By Brian Goslow
When it comes to a new safe driving bill in Massachusetts, Saugus resident John Andreucci, 71, is adamantly opposed to any legislation that targets a specific age group. “It’s about as discriminatory as you can get,” he said. “Any part that has to do with a single group or people, I’m opposed to.”
At press time, Senate and House conference committees were hammering out a final version of the bill before it’s returned to the Legislature for further discussion and a vote. While the age for mandatory testing hasn’t been determined, recent debate has focused on 75. Follow-up testing would be required every three years after that.
“It originally was going to be 65, but most people that age have their facilities intact,” said Andreucci. He thought the age was raised to 75 after elected officials belatedly realized the proposed legislation could cost them their jobs at election time.
It’s also unclear who would have the final say on a driver’s ability to stay on the road — and where that determination would be made. Medical offices have been the location most mentioned, but one medical group has proposed the Registry of Motor Vehicles (RMV) or another location under state jurisdiction.
“Most primary care physicians wouldn’t feel comfortable being the final decision maker,” said Dr. Dennis Dimitri, president of the Massachusetts Academy of Family Physicians and a family health practitioner at UMass Memorial Health Care in Worcester.
“If it’s required that physicians make a report to the Registry of Motor Vehicles about patients, on a simple form, that would be easy. But if it meant making an evaluation, assessment and decision about a person’s driving ability, that’s very problematic for most physicians.”
Dmitri said a driving ability evaluation could be a time consuming task, adding to an already overloaded appointment schedule. “ He called such a burden “unreasonable.”
In a March 18 letter to state representatives, the Massachusetts Medical Society (MMS), noted multiple tests would be required to assess a person’s physical ability, cognitive skills and vision and that a single health care provider might not be able to conduct them all, requiring a driver to go to multiple providers. The addition of thousands of such assessments to physicians’ workloads could potentially delay patients seeking medical appointments and care.
Then there’s the question of cost.
“It appears unlikely that either Medicare or private “medigap” health insurance would cover their cost,” the MMS letter stated. “This could create a significant burden on many applicants who would have to pay for this testing as an out-of-pocket expense.”
The MMS also questioned whether health-care providers would be willing to affirmatively certify patients as fit to drive without specific protections against civil liberties.
“We need protection against liability for a physician if a patient gets into an accident and dies,” said Dimitri. “That could occur if someone said a physician should have reported them.”
Ultimately, he said, the onus is on the RMV to develop a process where a simple report from a physician would lead to the registry making a final decision. “A mandate to do a report would be similar to a mandate in reporting suspected cases of child and elder abuse,” Dimitri said, “but it’s up to the state to decide whether abuse or neglect exists.”
Calls for cognitive and physical testing have been controversial. “There’s wide agreement in the medical and academic communities that the kind of testing that will screen out bad drivers doesn’t currently exist,” said AARP Massachusetts State Director Deborah Banda. “For legislators to mandate testing that doesn’t exist isn’t proper.”
Banda noted that the way the legislation was written when it was returned to committee in early March, anyone in the health care chain, including a dentist, could give the test. She said it has yet to be determined who would pay for any mandatory testing, be it the person tested, the state or the person’s health-care insurer.
AARP Massachusetts, which has been meeting with committee members during the legislative process, supports four provisions under consideration:
•The identification of drivers of all ages with impairments by improving the voluntary medical reporting system. AARP gives the example of a strong medical reporting system in Missouri led to a decrease in accidents, saving lives and making its roads safer.
•The implementation of a trigger system to weed out unsafe drivers of all ages; drivers who are in three accidents would automatically be reassessed. “We’ve been asking for in-person renewals every five years,” Banda said. “It would get younger and older bad drivers off the road. This debate must focus on ability, not age.” Currently, drivers can alternate every five years between in-person and remote renewals.
•Ban texting (legislation on this issue is in the House and Senate version and is likely to be included in the final version of the bill).
•Establish a commission to look at transportation alternatives for those who shouldn’t be driving.
Many older drivers who are aware they shouldn’t be on the road continue to do so because they have no other transportation available. “It’s one of the huge issues,” Banda said. “If we take away a driver’s license, especially in isolated or rural areas, how are they going to get to their doctor’s appointments, the grocery store, church services and remain a vital member of their communities. It’s only going to grow as the population ages and their numbers increase.”
Seniors can be very resistant to giving up their driving privileges. “It has a major impact on their ability to live independently,” Dimitri said. “Usually, a family member is the one to tell mom and dad to stop driving and take away their keys.”
Family members, friends and physicians, can be wary of taking action for fear of upsetting that person. Dimitri would like to see a system where people could anonymously report their concerns to the RMV. “That takes the onus off of them and into the authority of the objective authority,” he said.
Dimitri doesn’t feel any driver’s safety legislation should be age specific. “There are many many older drivers who are fully capable of driving,” he said. “But there are younger drivers with things that at times affect their driving safely.”
For example, physicians aren’t required to report a person who suffers a seizure disorder to the RMV. However, it’s expected they would tell them to wait six months before returning to the road. “That’s a disease specific situation,” Dimitri said. Suffering a stroke doesn’t necessarily forbid a return to driving either, he said, but it’s difficult to decide whether someone who’s had a stroke should drive. “Most physicians aren’t set up to do that evaluation in their office,” he noted.
Then there’s the slow onset of dementia, where it’s a matter of deciding when there’s a problem and action is needed. “What often happens is the family has to make the difficult decision of taking the keys away from an impaired family member for the safety of the family and those on the road,” Dimitri said. Because they see a person on a much regular basis than a doctor, a family member or friend of someone suffering with dementia may be more capable of evaluating physical and cognitive abilities. “We need a better way of dealing with that,” said Dimitri.”
Until there is a better way of judging a person’ ability to continue driving, Andreucci is skeptical about what the legislature will finally put into place. “You could shoot foul shots,” he suggested cynically. “If I get seven out of 10, I keep my license.”
He doesn’t feel it’s fair to put any person, let alone seniors with their way of life on the line, under the pressure of a single test to determine whether they keep their license. He compares it to a professional athlete playing in a major sporting event. “They can make every shot in practice but in a championship situation, they’ll miss the last two shots that could have won the game and end up with nothing,” he said. “With a mandatory driving test, if you don’t pass, you won’t be able to get around anymore. Talk about pressure.”
Andreucci is a sports official for volleyball and track and field events throughout the North Shore and up into New Hampshire. “I couldn’t do it, absolutely 100 percent couldn’t do what I’m doing, if I couldn’t drive,” he said.
Ironically, in sports, he’s judging those at the other end of the driving curve, where teenagers taking their driver’s test are given endless attempts to pass. “If you fail your driver’s test at 16 1/2, you can take it again,” Andreucci said. “You won’t be able to do that if you fail at 75.
“Of all the people I know that are driving, I’d rather be driving with them now than when they were teenagers. All the nutty things they did, I don’t know how we made it. I know there’s some of them I wouldn’t ride with them then, but 50, 60 years later, I’d drive with them now.”