Section 4.15 - Health and Medical Examination(1) Each applicant and individual holding a Commission must be and must remain in good physical and mental health and be at all times fit to perform the duties of a Pilot.(2) Each individual holding a Commission must have a physical examination that meets the license requirements of the US Coast Guard by a medical doctor licensed and qualified to practice in Massachusetts or their state of residence on an annual basis so as to demonstrate good physical and mental health. The Commissioned Pilot shall submit to the Commissioner a copy of such medical report USCG Form 719K in the first quarter of each calendar year. The cost of such medical examination shall be at the expense of the Commissioned Pilot.(3) Should the medical and mental examination made by the physician cause US Coast Guard action affecting the validity of the Commissioned Pilot's US Coast Guard license, then the pilot shall immediately report this fact to the Commissioner, who shall suspend the Pilot's Commission until such time as the medical issues are resolved with the US Coast Guard, and the Commissioned Pilot is issued a valid US Coast License. If the period of the Pilot's suspended license exceeds one-year, recency trips and/or renewal examination may be required by the Commissioner.(4) In the event that a Commissioned Pilot is prescribed prescription drugs by a physician or mental health professional between US Coast annual physicals, the Pilot shall notify the Commissioner in writing, and report the duration that such prescription drugs have been prescribed.(5) Pursuant to US Coast Guard regulations, a Commissioned Pilot providing pilotage services under the authority of his or her US Coast License shall be subject to substance abuse screening, commonly referred to as "drug testing". Such drug testing shall conform to all elements of screening, including pre-employment (applicants), random selection, post accident and probable cause. In the event that a drug test is reported as "positive" to the US Coast Guard, the Commissioned Pilot shall immediately notify the Commissioner via the most expedient means of communication. The Commissioner shall immediately suspend the Commission of the Commissioned Pilot. If and when the Commissioned Pilot's license is reinstated, the Commissioner may or may not reinstate the Pilot's Commission, but will permit the Commissioned Pilot a hearing to ascertain if reinstatement is appropriate, and if so the Commissioner may require recency trips and/or renewal application.(6) Commissioned Pilots who are involved in an "unusual incident" as defined in 995 CMR 4.00, or show probable cause to the US Coast Guard shall be subject to urine screen for drugs and blood tests or breathalyzer for alcohol content of the Commissioned Pilot. If the Blood Alcohol Content (BAC) of the Commissioned Pilot is above 0.04%, then the Commissioned Pilot shall immediately notify the Commissioner via the most expedient means of communication. The Commissioner shall immediately suspend the Commission of the Commissioned Pilot. If and when the Commissioned Pilot's license is reinstated, the Commissioner may or may not reinstate the Pilot's Commission, but will permit the Commissioned Pilot a hearing to ascertain if reinstatement is appropriate, and if so the Commissioner may require recency trips and/or renewal application.