The question of whether to drive or not is perhaps one of the most pressing to face dementia-afflicted patients. Basically, a person is licensed to drive when he or she is shown (usually by testing) to have mastered the mechanics and rules of driving as well as to be of legal age and of normal mental competence. Impairments of any sort might jeopardize mechanical mastery, obedience to and retention of the rules of the road, or general mental function. These factors, by themselves or together, may put the affected driver at risk (to him- or herself, or to others). However, a mere diagnose of Alzheimer’s Disease may not signal gross deficiencies in any relevant area. There are really two main facets to the query. One is: Is It Safe to Drive? I have covered this topic more fully elsewhere. (See HERE.)
It will have to suffice here to say (as was noted in my article on safe driving) that Alzheimer’s (and related dementias) affects coordination, cognition, concentration, decision-making, emotion, focus, memory, perception, reaction time, spatial awareness, understanding, and much else besides. Consequently, an Alzheimer’s sufferer might get “lost” more frequently than a non-sufferer; he or she may “misjudge” distances and turns; and such a person might “forget” (or neglect) good driving practices (otherwise known as the “rules of the road”). While these things tend to render a person with Alzheimer’s indisputably unsafe behind a wheel, the second question remains: what are the relevant legalities? I will tackle this, presently.
(For our State-specific guide to the relevant laws, see HERE.)
Does Alzheimer’s Mean Automatic License Revocation?
First and perhaps most obviously, does a diagnosis of some sort of dementia (including Alzheimer’s Disease) automatically entail license revocation? The short answer is: No – not necessarily.
Number one, remember that most forms of dementia – chiefly, for our purposes, Alzheimer’s – come in degrees or stages. (For a primer, see HERE.) Early-stage patients may still be able to drive even if, by middle stage, most sufferers are generally unsafe behind the wheel.[1]
While, again, this is not an article about safety, the present point is that unless a given driver is demonstrably unsafe, there are few grounds on which to base a case for revocation.[2]
Having said that, diagnoses of dementia may be grounds for license restriction.
What Is the Usual Process?
Different states tackle this differently. (For a State-specific guide to the relevant laws, see HERE.) But, speaking only in general terms, what typically happens is something like the following.
A person goes in for his or her license renewal. The renewal application has a question something like: “Do you suffer from a medical condition that could or does impair your ability to drive safely?” If a person answers “yes,” then that person would be medically evaluated straight away. (Possible results of this process are enumerated, below.) If, on the other hand, a person answers “no,” then he or she would have to undergo the usual renewal tests (driving, knowledge, vision, etc.), if any. If the applicant passes the tests, and has no impairments that are severe enough to be observed by the bureau/department of motor vehicle (BMV/DMV) employee, then the license will be renewed.
If the applicant’s license is renewed, then the entire process becomes reactive. To put it another way, the driver will be allowed to operate a motor vehicle with no restriction/oversight unless or until he or she is brought to the attention of the BMV/DMV. This might occur when the person’s doctor reports him or her for some medical reason. A handful of states have mandatory-reporting laws. (See the last paragraph of the next section for a list of said states.) Most states do not have such a requirement. However, physicians may report people for ethical reasons, to mitigate the attendant liability risks, or for other reasons.
A driver may also be reported by a court of law or by a law-enforcement officer. For example, these sorts of reports might occur after a traffic accident, traffic hearing, or traffic stop.
Finally, a person may be reported by a family member, caretaker, or even (in some jurisdictions) by concerned citizens or neighbors. Many times, these reports are treated as affidavits and must be dated, notarized, and properly signed. Typically, anonymous reports are rejected. However, a few states (including Florida, Ohio, South Dakota, and Washington, D.C.) treat reports as confidential. The concern with anonymous or strictly confidential reporting is twofold. Number one, for obvious reasons, states wish to avoid nuisance or revenge reporting (i.e., people reporting drivers for reasons of personal vengeance and the like). Number two, Western legal systems usually have provisions for enabling accused persons to confront their accusers.
(Again, to see the laws and regulations that are specific to your State, click HERE.)
Who Ultimately Decides Whether a Person May Drive?
Doctor’s evaluations usually settle the question either way. In a few states, physicians are actually required by law to report a diagnosis of Alzheimer’s (among other conditions) to various governmental bodies and, ultimately, to the department that oversees licensing or motor vehicles (such as the state BMV/DMV). (To get a sense of the myriad state-specific differences that arise at this point, see below.)
Even in states that do not mandate doctor reporting, there are usually mechanisms in place that allow other concerned or interested individuals (e.g., chiefly doctors, but also law-enforcement officials, relatives, or others) to file a report. In fact, most states are reactive in this way.[3] To put it slightly differently, the usual state of affairs is to leave licensed drivers alone unless or until one of more of the following occurs.
- A person discloses that he or she suffers from some cognitive impairment, dementia, seizure disorder, etc. (that is, the afflicted person reports him- or herself);
- The driver is brought to the attention of the licensing body via multiple accidents or other incidents; or
- The Alzheimer’s sufferer is reported to the licensing agency by family members, law-enforcement personnel, or (mainly) physicians.
When any one of these “triggers” is tripped, the licensing or motor-vehicle department typically initiates a review process. This is the process by which the driver in question is put under scrutiny in an effort to ascertain his or her actual competency.
The individual’s driving and medical records may be examined. It is not uncommon for the licensing/motor-vehicle evaluators to send a letter to the targeted driver indicating that he or she is under review and giving said individual the opportunity to obtain the written opinion of his or her own doctor.[4] The review process may also involve requalifying the individual for a driver’s license by way of administering driving, vision, and written retesting.
In the end, for most states, the final word is given to competent medical personnel. Physicians evaluations are awarded immense weight. Additionally, “[s]ix States [California, Delaware, Nevada, New Jersey, Oregon, and Pennsylvania] currently require physicians to report certain types of impairments to the State licensing agency.”[5]
What Are the Main Outcomes of the Review Process?
- Renewal – If a person obtains a favorable evaluation from his or her physician, then his or her license will likely be renewed. However, the licensing body may require more frequent reevaluations.
- Restriction – Alternatively, a person could have his or her driver’s license renewed, but with certain provisos or restrictions. For example, someone might be limited to driving in a particular area, or to driving only during certain times of day (say, being required to avoid driving at night).
- Revocation – If the person in question fails the retesting outright, or if the physician statement is unfavorable (from the point of view of renewal), then the license probably will not be renewed. Depending upon the state, there might be an appeals process or even the possibility of reexamination.[6]
What Are Possible Legal Repercussions From Driving While Cognitively Impaired?
Let’s face it, a main concern has got to be exposure to legal liability. If a licensed Alzheimer’s sufferer has an accident, is he or she open to a lawsuit? As I have stated elsewhere, I am incompetent to provide legal advice, but, intuitively, the short answer this time is surely yes. For one thing, almost anyone involved in an accident might be open to a legal action. Observe, also, that Alzheimer’s (and other dementias) are far from the only sorts of driving impairments. (Driving while under the influence of alcohol or drugs would also be impairments in the relevant sense.)
However, there is much more nuance than a mere “yes.” The fact that an Alzheimer’s-afflicted driver might open him- or herself up to a lawsuit in the event of an accident does not, by itself, imply that the Alzheimer’s Disease is necessarily a factor – let alone the deciding factor – in such a case.
Several issues are important. Number one, the Alzheimer’s-affected driver would have to be the one at fault. Number two, the Alzheimer’s Disease (or other dementia) would have to have been determined to be a causal factor.[7] To put a finer point on it, the available evidence would have to show (to any pertinent legal standard) that the afflicted driver’s impairment contributed to the occurrence of the accident.
However, there are circumstances that can create serious liability issues for Alzheimer’s sufferers, their families, and their physicians.
For instance, there could be severe legal consequences if there is good reason to believe that an afflicted person, his or her family, or his or her physician ignored or failed to adequately address signs that the relevant driver was unsafe behind the wheel. A person who ought to voluntarily submit to medical evaluation or who ought to disclose a cognitive impairment, but who does neither, could be legally liable. Of course, sometimes Alzheimer’s impacts self-awareness. In cases where this awareness deficit exists, it may be that the sufferer’s culpability is mitigated. But, presumably, this would have to be determined by a court or judge of competent jurisdiction. The intuitive point is that if a person knowingly and willingly operates a motor vehicle while impaired, then he or she might have to face legal consequences.
Similarly, family members or physicians who allow persons under their care to drive while impaired could also face legal actions. Of course, there are complications and subtleties to these questions. A key phrase is such cases is “good faith.” The driver and his or her caretakers (if any) are expected to act in good faith and with reason and experience, jointly applied.
Once again, these considerations are supplied merely for illustrative purposes. They are neither meant to be exhaustive nor applicable to every situation. If you or a loved one is suffering from some form of dementia, then you should seek professional advice. Doctors and lawyers both have their own spheres of competence, and both sorts of professional may have something relevant to say on this issue.
State-Specific Complications
Legalities pertaining to drivers’ licensing are handled by the individual U.S. States. Each state has its own procedures. (For a list of State-specific laws, see HERE.) Indeed, each state has its own departmental structures.
In sixteen (16) states (such as Arizona, Delaware, Hawaii, Idaho, Iowa, Kentucky,[8] Maryland, Massachusetts, North Carolina, North Dakota, Oregon, Pennsylvania, Vermont,[9] West Virginia, Wisconsin, and Wyoming), drivers’ licensing is overseen by a Department of Transportation.
In other states, the Department of Transportation merely deals with the building and maintenance of public highways and roads and licensing is managed elsewhere.
It could be under the auspices of a Department of Revenue (as it is in Colorado, Kansas, Missouri, and Rhode Island).
Sometimes (as is the case in Alabama, Florida,[10] Minnesota, Mississippi, New Hampshire, Ohio, Oklahoma, South Dakota, Tennessee,[11] Texas, and Utah) licensing is directed by a Department of Public Safety.
The Secretary of State’s Office facilitates licensing in Illinois, Maine, and Michigan.
A handful of states have one-of-a-kind departments. In Montana, drivers are licensed by the Department of Justice; Arkansas seemingly has a hybrid Department of Finance and Administration; whereas, in Washington State, there is literally a Department of Licensing.
In Georgia, it’s called Driver Services. (The same phrase crops up in other states, too. But in Illinois, Pennsylvania, Tennessee, and Wyoming, “Driver Services” is a subset of some larger, overarching, agency.)
Then there is another layer of terminological difference. Most states (i.e., by my count, Alaska, Arizona, Colorado, Idaho, Kansas, Kentucky, Montana, New Hampshire, New Mexico, North Carolina, North Dakota, Oregon, Rhode Island, Utah, West Virginia, and Wisconsin) refer to their motor vehicles agencies as “Divisions.”
Similar units are called “Departments” in California, Connecticut, Washington D.C., Maryland, Nebraska, Nevada, New York, South Carolina, Vermont, and Virginia.
On the contrary, “Bureaus” carry out licensing functions in Indiana, Maine, and Ohio.
And usual, some states have sui generis labels (in Louisiana, there is an “Office” of Motor Vehicles; in Massachusetts, it’s called the “Registry” of Motor Vehicles; and it’s a Motor Vehicle “Commission” in New Jersey.) Still other states use combination terms. Iowa and Minnesota both have composite names such as the Division of Motor Vehicles and Driver Services.
Additional Resources:
See, also, our “Car-Modification Recommendations,” here:
Notes:
[1] One wrinkle, here, is that persons with even advanced dementia may have “good” days during which they seem to lucid and able to reason. These good days will be sprinkled in the midst of “bad” days where the person’s cognitive abilities are subpar. Even though this variability is well known, it is likely that, as far as driving is concerning, the safest course is to make licensing decisions based upon a person’s worst days, rather than their best ones. The reason is that an Alzheimer’s sufferer has little to no power over whether a day will be “bad” or “good.” Therefore, any given driving outing is left to chance. If the Alzheimer’s-afflicted individual has declined to the point where he or she would be unsafe driving on “bad” days, then it’s probably time to hand the license over.
[2] It is not enough That a given driver with early-stage Alzheimer’s or Mild Cognitive Impairment will, given the natural course of the disease, eventually become unsafe is not enough.
[3] That is, the majority of states do not seem to proactively restrict Alzheimer’s patients. Instead, most states wait until a credible concern is filed, and then the driver in question is subjected to scrutiny.
[4] In some cases, of course, the family doctor may be the person who referred the individual to the licensing body for medical review in the first place. Whenever a physician is involved, the licensors will elicit the physician’s considered opinion of the patient’s ability to drive safely.
[5] Here is an illustration of the authority given to healthcare professionals. One reference, for the state of Nebraska, states: “If the guidelines …indicate that [a] driv[ing] test need not be administered, but if [a] physician indicates on the …Physician [Statement] that one should be administered, follow the physician’s recommendations.” On the mandatory-reporting laws, see Medical Oversight of Noncommercial Drivers, Highway Special Investigation Report, Washington, D.C.: National Transportation Safety Board, 2004, Appendix E, p. 69. “California Lapses of consciousness and Alzheimer’s Disease severe enough to be likely to impair a person’s ability to operate a motor vehicle [;] Delaware Loss of consciousness due to diseases of the central nervous system[;] Nevada Epilepsy[;] New Jersey Recurrent convulsive seizures, recurrent periods of unconsciousness, or recurrent impairment or loss of motor coordination due to conditions such as epilepsy[;] Oregon Loss of consciousness or control. Cognitive and functional impairments that are severe and/or uncontrollable to a degree that may preclude safe operation of a motor vehicle and are not correctable by medication, therapy, surgery, driving device, or technique[; and] Pennsylvania Lapses of consciousness or other mental or physical disabilities affecting the ability of a person to drive safely[.]” Ibid.
[6] Again, however, if a driver is evaluated as unsafe because he or she is having one is his or her “bad” days, then this probably should be taken as an indication that the condition has advanced to the point where the driver is not reliably safe. A person should probably not be licensed just because he or she might be safe, but because he or she is predictably safe. While they may enjoy periods of lucidity, at a certain point in their decline, Alzheimer’s patients are no longer predictably safe. Therefore, unfortunately, they are not reliably safe, and probably should not be licensed. Another issue is the cost. Although some states may not charge for the initial review, if the outcome is contested, then the affected driver may end up having to pay for any requested reevaluations.
[7] Even if were not the only factor. It is arguable that many (if not most) accidents have complex causes.
[8] The Transportation Cabinet.
[9] Agency of Transportation.
[10] Technically, here, it is the Department of Highway Safety and Motor Vehicles.
[11] Safety and Homeland Security.