As a trial lawyer in California who has type 1 diabetes, I have represented more than two dozen people with diabetes whose driver’s licenses were suspended by the state Department of Motor Vehicles (DMV). While all of my clients eventually had their licenses returned, they all suffered emotionally and financially while inadequately trained and overworked DMV hearing officers delayed and denied the return of their driving rights for weeks or months at a time.
California law, like that of all states, provides that a driver’s license may be suspended if a person with diabetes is found to be an unsafe driver. This necessary regulation, however, is all too often mishandled and misunderstood by people who have not been sufficiently trained to make a reasonable judgment about the relationship between blood-glucose control and driving ability.
Anyone who has been diagnosed with diabetes, or who is closely involved with someone who has diabetes, knows all too well that blood-glucose control is a complex issue. Those of us fortunate enough to have good long-term blood-glucose levels know that it can take a great deal of work to achieve those results. However, despite our best efforts, we can still make mistakes that lead to low or high blood-glucose levels.
An irony of tight blood-glucose control is that the very people who are most successful at managing their diabetes may also be the very ones whose blood-glucose levels are more likely to fall too low, which can cause them to experience a dangerous hypoglycemic reaction. People practicing tight control can, of course, be educated to avoid and handle hypoglycemia.
The confusion that inadequately trained DMV hearing officers often have about these facts is well illustrated by one client whose license was suspended after his doctor wrote on a DMV medical form that his type 2 diabetes was “poorly controlled.” That comment alone caused the suspension.
When we looked more carefully at his diabetes, it was immediately obvious that he posed no driving safety risk whatsoever and that his suspension was plainly improper. This client had never taken insulin in his life and had never experienced hypoglycemia. He had never been hospitalized, fallen unconscious or become disoriented from going too low. He might have been slowly killing himself from poorly controlled blood-glucose levels, but his death would be unlikely to result from a driving accident. His “poor control” was entirely irrelevant to driving safety and should never have led to his license suspension.
If the DMV hearing officer reviewing the case had been better trained, these facts would have been obvious at my client’s initial license review, and he would not have needed an attorney. Unfortunately, either this client did not explain the facts well enough for the hearing officer to understand or the hearing officer was unable or unwilling to review and understand the facts sufficiently to make a reasonable determination.
More often, I have represented people whose licenses were suspended after they were rushed to the hospital with a low blood-glucose level and an emergency room physician reported the incident to the DMV. In the cases I have reviewed, it apparently made no difference to the DMV whether the hypoglycemic event occurred while the person was home in bed in the middle of the night, was exercising, or was driving a car. The driver’s license was suspended because of a single significant low blood-glucose event that was reported to the DMV, regardless of how or why the incident occurred and regardless of whether any driving safety risk was involved.
The real issues that need to be considered are whether the driver with diabetes:
- has hypoglycemic unawareness that can be improved,
- takes the necessary precautions to avoid hypoglycemia while driving and
- is prepared to handle a hypoglycemic event if one does occur while he or she is driving. Unfortunately, too few DMV hearing officers are trained to understand and consider these critical issues.
In other states, such as Hawaii, a license cannot be suspended for a medical reason without the review of a panel of physicians. Assuming the physicians have specific knowledge of the medical condition at issue, this type of review is clearly preferable.
At a minimum, all states need to develop pertinent and up-to-date criteria for assessing the safety risk of drivers with diabetes and need to educate the people reviewing the information to understand the nature of the illness and the precautions necessary to avoid dangerous driving events.
Most people with diabetes can learn to understand, avoid and properly handle hypoglycemic events. Therefore, more effort should be made to ensure that necessary education and medical care are being provided before taking the ultimate and drastic step of suspending a driver’s license when there is no significant basis for considering the driver a safety risk. Those efforts will enable us to avoid the unintended consequence of causing people with diabetes to resist or avoid proper medical care for fear of being reported to the DMV.
If DMV hearing officers are properly prepared to understand and handle physician assessments, it will allow drivers with serious medical conditions to be open and frank with their physicians when they seek treatment for their illness and the training necessary to avoid the dangerous consequences of hypoglycemia.