Medical Review Practices for Driver Licensing Volume 2: Case Studies of Medical Referrals and Licensing Outcomes in Six States

Lococo, Kathy H.; Sifrit, Kathy J.; Stutts, Jane C.; Joyce, John; Staplin, Loren · 2017 · ROSA P / United States. National Highway Traffic Safety Administration

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Summary

This report, part of a three-volume series by the National Highway Traffic Safety Administration, examines driver medical review practices in the United States. Specifically, it analyzes how six states—Maine, Ohio, Oregon, Texas, Washington, and Wisconsin—identify, assess, and render licensing decisions for drivers referred for medical review due to safety concerns. The study aims to understand referral sources, review requirements, and licensing outcomes to improve the efficiency and safety of these processes. The researchers conducted case studies using a systematic random sample of 500 drivers referred for initial medical review in 2012 from each of the six states. Data collection was performed by retired or current licensing agency staff trained by the research team, using a standardized Microsoft Access database to record referral sources, medical review steps, and final outcomes. Exclusion criteria removed cases involving commercial licenses, court-adjudicated incompetence, or prior periodic reviews. The study categorized outcomes into three broad groups: licensing actions based on medical guidelines or test performance (e.g., restrictions, periodic review, or revocation for medical unfitness); drivers opting out of licensure (voluntary cancellation or non-compliance); and no change in license status. Findings revealed significant variation in referral sources and outcomes across states. Self-referrals were dominant in Maine (91%) and Ohio (59%), while physician referrals were most common in Oregon (74%). Law enforcement referrals were substantial in Washington (66%) and Wisconsin. Outcomes varied by state and source; for instance, in Oregon and Texas, over 99% of cases resulted in a change of license status regardless of the referral source. In contrast, physician referrals in Maine, Oregon, and Wisconsin had high probabilities (80–91%) of resulting in licensing actions based on medical guidelines or test performance, whereas physician referrals in Texas and Washington resulted in such actions less frequently (33–41%). Non-compliance with medical review requirements was a leading cause of license removal in several states, particularly where strict deadlines for submitting medical reports were enforced. The study concludes that differences in medical review processes, reporting requirements, and educational outreach contribute to the observed variations in outcomes. The authors recommend practices to increase appropriate referrals, improve the medical review process to balance public safety with driver mobility, and focus agency resources on drivers most in need of review. Specifically, they suggest reducing the proportion of referrals that result in no change in license status to enhance efficiency. The report provides detailed state-by-state analyses and appendices offering further insights into demographics, appeal rates, and case costs, serving as a resource for policymakers aiming to refine driver licensing medical review protocols.

Key finding

Periodic review only was the most common licensing outcome across the six states, while license removal rates varied significantly based on referral source and state-specific procedures.

Methodology

dataset

Sample size: 3000

Provenance

The full processing record for this entry. Every stage of this paper's journey through the pipeline is logged — what ran, with which tool and model, how many attempts it took, and when it last completed. Discovered via bulk_ingest_rosap on 2026-05-23 (6 acquisition events logged).

Summary generated by qwen3.6-27b-prismaquant on 2026-06-10; verification: verified.

Topics

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• licensing policy
• fitness to drive assessment
• medical conditions