Are applicants for a driver's license asked questions about diabetes?
No. However, the driver's license application (first-time and renewal) asks an applicant whether he or she has experienced convulsions, epilepsy, or blackouts; paralysis; heart attack, heart disease, or stroke; or "other" medical conditions within the preceding six months. Missouri Driver License Bureau "Mail-in Driver License Application," Form 4317 (Rev.8-2011). If an applicant answers yes to any of these questions, he or she may be examined for an individual's fitness to operate a motor vehicle safely.
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 state accepts reports of potentially unsafe drivers from police officers, the courts, physicians, social workers, close family members, and hospitals. Mo. Rev. Stat. § 302.291(3)-(4) (2013) (specifying persons whose reports of driver incompetence the licensing agency has good cause to believe). Close family members and spouses may only report drivers one time within a 12 month period. Mo. Rev. Stat. § 302.291(3) (2013). The licensing agency does not accept anonymous reports, and it investigates any referral if its source is questionable before evaluating the driver. Missouri Driver License Bureau, "Driver Condition Report," Form 4319 (Rev. 04-2010). 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 a certain number of accidents or accumulate a given number of points.
What is the process for medical evaluations of drivers?
When the licensing agency receives information indicating that a driver may be medically unsafe to operate a motor vehicle, through answers to questions on the license application or through one of the referral sources listed above, agency personnel investigate the situation to decide whether a medical evaluation is required. Mo. Rev. Stat. § 302.291 (1) (2013) (general authorization for medical evaluations). The agency may set an examination within 10 days of giving notice. Refusal to submit the examination within 30 days of receiving notice may lead to a loss of license. The official physician's statement form asks the physician to indicate whether the patient has Diabetes (Type 1 or 2), uses insulin, or has retinopathy that affects vision. Missouri Driver License Bureau, "Physician's Statement," Form 1528 (Rev. 10-2012). For each condition, the physician may indicate if the condition ranges from "severe" to "mild" or "unimpaired." The physician then indicates whether the or not the individual is "likely" capable of operating a motor vehicle safely, "unclear if capable," or "not capable." The physician may indicate any recommended evaluations or licensing restrictions. Periodic follow-up medical evaluations may be required on the recommendation of the physician. Mo. Rev. Stat. § 302.291(1) (2013).
Are physicians required by law to report drivers who have medical conditions that could affect their ability to drive safely?
There is no statutory authority requiring physicians to report drivers with medical conditions that could affect their ability to drive safely to a central state agency. However, physicians and other medical professionals may voluntarily report to the licensing agency any patient diagnosed or assessed as having a disorder or condition that may prevent such person from safely operating a motor vehicle. Mo. Rev. Stat. § 302.291(4) (2013). Any such report must state the diagnosis or assessment and whether the condition is permanent or temporary, and the existence of a physician-patient relationship will not prevent the making of a report by authorized medical professionals. Mo. Rev. Stat. § 302.291(4) (2013). All reports and medical records so submitted are kept confidential, except upon order of a court of competent jurisdiction or during review of a decision of the licensing agency in circuit court. Mo. Rev. Stat. § 302.291(5) (2013).
Are physicians who report drivers with medical conditions immune from legal action by the patient?
Yes. Any physician or other authorized medical professional who makes a report in good faith is immune from any civil liability that otherwise might result from making the report. Mo. Rev. Stat. § 302.291(5) (2013). Members of the Medical Advisory Board are immune from civil or criminal liability for their official actions, provided that they act in good faith and that there is no fraud or malice. Mo. Rev. Stat. § 302.292(2) (2013).
Who makes decisions about whether drivers are medically qualified?
Decisions generally are made by licensing agency personnel. In certain situations, cases may be referred to the state's independent, three member Medical Advisory Board for recommendations, which are made on a case-by-case basis; however, the licensing agency retains ultimate authority over all licensing decisions. Mo. Rev. Stat. § 302.292(1) (2013) (specifying that the function of the Medical Advisory Board is "to advise the [licensing agency] on medical criteria for the reporting and examination of drivers with medical impairments"). The Medical Advisory Board relies on a physician's opinion as to whether an individual can drive safely.
What are the circumstances under which a driver may be required to undergo a medical evaluation?
A driver may be required to undergo a medical evaluation if the licensing agency has "reasonable grounds to believe that [he or she] is suffering from some known physical or mental ailment which ordinarily would interfere with [his or her] fitness to operate a motor vehicle safely upon the highways." Mo. Rev. Stat. §§ 302.173(1), .291(1) (2013). A driver may be required to undergo periodic medical evaluations if he or she has a condition that could impair safe driving. Mo. Rev. Stat. § 302.291(1) (2013).
Has the state adopted specific policies about whether people with diabetes are allowed to drive?
No. The evaluation form given to physicians for medical examinations has specific questions about diabetes and insulin use. Missouri Driver License Bureau, "Physician's Statement," Form 1528 (Rev. 10-2012). However, Missouri has adopted no specific statutory or regulatory medical guidelines related to diabetes.
What is the state's policy about episodes of altered consciousness or loss of consciousness that may be due to diabetes?
A medical evaluation usually is required for any episode of loss of consciousness within the preceding six months. Missouri Driver License Bureau "Mail-in Driver License Application," Form 4317 (Rev.8-2011). The physician's statement required for medical evaluations asks questions about loss of consciousness, including the dates of the most recent episodes. Missouri Driver License Bureau, "Physician's Statement," Form 1528 (Rev. 10-2012).
Although Missouri does not impose a set episode-free period, in order to be licensed, a driver generally must be free of episodes for six or more months or have a statement from a physician indicating that his or her condition will not impair his or her driving ability. When an individual subject to episodes of loss of consciousness is granted a license, the licensing agency usually issues a conditional license for a period of one year, Mo. Rev. Stat. § 302.301(1) (2013) (providing that the licensing agency may issue licenses with restrictions appropriate to assure the safe operation of motor vehicles by license holders), after which time it confirms that the individual has been episode-free within the preceding year. (Note: there is no statutory or regulatory authority for these rules, but the Epilepsy Foundation cites the same policy.)
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?
As there is no set episode-free period, a driver whose license has been suspended because of a recent episode of loss of consciousness may be able to regain his or her driver's license by obtaining a statement from a physician indicating that his or her condition will not impair his or her driving ability. (Note: there is no statutory or regulatory authority for this rule, but the Epilepsy Foundation cites the same policy.)
What is the process for appealing a decision of the state regarding a driver's license?
An individual whose driving privileges are suspended or restricted for medical conditions may appeal to the circuit court of the county of his or her residence for administrative review of the licensing decision. Mo. Rev. Stat. § 302.311 (2013). An appeal must be made within 30 days of receiving notice of the licensing decision. Mo. Rev. Stat. §§ 302.291(10), .311 (2013). The circuit court will hear the case de novo and may affirm, modify, or set aside the licensing agency's decision. Mo. Rev. Stat. § 302.311 (2013). An aggrieved individual may appeal the determination of the circuit court as in civil cases. Mo. Rev. Stat. § 302.311 (2013).
May an individual whose license is suspended or denied because of diabetes receive a probationary or restricted license?
Yes. After an individual has undergone and submitted a medical evaluation, the licensing agency may issue him or her a restricted license if it deems such action to be appropriate. Mo. Rev. Stat. § 302.291(1) (2013); Mo. Rev. Stat. § 302.301 (2013) (specifying the restrictions that the licensing agency may impose). Furthermore, the licensing agency may, when good cause appears, issue a license with restrictions appropriate to assure the safe operation of a motor vehicle by an individual. Mo. Rev. Stat. § 302.301(1) (2013).
Is an identification card available for non-drivers?
Yes, with proper identification and payment of a $6.00 fee. Mo. Rev. Stat. § 302.181(7) (2013); Mo. Code Regs. Ann. tit. 12, § 10-24.110, .448 (2013). Nondriver's licenses, as they are called in Missouri, are valid for a period of six years, unless the holder is age 70 or older, in which case the nondriver's license is valid indefinitely. Mo. Rev. Stat. § 302.181(7) (2013). An individual suffering from a permanent disability may ask the licensing agency to issue him or her a nondriver's license indicating such status after presenting a medical statement completed and certified by a healthcare provider. Mo. Rev. Stat. § 302.182(1) (2013); Mo. Code Regs. Ann. tit. 12, § 10-24.485(3) (2013).
Driver licensing in Missouri is administered by the Customer Assistance Bureau within the Division of Motor Vehicle and Driver Licensing of the state Department of Revenue.