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Is it fair to prevent people with diabetes from driving at work when theymay be as fit to do so as the next man? It is all too easy to simply apply ablanket ban to specified medical conditions, rather than spend time and moneycarrying out regular medical assessments to determine an individual’s fitnessto drive, by Tim Hoy Setting, maintaining and assessing medical standards for employees are justsome of the many responsibilities the majority of occupational healthpractitioners face. When an organisation has employees working in potentially hazardous jobs, itis vital that its medical standards address the need for a safe system of work.Historically, the most common way of doing this has been the application ofblanket bans on anyone with a specified medical condition who may wish todrive, work at heights, use firearms, work offshore or engage in work thatinvolves potential hazards. Diabetes discrimination in employment has become the topic I have championedsince 1989. During that time I have won 103 cases and lost just five. There areseveral other medical conditions that attract similar blanket bans, most ofwhich could be judged in a more scientific way if a qualitative clinicalassessment was made. The problem with the current approach is that personnelofficers, who do not have the requisite specialist medical knowledge andqualifications to make fully informed decisions, may apply it in either theselection or dismissal process. However, with the exemptions to the Disability Discrimination Act to police,prison officers and firefighters set to be lifted in October 2004, another hostof careers will benefit from the protection of the law. Despite my profile as a diabetes and disability rights campaigner, my firstpriority is always for the provision of a safe system of work, over and abovemy concern for the rights of people with diabetes. Many of the regulations Ihave been impassioned about challenging have been in the area of driving. ‘Safety first’ is repeatedly cited as the reason for the rigid adherence tothese blanket bans. However, when one starts to scratch the surface, theassertion that they are in the name of safety doesn’t stand up to scrutiny.Blanket bans are there because they are cheap and easy to apply, although thisso-called ‘cost-effectiveness’ is little consolation to people who may havejust lost their livelihood. When I hear government ministers, politicians, policymakers and civilservants state that these arbitrary and punitive bans are there to ensure theUK maintains the highest possible standards of road safety, I am amazed theycan keep a straight face. There is, of course, a valid rationale for wantingthese vehicles to be driven safely and I would never support the retention of alicence for someone whose medical condition was not adequately controlled. To be of any value, the process of risk assessment needs the specific riskto be quantified and clearly specified. The current blanket bans rely on aperceived risk and therefore are based on unreferenced assumptions. All mannerof medical conditions can cause complications or problems that would makesomeone unfit to drive, but rarely are the problems automatic, or a foregoneconclusion. DVLA rules The Driver and Vehicle Licensing Agency (DVLA) categorises vehicles intogroup I and group II. Group I applies to the private light goods vehicles (carsand motorcycles). Group II now comprises vehicles that have more than nineseats or weigh more than 3.5 tonnes. David (his name has been changed) has been allowed to continue driving thesesmaller group II vehicles because ‘grandfather rights’1 afforded him anautomatic right to do so after the EU added the vehicle categories C1 and D12. David has twice lost his job due to his unsafe driving. He has penaltypoints on his licence although he has never been banned. His declining visualacuity is nearing the point where he will not be able to retain a basic carlicence. The nonsense is that this information, which is entirely relevant topublic and road safety, is apparently of no interest to the DVLA or David’semployers. No rights for the diabetic In contrast, when my licence needed to be renewed, the C1 and D1 categorieswere removed automatically because I have insulin-treated diabetes. No‘grandfather rights’ for the ‘dodgy old diabetic’. This is despite the factthat I have a visual acuity of 6/4 in both eyes, have six- monthly diabetescheck-ups that indicate tightly controlled glycaemic management and I have anaccident-free driving record. The fact that after my diagnosis I had been allowed to drive these vehiclesuntil I renewed my licence after the changes, meant that for a period of morethan five years, I was permitted to continue driving these larger vehicles,regardless of whether I was safe or not. After months of campaigning, people with insulin-treated diabetes can now beconsidered for a C1 licence, subject to passing an annual clinical assessment. There is another idiosyncrasy within the UK’s disparate rules that havecaused a number of people to lose their jobs. When a Group I vehicle is usedother than for the category referred to as social, domestic and pleasure,employers occasionally apply the medical standards for Group II vehicles. In about a third of the local authority taxi licensing offices in the UK,for example, the Group II medical standard is applied to taxi drivers oninsulin – i.e. they are automatically banned from driving for hire and reward. The appeal cases I have been involved with have concerned drivers of theseHackney cabs, ambulances, police cars and Port Authority vehicles. Despitethese not being Group II vehicles by size or passenger capacity, the employershave applied the diabetes medical standard for their employees using insulin,because the alternative would be a medical assessment. Even when these additional tests are in place, such as the Police Service’sadvanced driver training and the Fire and Ambulance Services’ internal tests,the vehicles used for response driving are not fitted with tachographs, whichis a European safety requirement for Group II vehicles. So, as well as having apoor medical history, our friend ‘David’ has no limitations placed on his hoursof work. Again, my assumption is that it costs money to fit and monitortachographs, so they are avoided. Exemptions from the Road Traffic Act that allow emergency service responsedrivers to exceed the speed limit and to treat red traffic lights as a give waysign clearly need to be balanced by employing drivers who are safe. But, under these somewhat less-than-scientific rules, a driver who uses themaximum dose of sulphonylureas, whose diabetes remained undiagnosed for adecade before discovery, whose father died of myocardial infarction at the ageof 38, smokes 30 cigarettes a day and has excessively high lipid levels, could(under the rules) be considered more employable as a driver of certainvehicles, than for example, Steve Redgrave, Gary Mabbutt or me. Attempts to try to justify the disparity of rules between those drivers whouse insulin and those who do not are not backed up with any actuarial data fromthe insurance companies. The assumption remains that using insulin equates withunsafe driving. In fact, statistically, the opposite is the case. As a42-year-old person with insulin-treated diabetes, I am substantially lesslikely to cause an injurious road traffic accident than non-diabetic malesunder 25 years of age. While insurance premiums are significantly higher for this group of youngmen, they are not subjected to any blanket bans in the name of road safety assuch a draconian action would apparently contravene their civil liberties. But when any of us is diagnosed with this manageable condition, we areautomatically deprived of the civil liberties that a less-safe group of peoplecan take for granted. I refuse to allow such stereotyping dogma to continueunchecked. Lack of clear answers In researching the legal position on Group II vehicles for this article, Icontacted the DVLA and numerous other government departments for a statement onthe status quo. Depending on what day of the week I telephoned and to whom Ispoke, the answers varied from call to call. Each time I attempted to get adefinitive response, I would be diverted from one government department toanother, each one stating in turn that it wasn’t their responsibility. If the DVLA can’t even offer a simple response on the requirement oftachographs, for instance, then what hope is there for an OH physician tryingto get a coherent policy statement from them? The Department of Health has stated there are no blanket driving bansagainst ambulance workers and paramedics3. The UK Fire Service applies theright of individualised assessments for their employees with diabetes. I hastento add that these are the most stringent rules in existence and have beenendorsed by a number of authoritative bodies4. The most disabling thing about my diabetes remains the attitude of otherstowards it. Thankfully, OH physicians around the UK are becoming more focusedon the need to assess, rather than automatically discard employees. Unless the rules are changed to outlaw automatically proscribed functionsfor people with diabetes, then employees will be sacked for their honesty, orwill choose to conceal their diagnosis. The latter option, although frequentlychosen, does no favours for those of us who truly seek a safe set of rules towork by. Tim Hoy is a station officer and UK secretary, International Register ofFirefighters with Diabetes Footnotes 1. Grandfather rights allow someone who has already been driving a certainclass of vehicle (before changes are made to the criteria) to continue doingso. All new applicants for the licence, must pass the more stringent rules. 2. C1 = medium-sized vans 3.5 tonnes to 7.5 tonnes. D1 = minibuses between 9and 17 seats. 3 Health Minister John Hutton (2002) Hansard 14 March 2002 column 1245W. 4 The Royal College of Physicians, WHO, Juvenile Diabetes Federation(Europe) and Diabetes UK’s Professional Advisory Group. The Faculty of OccupationalMedicine (FOM) ratified a similar set of rules. Discrimination in the dockOn 1 Dec 2002 in Personnel Today Comments are closed. Previous Article Next Article Related posts:No related photos.