Due to the varied nature of epilepsy, the Epilepsy Foundation opposes across-the-board seizure-free requirements, and endorses individualized evaluations of ability to drive. Individualized determinations of ability should be based, in part, upon the following factors: type(s) and frequency of seizures, presence of an aura (warning), customary time of seizure occurrence (e.g. nocturnal, upon waking), willingness to take prescribed medication(s), and any side effects of medication.
The Foundation recognizes that some states may feel the need to retain a specific seizure-free period requirement. Where this is so, the approach used by Wisconsin is a reasonable alternative. Wisconsin will license people who have been free of any episodes of altered consciousness or loss of bodily control for three months. Periodic medical reports may be requested as a condition of licensure. After a driver has been episode free for five years, he or she is no longer required to submit reports.
Where it may not be advisable to issue an unrestricted license, and where a significant risk would not be posed, a restricted or probationary license should be available to allow the least interference with daily routine affairs. These alternatives would encourage people to exercise a higher degree of responsibility for their conditions (i.e., being honest with their doctors and with DMV), knowing that they will receive fair, individualized consideration. This will help states serve the competing interests of public safety and individual opportunity. It will also help eliminate the perceived need for laws which require that physicians report people with epilepsy to a state agency, usually the agency that issues driver's licenses. The Epilepsy Foundation's opposition to such laws is explained more fully in the section on reportability.
The Foundation also believes that an unreasonable burden is posed by requiring periodic medical reports for an indefinite period of time. After it is established that, in all probability, the person's seizures will remain controlled, these reports should no longer be required.
The Foundation endorses the statutory creation of Medical Advisory Boards including at least one licensed neurologist, preferably with an expertise in epilepsy. This Board should recommend factors to be used in eligibility determinations, and should recommend and participate in review procedures. This will help assure that proper consideration is given to the characteristics of the individual's condition and to the personal physician's evaluation.
When DMV believes that a license should be suspended or revoked, a hearing should be held prior to such action being taken, unless there is a reasonable basis to believe that an imminent danger is posed by the person's continuing to drive. Likewise, unless such a danger exists, the decision to suspend or revoke a license should be stayed pending an appeal of that decision. Judicial review of the licensing agency's final decision should be available, and should be explicitly stated in the licensing statute or regulations. Notices of proposed actions-denial, suspension, revocation-should include information on the right to appeal, and the necessary procedures and time limits.
The Epilepsy Foundation endorses legislation and regulations which include the provisions discussed above, i.e., no set seizure-free period, availability of restricted licenses, Medical Advisory Boards, hearings prior to license revocation except where an imminent danger is posed, an explicit provision for judicial review, and a provision for voluntary surrender of licenses.
The U.S. Department of Transportation (DOT) has regulations which bar anyone with any history of epilepsy from being licensed to drive in interstate trucking. While requirements for other medical conditions may be waived upon an individual showing that such waiver is appropriate, waivers for epilepsy are not permitted. These regulations are currently under review. State regulations for licensing intrastate truck drivers vary considerably from state to state. Some mirror the federal regulations, others have less stringent requirements or use the same standards as for personal licenses.
The Epilepsy Foundation believes that a blanket denial of commercial licenses to all persons who have ever had epilepsy is inappropriate. Regulations governing commercial licensing should provide for an individualized determination of a licensee's or applicant's fitness to drive and the circumstances of his employment.
...On Mandatory Physician Reporting:
Since l974, the Epilepsy Foundation has firmly opposed mandatory reporting laws. The Foundation's position statement is as follows:
The Epilepsy Foundation favors a system of self-reporting in which the individual takes primary responsibility for the condition and the limitations it poses. Mandatory reporting laws result in violations of the confidential nature of the physician-patient relationship, and the possible erosion of this relationship. Proper diagnosis and treatment of epilepsy depend greatly upon the development of an honest, trusting relationship between an individual and his physician. Accurate information concerning seizure activity is of critical importance. If a patient knows or fears that his doctor is obligated to report him to the state, he may withhold crucial information with potentially fatal consequences.
...On Physician Immunity Laws:
While the Epilepsy Foundation opposes mandatory physician reporting laws, it does support state laws which give physicians "good faith" immunity for participating in the driver licensing process, and for voluntarily reporting those patients who pose an imminent threat to public safety because they are driving against medical advice. "Good faith" should be defined as acting in accordance with a reasonable standard of care.