The statewide board of doctors in charge of reviewing driver’s license applications for disabled and elderly drivers has been unable to fill four of its five seats, preventing more than 100 would-be drivers on Oahu from getting their licenses for the last six months.
One of them, 16-year-old Case McKinley, who has cerebral palsy, cannot fulfill his boyhood desire to get his learner’s permit like most of his friends.
"It’s freedom, you know," McKinley said at his home in Pupukea after riding a bus home from school at Waialua High & Intermediate School, where he is a sophomore with a 3.8 grade-point average while taking advanced placement courses. "I want it really, really badly. Freedom — independence — for me is huge. So I’m just really frustrated."
In May, McKinley applied for a learner’s permit at the Kapolei Department of Motor Vehicles, where he said a clerk saw him walking awkwardly and told him he needed medical clearance from his doctor to drive, which McKinley later obtained.
On Aug. 13 — his 16th birthday — McKinley went to the Kalihi DMV to check on the status of his application and said he got stonewalled.
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NO QUORUM, NO ACTION
State Department of Transportation’s Medical Advisory Board:
>> Purpose: To approve applicants who may be physically impaired for driver’s licenses
>> Members: State law requires five (a psychiatrist, neurologist, orthopedic surgeon, ophthalmologist or optometrist and cardio- vascular specialist). Three are required for a quorum.
>> Current membership: One, Dr. Dennis Crowley, who has served since 2007 and whose term expires in June
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So McKinley protested by refusing to leave until he said a Honolulu police officer arrived and ordered DMV officials to show McKinley his file.
That’s when McKinley first learned that the state Department of Transportation has a Medical Advisory Board that must approve his application to the DMV, a city agency.
Ultimately, McKinley learned that the unpaid five-member board that needs to review his application — along with more than 100 others submitted on Oahu and a dozen or so from the neighbor islands — is currently two board members short of the minimum of three members needed to convene.
According to the state, the volunteer board must consist of five doctors: "One psychiatrist, one neurologist, one orthopedic surgeon, one ophthalmologist or optometrist and one specialist in cardiovascular disease."
It’s one of more than 170 state boards and commissions that collectively have more than 200 vacancies, said Cindy McMillan, spokeswoman for Gov. David Ige, who appoints members to the Medical Advisory Board pending ratification by the state Senate.
But the DOT’s Medical Advisory Board’s seats have been particularly difficult to fill, McMillan said.
"There is only one doctor on the five-member board," she said. "That is clearly not enough people to meet quorum. How widespread is this problem finding people to volunteer for boards in general?
"Some boards are easier to fill, but this particular board is very difficult because it’s made up of all doctors. And they can’t just be any doctor. They have to be specialists."
The lone member of the board — Dr. Dennis Crowley, a specialist in physical medicine and rehabilitation, fills the DOT’s "psychiatry" requirement. Crowley has been serving since July 2007.
Until August, Crowley said, the board had always had a minimum of three members to hold a quorum, but it was "rare" that it had all five members. The terms of two members expired in August, and no monthly meeting has been held since due to lack of a quorum, Crowley said.
At the last meeting in August — during a discussion on whether the board could still act with just Crowley — "we were called out by a citizen who was threatening to take legal action," said DOT spokesman Tim Sakahara.
"We were trying to get these cases through because we know there’s a need. Obviously, we had to stop. We can’t operate without a quorum, and we do recognize that. Since then, that’s when these 100 cases have backed up."
Crowley said no applications are considered without a quorum.
During his term, Crowley estimates that he has reviewed hundreds of doctors’ recommendations on behalf of driver’s license applicants. The overwhelming majority have been approved, he said.
But Crowley believes the board serves as "a necessary step in the process" that gives "that much more assurance that the right decision is made."
When he was originally asked to serve, Crowley said he agreed because it’s "good payback to the community," adding, "I’ll be ready to meet as soon as we have enough physicians to have a quorum."
The monthly meetings typically last less than one hour, Crowley said. He is 72, and his term expires in June, after eight years.
Dr. Chris Flanders, executive director of the Hawaii Medical Association, said Hawaii’s perennial physician shortage makes it hard to find doctors for the statewide Board of Medicine that’s in charge of physicians’ licenses and discipline — let alone to volunteer without pay for the DOT Medical Advisory Board.
"The Board of Medicine is our most important board," Flanders said. "But with our fairly significant physician shortage already, all the physicians are working that much harder to make up the difference. So even with something that’s so prominent as the Board of Medicine, we struggle a bit to find volunteers."
Trying to find five specialists to serve on the Medical Advisory Board "is a little harder," Flanders said.
But Flanders said it’s important for doctors to help disabled and elderly would-be drivers follow the required state and county processes.
"It’s part of patient care, frankly," Flanders said. "If we’ve got that big of a waiting list, something’s got to happen."
Sheri Kajiwara, director of Honolulu’s Department of Customer Service, which oversees the city’s Department of Motor Vehicles, said, "I feel really badly for the people who have been waiting so long."
Kajiwara acknowledged that untrained DMV clerks make the initial decision to require people such as McKinley and elderly drivers to obtain medical clearance from a doctor.
"If an examiner sees shaky hands, or limping or motor skills that may be questioned, they can say, ‘I would like to ask that you provide a doctor’s note.’ It is subjective, but it is purely in the interest of public safety," Kajiwara said.
But "as long as a doctor says it’s OK to drive and the board gives its approval, then we will issue the license," Kajiwara said.
"It’s unacceptable that people get stuck in this trap," said state Sen. Gil Riviere (D, Heeia-Laie-Waialua), who was contacted by McKinley’s father. "This is woefully unfair. We have got to raise awareness among physicians to get them to volunteer."
The city’s Corporation Counsel’s office is researching the liability and legal issues involved in whether Honolulu DMV officials can issue preliminary approvals for license applications based on doctor’s notes until the state’s Medical Advisory Board can be empaneled.
But Kajiwara said "legal opinions take time," adding, "The matter is really weighing public safety with an individual’s right to drive."
In the meantime, McKinley has to rely on TheBus, his parents and his 18-year-old brother, Max, to drive him around.
He walks with an uneven gait and often uses a wheelchair or forearm crutches. He loves the outdoors and surfs and skis with specially modified equipment.
When he takes his driver’s test and eventually drives on his own, McKinley plans to use a modified steering wheel and hand controls to operate the pedals.
McKinley’s fight to drive is hardly his first battle.
In 2007 his parents, Jason and Gina, sued the owners and operators of the Turtle Bay Resort on his behalf and reached a settlement that included the re-installation of handicapped parking spaces and a host of other modifications to make the resort compliant with the federal Americans With Disabilities Act.
In 2013, Case, whom the family calls "Casey," also successfully fought to be included in the Honolulu Marathon with his wheelchair.
Dr. James Barahal, a medical doctor and president of the marathon, wrote in a 2013 email to Jason, "After more deliberation and review of our race guidelines, we are pleased to inform you that we will make all reasonable accommodations so that Casey can participate in the 2013 Honolulu Marathon.
"Our initial reluctance was based on our concern for the safety of all participants, and as such we may request that minor modifications, such as reflectors or lights, be placed on Casey’s specialty wheelchair. … Thank you for helping us to make the correct decision."
Next fall, as a high school junior, McKinley plans to take advanced placement classes at Leeward Community College and wants to be able to drive himself from Pupukea to Pearl City.
Until then McKinley often dreams in his sleep that he’s driving his brother’s Ford F-150 truck down "Pineapple Road" near Dole Plantation.
In the dream the road never ends. And McKinley just keeps on driving.
Nothing blocks his way.
