Can a Maryland doctor report a patient's medical condition, like seizures or poor vision, to the Motor Vehicle Administration if it might affect their ability to drive safely?

Plain-English summary

The Administrator of Maryland's Motor Vehicle Administration (MVA) asked the Attorney General how far a physician could go in disclosing a patient's diagnosis to the MVA if the doctor believed the patient's physical or mental condition made it unsafe for them to drive. This mattered because Maryland law generally protects the confidentiality of medical records, but also lets the MVA suspend or deny a driver's license to someone whose driving would be unsafe given their medical condition.

The Attorney General found that a specific statute, TR section 16-119, was written to bridge this gap: it lets (but does not require) physicians report the name, birthdate, and address of a patient with certain disorders to the MVA's Medical Advisory Board, and generally shields the physician from liability for making such a report. The opinion concluded psychiatrists and licensed psychologists were the one exception, since Maryland's psychiatrist-patient privilege statute barred them from disclosing a patient's mental or emotional disorder without the patient's consent, even under this reporting law. But the opinion identified a significant gap in how the law was actually being implemented: the statute only authorizes reports about disorders that have been formally "defined" by the Department of Health and Mental Hygiene together with two named medical and optometric bodies, and that definition had never been adopted. MVA had informally been relying on its own separate regulatory list of reportable conditions for license applicants, but the opinion found that list neither matched nor could substitute for the statutorily required definition, since it included at least one unrelated condition (loss of a limb) and omitted vision problems entirely. The opinion urged MVA to press for the required definition to be adopted properly, including through an emergency regulation if necessary, and separately concluded that this kind of medical reporting requirement did not violate a patient's constitutional privacy rights, following the U.S. Supreme Court's reasoning in a similar prescription-drug reporting case.

Currency note

This opinion was issued in 1986. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.

Common questions

Could a Maryland doctor in 1986 tell the Motor Vehicle Administration that a patient had a seizure disorder that might affect their driving?
Yes, according to this opinion, physicians were generally authorized (though not required) to report disorders involving lapses of consciousness or loss of visual acuity to the MVA's Medical Advisory Board under TR section 16-119.

Could a psychiatrist report a patient's mental health condition to the MVA without the patient's permission?
No. The opinion concluded the psychiatrist-patient privilege statute barred psychiatrists and licensed psychologists from disclosing information about a patient's mental or emotional disorder to the MVA without the patient's consent, even though the general reporting statute otherwise allowed physician reports.

Was Maryland actually able to rely on physician reports of medical conditions at the time this opinion was written?
Only shakily. The opinion found that the reporting statute only covered disorders that state health and medical authorities were supposed to formally define, and that definition had never been adopted, so it recommended MVA push for the definition to be issued, including on an emergency basis if needed, to put the reporting system on solid legal footing.

Background and statutory framework

Maryland's Vehicle Law lets the MVA deny, suspend, or revoke a driver's license for anyone whose driving would be "inimical to public safety" or who "cannot drive safely because of his physical or mental condition," working through the MVA's Medical Advisory Board, which evaluates reported individuals and advises on fitness to drive. TR section 16-119 supplies the reporting mechanism: it authorizes physicians and other qualified professionals to report a patient's name, birthdate, and address to the Board if the patient has "any such disorder," but that authorization is expressly tied to disorders "defined" through a required joint process involving the Department of Health and Mental Hygiene, the Medical and Chirurgical Faculty of Maryland, and the State Board of Examiners in Optometry, covering only disorders involving lapses of consciousness or loss of visual acuity meeting the vision requirements.

The opinion found this required definition had simply never been issued, leaving MVA's own regulatory list of reportable conditions (adopted for license applicants to self-disclose, not for physician reporting) to fill the gap in practice, even though that list didn't track the statute: it included an unrelated condition (loss of a limb) and, because license applicants are separately screened by a vision test, omitted vision problems altogether. Because the statute's authorization to report is explicitly conditioned on the formal definition existing, the opinion concluded the reporting mechanism rested on inadequate legal footing without it. On confidentiality, the opinion worked through the general medical-records confidentiality statute, finding it did not bar these reports because it expressly excepts information given to a government agency performing lawful duties authorized by the legislature, and worked through the psychiatrist-patient privilege statute, finding it did bar psychiatrists and psychologists specifically (since Maryland otherwise recognizes no general physician-patient privilege) from making such reports without consent. Finally, the opinion turned to the U.S. Constitution, applying the Supreme Court's Whalen v. Roe decision (which upheld a New York law requiring physicians to report patients receiving certain prescription drugs) to conclude that Maryland's confidentiality safeguards around MVA's own use of these reports, kept confidential, disclosable only by court order, and usable only to assess driving fitness, adequately protected patients' privacy interests.

Citations

Statutes:

• TR §16-119 (physician reporting authorization for disorders affecting driving safety)
• TR §16-119(a) (requirement that DHMH, the Medical and Chirurgical Faculty, and the Optometry Board define reportable disorders)
• TR §16-119(b)(1) (authorization to report name, birthdate, and address of a patient with a defined disorder)
• TR §16-119(b)(2) (bar on reporting information from a confidential or privileged relationship without consent)
• TR §16-119(d) (confidentiality of reports made to MVA)
• TR §16-119(e) (immunity from liability for good-faith reporting)
• TR §16-103.1(5) (disqualification from licensure if driving would be inimical to public safety)
• TR §16-206(a)(1)(ii) (MVA authority to suspend, revoke, or refuse to issue or renew a license for an unfit or unsafe driver)
• TR §16-208(a)(2) (MVA authority to suspend a license for physical or mental condition)
• TR §16-110.1(e) (vision requirement for license issuance)
• TR §16-110(c)(1)(i) (vision test requirement)
• TR §16-118(c)(1) (Medical Advisory Board's role in assessing public safety and welfare)
• TR §12-104(b) (MVA's authority to adopt regulations to carry out the Vehicle Law)
• COMAR 11.17.03.02 (MVA's list of reportable physical or mental conditions for license applicants)
• COMAR 11.17.03.02J (listed condition: loss of limb or limbs)
• SG §10-101(e)(1) (Administrative Procedure Act definition of "regulation")
• HG §4-301(b) (general medical records confidentiality)
• HG §4-301(c)(4) (exception for disclosure to a government agency performing lawful duties)
• CJ §9-109(b) (psychiatrist/psychologist-patient privilege)
• SG §10-617(b) (mandatory withholding of medical or psychological information from public inspection)

Cases:

• 62 Opinions of the Attorney General 157, 160 (1977)
• Robinson v. State, 249 Md. 200, 221 (1968)
• Franklin v. State, 8 Md. App. 134, 141 (1969)
• Whalen v. Roe, 429 U.S. 589, 598, 602 n. 29, 605 (1977)

Source

• Landing page: https://oag.maryland.gov/resources-info/Pages/attorney-general%E2%80%99s-opinions.aspx
• Original PDF: https://oag.maryland.gov/resources-info/Documents/pdfs/Opinions/1986/Volume71_1986.pdf

Original opinion text

Best-effort transcription from a scanned PDF. Minor errors may remain, the linked PDF is authoritative.

Vehicle Laws—Driving Privilege—Disclosure of Medical Disorders—Physicians Are Authorized To Report Certain Disorders To The Medical Advisory Board, But A Definition Of Reportable Disorders Should Be Adopted.

May 6, 1986

W. Marshall Rickert, Administrator
Motor Vehicle Administration

You have requested our opinion on the extent to which a physician may disclose to the Motor Vehicle Administration ("MVA") information derived from diagnosing and treating a patient, if the physician believes that the patient has a physical or mental condition that would impair the patient's ability to drive safely.

For the reasons stated below, we conclude that physicians are generally authorized by §16-119 of the Transportation Article ("TR" Article) to report certain disorders characterized by lapses of consciousness or loss of visual acuity to the MVA's Medical Advisory Board. The only exception is that a psychiatrist (or licensed psychologist) may not disclose information relating to a patient's mental or emotional disorder without the patient's consent.

However, the statute authorizes a physician to disclose only those specific disorders that have been "defined" by the Department of Health and Mental Hygiene, in consultation with the Medical and Chirurgical Faculty of Maryland and the Board of Examiners in Optometry. No such definition has yet been issued. In order to make the reporting mechanism effective, this definition should be properly adopted. MVA should give serious consideration to adoption of an interim regulation on an emergency basis.

I
Vehicle Law's Authorization for Disclosure

The Maryland Vehicle Law broadly disqualifies from licensure any individual "[w]hose driving of a motor vehicle on the highways the [MVA] has good cause to believe would be inimical to public safety or welfare." TR §16-103.1(5). The MVA "may suspend, revoke, or refuse to issue or renew the license" of anyone who is "an unfit [or] unsafe ... driver of a motor vehicle." TR §16-206(a)(1)(ii). See also TR §16-208(a)(2) (MVA authorized to suspend license of "any individual who cannot drive safely because of his physical or mental condition"). Certainly, some medical problems are inconsistent with safe driving. See, e.g., TR §16-110.1(e) (driver's license may not be issued to individual who does not meet specified vision requirement).

TR §16-119 is intended to help the MVA identify those persons whose medical condition might preclude licensure. In general terms, it authorizes, but does not require, physicians and other persons who are authorized to diagnose and treat certain disorders to report the name, address, and birthdate of a patient "who has any such disorder." TR §16-119(b)(1). The statute makes clear that a physician or other person who decides to make such a report is protected against civil or criminal liability, unless a privilege is violated. TR §16-119(e). With regard to the only applicable privilege, see Part II B below.

The MVA then "arrange[s] for an examination of each reported individual who holds a driver's license" to determine whether cancellation of his or her driver's license is required. The MVA's Medical Advisory Board both receives the reports from physicians and advises whether a person's driving "would be contrary to public safety and welfare because of an existing or suspected mental or physical disability." TR §16-118(c)(1).

A prerequisite to the effective functioning of this reporting and investigation procedure is a clear identification of reportable disorders. The statute requires that these be "define[d]":

"The Department of Health and Mental Hygiene, together with the Medical and Chirurgical Faculty and the State Board of Examiners in Optometry, shall define:

(1) Disorders characterized by lapses of consciousness; and

(2) Disorders that result in a corrected visual acuity that fails to comply with the vision requirements of this subtitle." TR §16-119(a) (emphasis added).

As far as we are aware, the required definition has not been adopted. The definition of these disorders would unquestionably be a "regulation," within the meaning of the Administrative Procedure Act. See §10-101(e)(1) of the State Government Article. Although DHMH, the Medical and Chirurgical Faculty, and the Optometry Board are collectively responsible for defining the pertinent disorders, MVA has the ultimate authority to embody the definition in a regulation necessary "to carry out ... the Maryland Vehicle Law." TR §12-104(b).

This regulatory vacuum has, in practice, been filled by a related listing of disorders, adopted by MVA as a "list of reportable physical or mental conditions" to be disclosed by the applicant for a driver's license. COMAR 11.17.03.02. The Medical Advisory Board apparently receives a small number of reports about these conditions from physicians.

The difficulty, however, is that the list of conditions in COMAR 11.17.03.02 does not, and, indeed, since it has not been "defined" by DHMH and the other two entities, cannot comport with the requirements of TR §16-119(a). The list is at once over- and underinclusive. It includes at least one condition that has nothing to do with either lapses of consciousness or loss of vision. COMAR 11.17.03.02J ("[l]oss of limb or limbs"). Conversely, the list does not include any reference to vision problems. In context, this omission is readily understandable. An applicant for a license need not disclose vision problems, for he or she cannot in any event be licensed without having first passed a vision test. See TR §§16-110(c)(1)(i) and 16-110.1(e).

The absence of the required definition of reportable disorders undercuts the reporting mechanism in TR §16-119(b):

"(1) Except as provided in paragraph (2) of this subsection, any physician and any other person authorized to diagnose, detect, or treat disorders defined under subsection (a) of this section may report to the Medical Advisory Board and to the subject of the report, in writing, the full name, date of birth, and address of each individual 15 years old or older who has any such disorder.

(2) Unless authorized by the individual in writing, a report may not be made from information derived from the diagnosis or treatment of any individual on whom a confidential or privileged relationship is conferred by law." (Emphasis added.)

Because no disorders have been "defined under subsection (a) of this section," the authorization to report in TR §16-119(b)(1) has a totally inadequate foundation.

This is not a minor technical problem that could perhaps be ameliorated over time through administrative practice. The reporting of information from medical records that, as discussed in Part II A below, are otherwise protected from disclosure is a serious matter. The General Assembly intended that the basis for such reporting to MVA be defined by specified, expert entities, DHMH, the Medical and Chirurgical Faculty, and the Optometry Board. In our view, no alternative basis complies with the plain direction of the statute.

Thus, we strongly recommend that TR §16-119 be implemented through a proper definition of reportable disorders.

II
State Law Restrictions on Disclosure of Physicians' Records

A. Medical Records

Under §4-301(b) of the Health General Article ("HG" Article), a "provider of medical care who has custody of medical records may not reveal specific information contained in those records to any person unless authorized by the individual on whom the record is kept." However, this limitation is not imposed on a provider of medical care who is "[providing] information to a government agency performing its lawful duties as authorized by an act of the Maryland General Assembly or the United States Congress." HG §4-301(c)(4).

The Medical Advisory Board plays a key role, defined by statute, in the MVA's process of assessing the physical and mental condition of individuals who seek to drive on highways in Maryland. TR §16-118. The reports that the Medical Advisory Board receives from physicians are an integral part of the MVA's "perform[ance] [of] its lawful duties." Therefore, the general prohibition in HG §4-301(b) does not prohibit physicians from reporting under TR §16-119. Likewise, the American Medical Association's Principles of Medical Ethics do not prevent a physician from reporting a patient's condition pursuant to TR §16-119. Section 4 of these principles states: "A physician shall respect the rights of patients, colleagues and of other health professionals and shall safeguard patient confidences within the constraints of the law." One of the "constraints of the law" is TR §16-119. Cf. 62 Opinions of the Attorney General 157, 160 (1977) (application of principles of medical ethics to disclosure of suspected child abuse).

B. Psychiatrist-Patient Privilege

TR §16-119(b)(2) prohibits the reporting, without the patient's consent, of "information derived from the diagnosis or treatment of any individual on whom a confidential or privileged relationship is conferred by law." The law confers "a confidential or privileged relationship" only on the patient of a psychiatrist or licensed psychologist:

"Unless otherwise provided, in all judicial, legislative, or administrative proceedings, a patient... has a privilege to refuse to disclose, and to prevent a witness from disclosing, communications relating to diagnosis or treatment of the patient's mental or emotional disorder." §9-109(b) of the Courts Article.

Apart from the limited privilege in §9-109 of the Courts Article, there is no physician-patient privilege in Maryland. E.g., Robinson v. State, 249 Md. 200, 221 (1968); Franklin v. State, 8 Md. App. 134, 141 (1969).

Accordingly, even if a "mental or emotional disorder" were defined as a disorder subject to reporting under TR §16-119(b)(1), the treating psychiatrist or psychologist is prohibited by TR §16-119(b)(2) from reporting that disorder.

III
Constitutional Considerations

The reporting by physicians of disorders related to driving ability is not an impermissible invasion of a patient's constitutional right to privacy. In Whalen v. Roe, 429 U.S. 589 (1977), the Supreme Court held that the impact of comparable reporting requirements is insufficient to constitute an invasion of any right or liberty protected by the Fourteenth Amendment.

The New York statute at issue in Whalen requires that physicians report the name, address, and age of all persons who have obtained certain prescription drugs for which there is both a lawful and an unlawful market. This information is submitted to the health department by means of a copy of the prescription form, which itself also discloses the prescribed drug, the dosage, and the dispensing pharmacy. Confidential treatment of this information is required by statute and regulation.

In upholding this "aid in the enforcement of law designed to minimize the misuse of dangerous drugs," the Supreme Court emphasized the breadth of state police powers in protecting public health and safety. 429 U.S. at 598. The Court cited as "[familiar examples]" of constitutionally permissible infringements on medical privacy "statutory reporting requirements relating to venereal disease, child abuse, injuries caused by deadly weapons, and certifications of fetal death." 429 U.S. at 602 n. 29. The reporting mechanism in TR §16-119 is grounded in similar public safety concerns.

Moreover, TR §16-119(d), like the New York reporting requirement at issue in Whalen, provides for the confidentiality of reported information:

"(1) The reports made to the Administration under this section:

(i) Are confidential;

(ii) May be disclosed only on court order; and

(iii) May be used only to determine the qualifications of an individual to drive.

(2) A person may not use these reports for any other purpose."

See also §10-617(b) of the State Government Article (custodian shall deny inspection of "medical or psychological information about an individual"). We are aware of no instance in which the confidentiality of a report has been compromised in any way. Once a physician reports that a patient has one of the defined disorders, the Medical Advisory Board then requests that the individual consent to the release of complete medical information so that the Board can decide whether the driving of a vehicle by the individual is contrary to public safety and welfare. As with New York's prescription reporting law, the "statutory scheme, and its implementing administrative procedures, evidence a proper concern with, and protection of, the individual's interest in privacy." 429 U.S. at 605.

IV
Conclusion

In summary, it is our opinion that physicians are generally authorized by §16-119 of the Transportation Article ("TR" Article) to report certain disorders characterized by lapses of consciousness or loss of visual acuity to the MVA's Medical Advisory Board. The only exception is that a psychiatrist (or licensed psychologist) may not disclose information relating to a patient's mental or emotional disorder without the patient's consent.

However, the statute authorizes a physician to disclose only those specific disorders that have been "defined" by the Department of Health and Mental Hygiene, in consultation with the Medical and Chirurgical Faculty of Maryland and the Board of Examiners in Optometry. No such definition has yet been issued. In order to make the reporting mechanism effective, this definition should be properly adopted. MVA should give serious consideration to adoption of an interim regulation on an emergency basis.

Stephen H. Sachs
Attorney General
Rebecca M. Hornbeck
Assistant Attorney General

Jack Schwartz
Chief Counsel
Opinions and Advice