Md. Code Regs. 11.17.03.04 - Medical Advisory Board Guidelines
A. The Medical Advisory Board shall follow
the guidelines set forth in §§B-J of this regulation when making a
recommendation to the Administration.
B. Cardiovascular Impairments.
(1) Contraindications. Contraindications for
the safe operation of a motor vehicle under any circumstance may include, but
are not limited to:
(a) Unstable
angina;
(b) Recovering from
myocardial infarction of less than 4 weeks duration;
(c) Recovering from open heart surgery within
the past 6 weeks;
(d) Recovering
from heart transplantation surgery, 6 weeks after discharge;
(e) Placement of a left ventricular assist
device discharge;
(f) Severe,
uncontrolled congestive heart failure;
(g) Severe, uncontrolled
hypertension;
(h) Cardiac
infections not responding to appropriate therapy;
(i) Unoperated critical aortic stenosis or
subaortic stenosis;
(j) Unoperated
aneurysms of the aorta or cerebrovascular system;
(k) Loss of or impaired consciousness due to,
but not limited to, uncontrolled arrhythmias, pacemaker failures, and
cardiomyopathy;
(l) A symptom
within 6 months after discharge of an automatic implantable cardioverter
defibrillator (AICD);
(m) Any of
the following arrhythmias:
(i) Alternating
left or right bundle branch block (LBBB or RBBB) second degree AV;
(ii) Mobitz II (distal AV block);
or
(iii) Acquired third degree AV
block; and
(n) Survivors
of sudden death with automatic implantable cardioverter defibrillator (AICD)
devices still discharging at intervals of less than 3 months.
(2) An individual who has a
condition listed in §B(1) of this regulation may be considered for a
license by submitting evidence acceptable to the Medical Advisory Board that
the condition:
(a) Has been modified, either
medically or surgically; and
(b) Is
well controlled without recurrence or relapse.
(3) Cases shall be evaluated on an individual
basis by the Medical Advisory Board in doubtful or unclear
circumstances.
(4) Additional or
periodic follow-up reports may be required by the Administration for review by
the Medical Advisory Board.
C. Diseases of the Endocrine System.
(1) Diabetes Mellitus. An individual with
diabetes mellitus requiring insulin may be reviewed by the Medical Advisory
Board.
(2) Hypoglycemia. An
individual who suffers from recurrent severe uncontrolled attacks of
hypoglycemia may not operate any type of motor vehicle and may not be
considered for any class license.
D. Diseases of the Neuromusculoskeletal
System. An individual who has a significant musculoskeletal impairment shall be
evaluated by the Medical Advisory Board before being licensed initially or
before having the individual's license to operate a motor vehicle
renewed.
E. Diseases of the Nervous
System.
(1) Cerebral Hemorrhage, Infarction,
or Traumatic Brain Injury (TBI). An individual who has had a cerebral
hemorrhage, infarction, or TBI that has resulted in a marked change in
personality, alertness, ability to make decisions, loss of coordination, motor
power, visual acuity, visual field, or any other neurological deficit shall be
reviewed by the Medical Advisory Board.
(2) Seizures.
(a) The driver's license or driving privilege
of an individual with seizures may be suspended or refused for a period of 90
days or more from the date of the last seizure.
(b) An individual whose driver's license or
driving privilege has been suspended or refused under §E(2)(a) of this
regulation 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.
(c) The
Medical Advisory Board shall consider favorable and unfavorable modifiers under
§E(2)(e) and (f) of this regulation in determining whether to recommend
that the suspension or refusal period be withdrawn or modified to more or less
than 90 days.
(d) The withdrawal or
reduction or increase of the suspension or refusal period shall be based upon
the recommendation of the Medical Advisory Board.
(e) Favorable modifiers include:
(i) Seizures during medically directed
medication changes;
(ii) Simple
partial seizures that do not interfere with consciousness or motor
control;
(iii) Seizures with
consistent and prolonged auras;
(iv) Established pattern of pure nocturnal
seizures; and
(v) Favorable driving
record.
(f) Unfavorable
modifiers include:
(i) Noncompliance with
medication or medical visits;
(ii)
Alcohol or drug abuse in the past 3 months;
(iii) Unfavorable driving record;
(iv) Structural brain lesion;
(v) Placement of a vagal nerve stimulator to
control seizure activity; and
(vi)
Seizure control requiring three or more medications.
(g) Periodic follow-up reports may be
required by the Administration for review by the Medical Advisory
Board.
(h) At the conclusion of the
suspension or refusal period, the Medical Advisory Board shall reevaluate the
individual and recommend appropriate action.
(i) The procedures for the restoration of the
driver's license following a period of ineligibility are set forth in COMAR
11.17.04.
F.
Narcolepsy. An individual under treatment for this condition may not be
considered for any class of license until the individual has been free of
symptoms for at least 6 months and is experiencing no side effects from
medications. The individual shall be cleared by the Medical Advisory
Board.
G. Psychiatric Disorders.
(1) Psychopathic Personality. An individual
who has a disregard for accepted social values, who has a history of impulsive
or irresponsible behavior, and who is frequently rebellious to authority or
openly aggressive, with consequent loss of caution and good judgment, may not
be considered for any class of license.
(2) Personality, Character, and Psychotic
Disorders. An individual with severe symptoms of personality, character, or
psychotic disorders shall be evaluated by the Medical Advisory Board for a
license on the basis of alertness, social behavior, psychomotor retardation,
and side effects from drug therapy.
H. Substance Use Disorders. In this section,
a certified substance abuse treatment program means a program which has been
certified by the Alcohol and Drug Abuse Administration of the Department of
Health and Mental Hygiene.
(1) A severe
substance use disorder is characterized by physical or psychological
dependence, or both, on certain psychoactive chemical substances, as shown
through the continued use of these psychoactive chemical substances despite
harmful or adverse circumstances. A mild or moderate substance use disorder
involves harmful or hazardous use of substances which can be both licit, for
example medication, and illicit. These substances include, but are not limited
to:
(a) Central nervous system depressants
such as alcohol, tranquilizers, and opiates and their derivatives;
(b) Hallucinogens;
(c) Stimulants; and
(d) Volatile solvents.
(2) Before being considered for a license, an
individual who has been involved in two alcohol-related or other
substance-related driving incidents during the past 5 years, or three or more
alcohol-related or other substance-related driving incidents in a lifetime, is
required to submit satisfactory evidence to the Administration of:
(a) Complete abstinence from substance use
for 6 months or as determined by the Administration on a case-by-case
basis;
(b) Enrollment in, or
completion of a substance abuse treatment program for at least 90 days or
longer as determined by the Administration on a case-by-case basis;
and
(c) Participation in a
self-help group for a period of time as determined by the Administration on a
case-by-case basis.
(3)
As a condition for approval, the Administration may impose certain
restrictions, limitations, or other requirements determined to be appropriate
to ensure an individual's safe driving of a motor vehicle, including enrollment
in an ignition interlock program.
(4) Regardless of the number of incidents, if
as the result of investigation, or assessment, an applicant is determined to
have alcoholism or a chemical addiction that has not been addressed, the
Administration may require evidence of at least 90 days of satisfactory
completion of a certified substance abuse treatment program.
I. An individual who is a
paraplegic, quadriplegic, or has the loss of one or more limbs may be required
by the Medical Advisory Board to submit to driver's reexamination to determine
the individual's ability to safely operate a motor vehicle.
J. Traumatic Brain Injury. After the review
of medical reports submitted by a physician, a rehabilitation facility, or an
occupational therapist, the Medical Advisory Board or Administration may
require an examination or reexamination consisting of law, vision and driving
tests.
Notes
Regulations .04 amended effective June 21, 1982 (9:12 Md. R. 1224)
Regulations .04 amended effective June 21, 1982 (9:12 Md. R. 1224)
Regulation .04 amended effective January 15, 1996 (23:1 Md. R. 29); September 30, 2002 (29:19 Md. R. 1525); April 7, 2008 (35:7 Md. R. 750); May 2, 2011 (38:9 Md. R. 553)
Regulation .04E amended effective November 10, 2003 (30:22 Md. R. 1583)
Regulation .04F amended effective September 7, 1987 (14:18 Md. R. 1967)
Regulation .04I amended effective April 20, 2009 (36:8 Md. R. 596); amended effective 43:6 Md. R. 409, eff.
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