Title 67--TRANSPORTATION DEPARTMENT OF TRANSPORTATION [67 PA. CODE CH. 83] Physical and Mental Criteria, Including Vision Standards Relating to the Licensing of Drivers [34 Pa.B. 3718] The Department of Transportation, under the authority of 75 Pa.C.S. §§ 1517, 1518 and 6103) (relating to medical advisory board; reports on mental or physical disabilities or disorders; and promulgation of rules and regulations by department), amends Chapter 83 (relating to physical and mental criteria, including vision standards relating to the licensing of drivers) to read as set forth Annex A.
Purpose
The purpose of Chapter 83 is to set forth physical and mental criteria, including vision standards, for the licensing of drivers, formulated by the Medical Advisory Board (Board) under 75 Pa.C.S. §§ 1517 and 1518. In addition to their use by the Department in connection with its responsibilities under 75 Pa.C.S. (relating to the Vehicle Code), these physical and mental criteria are to be used by medical providers in conducting physical examinations of applicants for learner permits and driver licenses, and by physicians and other persons authorized to diagnose and treat disorders and disabilities covered in Chapter 83 to determine whether a person should be reported to the Department as having a disorder affecting the ability of the person to drive safely.
Summary of Comments and Changes in the Final-Form Rulemaking
The proposed rulemaking was published at 33 Pa.B. 4171 (August 23, 2003). The proposed rulemaking was also submitted to the Independent Regulatory Review Commission (IRRC) and the House and Senate Transportation Committees.
IRRC submitted several comments regarding clarity and consistency of the language in the proposed rulemaking. The first comment noted a discrepancy between the definition of ''aura'' in the proposed rulemaking and the description of an aura in the preamble. The definition describes an aura as a seizure which did not interfere with mechanical or sensory ability, while the preamble indicated it was an event experienced prior to a seizure. In response to the comment, the definition in the final-form rulemaking has been clarified to state that an ''aura'' is ''an epileptic episode, sometimes experienced before or in lieu of a seizure, which does not alter an individual's ability to think clearly or interfere with an individual's mechanical or sensory ability to operate a motor vehicle.''
IRRC also pointed out inconsistency in the phrasing in § 83.3 (relating to visual standards) describing visual acuity standards. In response, all references have been changed to ''visual acuity of less than.'' IRRC also requested in § 83.3(c)(3) regarding drivers limited to roads other than freeways a cross-reference to the definition of ''freeway'' in 75 Pa.C.S. The cross-reference has been inserted.
IRRC also suggested that the language in § 83.3(5), regarding drivers limited to driving ''within a specific geographic area,'' lacked clarity. The paragraph was clarified to read: ''If determined by the Department to be appropriate, the person's driving privilege is limited to driving within a limited radius of the person's residence as recommended by a licensed physician.'' This language permits drivers with visual limitations to be permitted to drive in familiar territory near to their home as their physician may recommend.
IRRC noted that § 83.4 (relating to seizure disorder), strictly construed, permitted drivers who experienced only one aura in the previous 6 months to continue driving but would disqualify drivers who had experienced more than one aura. This was not the intent. The section has been clarified to provide that drivers who have experienced only auras within the previous 6 months are not disqualified to drive.
In § 83.5(b)(2)(i) and (3)(i) (relating to other physical and medical standards), IRRC noted that the proposed rulemaking provided that the ''provider shall inform the patient of the prohibition against driving due to the functional impairment'' and questioned how the Department planned to enforce the requirement. There is no mechanism to enforce this provision and it was intended as a reminder to providers that, even if the functional impairment does not require reporting to the Department, patients should be advised that it is unlawful to drive. The subparagraphs have been made advisory by changing ''shall'' to ''should.''
IRRC also noted that § 83.5(b)(5), regarding evidence of mental disorder, used the phrase ''examination by a physician.'' IRRC pointed out that the Pennsylvania Psychological Association (PPA) had also commented that this phrase excluded nonphysician providers who also diagnose mental disorder. The phrase has been changed to ''examination by a provider.'' IRRC commented further that the language regarding behavioral history ''provided by self or others'' lacked clarity with respect to who the ''others'' might be. The provision has been changed to ''as provided by self or others familiar with the person's behavior.'' It is thought that this language is broad enough to include relatives, friends, coworkers and neighbors with the qualification that they have familiarity with the person's behavior. This language is preferable to a list of specific relationships which could include many with little knowledge of the person's behavior and exclude individuals with considerable knowledge.
IRRC also sought clarity in § 83.5(c) permitting the Department to require a driver to undergo a ''special driving examination.'' IRRC questioned what a ''special driving examination'' would entail. There is no ''special'' driving examination intended by this section and the word ''special'' has been eliminated. The section now provides that, if the Department has reason to believe that a driver, otherwise apparently qualified to drive under Chapter 83, does not have the ability to safely operate a motor vehicle, the Department may require the driver to undergo a driving examination to determine competency.
Finally, IRRC noted an inconsistency in the references to ''physicians'' and ''licensed physicians'' throughout the proposed rulemaking. Since ''licensed physician'' is defined in § 83.2 (relating to definitions), IRRC suggested that this term be used throughout. The change to ''licensed physician'' has been made with respect to provisions requiring a condition to be verified by a physician to clarify that the verification must be made by a properly credentialed professional. However, § 83.4(c) and § 83.6 (relating to providers to report unqualified person) impose a reporting requirement consistent with 75 Pa.C.S. § 1518. Section 1518 of 75 Pa.C.S. uses the term ''physician,'' not ''licensed physician.'' The change suggested by IRRC, if applied in § 83.4(c), could inappropriately limit the reporting requirement to ''licensed physicians.'' Clarification in § 83.4(c) has been achieved by changing the word ''physician'' to ''provider.'' No change to the language of § 83.6, which mirrors that of 75 Pa.C.S. § 1518, has been made.
Alan Welder of Shillington, PA, proposed changes to § 83.3(e) regarding the 120° field of vision requirement. He specifically suggested that measurement of a driver's field of vision be permitted within 5° of the horizontal meridian to allow for consideration of the height of an individual driver. The optometrist serving on the Board has indicated that, to the extent that the comment urges that more specific visual field standards be quantified, the comment has merit. The optometrist opined that this one specific change in the regulation would not be beneficial as it does not address all of the many complex factors to be considered in the development of more specific visual field standards. On this advice of the member of the Board, the Department has not made the suggested change.
Comment was also received from the Pennsylvania Optometric Association fully supporting the proposed rulemaking.
The PPA commented that § 83.5(b) as drafted reads that a person will not be qualified to drive if they have a condition ''likely to impair the ability to control and safely perform motor functions necessary to drive a motor vehicle.'' The PPA notes that some of the skills delineated thereafter in the section regard cognitive skills, not motor skills. The language has been changed to ''likely to impair the ability to control and safely operate a motor vehicle'' to capture all types of conditions. The PPA also commented that § 83.5(b)(5) used the phrase ''examination by a physician.'' The PPA notes that this phrase excluded nonphysician providers who also diagnose mental disorder. As previously noted, the phrase has been changed to ''examination by a provider.''
Edward H. Dench, Jr., MD submitted comments as President of the Pennsylvania Medical Society (PMS) and noted that generally, there was no opposition to the proposed rulemaking. With respect to § 83.4, Dr. Dench commented that the reduction of the required seizure-free period from 12 to 6 months before restoration of driving privileges and the amendment permitting persons who only experience auras to drive both seemed reasonable given advances in treatment regimens for seizure disorders. Dr. Dench commented, however, that persons who experience an aura prior to seizure should not be allowed to drive unless they complete the 6-month seizure-free period, with possible noted exemptions. First, the Department notes that § 83.4(b) provides for a waiver of the seizure-free period requirement only upon the recommendation of a licensed physician. Individual physicians may disagree in their judgment regarding whether a person who has had a seizure or seizures within the previous 6 months which were preceded by ''a specific prolonged aura accompanied by sufficient warning'' should be permitted to drive. The restriction proposed by Dr. Dench would prohibit a person from driving who may continue to have periodic seizures but who is able, because of the prolonged aura preceding the seizure, to safely cease operation of the vehicle before the onset of the seizure. The Department does not believe the medical community is united in the view that this should always be the case. The Department again notes that the recommendation of a licensed physician would be required before the driving privilege would be restored.
Dr. Dench's letter also conveyed a comment of a PMS member regarding § 83.4(c)(4). As proposed, the language appears to permit a person who has been seizure-free for 6 months but suffers a seizure as a result of a head injury to receive a waiver to continue driving. The comment notes that the presence of an early post-traumatic seizure may increase the likelihood of subsequent seizures and recommends that the 6-month seizure-free period not be waived in the case of post-traumatic seizures. The Department's consulting physician agrees and ''nonrecurring trauma'' has been deleted from the final-form rulemaking.
Persons and Entities Affected
The final-form rulemaking affects persons qualified or wishing to be qualified to drive, health care providers and the State Police.
Fiscal Impact
Implementation of the final-form rulemaking will not require the expenditure of any additional funds by the Commonwealth or local municipalities. The final-form rulemaking will not impose any additional costs on the medical community and may reduce costs by providing clearer medical criteria and thus reduce unnecessary reporting by physicians and the need for follow-up medical examinations for drivers. It may impose additional costs on drivers wishing to apply for the restricted license for low vision drivers because of the requirement for an annual vision examination.
Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on August 11, 2003, the Department submitted a copy of the notice of proposed rulemaking, published at 33 Pa. B. 4171, to IRRC and the Chairpersons of the House and Senate Transportation Committees for review and comment.
Under section 5(c) of the Regulatory Review Act, IRRC and the Committees were provided with copies of the comments received during the public comment period, as well as other documents when requested. In preparing the final-form rulemaking, the Department has considered all comments from IRRC, the House and Senate Committees and the public.
Under section 5.1(j.2) of the Regulatory Review Act (71 P. S. § 745.5a(j.2)), on May 12, 2004, the final-form rulemaking was deemed approved by the House and Senate Committees. Under section 5.1(e) of the Regulatory Review Act, IRRC met on May 13, 2004, and approved the final-form rulemaking.
Effective Date
This final-form rulemaking will be effective upon publication in the Pennsylvania Bulletin.
Sunset Provisions
The Department is not establishing a sunset date for the final-form rulemaking, since the amendments are needed to administer provisions required under 75 Pa.C.S. The Department will continue to closely monitor the regulations for their effectiveness.
Contact Person
The contact person for technical questions about this final-form rulemaking is Michael P. Kistler, Manager, Driver Safety Division, Bureau of Driver Licensing, 1101 S. Front Street, 4th Floor, Harrisburg, PA 17104, (717) 772-2119.
Order
The Department orders that:
(a) The regulations of the Department, 67 Pa. Code Chapter 83, are amended by amending §§ 83.2--83.5 and by adding § 83.6 to read as set forth in Annex A.
(b) The Secretary of the Department shall submit this order and Annex A to the Office of General Counsel and the Office of Attorney General for approval as to legality and form, as required by law.
(c) The Secretary shall certify this order and Annex A and deposit them with the Legislative Reference Bureau, as required by law.
(d) This order shall take effect upon publication in the Pennsylvania Bulletin.
ALLEN D. BIEHLER, P. E.,
Secretary(Editor's Note: For the text of the order of the Independent Regulatory Review Commission, relating to this document, see 34 Pa.B. 2893 (May 29, 2004).)
Fiscal Note: Fiscal Note 18-374 remains valid for the final adoption of the subject regulations.
Annex A TITLE 67. TRANSPORTATION PART I. DEPARTMENT OF TRANSPORTATION Subpart A. VEHICLE CODE PROVISIONS ARTICLE IV. LICENSING CHAPTER 83. PHYSICAL AND MENTAL CRITERIA, INCLUDING VISION STANDARDS RELATING TO THE LICENSING OF DRIVERS § 83.2. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Act--75 Pa.C.S. § 101--9910 (relating to Vehicle Code).
Aura--An epileptic episode, sometimes experienced before or in lieu of a seizure, which does not alter an individual's ability to think clearly or interfere with an individual's mechanical or sensory ability to operate a motor vehicle.
CRNP--Certified registered nurse practitioner--A registered nurse licensed in this Commonwealth who is certified, by both the State Board of Nursing and the State Board of Medicine, in a particular clinical specialty area and who, while functioning in the expanded role as a professional nurse, performs acts of medical diagnosis or prescription of medical therapeutic or corrective measures in collaboration with and under the direction of a physician licensed to practice medicine in this Commonwealth.
Daylight--Hours between sunrise and sunset.
Department--The Department of Transportation of the Commonwealth.
Licensed optometrist--A doctor of optometry licensed by the State Board of Optometry.
Licensed physician--A doctor of medicine licensed by the State Board of Medicine or a doctor of osteopathy licensed by the State Board of Osteopathic Medical Examiners.
Nocturnal--As used in relation to seizures, the term means occurring during sleep.
Seizure--A paroxysmal disruption of cerebral function characterized by altered consciousness, altered motor activity or behavior identified by a licensed physician as inappropriate for the individual.
Seizure disorder--Condition in which an individual has experienced a single seizure of electrically diagnosed epilepsy, or has experienced more than one seizure not including seizures resulting from an acute illness, intoxication, metabolic disorder, or trauma.
Telescopic lens--A telescopic low vision device.
§ 83.3. Visual standards.
(a) Driving without corrective lenses. A person with visual acuity of 20/40 or better combined vision may drive without corrective lenses.
(1) If a person with visual acuity of 20/40 or better combined vision, however, has visual acuity of less than 20/40 in one eye, the vision in that eye shall be corrected to its best visual acuity.
(2) A person with visual acuity of 20/40 or better combined vision and who has visual acuity of less than 20/40 in one eye, may drive without corrective lenses upon determination by a licensed optometrist or ophthalmologist that the person's combined vision would not be improved by the use of corrective lenses.
(b) Driving with corrective lenses. A person with visual acuity of less than 20/40 combined vision shall wear lenses correcting combined vision to 20/40 or better while driving, except that if correction to 20/40 is not possible, the person may drive in daylight hours only if one of the following are met:
(1) The combined vision has been corrected to 20/60 or better.
(2) Visual acuity is less than 20/60 combined vision but at least 20/70 combined vision with best correction, but only upon recommendation of a licensed optometrist or licensed physician who has equipment to properly evaluate visual acuity.
(c) Visual acuity of less than 20/70.
(1) A person with visual acuity of less than 20/70 combined vision but at least 20/100 combined vision with best correction may apply for and may be issued a restricted license only upon recommendation of a licensed optometrist or ophthalmologist or licensed physician who has equipment to properly evaluate visual acuity, and only if the following conditions or limitations are satisfied:
(i) The person takes and successfully passes a complete vision examination, including plotted visual fields, upon application and annually thereafter.
(ii) The person takes and successfully passes a driver's examination upon application.
(iii) The person's driving privilege is limited to roads other than freeways, as defined in 75 Pa.C.S. § 102 (relating to definitions).
(iv) The person's driving privilege is limited to passenger vehicles weighing no more than 10,000 pounds, and excludes operation of a motorcycle.
(v) If determined by the Department to be appropriate, the person's driving privilege is limited to driving within a limited radius of the person's residence as recommended by a licensed physician.
(2) Violation of these conditions or limitations shall result in the recall of the restricted license. In addition, an annual review of the person's accident and violation history will be conducted by the Department and the restricted license may be recalled if the Department determines that the person was involved in an at fault accident or convicted of two moving violations committed within a 1-year period.
(d) Visual acuity of less than 20/100. A person with visual acuity of less than 20/100 combined vision with best correction will not be qualified to drive.
(e) Vision requirements. A person shall have a combined field of vision of at least 120° in the horizontal meridian, excepting the normal blind spots.
(f) Sight in one eye. A person may be adequately sighted in only one eye and still meet the requirements of this section The person's driving privilege will be restricted to vehicles having mirrors so located as to reflect to the person a view of the highway for a distance of at least 200 feet to the rear.
(g) Telescopic lenses. Correction through the use of telescopic lenses is not acceptable for purposes of meeting acuity requirements.
§ 83.4. Seizure disorder.
(a) General. A person who has a seizure disorder will not be qualified to drive unless a licensed physician reports that the person has been free from seizure for at least 6 months immediately preceding, with or without medication. A person will not be disqualified if the person has experienced only auras during that period.
(b) Waiver. Waiver of the freedom from seizure requirement may be made upon specific recommendation by a licensed physician if one of the following conditions apply:
(1) A strictly nocturnal pattern of seizures or a pattern of seizures occurring only immediately upon awakening has been established over a period of at least 2 years immediately preceding, with or without medication.
(2) A specific prolonged aura accompanied by sufficient warning has been established over a period of at least 2 years immediately preceding, with or without medication.
(3) The person previously had been free from seizure for a 6 month period and the subsequent seizure or seizures occurred as a result of a prescribed change in or removal from medication while under the supervision of a licensed physician. This waiver will only be provided upon reinstitution of previous medication.
(4) The person previously had been free from seizure for 6 months and the subsequent seizure or seizures occurred during or concurrent with a nonrecurring transient illness, toxic ingestion, or metabolic imbalance.
(c) Reporting requirements for provider. Every provider who treats a person who has experienced a single seizure shall provide, consistent with 75 Pa.C.S. § 1518(b) (relating to reports on mental or physical disabilities or disorders), a report to the Department which shall constitute cause for the Department to direct the person to undergo an examination prescribed under 75 Pa.C.S. § 1519 (relating to determination of incompetency).
§ 83.5. Other physical and medical standards.
(a) General disqualifications. A person who has any of the following conditions will not be qualified to drive:
(1) Unstable or brittle diabetes or hypoglycemia, unless there has been a continuous period of at least 6 months freedom from a related syncopal attack.
(2) Cerebral vascular insufficiency or cardiovascular disease which, within the preceding 6 months, has resulted in one or more of the following:
(i) Syncopal attack or loss of consciousness.
(ii) Vertigo, paralysis or loss of qualifying visual fields.
(3) Periodic episodes of loss of consciousness which are of unknown etiology or not otherwise categorized, unless the person has been free from episode for the year immediately preceding.
(b) Disqualification on provider's recommendation. A person who has any of the following conditions will not be qualified to drive if, in the opinion of the provider, the condition is likely to impair the ability to control and safely operate a motor vehicle:
(1) Loss of a joint or extremity as a functional defect or limitation.
(2) Impairment of the use of a joint or extremity as a functional defect or limitation.
(i) The provider should inform the patient of the prohibition against driving due to the functional impairment.
(ii) The provider shall inform the Department in writing of the impairment if the condition has lasted or is expected to last longer than 90 days.
(3) Rheumatic, arthritic, orthopedic, muscular, vascular or neuromuscular disease.
(i) The provider should inform the patient of the prohibition against driving due to the functional impairment.
(ii) The provider shall inform the Department in writing of the impairment if the condition has lasted or is expected to last longer than 90 days.
(4) Cerebral vascular insufficiency or cardiovascular disease which, within the preceding 6 months, has resulted in lack of coordination, confusion, loss of awareness, dyspnea upon mild exertion or any other sign or symptom which impairs the ability to control and safely perform motor functions necessary to operate a motor vehicle.
(5) Mental disorder, whether organic or without known organic cause, as described in the current Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association, 1700 18th Street NW, Washington, DC 20009, especially as manifested by the symptoms set forth in (i)--(iii). While signs or symptoms of mental disorder may not appear during examination by the provider, evidence may be derived from the person's history as provided by self or others familiar with the person's behavior.
(i) Inattentiveness to the task of driving because of, for example, preoccupation, hallucination or delusion.
(ii) Contemplation of suicide, as may be present in acute or chronic depression or in other disorders.
(iii) Excessive aggressiveness or disregard for the safety of self or others or both, presenting a clear and present danger, regardless of cause.
(6) Periodic episodes of loss of attention or awareness which are of unknown etiology or not otherwise categorized, unless the person has been free from episode for the year immediately preceding, as reported by a licensed physician.
(7) Use of any drug or substance, including alcohol, known to impair skill or functions, regardless whether the drug or substance is medically prescribed.
(8) Other conditions which, in the opinion of a provider, is likely to impair the ability to control and safely operate a motor vehicle.
(c) Driving examination. A person who has any of the conditions enumerated in subsection (b)(1), (2), (3) or (8) may be required to undergo a driving examination to determine driving competency, if the Department has reason to believe that the person's ability to safely operate a motor vehicle is impaired. The person may be restricted to driving only when utilizing appropriate adaptive equipment.
§ 83.6. Providers to report unqualified persons.
Physicians and other persons authorized to diagnose and treat disorders and disabilities defined by the Medical Advisory Board shall report to the Department, in writing, the full name, date of birth and address of every person 16 years of age and older diagnosed as having any specified disorder or disability within 10 days, under 75 Pa.C.S. § 1518 (relating to reports on mental or physical disabilities or disorders).
[Pa.B. Doc. No. 04-1292. Filed for public inspection July 16, 2004, 9:00 a.m.]
