DEPARTMENT OF TRANSPORTATION [67 PA. CODE CH. 83] Physical and Mental Criteria, Including Vision Standards Relating to the Licensing of Drivers [33 Pa.B. 4171] The Department of Transportation (Department), under the authority in 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), proposes to amend Chapter 83 (relating to physical and mental criteria, including vision standards relating to the licensing of drivers) to read as set forth in Annex A.
Purpose of the Chapter
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.
Purpose of the Proposed Rulemaking
The purpose of the amendments to Chapter 83 is to provide for waiver of the seizure-free requirements for drivers who have a seizure disorder but who are not a threat to public safety and who would have their driving privileges recalled under the current regulations. The proposed rulemaking also proposes new vision criteria to provide a waiver from the corrective lens requirement for certain drivers whose combined vision would not be improved by the use of corrective lenses for one eye and to provide for a restricted license for certain drivers whose combined visual acuity is less than 20/70 but is at least 20/100.
The regulations reflect consultation with the Board, as required by 75 Pa.C.S. §§ 1517 and 1518. The Board, after having conducted in-depth reviews and discussions, has determined that the regulations require amendments to make them consistent with existing medical practice and improved technology. The Department has also actively sought the participation of representatives from hospitals, rehabilitation facilities and special interest groups. The proposed rulemaking reflects the collective concurrence of the constituencies consulted in developing the amendments to the existing regulations.
Summary of Significant Amendments
Section 83.2 (relating to definitions) has been amended to add the terms ''seizure'' and ''seizure disorder.'' These terms replace the term ''epilepsy'' in § 83.4 (relating to epilepsy). This broader terminology takes into consideration a number of symptoms and conditions that are not specifically epilepsy but are seizure disorders that can affect a person's ability to operate a motor vehicle safely. In addition, this definition states that the term ''seizure disorder'' does not include isolated events caused by acute illness, intoxication, metabolic imbalance or trauma. Many individuals are reported to the Department as having seizure disorders when, in fact, they have had a seizure attributable to something other than electrically diagnosed epilepsy.
Section 83.2 has been amended to add the term ''aura.'' This term defines the physical warning many people experience prior to a seizure or instead of a seizure. It does not cause a change in the individual's ability to think clearly or in the ability to safely operate a motor vehicle.
Section 83.3 (relating to visual standards) has been amended to permit an individual to obtain a waiver of the requirement to wear corrective lenses provided a licensed optometrist or ophthalmologist certifies that the individual's combined visual acuity would not be improved with use of corrective lenses.
Section 83.3 has been amended to permit an individual who does not meet the current visual acuity standard of 20/70 combined vision to apply for a special restricted license if the combined visual acuity is at least 20/100. Research has indicated that in this range of visual acuity there is still ample sight to operate a vehicle safely with some restrictions.
The driver would have to successfully pass both a driver's examination and a complete vision examination. This special license granted would restrict the individual to daylight driving only, driving on roads other than freeways and driving a passenger vehicle weighing no more than 10,000 pounds; the special license would not permit the driver to operate a motorcycle. A complete vision examination will be required annually and there will also be an annual review of the individual's driving record. The license will be recalled if there is a violation of the conditions or limitations.
Section 83.3 has been amended to reduce the required horizontal field of vision from 140° to 120°. Studies indicate that drivers with a field of vision of only 120° are still able to scan the area necessary to safely operate a motor vehicle.
Section 83.4 has been amended to eliminate the requirement for individuals 16 and 17 years of age to be seizure free for 2 years. In the past, seizure disorders in adolescents were difficult to distinguish from brain tumors and other similar neurological disorders. The 2-year waiting period was necessary to make a proper diagnosis. With diagnostic advances in this area, this concern has been eliminated.
Section 83.4 has also been amended to reduce the required seizure free period from 1 year to 6 months. Neurologists have indicated that advances in research and medication now allow them to determine, within a shorter time period, when an individual's seizure disorder is under control by medication. In addition, this section has also been amended to allow persons who experience only auras to retain their driving privilege. The aura does not interfere with the ability to drive and thus poses no risk.
Additional changes have been made to the waiver provisions of § 83.4. A waiver of the freedom from seizure requirement for ''a pattern of seizures immediately upon awakening'' has been added to the waiver for strictly nocturnal seizures. Seizures which occur only while the individual is waking, and therefore not driving, pose no risk. The period of time for the establishment of a history of these patterns has been shortened to 2 years, as has the time period for the establishment of a history of experiencing only auras. Neurologists are now confident that the consistency of a pattern can be established in a much shorter period of time.
The waiver provisions of § 83.4 have also been amended to allow an individual who has had a seizure due to a prescribed change in or removal from medication while under medical supervision, to retain his driving privilege, provided the individual is returned to the medication with which the seizure disorder was previously controlled. Amendments to this section also allow an individual who has had a seizure due to a nonrecurring transient illness, toxic ingestion, metabolic imbalance or nonrecurring trauma, to retain his driving privilege. Seizures occurring as a result of these conditions are not true seizure disorders, but rather the seizure is secondary to the causing condition. Treatment of the underlying cause of the seizure eliminates the concern that additional seizures will occur.
A provision has also been added which clarifies the reporting requirements for single seizures. This will allow the Department to better ensure that individuals with uncontrolled seizure disorders will be identified.
Section 83.5 (relating to other physical and medical standards) has been amended to define and further clarify general disqualifications due to other physical and mental conditions likely to interfere with the ability to operate a motor vehicle safely. These general disqualifications have also been broken down into two categories to differentiate those conditions which require a physician to recommend recall of the driving privilege from those which automatically require that recall. A 6-month driving prohibition was added to § 83.5(a) for cerebral vascular insufficiency or cardiovascular disease resulting in syncopal attacks, loss of consciousness, vertigo, paralysis or loss of qualifying visual fields. A 1-year driving prohibition was added for periodic episodes of loss of consciousness that are of unknown etiology or not otherwise categorized.
Section 83.5(b) has been amended to include a short-term term disability provision wherein the physician will inform the patient that he has a short-term condition that will impair the ability to safely operate a motor vehicle, but because of the brevity of the condition will not be required to report the condition to the Department. This will be used for conditions that are self-correcting, normally healing, and fully recoverable, such as a broken arm.
Section 83.5 has been amended to eliminate standards for mental deficiencies. Functional mental ability to operate a vehicle safely can be demonstrated by successfully passing the complete driver's examination. The standards in this section regarding mental disorders have been expanded to better explain current psychiatric rationale and to stress the importance of the physician's clinical judgement.
Section 83.6 (relating to providers to report unqualified person) has been added to clarify the statutory requirement in 75 Pa.C.S. § 1518 that every provider is to report to the Department each person found to be unqualified to drive under Chapter 83. This was added to ensure that physicians are aware of their statutory reporting requirements.
Persons and Entities Affected
The proposed rulemaking affects all persons qualified or desiring to be qualified to drive, health care providers and the State Police.
Fiscal Impact
Implementation of the proposed rulemaking will not require the expenditure of additional funds by the Commonwealth or local municipalities. The proposed rulemaking will not impose 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 this proposed rulemaking and a copy of a Regulatory Analysis Form to the Independent Regulatory Review Commission (IRRC) and to the Chairpersons of the House and Senate Transportation Committees. A copy of this material is available to the public upon request.
Under section 5(g) of the Regulatory Review Act, IRRC may convey any comments, recommendations or objections to the proposed regulations within 30 days of the close of the public comment period. The comments, recommendations or objections shall specify the regulatory review criteria which have not been met. The regulatory Review Act specifies detailed procedures for review, prior to final publication of the rulemaking, by the Department, the General Assembly and the Governor of comments, recommendations or objections raised.
Sunset Provisions
The Department will make the proposed rulemaking effective upon final-form publication following appropriate evaluation of comments, suggestions or objections received during the period allowed for public comment. The Department is not establishing a sunset date for these regulations, since these regulations are needed to administer provisions required under 75 Pa.C.S. The Department, however, will continue to closely monitor the regulations for effectiveness.
Public Comments
Interested persons are invited to submit written comments, suggestions or objections regarding the proposed rulemaking to Rebecca L. Bickley, Director, Bureau of Driver Licensing, 1101 South Front Street, Harrisburg, PA 17104, within 30 days of the publication of this proposed rulemaking in the Pennsylvania Bulletin.
Contact Person
The contact person for technical questions about the proposed 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.
ALLEN D. BIEHLER, P. E.,
SecretaryFiscal Note: 18-374. No fiscal impact; (8) recommends adoption.
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:
* * * * * Aura--An epileptic 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.
* * * * * Licensed optometrist--A doctor of optometry licensed by the State Board of [Optometrical Examiners] Optometry.
* * * * * 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 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.
* * * * * § 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[, but if that person has less visual acuity than 20/40 in one eye, that eye shall be corrected to its best visual acuity].
(1) If a person with visual acuity of 20/40 or better combined vision, however, has less visual acuity 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 less visual acuity than 20/40 combined vision shall wear lenses correcting [his] 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:
* * * * * (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.
(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 specific geographic area.
(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 [20/70] 20/100 combined vision with best correction [is] will not [authorized] be qualified to drive.
[(d)] (e) Vision requirements. A person shall have a combined field of vision of at least [140°] 120° in the horizontal meridian, excepting the normal blind spots.
[(e)] (f) Sight in one eye. A person may be adequately sighted in only one eye and still meet the requirements of this section[; however, the]. 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.
[(f)] (g) * * *
§ 83.4. [Epilepsy] Seizure disorder.
(a) General. A person [suffering from epilepsy may] who has a seizure disorder will not be qualified to drive unless [their personal licensed] a physician reports that the person has been free from seizure for [a period of] at least [1 year] 6 months immediately preceding, with or without medication. A person will not be disqualified if the person has experienced only an aura during that period.
(b) [Applicants between the ages of 16 and 18 years. Applicants between the ages of 16 and 18 years applying for their first license shall have been free from seizure for a period of at least 2 years immediately preceding, with or without medication.
(c)] Waiver. Waiver of the freedom from seizure requirement may be made upon specific recommendation by a licensed physician [who specializes in neurology or neurosurgery] if one of the following conditions apply:
(1) A strictly nocturnal pattern of [the condition] seizures or a pattern of seizures occurring only immediately upon awakening has been established over a period of at least [3] 2 years immediately preceding, with or without medication[; or].
(2) A specific prolonged aura accompanied by sufficient warning has been established over a period of at least [5] 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 wavier 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, metabolic imbalance or nonrecurring trauma.
(c) Reporting requirements for physicians. Every physician 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 [afflicted by] who has any of the following conditions [may] will not be qualified to drive [if, in the opinion of the examining physician, the conditions are likely to interfere with the ability to control and safely operate a motor vehicle]:
(1) [Loss or impairment of the use of a foot, leg, finger, thumb, hand or arm, as a functional defect or limitation.
(2)] * * *
[(3)] (2) Cerebral vascular insufficiency or cardiovascular disease[, including hypertension, with accompanying signs and symptoms.] 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.
[(4)] (3) Periodic episodes of loss of consciousness [, attention or awareness from whatever cause] 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 perform motor functions necessary to drive 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 shall 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.
[(5)] (3) Rheumatic, arthritic, orthopedic, muscular, vascular or neuromuscular disease.
(i) The provider shall 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.
[(6) Mental deficiency or marked mental retardation in accordance with the International Classification of Diseases. For diagnostic categories, terminology and concepts to be used in classification, the physician should refer to the Diagnostic and Statistical Manual of the American Psychiatric Association and the Manual on Terminology and Classification in Mental Retardation of the American Association on Mental Deficiency.
(7)] (5) Mental [or emotional] disorder, whether organic or [functional.] 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 subparagraphs (i)--(iii). While signs or symptoms of mental disorder may not appear during examination by the physician, evidence may be derived from the applicant's history as provided by self or others.
(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.
[(8)] (7) * * *
[(9) Another] (8) Any other condition which, in the opinion of [the examining licensed physician, could interfere with] a provider, is likely to impair the ability to control and safely operate a motor vehicle.
[(b)] (c) Special driving examination. A person [afflicted by] who has any of the conditions enumerated in subsection [(a)(1), (5) or (9)] (b)(1), (2), (3) or (8) may be required to undergo a special driving examination to determine driving competency. The person may be restricted to driving [a vehicle equipped in a manner prescribed by the examining licensed physician or by the Department] 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 15 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. 03-1629. Filed for public inspection August 22, 2003, 9:00 a.m.]
