANA
-No specific regulations identified with respect to a cast or immobilization device.
-Applicants are asked general questions about physical disability on the application including “do you suffer from any chronic or potentially chronic condition that may cause a loss of consciousness or control”, “do
you have any physical condition that impairs your ability to exercise ordinary and reasonable control in the safe operation of motor vehicle”, and “do you rely on any adaptive equipment or operational restrictions to
attain the ability to exercise ordinary and reasonable control”. If present, then it is possible that the applicant will have to undergo a medical examination.
-The Driver Medical Evaluation form asks physicians to generally describe “any condition which may interfere with the safe operation of a motor vehicle” and specifically asks about “impaired motor function”, and
“neurological or neuromuscular disease”.
-The Montana Drivers Manual states that “Many health problems can affect your driving….even little problems like a sore leg can affect your driving. If you are not feeling well and need to go somewhere, let
someone else drive. You should decide each you drive if you are physically able or mentally capable to drive safely.”
-Applicants are not specifically asked about diabetes on the application form.
-The Driver Medical Evaluation form does not ask specifically about “diabetes”, but it does ask physicians to generally describe “any condition which may interfere with the safe
operation of a motor vehicle” and specifically asks about “other metabolic disorders”.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, but may choose to do so.
-Physicians are immune from civil and criminal liability with respect to reporting of drivers.
-Montana MVD: https://dojmt.gov/driving/
-Montana Drivers License renewal application: https://media.dojmt.gov/wp-content/uploads/Renewal-of-Class-D-Driver-License-by-Mail.pdf
-Montana Driver Manual: https://media.dojmt.gov/wp.../MT-Driver-Manual-Jan-2015_Web.pdf
-Montana Driver Medical Evaluation form: https://media.dojmt.gov/wp-content/uploads/20-1900-15.pdf
-Montana Code: http://leg.mt.gov/bills/mca_toc/61.htm; http://leg.mt.gov/bills/mca/61/5/61-5-120.htm; http://leg.mt.gov/bills/mca/61/5/61-5113.htm; http://leg.mt.gov/bills/mca/61/5/61-5-207.htm
NEBRASKA
-No specific regulations identified with respect to a cast or immobilization device.
-Applicants are asked specific questions on the application form such as “do you experience any condition which affects your ability to operative a motor vehicle due to loss or impairment of foot/leg, range of
motion/mobility, neurologic/neuromuscular disease”. If present, it is possible that the applicant will be required to undergo a medical examination.
-The Nebraska Statement of Physician specifically asks about “limiting or progressive neuromuscular diseases” and asks physicians to describe the patient’s neuromuscular “function” and “limitations”.
-Applicants are specifically asked about diabetes on the application form. If present, it is possible that the applicant will be required to undergo a medical examination.
-The Nebraska Statement of Physician specifically asks physicians to comment about “diabetes” including the presence of “peripheral arterial disease”.
-Physicians are not required to report drivers with medical conditions that could affect driving ability, but may choose to do so. Anonymous reports are not accepted.
-Physicians are not held liable for tort with respect to the reporting drivers.
-Nebraska DMV: http://www.dmv.nebraska.gov/index_html
-Nebraska Driver’s Manual: www.dmv.nebraska.gov/examining/pdf/engdrivermanual.pdf
-Nebraska Driver’s License Application form: http://www.dmv.nebraska.gov/examining/pdf/classoidform.pdf
-Nebraska Statement of Physician: http://www.dmv.nebraska.gov/examining/pdf/statementofphysician.pdf
-Nebraska Vehicle Code: http://uniweb.legislature.ne.gov/laws/browse-chapters.php?chapter=60
-http://law.justia.com/codes/nebraska/2009/Chapter60/60-4_118.html
-http://law.justia.com/codes/nebraska/2009/Chapter60/60-4_130_01.html
NEVADA
-No specific regulations identified with respect to a cast or immobilization device.
-Applicants are asked “do you have any disability, illness, missing extremity, or take any medication that could affect your driving ability”.
-The Physical Evaluation Form very generally asks physicians to describe any “medical condition that would prevent this patient from operating a motor vehicle safely”.
the same general question but does give physicians the option of putting an indicator of a medical condition on the license including “difficulty in walking”.
-Applicants are not specifically asked about diabetes on the application form.
-The Physical Evaluation Form does not specifically ask about the presence of diabetes. Neither does the Confidential Physician’s Report but it does give physicians the option of
putting an indicator of a medical condition on the license including “diabetes with other coma”.
-Physicians are not required to report drivers with medical conditions that could affect driving ability with the exception of epilepsy, but may choose to do so. Anonymous
reports are not accepted but the physician’s form is confidential.
-There is no statutory immunity from civil or criminal liability with respect to reporting potentially unsafe dri
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The intention of this investigation was to interrogate individual US states with respect
to the topic of driving in the setting of lower extremity impairment. It is evident that
there is a relative lack of consensus regarding safe driving practices following lower
extremity injury, surgical procedures and pathology and unfortunately, the absence of
specific legal guidance in most states often has the potential to leave the physician and
patient in a compromised position. On a personal note, we can tell you that in our
practice we now generally tell post-operative patients that they should not drive unless in
regular shoegear and not taking any narcotic pain medication. And we recommend to
most patients with diabetes and neuropathy that they should have their driving formally
evaluated at a driving school. It is our hope that this information is useful in the
development of future investigations that focus on driving safety in drivers with lower
extremity dysfunction.
A
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In addition to these state specific results, The American Association of Motor
Vehicle Administrators, in conjunction with the National Highway Traffic Safety
Administration, has issued a Driver Fitness Medical Guidelines document statement
[11]. Within this briefing, several medical conditions are highlighted including vision
problems, dementia, seizure disorders, brain injury, musculoskeletal disease, and
relevant to this particular investigation, diabetes and extremity impairment. Their
focus on diabetes is strictly from a hypoglycemia standpoint, indicating that drivers
should carry the proper medications or have a passenger accompanying them who
would be able to assist them if an episode were to arise. While retinopathy is
mentioned, no focus is given to lower extremity neuropathy and its potential
deleterious effects on driving. Regarding lower extremity injury or surgery, the only
specific literature-based recommendation made was for ACL surgery, in which they
deemed it safe for return to driving in 4-6 weeks post operatively. In looking at other
fractures, hip or knee arthroplasties, or other orthopedic conditions, there was no
consensus in the literature that supported a statement from these boards regarding a
designated time for return to driving, only relaying that the situation must be
addressed on a case by case basis.
The Confidential Physician’s Report asks
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The Confidential Physician’s Report asks
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