Maryland

Maryland

Are applicants for a driver's license asked questions about diabetes?

Yes. The driver's license application (first-time and renewal) asks the applicant whether he or she has any physical or mental condition that may affect his or her driving. If an applicant answers yes to this question, he or she is required to have a medical evaluation form completed by his or her physician (Physician Report) and to complete and return a health questionnaire (Driver Wellness & Safety Division Health Questionnaire). See Md. Code Regs. 11.17.03.03 (2013) (license application showing treatment for listed disorders may need to obtain a physician report). "Diabetes requiring insulin" is a listed condition that must be reported. Md. Code Regs. 11.17.03.02-1(A)(2) (2013). All drivers who report having diabetes requiring insulin will be required to have an evaluation by the Medical Advisory Board. Md. Code Regs. 11.17.03.04(4)(C)(1) (2013). For more information, see Maryland Motor Vehicle Administration, "Maryland Driver's License."

What other ways does the state have to find out about people who may not be able to drive safely because of a medical condition?

The state accepts reports of potentially unsafe drivers from physicians and any other treating medical staff. Md. Code Regs. 11.17.03.03 (2013). It also accepts reports from police officers, the courts, physicians, family members, friends, other citizens, and hospitals. The licensing agency accepts anonymous reports but does investigate reports from family members and the general public before it initiates an evaluation. Drivers also may be required to undergo medical evaluations if they have impairments which are observed by licensing agency personnel during the licensing process, if they are involved in at-fault accidents involving a fatality, where their licenses has been previously revoked for medical reasons, or when they apply for handicapped parking permits. See generally Md. Code Regs. 11.17.03.08(A)(1)-(4) (2013) (listing sources by which the licensing agency may learn of a driver's medical condition).

What is the process for medical evaluations of drivers?

When the licensing agency has reason to believe that an individual who holds or applies for a license has diabetes, it will require the individual to have a medical evaluation. The individual must submit medical information, including a health questionnaire (Driver Wellness & Safety Division Health Questionnaire) and an evaluation form completed by a physician (Physician Report) for review by the licensing agency. See Md. Code Regs. 11.17.03.03(A) (2013) (physician's report required); Md. Code Regs. 11.17.03.02-1(C) (2013) (applicant must answer any questions about medical condition).

The health questionnaire asks very detailed questions about the applicant's family history and medical status. Md. Motor Vehicle Admin., "Health Questionnaire," Form DC-001 (Rev. 06-10). Specific questions include information about insulin use for diabetes, HbA1C tests, blood glucose testing, black-outs, and foot problems. Id.

The physician evaluation form asks the physician to provide the date of the applicant's diagnosis, results of physical examinations and laboratory tests, information on any medications taken, and the prognosis. Md. Motor Vehicle Admin., "Physician/Healthcare Provider Report," Form DC-119 (Rev. 03-10). The physician also is asked to describe the limitations of the condition and its impact on the applicant's ability to safely operate a motor vehicle. Id. The physician must indicate the date of any diagnosis of "diabetes requiring insulin," and any dates of lost consciousness. Id. The physician gives a professional opinion, on whether the applicant can safely operate a motor vehicle. Id.

Medical evaluation forms must be returned to the licensing agency, where they are evaluated and a licensing decision is made. See Md. Code Regs. 11.17.03.03(B) (2013). The Medical Advisory Board will evaluate all cases involving diabetes that requires insulin use. Md. Code Regs. 11.17.03.04(4)(C)(1) (2013). Applications sometimes are put on hold while the agency requests and waits for the results of laboratory tests such as blood glucose tests. Periodic follow-up medical evaluations may be recommended for chronic medical conditions such as diabetes, see Md. Code Regs. 11.17.03.04(B)(4) (2013), usually at six-month or one year intervals.

Are physicians required by law to report drivers who have medical conditions that could affect their ability to drive safely?

There is no statutory authority requiring physicians to report drivers with medical conditions that could affect their ability to drive safely to the state licensing agency. However, physicians may voluntarily submit written reports to the Medical Advisory Board concerning individuals with conditions characterized by loss of consciousness or significantly impaired visual acuity. Md. Code Ann., Transp. § 16-119(b)(1) (2013); see also Md. Code Regs. 11.17.03.02(A)(1)-(2) (2013) (authorizing discretionary reporting of drivers with qualifying medical conditions). The content of such reports is kept confidential. Md. Code Ann., Transp. § 16-119(b)(2) (2013). Such reports may contain the full name, date of birth, and address of each individual 15 years old or older who has any such disorder. Md. Code Ann., Transp. § 16-119(b)(1) (2013); see also Md. Code Regs. 11.17.03.02(A)(1)-(2) (2013).

Are physicians who report drivers with medical conditions immune from legal action by the patient?

A civil or criminal action may not be brought against any physician who makes such a report and who does not violate any confidential or privileged relationship conferred by law. Md. Code Ann., Transp. § 16-119(e) (2013).

Who makes decisions about whether drivers are medically qualified?

The applications of individuals with diabetes requiring insulin are referred to the state's Medical Advisory Board, which includes physicians of various specialties who work within the licensing agency to make licensing recommendations. See Md. Code Ann., Transp. § 16-118(c)(1) (2013) (authorizing the Medical Advisory Board to issue advisory opinions); Md. Code Regs. 11.17.03.04(4)(C)(1) (2013) (all diabetics requiring insulin referred to Board). Ultimate authority over licensing decisions resides with the licensing agency itself. See Md. Code Ann., Transp. § 16-113(a)(1), -201(a), -206(a)(1) (2013); Md. Code Regs. 11.17.04.04(A) (2013). For more information, see Maryland Motor Vehicle Administration, "Medical Advisory Board Referral."

What are the circumstances under which a driver may be required to undergo a medical evaluation?

An applicant may be required to undergo a medical evaluation if he or she has or has developed one or more specified medical conditions, including impaired or loss of consciousness, and diabetes requiring insulin. See Md. Code Regs. 11.17.03.02-1(A) (2013). Drivers also may be required to undergo medical evaluations if they have impairments which are observed by licensing agency personnel during the licensing process, if they are involved in at-fault accidents involving a fatality, where their licenses has been previously revoked for medical reasons, or when they apply for handicapped parking permits. See generally Md. Code Regs. 11.17.03.08(A)(1)-(4) (2013). Furthermore, the licensing agency has authority to conduct any additional physical or mental examination that it considers necessary to determine an applicant's fitness to drive a motor vehicle safely. Md. Code Ann., Transp. § 16-110(c)(3) (2013).

Has the state adopted specific policies about whether people with diabetes are allowed to drive?

Yes. A licensee or applicant for a driver's license must notify the licensing agency if he or she has or has developed diabetes requiring management with insulin. Md. Code Regs. 11.17.03.02-1(A)(2) (2013). The guidelines for the Medical Advisory Board state that an individual who suffers from recurrent, severe, and uncontrolled attacks of hypoglycemia may not be licensed. Md. Code Regs. 11.17.03.04(C)(1) (2013). An individual with diabetes mellitus requiring management with insulin may be interviewed at least once by the Medical Advisory Board to determine whether the individual has adequate knowledge of the disease and its relationship to the operation of a motor vehicle. See Md. Code Regs. 11.17.03.04(C)(2) (2013). For more information, see Maryland Motor Vehicle Administration, "Customer Self-Report of a Medical Condition."

What is the state's policy about episodes of altered consciousness or loss of consciousness that may be due to diabetes?

A licensee or applicant is required to notify the licensing agency if he or she has or has developed epilepsy or impaired or loss of consciousness, fainting, blackout, or seizure. Md. Code Regs. 11.17.03.02-1(A)(3), (15) (20113). Physicians may submit written reports to the Medical Advisory Board concerning individuals with conditions characterized by loss of consciousness. Md. Code Ann., Transp. § 16-119(b)(1) (2013); Md. Code Regs. 11.17.03.02(A)(1) (2013). State regulations define loss-of-consciousness conditions as including, among other conditions, severe hypoglycemia. Md. Code Regs. 11.17.03.02(B)(2)(g) (2013). Upon receiving such a report, the licensing agency will schedule an examination of the individual if he or she currently holds a driver's license. Md. Code Ann., Transp. § 16-119(c)(1) (2013). A judgment of significant risk will be assessed based on knowledge of the individual's past history of lapses of consciousness and the present state of his or her health; how well the individual's disorder is controlled; or how much the individual's condition has improved. Md. Code Regs. 11.17.03.02(B)(3)(a)-(c) (2013). If an individual experiences a seizure, his or her case may be referred to the Medical Advisory Board and his or her license may be suspended for 90 days. See Md. Code Regs. 11.17.03.04(E)(2)(a) (2013). An individual must be seizure-free for 90 or more days for his or her driver's license to be reinstated. See Md. Code Regs. 11.17.04.03(A) (2013). The Medical Advisory Board may require follow-up medical evaluations. Md. Code Regs. 11.17.03.04(E)(2)(g), (B)(4) (2013). For more information, see Maryland Motor Vehicle Administration, "Customer Self-Report of a Medical Condition."

Does the state allow for waivers of this policy, e.g., a waiver for a one-time episode of severe hypoglycemia that has mitigating factors (e.g., recent change in medication, illness, etc.) or that has been addressed with a physician?

>Yes. An individual whose license has been suspended or denied because of a condition characterized by loss of consciousness may request that the period of suspension or refusal be withdrawn or modified by submitting evidence of favorable modifiers acceptable to the Medical Advisory Board. Md. Code Regs. 11.17.03.04(E)(2)(b) (2013). If the Medical Advisory Board makes a favorable recommendation to the licensing agency, the individual's license may be reinstated before the 90-day seizure-free period has elapsed. Md. Code Regs. 11.17.03.04(E)(2)(c)-(d) (2013). Favorable modifiers include seizures during medically directed medication changes; simple partial seizures that do not interfere with consciousness or motor control; seizures with consistent and prolonged auras; established pattern of pure nocturnal seizures; and a favorable driving record. Md. Code Regs. 11.17.03.04(E)(2)(e)(i)-(v) (2013). However, the Medical Advisory Board also may recommend extending the requisite seizure-free period beyond 90 days upon considering unfavorable modifiers, which include noncompliance with medication or medical visits; alcohol or drug abuse in the past three months; an unfavorable driving record; structural brain lesions; placement of a vagal nerve stimulator to control seizure activity; and seizure control requiring three or more medications. Md. Code Regs. 11.17.03.04(E)(2)(c)-(d), (f)(i)-(v) (2013).

What is the process for appealing a decision of the state regarding a driver's license?

The licensee or applicant may request an administrative hearing to appeal a suspension or denial. Md. Code Ann., Transp. § 16-206(d)(1) (2013). The request for an administrative hearing must be made in writing within 15 days of the date that the notice was mailed to the Office of Administrative Hearings. Md. Code Ann., Transp. § 12-203(b)(1) (2013). The hearing shall be conducted within 30 days of receipt of the request, Md. Code Ann., Transp. § 12-203(b)(2) (2013), and a decision shall be rendered within 30 days of its conclusion, Md. Code Ann., Transp. § 12-203(b)(3) (2013). The licensing agency will specify the precise time and date of the administrative hearing. Md. Code Ann., Transp. § 12-205 (2013). Following the conclusion of the administrative hearing, an individual may appeal to the circuit court for the county in which he or she resides. Md. Code Ann., Transp. § 12-209(a)(2) (2013). If an appeal is filed in the circuit court, the licensing agency will grant a stay of its decision unless "substantial and immediate harm could result to the licensee or others," and furthermore, such a stay shall not exceed 120 days in any case. Md. Code Ann., Transp. § 12-209(c) (2013).

May an individual whose license is suspended or denied because of diabetes receive a probationary or restricted license?

No. However, the licensing agency may issue a driver's license with restrictions "appropriate to assure the safe driving of a motor vehicle by the licensee." Md. Code Ann., Transp. § 16-113(a)(1)(iii) (2013).

Is an identification card available for non-drivers?

Yes, with proper identification and payment of a fee. Md. Code Ann., Transp. § 12-301(a)-(b) (2013); see also Md. Code Regs. 11.17.06.01 (2013) (providing that the Motor Vehicle Administration shall issue identification cards). A fee is not required if an applicant is 65 years old or older; is legally blind; has permanently lost the use of a leg or an arm; is permanently disabled so severely that the applicant cannot move without the aid of crutches or a wheelchair; or has a physical or mental impairment that substantially limits a "major life activity" as defined in the federal Americans with Disabilities Act. Md. Code Ann., Transp. § 12-301(b)(2)(i)-(v) (2013). Identification cards are valid for five-year periods, unless the holder is 65 years old or older, in which case it is valid for an eight-year period. Md. Code Ann., Transp. § 12-301(i)(1)-(2) (2013). For more information, see Maryland Motor Vehicle Administration, "Maryland Identification Cards."

Resources

Driver licensing in Maryland is administered by the Motor Vehicle Administration within the state Department of Transportation.