Bars in Maryland cannot be held liable for injuries their patrons cause after they leave, Maryland’s highest court ruled Thursday in a 4 to 3 vote.

The grandparents of a 10-year-old girl who was killed when a drunk driver hit their family car in 2008 sued the Gaithersburg bar that served Michael Eaton, the driver, 21 drinks before he hit the road. But the Court of Appeals ruled that the bar, Dogfish Head Alehouse, is not liable for the crash.

In 43 states and the District of Columbia, according to statistics compiled by Mothers Against Drunk Driving, vendors of alcohol can be held liable in at least some circumstances for accidents that occur after they serve drinks to a visibly intoxicated customer. Maryland, Virginia and Delaware are among the seven states that lack “dram-shop” liability provisions, as they are known. The others are Kansas, Nebraska, Nevada and South Dakota.

The Rev. William Warr Jr. and his wife, Angela Warr, had hoped to change that in Maryland. In August 2008, Eaton ordered 17 beers and several drinks of hard liquor, including a shot of tequila and something called a lemon drop, according to court records.

Then he drove between 88 and 98 miles per hour along Interstate 270. He hit the Warrs’ vehicle from behind. Ten-year-old Jazimen Harris was killed, and the Warrs and another granddaughter were injured.

Eaton was sentenced to eight years in prison for manslaughter, and the Warrs sued the bar.

The court offered the same opinion that it gave in 1951 and 1981 — that bars in Maryland are not liable for accidents their patrons cause, even if the bars fail to stop serving patrons who are clearly drunk.

In her dissenting opinion, Judge Sally Adkins noted that public opinion on drunken driving has changed greatly since the last time the court considered dram-shop liability.

The court suggested in 1981 and in Thursday’s decision that the legislature could choose to pass a dram-shop measure. But Adkins pointed out that four bills on the subject introduced between 1987 and 2012 have never made it out of committee.

Jason Fernandez, an attorney who helped represent the Warrs, said legislators will not consider the topic because insurance companies resist the laws.

“At some point in time, some branch of the government has got to step up and save lives,” Fernandez said. “The legislature couldn’t, so we asked the court to do so, and they chose not to.”

In her dissent, Adkins cited a study that found dram-shop liability (the term comes from a term for a shop where spirits were sold by the dram) reduced fatalities by 3 to 11 percent. She calculated that in Maryland 14 people would be saved each year by such a provision.

“The majority of the general public would be outraged at a commercial vendor who, for the sake of profit, continues to serve an already drunk person well past the line of being ‘visibly under the influence,’ to the point of becoming aggressive and violent, and then sends him on his way, where he gets behind the wheel of a vehicle and kills a ten-year-old girl,” she wrote. “By the standards of our community, this is morally blameworthy.”