Are applicants for a driver's license asked questions about diabetes?
Yes. All first-time and renewal applicants are required to complete a section of the licensing application that contains questions about medical conditions. This section asks whether an individual has had a condition within the last five years that affects his or her ability to operate a motor vehicle safely. One of the conditions specifically listed as part of this question is diabetes. Drivers who answer "Yes" to this question may be required to have their physician complete a medical evaluation form. An applicant will review his or her driver's license application with a field technician, briefly describing his or her medical condition, and the field technician then will determine whether review of the application by the Driver Safety Branch is necessary. See Cal. Dept. of Motor Vehicles, "Diabetes and Driving" FFDL 40 (REV. 9/2011).
What other ways does the state have to find out about people who may not be able to drive safely because of a medical condition?
The licensing agency receives information from many sources, including "law enforcement, physicians and surgeons, judges, family members and acquaintances." See Cal. DMV, "Driver Safety Information Medical Conditions and Traffic Safety." Peace officers and judges have the discretion to request a reexamination of any driver they meet if they have "reasons to believe the person may be unable to drive safely." Id. Physicians may report diabetes as an unsafe medical condition. See Cal. Health & Safety Code § 103900(a) – (d); see infra for more information. Anyone may request a review of an individual's ability to drive safely by submitting a form to the licensing agency. See Cal. Dept. of Motor Vehicles, "Request for Driver Reexamination Form," DS 699 (REV.8/2012). The licensing agency will maintain the confidentiality of all such requests although the requesting party must identify him- or herself on the form. Id.
Drivers also may be required to have medical evaluations if they have impairments which are observed by licensing agency personnel during the licensing process or if they are involved in crashes involving a fatality or are involved in a given number of crashes in a certain time period. Cal. Veh. Code § 13800 (2013); see also Cal. Dept. of Motor Vehicles, "DMV's Reexamination Process," FFDL 27 (REV. 2/2013).
What is the process for medical evaluations of drivers?
When the licensing agency becomes aware that a person has a medical condition that could impair safe driving performance, the agency will request medical information from that person and his or her physician through a medical evaluation form. Cal. Veh. Code § 12814(a) (2013) (authorizing examination upon renewal of license); Cal. Veh. Code § 12818(a) (2013) (authorizing reexamination upon request relating to a physical or mental condition impairing an individual's ability to drive safely); Cal. Veh. Code § 13800 (2013) (authorizing examination when records indicate that a driver is incompetent to operate a motor vehicle).
In addition to providing the diagnosis, the physician is asked to indicate the following: (1) whether the condition is improving, stable, worsening, or subject to change; (2) medications prescribed; (3) whether side effects of medications may interfere with the ability to safely operate a motor vehicle; (4) whether the medical condition affects safe driving ability; and (5) whether the physician has advised against driving. Cal. Dept. of Motor Vehicles, "Driver Medical Evaluation," DS 326 (REV. 11/2010).
Form DS 326 also has a section specific to diabetes, which asks about the following: (1) type of diabetes; (2) the date of diagnosis; (3) the treatment regimen and whether the individual is compliant; (4) whether diabetes is currently controlled and how long control has been maintained; (5) whether the individual has experienced hypoglycemic or hyperglycemic episodes during the last three years; (6) what complications have resulted from these episodes; (7) whether the individual has received diabetes education from a health care professional; (8) the patient's fasting blood glucose levels. The licensing agency uses the information along with other non-medical factors in reaching a licensing decision. Id.
For more information, see Cal. Dept. of Motor Vehicles, "Physical and Mental Evaluation Guidelines," (Accessed Aug., 2013); Cal. Dept. of Motor Vehicles, "Diabetes Mellitus," (Accessed Aug., 2013); and Cal. Dept. of Motor Vehicles, "DMV's Reexamination Process," FFDL 27 (REV. 2/2013).
Are physicians required by law to report drivers who have medical conditions that could affect their ability to drive safely?
Physicians and surgeons are required by law to report to the licensing agency any individual 14 years or older who has been diagnosed with a disorder characterized by lapses of consciousness. Cal. Health & Safety Code § 103900(a) (2013). The physician reporting law lists hypoglycemia and hyperglycemia associated with diabetes as conditions which "do not always, but may progress to the level of functional severity" that would require the physician to report them. See Cal. Health & Safety Code § 103900(d) (2013). Even in instances where reporting is not required by law, a physician or surgeon may report an individual's condition if the physician or surgeon "reasonably and in good faith believes that the reporting of a patient will serve the public interest." Cal. Health & Safety Code § 103900(a) (2013).
Are physicians who report drivers with medical conditions immune from legal action by the patient?
Physicians or surgeons reporting on patients with disorders "characterized by lapses of consciousness" will not be held civilly or criminally liable to any patients for making reports pursuant to Cal. Health & Safety Code § 103900(f) (2013).
Who makes decisions about whether drivers are medically qualified?
Drivers with medical conditions or functional impairments are evaluated by non-medical administrative staff in the licensing agency's Driver Safety Branch. These staff have other responsibilities in addition to medical evaluation. The agency has the sole responsibility for decisions regarding the patient's driving qualifications and licensure. See Cal. DMV., "Diabetes and Driving" FFDL 40 (REV. 9/2011).
While California has a medical advisory board, it is activated only when needed for formal revision of medical evaluation guidelines, and does not currently participate in assessing the medical qualifications of drivers.
What are the circumstances under which a driver may be required to undergo a medical evaluation?
Drivers may be required to have medical evaluations if they have impairments which are observed by licensing agency personnel during the licensing process, or if they are involved in crashes involving a fatality, or are involved in a given number of crashes in a certain time period. Cal. Veh. Code § 13800 (2013). A driver also may be required to undergo a medical evaluation if the licensing agency becomes aware that he or she has a medical condition that could impair his or her ability to drive safely. When the licensing agency becomes aware that a person has a medical condition that could impair safe driving performance, the agency will request medical information from that person and his or her physician through a medical evaluation form. See, supra, Cal. Veh. Code § 12814(a) (2013); Cal. Veh. Code § 12818(a) (2013); Cal. Veh. Code § 13800 (2013).
Has the state adopted specific policies about whether people with diabetes are allowed to drive?
The state developed detailed medical guidelines to assist agency personnel in evaluating individuals with conditions that may affect the ability to drive safely, such as diabetes. For more information, see Cal. Dept. of Motor Vehicles, "Diabetes Mellitus," (Accessed Aug., 2013); and Cal. Dept. of Motor Vehicles., "Diabetes and Driving," FFDL 40 (REV. 9/2011).
What is the state's policy about episodes of altered consciousness or loss of consciousness that may be due to diabetes?
State law provides that the licensing agency may refuse to issue or renew the license of an individual that has "a disorder characterized by lapses of consciousness." Cal. Veh. Code § 12806 (2013). The same is true for anyone who has had a "lapse of consciousness or an episode of marked confusion" within the last three years. Id. This loss of consciousness must be from a condition that may bring about recurrent episodes, or from a disability or disease which could affect the safe operation of a motor vehicle. Id.
In making a determination, the licensing agency may consider the following: (1) the effect(s) of the disorder on the physical and mental abilities necessary to drive safely and to exercise reasonable control of a motor vehicle; (2) the individual's testimony regarding the disorder and his or her ability to drive safely; (3) testimony from other individuals who have knowledge of the individual's disorder and his or her ability to drive safely; (4) whether the disorder is under control with or without medication; (5) the individual's reliability regarding compliance with any prescribed medical regimen; (6) other medical conditions which may affect the lapse of consciousness disorder; (7) the individual's driving record; (8) any other relevant evidence or factors which may affect the individual's ability to drive safely; and (9) a current medical evaluation of the individual provided by the individual's physician. Cal. Code Regs. tit. 13, § 110.01(a)-(h) (2013).
Does the state allow for waivers of this policy, e.g., a waiver for a one-time episode of severe hypoglycemia that has mitigating factors (e.g., recent change in medication, illness, etc.) or that has been addressed with a physician?
If the licensing agency determines upon evaluation of competent medical evidence and all relevant factors that the individual is able to drive safely and maintain reasonable control of a motor vehicle, when judged against the factors listed in Cal. Code Regs. tit. 13, § 110.01(a)-(h) (2013), then it may decide to take no action against the driver. Cal. Code Regs. tit. 13, § 110.02(a)-(b) (2013).
California evaluates all cases individually and considers whether any loss of consciousness was an isolated episode or a chronic impairment. An isolated episode whose cause is related to conditions that are unlikely to recur (such as allergic reactions to insect bites or adverse reactions to medications) will typically not result in any action. If the episodes are part of a chronic or recurring condition, the department evaluates the applicant based on the degree of control established after the episodes, and the probability that the individual will be able to maintain control of the condition in the future. Generally individuals who have controlled their condition and been episode free for three to six months can receive a probationary license that requires regular monitoring by their physician and submission of follow-up medical reports to the licensing agency. Individuals who have been under control and episode free for six or more months can be licensed without restriction if there is no significant likelihood that episodes will recur, but probation can be continued if medical factors indicate the possibility of recurrence. See Cal. Dept. of Motor Vehicles, "Driver Safety Information Lapses of Consciousness Disorders," (Accessed Aug., 2013).
What is the process for appealing a decision of the state regarding a driver's license?
There is an appeal process for drivers whose privileges are suspended, restricted, or revoked for medical or functional impairments. When a driver has received notice of an action being taken against his or her license, the driver must request a hearing within 10 days of receiving personal service or 14 days from the date the notice was mailed or will lose the right to a hearing. Individuals have the right to be represented by an attorney at their own expense, to review and cross examine testimony of any witness for the licensing agency, present evidence and relevant witnesses, or testify on their own behalf. Individuals who disagree with the hearing officer's decision may request a departmental review of the decision and may appeal the decision in superior court. Cal. Veh. Code §§ 14100-14112 (2013) (governing appeals hearings from denials of identification cards, driver licenses, or temporary driver licenses); see also Cal. Gov't Code §§ 11500-11530 (2013); Cal. Code Regs. tit. 13, § 15.05 (2013). For more information, see Cal. Dept. of Motor Vehicles, "Information About Driver Safety Administrative Hearings," (Accessed Aug., 2013).
May an individual whose license is suspended or denied because of diabetes receive a probationary or restricted license?
Yes, in some cases. See Cal. Veh. Code § 14250 (2013) (authorizing the licensing agency to issue a probationary license in lieu of suspension or revocation); see also Cal. Veh. Code § 14251 (2013) (authorizing the licensing agency to terminate or modify the conditions of probation whenever good cause exists). If the licensing agency determines upon evaluation of competent medical evidence the individual is able to drive safely and maintain reasonable control of a motor vehicle, then it may place the driver on medical probation. Cal. Code Regs. tit. 13, § 110.02(a)-(b) (2013).
California issues two types of probationary or restricted licenses for persons afflicted by lapse-of-consciousness disorders: Medical Probation Type II and Medical Probation Type III. Medical Probation Type II is issued to a driver with three to five months control of his or her condition and requires the driver to submit a Driver Medical Evaluation (DS 326) form, completed by a physician, to the licensing agency. The main factors to be considered in placing a driver on Medical Probation Type II include: seizure type; seizure manifestations; seizure, medical, and lifestyle history; and the seizure-free period prior to the last episode. Medical Probation Type III is issued to a driver with six months or more control of his or her condition, "but due to contributing factors there is a slight possibility of another seizure." The driver must report on his or her condition to the licensing agency on a regular basis, using the Medical Probation Reporting (DS 346) form. The factors to be considered in placing a driver on Medical Probation Type III are the same as in the case of Medical Probation Type II, but the licensing agency also considers more heavily the driver's established reliability and likelihood of complying honestly. Medical Probation Type III is not to be issued if a driver has exhibited noncompliance, withholding information from a physician or the agency, or inconsistent statements. No probation is required for drivers that have achieved six or more months of control and for whom there are no coexisting medication conditions that would aggravate the driver's seizures or impair his or her ability to safely operate a motor vehicle. For more information, see Cal. Dept. of Motor Vehicles, "Driver Safety Information Lapses of Consciousness Disorders," (Accessed Aug., 2013).
Type 1 provisions require a driver to 1) obey all traffic laws and remain free from traffic accident responsibility; 2) remain under the care of a physician and follow prescribed treatment; 3) report any adverse change in the medical condition to the licensing agency, and to the physician; and 4) refrain from operating a vehicle after alcohol or drug use or any medicine that may interfere with the safe operation of a motor vehicle. This provision is imposed for three years, at which time a review is conducted. Type II provisions are imposed when a driver has a history of difficulty in controlling a medical condition or when he or she has established control for only a short time. The driver is required to submit periodic reports from a physician to the agency. Typically, Type II with reporting does not extend beyond one year. If the driver has been compliant and has shown success in controlling the condition, then typically the reporting requirement is deleted, thus changing it to a Type I provision. Id.
Is an identification card available for non-drivers?
Yes. Any non-driver may receive an identification card by filing an application form and showing proper identification. Cal. Veh. Code § 13000 (2013). An identification card may be issued free-of-charge to any driver surrendering his or her driver's license based on a disqualifying physical or mental condition. Cal. Veh. Code § 13002(c)(2) (2013). For more information, see Cal. Dept. of Motor Vehicles, "Driver License Identification (ID) Card Information," (Accessed Aug., 2013).
Driver licensing in California is administered by the state Department of Motor Vehicles.