RULES AND REGULATIONS
DEPARTMENT OF TRANSPORTATION
[ 67 PA. CODE CH. 83 ]
Physical and Mental Criteria, Including Vision Standards Relating to the Licensing of Drivers
[40 Pa.B. 5813]
[Saturday, October 9, 2010]The Department of Transportation (Department), under 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 in Annex A.
Purpose of 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 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 Final-Form Rulemaking
Notice of proposed rulemaking was published at 38 Pa.B. 3501 (June 28, 2008). The proposed rulemaking was also submitted to the Independent Regulatory Review Commission (IRRC) and the House and Senate Transportation Committees (Committees).
IRRC submitted several comments on the proposed rulemaking regarding clarity and consistency of the language in the regulations. The first comment noted that in § 83.2 (relating to definitions), the Department missed a cross-reference to 75 Pa.C.S. § 1518. In response to the comment, the definition of ''chiropractor'' in the final-form rulemaking has been clarified to state that a chiropractor is ''a practitioner of chiropractic as defined in 75 Pa.C.S. § 1508.1(b) (relating to physical examinations) and 75 Pa.C.S. § 1518(g) (relating to reports on mental or physical disabilities or disorders).''
IRRC also recommended that the definition include a definition of ''provider'' as the term is used in several places throughout Chapter 83. The Pennsylvania Society of Physicians Assistants also submitted comments seeking clarification in the regulation as to which health care provider professionals were authorized to perform examinations and issue related reports. The Department included a definition of ''health care provider'' consistent with 75 Pa.C.S. § 1519, which includes licensed physicians, physician's assistants and registered nurse practitioners. The final-form rulemaking also uses the newly defined term throughout § 83.5 (relating to other physical and medical standards).
With respect to § 83.5(a)(1), IRRC noted that the subsection required the submission of the results of a Hemoglobin A1C (HbA1C) test and vision screening, but that the subsection did not indicate to what end the submission was required or what standards for the test results would be applicable. With respect to subsection (a)(1)(i), IRRC commented that the table which lists the ongoing examination requirements for drivers who experience a disqualifying diabetic episode was confusing. The Department agreed that the table was confusing and difficult to interpret as was the placement of the requirement for the submission of HbA1C and vision screening results. The table has been deleted from the final-form rulemaking and the entire subsection has been rewritten. The American Diabetes Association (ADA) also commented that results of an HbA1C test should not be established as a standard for disqualification of a driver. The ongoing examination requirements for drivers who have experienced a disqualifying diabetic episode are in narrative form in the final-form rulemaking and the submission of the HbA1C and vision screening results are more clearly identified as components of the examination. The significance of those results is determined by the treating health care provider who is charged with the certification that the individual has been episode free for the requisite period of time.
The ADA also commented that the inclusion of a standard of ''hyperglycemic unawareness'' was inappropriate. It was pointed out that a driver who tends not to be sensitive to the triggers of onset of a hyperglycemic episode can nevertheless drive safely with more frequent testing before driving or at regular intervals during long trips. The term has been deleted in the final-form rulemaking.
An additional letter of comment was received from the Pennsylvania Chiropractic Association lauding the inclusion of chiropractors in § 83.1 (relating to purpose) and offering no objection to the proposed rulemaking.
Persons and Entities Affected
This final-form rulemaking affects persons qualified or wishing to be qualified to drive, health care providers and the Pennsylvania State Police.
Fiscal Impact
Implementation of this final-form rulemaking will not require the expenditure of additional funds by the Commonwealth or local municipalities. This final-form rulemaking will not impose additional costs on the medical community. It should not impose additional costs to drivers because these examinations are part of normal diabetic care.
Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on June 28, 2008, the Department submitted a copy of the notice of proposed rulemaking, published at 38 Pa.B. 3501, to IRRC and the Chairpersons of the 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 Committees and the public.
Under section 5.1(j.2) of the Regulatory Review Act (71 P. S. § 745.5a(j.2)), on August 18, 2010, the final-form rulemaking was deemed approved by the Committees. Under section 5.1(e) of the Regulatory Review Act, IRRC met on August 19, 2010, 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 these regulations, since these regulations are needed to administer provisions required under 75 Pa.C.S. The Department, however, will continue to closely monitor these regulations for their effectiveness.
Contact Person
The contact person for technical questions about this final-form rulemaking is R. Scott Shenk, Manager, Driver Safety Division, Bureau of Driver Licensing, 1101 South 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 §§ 83.1, 83.2 and 83.5 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 the same 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 40 Pa.B. 5106 (September 4, 2010).)
Fiscal Note: Fiscal Note 18-410 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 § 83.1. Purpose.
Section 1517(b) of the act (relating to medical advisory board) authorizes the Department to adopt physical and mental criteria, including vision standards, for licensing of drivers under Chapter 15 of the act (relating to licensing of drivers). These physical and mental criteria have been formulated by the Medical Advisory Board under the authority of sections 1517 and 1518 of the act (relating to medical advisory board and reports on mental or physical disabilities or disorders). In addition to their use by the Department in connection with its responsibilities under Chapter 15 of the act, these physical and mental criteria shall be used by physicians, chiropractors, CRNPs and physician assistants in conducting physical examinations of applicants for learner's permits and driver's licenses and by physicians and other persons authorized to diagnose and treat disorders and disabilities covered in this chapter in determining whether a person examined by the provider should be reported to the Department as having a disorder affecting the ability of the person to drive safely.
§ 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 the State Board of Nursing 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.
Chiropractor—A practitioner of chiropractic as defined in 75 Pa.C.S. § 1508.1(b) (relating to physical examinations) and 75 Pa.C.S. § 1518(g) (relating to reports on mental or physical disabilities or disorders).
Daylight—Hours between sunrise and sunset.
Department—The Department of Transportation of the Commonwealth.
HbA1C test—A Hemoglobin A1C test monitors the long-term control of diabetes mellitus.
Health care provider—A licensed physician, a CRNP, a physician assistant or a licensed psychologist, as described in 75 Pa.C.S. § 1519 (relating to determination of incompetency).
Hyperglycemia—When the level of glucose (sugar) in the blood is too high based on current guidelines established by the American Diabetes Association.
Hypoglycemia—When the level of glucose (sugar) in the blood is too low based on current guidelines established by the American Diabetes Association.
Hypoglycemic reactions—Different degrees of hypogly- cemia which are classified as follows:
(i) Mild. Hypoglycemia that signals a blood glucose drop, which the individual can self correct with oral carbohydrates.
(ii) Severe. Hypoglycemia that requires outside intervention or assistance of others or that produces confusion, loss of attention or a loss of consciousness.
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.
Symptomatic hyperglycemia—High glucose levels in the blood that have caused a loss of consciousness or an altered state of perception, including, but not limited to, decreased reaction time, impaired vision or hearing, or both, and confusion.
Telescopic lens—A telescopic low vision device.
Type I Diabetes mellitus—A chronic disease caused by the pancreas producing too little insulin to regulate blood sugar levels.
Type II Diabetes mellitus—A chronic disease marked by high levels of sugar in the blood caused by the body failing to respond correctly to natural insulin.
§ 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 diabetes mellitus leading to severe hypoglycemic reactions or symptomatic hyperglycemia unless there has been a continuous period of at least 6 months free from a disqualification in this paragraph. Once the diabetic condition has stabilized, and as long as the individual has not had another disqualifying episode within the last 6 months, the driving privilege may be restored. The individual shall submit to a diabetic examination, which includes an HbA1C test as well as a vision screening, and the treating health care provider shall certify on a completed form provided by the Department that the individual has been free from a disqualifying episode. Thereafter, the individual shall submit to a diabetic examination, which includes an HbA1C test as well as a vision screening, in accordance with the following schedule:
(i) Six months after the diabetic examination required in this paragraph, the individual shall submit to a follow-up diabetic examination and the treating health care provider shall certify, on a completed form provided by the Department, that the individual has been free from a disqualifying episode.
(ii) Twelve months after the previous diabetic examination, the individual shall submit to a follow-up diabetic examination and the treating health care provider shall certify, on a completed form provided by the Department, that the individual has been free from a disqualifying episode.
(iii) Twenty-four months after the previous diabetic examination, the individual shall submit to a follow-up diabetic examination and the treating health care provider shall certify, on a completed form provided by the Department, that the individual has been free from a disqualifying episode.
(iv) Forty-eight months after the previous diabetic examination, the individual shall submit to a follow-up diabetic examination and the treating health care provider shall certify, on a completed form provided by the Department, that the individual has been free from a disqualifying episode.
(v) Diabetic examination may be required more frequently if recommended by the treating health care provider.
(vi) Providing the condition of the individual remains under good control, the individual will not be required to submit to additional diabetic examinations.
(2) A waiver may be granted if an individual has been previously free from severe hypoglycemic reactions or symptomatic hyperglycemia for the preceding 6 months and the subsequent severe hypoglycemic reaction or symptomatic hyperglycemia occurred while the individual was under the treating health care provider's care, during or concurrent with a nonrecurring transient illness, toxic ingestion or metabolic imbalance. This waiver will only be granted if the treating health care provider submits written certification indicating it is a temporary condition or isolated incident not likely to recur.
(3) 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.
(4) 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.
* * * * *
[Pa.B. Doc. No. 10-1931. Filed for public inspection October 8, 2010, 9:00 a.m.]
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