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‘Thrills’ await rehab driver trainer

Monday, June 23, 2003
Celia Storey
Arkansas Democrat-Gazette

When I die, I want to go peacefully in my sleep like Grandpa did — not terrified and screaming, like the passengers in his car. John Johnston can laugh at that awful old joke, but he knows the awful truth behind it. Johnston, an occupational therapist for Baptist Health Rehabilitation Institute in Little Rock, rides around with some scary drivers. About 6,000 times over the past 17 years, this cheery 58-year-old has slid into the passenger seat of the institute’s test car to find out whether the person behind the wheel belongs there.

The car is equipped with passenger-side controls, but "I tell people I’m a thrill-seeking personality," he says ruefully.

The majority of his test subjects have been stroke patients at the institute. "They may ask the doctor, ‘What about my driving?’ And if the doc knows about our program, he may say, ‘Let’s have you evaluated first.’ That’s the normal process," Johnston says. But he gets referrals "from all over," because he offers something rare among hospital services: road tests.

Most of the drivers he evaluates have brain damage. He also helps amputees, people with spinal-cord

injuries and kids with spina bifida who learn to drive using hand controls. He tests drivers with degenerative diseases such as Parkinson’s disease and multiple sclerosis. "More and more of that over the past few years," he says. "Lately I get quite a few referrals for people with dementia, Alzheimer’s. Families think they’re not safe to drive," so they ask a doctor to order an evaluation. "I don’t know why the docs won’t just say. ‘OK, stop driving.’ They want me to be the bad guy, I guess," he says, laughing. But all he can do is evaluate. He can’t yank a license.

Who can? "My office does that," says Mike Munns, administrator of the state Office of Driver Services.

Under Arkansas Code 27-16-909, Driver Services, "having good cause to believe that a licensed driver is incompetent" can require that driver to report for re-testing. "Good cause" comes from many sources, Munns says, including court and police reports, advice from doctors (who are not required by law to report incompetent drivers) and calls or letters from concerned citizens. "We really would like to have it in written form," Munns says. "We don’t want to go start hassling somebody over just an anonymous phone call. We put a lot more credence on the very front end of it if it comes from the law enforcement community or the medical community. Not saying that we don’t look at it seriously if it’s from a family member or someone else, but we’re really concerned if it comes from those groups."

More information about how Driver Services checks questions about a person’s fitness to drive can be obtained by calling (501) 682-1631.

A service like the institute’s gives families and their doctors ammunition to gently persuade a dangerous driver to park it, or, if necessary, the credible proof needed to prompt Driver Services to haul him in for re-testing. It can also reassure families who are worrying without good reason. "Sometimes it works and sometimes it doesn’t," Johnston says. "After someone’s driven for 50, 60 years, it’s overlearned skill. So even though they might have some dementia, with driving a lot of it is automatic. So they might do better than people think.

" But I had to tell a man the other day to stop driving. He had dementia, and he’d also had a stroke. It was pretty obvious that he wasn’t safe anymore — to me. It wasn’t obvious to him. "

The driving evaluation costs about $260 an hour. Some insurance plans cover the cost. Along with a referral, test subjects must have a valid license or a learner’s permit, and liability insurance.

The road test, in an unmarked, specially equipped car, starts in a parking lot and crosses busy Kanis Road to the Twin Lakes residential neighborhood in Little Rock.

" If Twin Lakes goes OK, "Johnston says," then we venture on out into multi-lane traffic like John Barrow Road and Markham Street, and if they’re not driving too slowly — usually that is the case, they drive so slowly you mention ‘speed up’ cause we’re getting honked at and gestured toward — then they can go all the way downtown and then back on the freeway. So I do get on the freeway. "

Accidents? Oh yes, he has had a few.

" Usually they’re minor little things, like I might wait a little bit too long to help somebody stop, because I have to be able to wait to the last second to see if someone’s really going to respond to what’s about to happen. "

He has only had one" very serious close call" when traffic stopped on the freeway and the recovering stroke patient he was testing stomped the gas instead of the brake. Johnston told that driver he hadn’t recovered enough for the road, but later the man’s skill did improve.

And there was an accident in which a woman drove him into a tree on the hospital grounds and the airbags inflated.

He keeps in mind that sometimes a driver who seems overwhelmed behind the wheel of the test car could be safe in his own car, in his small town, for short trips. "I’ve had to balance a person’s need for independence with the community’s need for safety," he says.

He thinks elderly drivers should take AARP’s 55 Alive course. But he doesn’t believe there is an age at which drivers become unsafe. "I’ve evaluated people 85, late 80s, that are really sharp and still doing a great job driving. It’s hard to say a cut-off age," he says. "But it’s something that has to be dealt with."

Meanwhile, he says, drive defensively. "You never know when I’m going to be out there!"

Copyright © 2003, Arkansas Democrat-Gazette