Roster of registered physicians in the State of North Carolina

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ROSTER OF
Registered Physicians
IN THE
State of North Carolina
March 1,1992
ISSUED BY
N.C. DOCUMENTS
CLEARINGHOUSE
DEC 14 1992
N.C. STATE LIBRARY
RALEIGH
BOARD OF MEDICAL EXAMINERS OF THE STATE OF NORTH CAROLINA
Digitized by the Internet Archive
in 2012 with funding from
LYRASIS Members and Sloan Foundation
http://archive.org/details/rosterofregister1992nort
ROSTER OF
Registered Physicians
IN THE
State of North Carolina
ISSUED BY
BOARD OF MEDICAL EXAMINERS OF THE STATE OF NORTH CAROLINA
Board of Medical Examiners
of the
State of North Carolina
Hector H. Henry, II, M.D., President
John W. Nance, M.D., Secretary
Bryant D. Paris, Jr., Executive Secretary
H. Diane Meelheim, Assistant Executive Secretary
MEMBERS
John Thomas Daniel Jr., M.D., Durham
Hector Himel Henry, II, M.D., Concord
John Wesley Nance, M.D., Clinton
F. M. Simmons Patterson, Jr., M.D., Pinehurst
Walter Michel Roufail, M.D., Winston-Salem
Ernest Burton Spangler, M.D., Greensboro
Nicholas Emanuel Stratas, M.D., Raleigh
Kathryn Howell Willis, Zirconia
FOREWORD
This roster is issued by the Board of Medical Examiners of the State of North Carolina.
REGISTRATION REQUIRED AS FOLLOWS:
Physicians - January 1 every even-numbered year
Resident's Training Licenses - January 1 every even-numbered year
Professional Corporations - January 1 every even-numbered year
Physician Assistants - July 1 annually
Nurse Practitioners - July 1 annually
The names of all physicians who are licensed to practice medicine in the State of North
Carolina who are currently registered with the Board of Medical Examiners of the State of
North Carolina on March 1, 1992, are included in this roster.
The names of physicians who hold resident's training licenses to practice medicine in
specified institutions in the state are not included in this roster.
Any information pertaining to omissions or corrections should be brought to the attention
of the Board.
Bryant D. Paris, Jr., Executive Secretary
Board of Medical Examiners of the State of North Carolina
1203 Front Street
Raleigh, North Carolina 27609
Mailing address: Post Office Box 26808, Raleigh, North
Carolina 2761 1-6808
Telephone (919) 828-1212
TABLE OF CONTENTS
Foreword iii
DOs and DONTs for Physicians v
Position Statements
Acupuncture vii
Administering Collagen Injections vii
Chelation Therapy for Atherosclerotic Diseases vii
Continuing Medical Education viii
Documentation of Physician/Patient Relationship viii
Guidelines on Physical Examinations viii
Individuals Who Aid a Physician ix
Ophthalmologists: Care of Cataract Patients ix
Physician Extenders in Urgent Care Situations x
Prescription Format x
Sexual Exploitation of Patients x
Treatment of and Prescribing for Family Members x
Use of Anorectics xi
Writing of Prescriptions for Controlled Substances xi
Management of Prescribing xii
Spotting the Chemically Dependent or Drug-Seeking Patient xiv
Laws of North Carolina Relating to the Practice
of Medicine xv
North Carolina Administrative Code xxix
Explanation of Specialty Codes lxxvii
Registered Physicians
Listed Alphabetically 1
Registered Professional Corporations
Listed Alphabetically 667
DOs AND DON'Ts FOR PHYSICIANS
Practice Suggestions:
1. Use as much care in writing pre-scriptions
as you would use in
writing personal checks. Specify
amounts and do not leave spaces
for x's or o's to be added to raise
the amount.
2. Do not leave your personal pre-scription
pads in positions accessi-ble
to the public.
3. Do not leave signed, blank pre-scription
pads in your office.
4. Write prescriptions for controlled
substances or mind-altering chemi-cals
with ink or indelible pencil (or
type) and manually sign the pre-scription
at the time of issuance.
5. Do not write prescriptions for large
quantities of Schedule 2 or 2N con-trolled
substances.
6. Do not prescribe controlled sub-stances
without seeing the patient.
7. When you receive a call from a
pharmacist requesting information
about prescriptions you have writ-ten,
respond courteously as, by
law, a pharmacist is responsible for
any forged prescription he fills.
8. Write a prescription for only one
substance on each blank.
9. Do not issue a prescription for con-trolled
substances or mind-altering
chemicals for a patient in the
absence of a documented physi-cian-
patient relationship.
10. Do not issue a prescription for con-trolled
substances or mind-altering
chemicals for yourself.
11. Do not prescribe for members of
your family. Treating one's family
is not illegal, but the Board wishes
to remind you that such prescribing
practices may lead to problems.
Written records of all prescriptions
for controlled substances and the
medical indications for them
should be maintained, but in many
instances such recording is neglect-ed.
Also, any prescriptions issued
should be within the scope of your
normal medical practice. The
Board urges you to delegate the
medical care for yourself and
members of your family to one or
more of your colleagues in order to
preclude involvement with govern-mental
regulatory agencies who
monitor physicians' prescribing
practices.
12. Do not prescribe amphetamines or
central nervous system stimulants
for weight control. In 1972, the
N.C. Medical Society adopted a
resolution which is supported by
the Board of Medical Examiners
that "...the members of the N.C.
Medical Society use no ampheta-mines
or methamphetamines for
appetite control and that the use of
these drugs be restricted to the
treatment of narcolepsy, hyperki-netic
children and other disorders
which in the opinion of the
patient's physician will be benefi-cial.."
13. Do not carry large stocks of con-trolled
substances in your bag.
Addicts look for these in physi-cians'
offices and cars.
14. If DEA numbers are printed on
prescriptions, they should be
incomplete and completed only
when the physician validates and
signs the prescriptions.
LAWS OR REGULATIONS
1. Sign prescriptions legibly in ink,
never in pencil. The body of the pre-scription
must be written legibly in
ink or typewritten.
2. Prescriptions must contain the
following information: full name and
DEA # of prescribing physician;
name, address and telephone number
of prescribing physician's practice;
indication of either "product selection
permitted" or "dispense as written";
and full name and address of patient.
3. Only in emergency situations should
you request pharmacists to fill
prescriptions for Schedule 2 or 2N
prescriptions over the telephone.
4. Prescribe controlled substances to
drug dependent persons only under
provisions regulated by law.
5. Dispense controlled substances,
including samples, only when
dispensing records are maintained for
two or more years and containers
with safety closure caps are properly
labelled according to law. Physicians
shall maintain a readily retrievable
record of all controlled substances
dispensed (or administered) whether
or not the practitioner charges the
patient for the controlled substances,
including samples.
6. Do not write prescriptions for con-trolled
substances for office use. The
law requires that you purchase
Schedule 2 and 2N controlled sub-stances
for your office on official
order forms obtained from DEA.
Schedule 3-5 drugs must be obtained
through a wholesale distributor by
means of a requisition.
7. Maintain security for any controlled
substances including samples.
8. Take a biennial inventory of all
controlled substances including sam-ples.
9. Before disposing of used syringes or
needles, render them inoperative.
10. The destruction of an outdated or
unwanted controlled substance by a
physician or his authorized agent
shall be witnessed by a federal or
state official who is authorized to
enforce the Federal or State
Controlled Substances Act.
Suggested reference material regarding prescribing laws:
Code of Federal Regulations, Title 21 of the U.S. Food and Drug Act, Part 1300
to End—published by Superintendent of Documents, U.S. Government Printing
Office, Washington, D.C. 20402.
North Carolina Controlled Substances Act and Regulations—published by the
N.C. Drug Commission, N.C. Department of Human Resources, 375 N. Salisbury St.,
Raleigh, N.C. 27603.
Below is a listing of addresses and telephone numbers that may be useful to you.
Please feel free to write or telephone the North Carolina Drug Commission for
additional information pertaining to drug laws and rules and regulations at any time
you have a need.
N.C. Drug Regulatory Branch
375 N. Salisbury St.
Raleigh, N.C. 27603
Telephone: (919) 733-4555
N.C. Board of Pharmacy
P.O. Box 459
Carrboro, N.C. 27510-2165
Telephone: (919) 942-4454
State Bureau of Investigation
3370 Garner Rd., P.O. Box 29500
Raleigh, N.C. 27626
Telephone: (919) 662-4500
Drug Enforcement Administration
75 Spring St. SW, Suite 740
Atlanta, GA. 30303
Telephone: (404) 331-7328
Drug Enforcement Administration
2300 W. Meadowview Rd., Suite 224
Greensboro, N.C. 27401
Telephone: (919) 378-5052
POSITION STATEMENTS
ACUPUNCTURE
On December 5, 1972, the Board of Medical Examiners of the State of North Carolina
stated its position that the practice of acupuncture is the practice of medicine.
Therefore, anyone wishing to practice acupuncture in the State of North Carolina, must
first be licensed to practice medicine by the Board of Medical Examiners.
ADMINISTERING OF COLLAGEN INJECTIONS
It is the position of the Board of Medical Examiners of the State of North Carolina that
by law the procedure of injecting collagen is a medical act as defined in N.C.G.S. 90-18,
and therefore if performed by a person other than a licensed physician, must be done
under the direct and immediate supervision of a licensed physician.
Further, it is the position of the Board that any advertisement regarding the injection of
collagen should not refer to any one other than the licensed physician performing this pro-cedure.
CHELATION THERAPY FOR
ATHEROSCLEROTIC DISEASES
WHEREAS, the use of chelation therapy for atherosclerotic vascular diseases (e.g.,
coronary artery disease, cerebral vascular disease, peripheral vascular disease) has been
advocated by some medical practitioners without evidence of well-controlled clinical stud-ies
to demonstrate that the use of the drug utilized in the chelation therapy for atheroscle-rotic
is both effective and safe; and
WHEREAS, current medical literature does not support the theories of decalcification
of atherosclerotic plaques presented by those advocates of chelation therapy, but does
question their proposed explanation of pathogenesis and mechanism of action therapy for
atherosclerotic diseases; and
WHEREAS, the United States Food and Drug Administration (FDA) does not approve
edetate disodium (EDTA) for treatment of atherosclerosis, although the FDA does
approve EDTA for chelation treatment of heavy metal poisoning; and
WHEREAS, patients on whom EDTA is used are at risk for kidney injury, emboli
(e.g., calcium, fat-filled plaques), and other medical complications which may make such
therapy dangerous; and
WHEREAS, the willingness of the ill to believe medical claims, even though unsup-ported
by medical evidence, may be a factor in giving people a false sense of security and
preventing appropriate therapy.
Now, therefore, be it RESOLVED that it is the opinion of the Board of Medical
Examiners of the State of North Carolina that chelation therapy is of no proven benefit in
the treatment of atherosclerotic disease and should not be used for this purpose until its
clinical efficacy is established by formal, controlled, clinical trials approved by the United
States Food and Drug Administration. Moreover, treatment with chelating agents, includ-ing
EDTA, has some associated toxicity and should not be considered a completely benign
procedure.
CONTINUING MEDICAL EDUCATION
Within the standards of acceptable and prevailing medical practice for North Carolina
physicians engaged in the active clinical practice of medicine, obtaining regular continuing
medical education is an integral part of maintaining professional competence to practice
medicine with a reasonable degree of skill and safety for patients.
The Board of Medical Examiners of the State of North Carolina strongly encourages its
licensees who are actively engaged in the clinical practice of medicine to obtain, and main-tain
documentation of, not less than one hundred fifty (150) hours every three years of
continuing medical education as directed by the Physicians' Recognition Award require-ments
of the AMA. The majority of these hours should be applicable to respective practice
specialties. (Membership in the AMA is not required for the Physicians' Recognition
Award.)
DOCUMENTATION OF
PHYSICIAN/PATIENT RELATIONSHIP
It is the position of the Board of Medical Examiners of the State of North Carolina that
a valid physician/patient relationship is documented by the presence of medical records
and should contain the following as outlined:
1. an appropriate history and physical or mental examination for the patient's chief
complaint as appropriate to the specialty;
2. diagnostic tests when indicated;
3. a working diagnosis;
4. treatment; and
5. documentation by date of all prescriptions written for drugs, with name of
medication, strength, dosage, quantity and number of refills.
GUIDELINES ON PHYSICAL EXAMINATIONS
It is the position of the Board of Medical Examiners that proper care is needed to avoid
charges of sexual misconduct by physicians. Patient complaints of sexual misconduct by
physicians are the most sensitive and difficult matters the Board investigates. In order to
prevent misunderstandings and protect physicians and their patients from allegations of
sexual misconduct, the Board offers the following guidelines:
1. Maintaining patient dignity should be foremost in the physician's mind when under-taking
a physical examination. The patient should be assured of adequate auditory
and visual privacy, and should never be asked to disrobe in the physician's immedi-ate
presence. Examining rooms should be safe, clean, and well maintained, and
should be equipped with appropriate furniture for the examination and treatment
(examining able, chairs, etc.). Gowns, sheets and/or other appropriate apparel should
be made available to protect patient dignity and decrease embarrassment to the
patient while promoting a thorough and professional examination.
2. A third party should be readily available at all times during a physical examination,
and it is suggested that the third party be actually present when the physician per-forms
an examination of the sexual and reproductive organs or rectum. When appro-priate,
the physician should have a third party present when examining a patient.
3. The physician should individualize the approach to physical examinations so that the
patient's apprehension, fear, and embarrassment are diminished as much as possible.
An explanation of the necessity of a complete physical examination, the components
of that examination, and the purpose of disrobing may be necessary in order to mini-mize
the patient's apprehension and possible misunderstanding.
4. The physician and staff should exercise the same degree of professionalism and cau-tion
when performing diagnostic procedures (i.e., electrocardiograms, electromyo-grams,
endoscopic procedures and radiological studies, etc.) as well as surgical pro-cedures
and post-surgical follow-up examinations when the patient is in varying
stages of consciousness.
5. The physician should be alert to suggestive or flirtatious behavior or mannerisms on
the part of the patient, and should not be in a compromising position.
6. The physician shall not exploit the physician/patient relationship for sexual or any
other purposes. Moreover, such an allegation against a physician constitutes grounds
for investigation on the basis of unprofessional conduct.
INDIVIDUALS WHO AID A PHYSICIAN
It is the position of the Board of Medical Examiners of the State of North Carolina that
the use of physician extenders be restricted to those covered by the Medical Practice Act
and the Nursing Practice Act (i.e., Physician Assistants and Nurse Practitioners), and that
the credentialing of such individuals by hospital credentialing committees should follow
the above-mentioned laws .
The hospital activities of other individuals who aid a physician should be limited to
manual assistance during procedures and only in the presence of a physician. This does not
exclude hospital staff from routinely making notations in patients' charts regarding com-pletion
of doctors' orders; i.e. nurses, dieticians, x-ray technicians, lab technicians, psychi-atric
technicians, etc. However, it is the position of the Board that, at no time, such indi-viduals
be allowed to make any entry in the patients' medical charts or order any medica-tions
even if immediately countersigned by the physician.
OPHTHALMOLOGISTS: CARE OF CATARACT PATIENTS
The evaluation, diagnosis and care for cataract surgical patients is primarily the respon-sibility
of the operating surgeon. The operating surgeon may not delegate to optometrists,
nurses, or anesthesiologists the responsibility for performing an adequate preoperative
examination. The surgeon must thoroughly examine each patient on whom he performs
surgery prior to time for that surgery. This thorough examination shall include a review of
the patient's history and an independent diagnosis by the operating surgeon of cataracts
requiring surgery. The operating surgeon shall have a detailed discussion with each patient
regarding the diagnosis and the nature of the cataract surgery, advising the patient fully of
the risks involved. All surgical decisions must be made by the operating surgeon.
Following surgery, the operating surgeon must perform the 24 hour postoperative
examination on every patient on whom he performs surgery, including clear documenta-tion
of such examination in the patient record. In the case of an emergency, the operating
surgeon shall ensure that another ophthalmologist performs the 24 hour postoperative
examination. Following the 24 hour postoperative examination, the operating surgeon
shall provide postoperative care for each patient on whom he performs surgery until the
healing process is complete. It is not improper to involve non-physicians in postoperative
care, so long as the operating surgeon maintains responsibility for the patient's postopera-tive
care and examines the patient in the period following surgery to assess the healing
process and the long-term results. Even in the case of repetitive surgical procedures, a
record should be kept including detailed surgical notes describing each patient, his or her
condition, the procedures, methods, prostheses, results, prognosis, medication relative to
the surgery, and significant variations in each surgical procedure. The act of severing a
suture following ophthalmologic surgery is a medical act which can only be performed by
the operating surgeon or by those health care practitioners to whom this act may be legally
delegated.
It is improper to permit non-physicians to prescribe medication except as provided by
statute. In instances where the surgeon communicates and collaborates with an optometrist
prescribing other than topical pharmaceutical agents not used for the purpose of examining the
eye, that communication and collaboration must be contemporaneous with the issuance of any
prescription and specific for each patient.
PHYSICIAN EXTENDERS IN
URGENT CARE SITUATIONS
It is the position of the North Carolina Board of Medical Examiners that it is not the
prevailing and accepted practice of medicine by supervising physicians to allow physician
assistants and nurse practitioners in urgent care centers to treat any patient with a poten-tially
dangerous medical condition without that patient being seen at the time of treatment
by that supervising physician.
PRESCRIPTION FORMAT
It is the usual and accepted standard of care in North Carolina that a DEA controlled
substance (2, 2N, 3, 3N, 4 and 5) should be written on a separate prescription blank.
Multiprescription blanks may be used for non DEA controlled medication prescriptions.
SEXUAL EXPLOITATION OF PATIENTS
It is the position of the Board of Medical Examiners of the State of North Carolina that
entering into a sexual relationship with a patient, consensual or otherwise, while a physi-cian/
patient relationship exists is unprofessional conduct and grounds for the suspension or
revocation of a physician's license. Formal actions taken by the Board of Medical
Examiners are released to the public through news media and medical organizations.
TREATMENT OF AND PRESCRIBING
FOR FAMILY MEMBERS
It is the position of the Board that, generally, a physician should not prescribe for fami-ly
members. Treating one's family is not illegal, but the Board wishes to remind physi-cians
that such prescribing practices may lead to problems. Written records of all prescrip-tions
for controlled substances and the medical indications for them should be maintained,
but in many instances such recording is neglected. Also, any prescriptions issued should be
within the scope of the physician's medical practice. The Board urges physicians to dele-gate
the medical care of themselves and their family members to one or more of their col-leagues
in order to preclude involvement with governmental regulatory agencies who
monitor physicians' prescribing practices.
Furthermore:
1. Treatment of the immediate family members should be reserved for minor illnesses,
temporary or emergency situations.
2. Appropriate consultations should be obtained for the management of major or
extended periods of illness.
3. No Schedule II, III, or IV controlled substances should be given or prescribed except
in emergency situations.
4. Records should be maintained of written prescriptions or administration of any
Schedule II, III, or IV controlled substances.
THE USE OF ANORECTICS
It is the position of the North Carolina Board of Medical Examiners that under special
circumstances anorectic agents may fill a limited adjunct role in the treatment of obesity in
individual patients, if such treatment primarily involves diet, exercise, behavior therapy
and frequent supervision by the physician.
If used, anorectic agents should be used for short term, non-repetitive periods of not
more than twelve weeks.
Anorectic agents may produce drug dependency in some patients.
The policy of the North Carolina Board of Medical Examiners regarding the use of
amphetamines and methamphetamines for treatment of obesity is still in effect. There are
no indications for use of these drugs in weight control.
WRITING OF PRESCRIPTIONS
FOR CONTROLLED SUBSTANCES
It is the position of the Board that prescriptions for controlled substances or mind-alter-ing
chemicals should be written in ink or indelible pencil or typewritten and should be
manually signed by the practitioner at the time of issuance.
No prescription for controlled substances or mind-altering chemicals should be issued
for a patient in the absence of a documented physician-patient relationship.
No prescription for controlled substances or mind-altering chemicals should be issued
by a practitioner for himself.
MANAGEMENT OF PRESCRIBING
The majority of physicians who are asked to appear before the Board are required to do
so because of their lack of information about the management and responsibilities
involved in prescribing controlled substances. The March 1991 edition of the Bulletin con-tained
an article entitled "Management of Prescribing with Emphasis on Addictive or
Dependence-Producing Drugs," and we would like to reiterate certain points addressed in
that article.
First and foremost: "It's not what you prescribe, but how well you manage the patient's
care, and document that care in legible form, that's important. The prescribing matters that
come before the Board are almost always related to the prescription of controlled sub-stances,
and the majority of subsequent disciplinary actions could have been avoided if the
physician had followed a few basic steps.
Step 1 : Before you prescribe anything, start with a diagnosis which is supported by his-tory
and physical findings.
Step 2: Create a treatment plan which includes the use of appropriate non-addictive
modalities, and make referrals to appropriate specialists.
Step 3: Before beginning a treatment regimen of controlled drugs, make a determina-tion
through trial or through a documented history that non-addictive modalities aren't
appropriate or they don't work.
Step 4: Make sure you are not dealing with a chemically dependent or drug-seeking
patient.
Step 5: Take the time to explain the relative risks and benefits of the drug and record in
the chart that this was done.
Step 6: Maintain regular monitoring of the patient, including frequent physical
monitoring.
Step 7: Make sure you are in control of the drug. Keep detailed records of the type,
dose, and amount of the drug prescribed. Monitor, record and personally control all refills.
Do not authorize office staff to refill prescriptions without consulting you.
Step 8: Maintain regular contact with the patient's family. The family is a good source
of information on the patient's response to the therapy regimen, behavioral changes, and
whether the patient is obtaining drugs from other sources or is self-medicating with drugs
or alcohol.
Step 9: Maintain adequate records.
Management of Prescribing with Emphasis on
Addictive or Dependence-Producing Drugs
The North Carolina Board of Medical Examiners is charged by the Governor to protect
the citizens of the State from harmful physician management. A significant number of
physicians who are asked to appear before the Board are required to do so because of their
lack of information about the management and responsibilities involved in prescribing
controlled substances. Frequently, the inadvertent offender is a physician with a warm
heart and a desire to relieve pain and misery, who is always pressed for time and finds
himself prescribing controlled drugs on demand over prolonged periods without adequate
documentation. These are often for chronic ailments such as headache, arthritis, old
injuries, chronic orthopaedic problems, backache and anxiety. (Terminal cancer pain
management is not a consideration here.) The purpose of the Board of Medical Examiners
in presenting the following information is to help licensed physicians in North Carolina
consider and reevaluate their prescribing practice of controlled substances. Practicing
physicians who become new Board members have often mentioned the abrupt education
they received in their own prescribing patterns. Moreover, there have been many requests to
the Board from physicians requesting detailed information on prescribing in certain specific
situations.
It's not what you prescribe, but how well you manage the patient's care, and document
that care in legible form, that's important.
The prescribing matters that come before the Board are almost always related to the
prescription of controlled substances. We feel that a majority of instances where physi-
cians have been disciplined by the Board for prescribing practices could have been avoid-ed
completely if they had followed the steps that are being outlined here.
To prevent any misunderstanding, it's necessary to state what the Board does not
have.
It does not have a list of "bad" or "disallowed" drugs. All formulary drugs are good if
prescribed and administered when properly indicated. Conversely, all drugs are ineffec-tive,
dangerous, or even lethal when used inappropriately.
It does not have some magic formula for determining the dosage and duration of
administration for any drug. These are aspects of prescribing that must be determined
within the confines of the individual clinical case, and continued under proper monitoring.
What's good for one patient may be insufficient or fatal for another.
What the Board does have is the expectation that physicians will create a record that
shows:— Proper indication for the use of the drug or other therapy — Monitoring of the patient where necessary —The patient's response to therapy on follow-up visits — All rationale for continuing or modifying the therapy
Step 1 : First and foremost, before you prescribe anything, start with a diagnosis which
is supported by history and physical findings, and by the results of any appropriate tests.
Too many times a doctor is asked why he or she prescribed a particular drug, and the
response is, "Because the patient has arthritis." Then the doctor is asked, "How did you
determine that?", and the answer is, "Because that's what the patient complained of."
Nothing in the record or in the doctor's recollection supports the diagnosis except the
patient's assertion. Do a workup sufficient to support a diagnosis, including all necessary
tests.
Step 2: Create a treatment plan which includes the use of appropriate non-addictive
modalities, and make referrals to appropriate specialists, such as neurologists, orthope-dists,
psychiatrists, etc. The results of the referral should be included in the patient's chart.
Step 3: Before beginning a regimen of controlled drugs, make a determination through
trial or through a documented history that non-addictive modalities aren't appropriate or
they don't work. A finding of intolerance or allergy to NSAIDs is one thing, but the asser-tion
of the patient that, "Gosh, Doc, nothing seems to work like that Percodan stuff!" is
quite another. Too many of the doctors the Board has seen have started a treatment pro-gram
with powerful controlled substances without ever considering other forms of treat-ment.
Step 4: Make sure you are not dealing with a drug-seeking patient. If you know the
patient, review the prescription records in the patient's chart and discuss the patient's
chemical history before prescribing a controlled drug. If the patient is new or otherwise
unknown to you, at a minimum obtain an oral drug history, and discuss chemical use and
family chemical history with the patient.
Step 5: It's a good idea to obtain the informed consent of the patient before using a
drug that has the potential to cause dependency problems. Take the time to explain the rel-ative
risks and benefits of the drug and record in the chart the fact that this was done.
When embarking on what appears to be the long term use of a potentially addictive sub-stance,
it may be wise to hold a family conference and explain the relative risks of depen-dency
or addiction and what that may mean to the patient and to the patient's family.
Refusal of the patient to permit a family conference may be significant
information.
Step 6: Maintain regular monitoring of the patient, including frequent physical moni-toring.
If the regimen is for prolonged drug use, it is very important to monitor the patient
for the root condition which necessitates the drug, and for the side effects of the drug
itself. This is true no matter what type of controlled substance is used or what schedule it
belongs to. Also, remember that with certain conditions, drug holidays are appropriate.
This allows you to check to see whether the original symptoms recur when the drug is not
given — indicating a continuing legitimate need for the drug or whether withdrawal symp-toms
occur — indicating drug dependence.
Step 7: Make sure YOU are in control of the supply of the drug. To do this, at a mini-mum
you must keep detailed records of the type, dose, and amount of the drug prescribed.
You must also monitor, record and personally control all refills. Do not authorize your
office personnel to refill prescriptions without consulting you. One good way to accom-
plish this is to require the patient to return to obtain refill authorization, at least part of the
time . Records of cumulative dosage and average daily dosage are especially valuable. A
thumbnail sketch of three cases will illustrate our point here. In the first case, a physician
prescribed Tussionex to a patient for approximately five years for a cumulative dosage of
nineteen and one half gallons. In the second case, a physician prescribed Tylenol 3's to a
patient for slightly more than a year at the average daily rate of 30 per day! The third case
is very similar, except that it was Tylenol 4's at the rate of 20 per day. Some quick obser-vations:
— No physician who was aware of that kind of prescribing would have continued
with it. — Few, if any, patients could have been consuming that much Tylenol with codeine.
In all likelihood, they were reselling it.
Another important part of controlling the supply of drug is to check on whether the
patient is obtaining drugs from other physicians. North Carolina law allows any current
treating physician to have access to a patient's prescription profile . Checking with pharma-cies
and pharmacy chains may tell you whether a patient is obtaining extra drugs or is doctor
shopping. Doctor shopping is illegal in North Carolina. If you are aware it is occurring, contact
your local police, SBI or the Board of Medical Examiners.
Step 8: Maintaining regular contact with the patient's family is a valuable source of
information on the patient's response to the therapy regimen, and may be much more accu-rate
and objective than feedback from the patient alone.
The family is a much better source of information on behavioral changes, especially
dysfunctional behavior, than is the patient. Dysfunctional changes may be observable
when the patient is taking the drug, or when the drug is withdrawn. These changes, at
either time, may be symptoms of dependency or addiction.
The family is also a good source of information on whether the patient is obtaining
drugs from other sources, or is self-medicating with other drugs or alcohol.
Step 9: To reiterate, one of the most frequent problems faced by a physician when he
or she comes before the Board or other outside review bodies is inadequate records. It's
entirely possible that the doctor did everything correctly in managing a case, but without
records which reflect all the steps that went into the process, the job of demonstrating it to
any outside reviewer becomes many times more difficult. Luckily, this is a problem which
is solvable.
Note
Much of the above was taken from information from continuing medical educa-tion
seminars conducted by the Minnesota Board of Medical Examiners and from
their newsletter of the fall of 1990. We express our appreciation to them.
SPOTTING THE CHEMICALLY
DEPENDENT OR DRUG-SEEKING PATIENT
Current Behavior. Must be seen right away, frequently after hours or late in the after-noon;
must have a specific narcotic right away; reluctant to provide reference information
such as primary physician; not a permanent resident - visiting or travelling through town;
refuses lab tests; presents characteristic types of pain - low back, root canal, migraines;
lost or stolen prescription needs replacing; blood in urine (from pricked finger) to simulate
kidney stone.
Medical History: Gives evasive or vague answers; may admit excessive use of ciga-rettes,
alcohol or prescription drugs; exaggerates medical problems; history of frequent
trauma or bizarre infections; general debilitation; unexplained sweating or chills.
Social History: Repeated auto accidents or DUIs; employment difficulties; child
abuse or severe family problems; family history positive for members with chemical
dependency.
Psychological History: Mood disturbances; suicidal thoughts; lack of impulse control;
thought disorders; sexual dysfunction.
Physical Examination: Overt debilitation; physical findings not proportionate to com-plaints;
unsteady gait; slurred speech; inappropriate pupil dilation or constriction; nystag-mus;
cutaneous signs of drug abuse.
Laws of North Carolina Relating to
the Practice of Medicine
Chapter 90.
Article 1.
Practice of Medicine.
Sec.
90-1
90-2.
90-3.
90-4.
90-5.
90-6.
90-7.
90-8.
90-<
90-10.
90-11
90-12.
90-13.
90-14.
90-14.
90-14.2.
90-14.
90-14
90-14
90-14.
90-14.
North Carolina Medical Society
incorporated.
Board of Examiners.
Medical Society nominates Board.
Board elects officers; quorum.
Meetings of Board.
Regulations governing applicants for
license, examinations, etc.;
appointment of subcommittee.
Bond of secretary.
Officers may administer oaths, an
subpoena witnesses, records
and other materials.
Examination for license; scope; con-ditions
and prerequisites.
Provision in lieu of examination.
Qualifications of applicant for
license.
Limited license.
When license without examination
allowed.
Revocation, suspension, annulment
or denial of license.
. Judicial review of Board's deci-sion
denying issuance of a
license.
Hearing before revocation or sus-pension
of a license.
Service of notices.
.4. Place of hearings for revocation
or suspension of license.
,5. Use of trial examiner or deposi-tions.
,6. Evidence admissible.
.7. Procedure where person fails to
request or appear for hearing.
Sec.
90-14
90-14.9
90-14.
90-14.
90-14.
90-14.
90-15
90-15.
90-16.
90-17
90-18
90-18
90-18.
90-19,
90-21
Appeal from Board's decision
revoking or suspending a
license.
Appeal bond; stay of Board
order.
Scope of review.
Appeal; appeal bond.
Injunctions.
. Reports of disciplinary action
by health care institutions;
immunity from liability.
. License fee; salaries, fees, and
expenses of Board.
1
Registration every two years with
Board.
Board to keep record, publication
of names of licentiates, tran-script
as evidence; receipt of
evidence concerning treatment
of patient who has not con-sented
to public disclosure.
(Repealed.)
Practicing without license; practic-ing
defined; penalties.
.1. Limitations of physician assis-tants.
2. Limitations on nurse practition-ers.
90-20. (Repealed.)
. Certain offenses prosecuted in
superior court; duties of
Attorney General.
Article ID.
Peer Review.
90-21.22. Peer review agreements.
Medicine and Allied Occupations.
Article 1.
Practice of Medicine.
§ 90-1. North Carolina Medical Society incorporated. — The association of regu-larly
graduated physicians, calling themselves the State Medical Society, is hereby
declared to be a body politic and corporate, to be known and distinguished by the name of
The Medical Society of the State of North Carolina. The name of the society is now the
North Carolina Medical Society.
§ 90-2. Board of Examiners.
(a) In order to properly regulate the practice of medicine and surgery, there is estab-lished
a Board of Medical Examiners of the State of North Carolina. The Board
shall consist of eight members. Seven of the members shall be duly licensed
physicians elected and nominated to the Governor by the North Carolina Medical
Society. The other member shall be a person chosen by the Governor to represent
the public at large. The public member shall not be a health care provider nor the
spouse of a health care provider. For purposes of board membership, "health care
provider" means any licensed health care professional and any agent or employee
of any health care institution, health care insurer, health care professional school,
or a member of any allied health profession. For purposes of this section, a person
enrolled in a program to prepare him to be a licensed health care professional or
an allied health professional shall be deemed a health care provider. For purposes
of this section, any person with significant financial interest in a health service or
profession is not a public member.
(b) No member appointed to the Board on or after November 1, 1981, shall serve
more than two complete consecutive three-year terms, except that each member
shall serve until his successor is chosen and qualifies.
(c) In order to establish regularly overlapping terms, the terms of office of the mem-bers
currently serving on the Board shall expire as follows: to on October 31,
1982; two on October 31, 1984; three on October 31, 1986. Terms of Board
members shall expire in direct relation to their date of appointment by the soci-ety;
the terms of the two members first appointed shall expire in 1982, and the
terms of the three members last appointed shall expire in 1986. No initial physi-cian
member of the Board may serve another term until at least three years from
the date of expiration of his current term. The Governor shall appoint the public
member not later than October 31, 1981.
(d) Any initial or regular member of the Board may be removed from office by the
Governor for good cause shown. Any vacancy in the initial or regular physician
membership of the Board shall be filled for the period of the unexpired term by
the Governor from a list of physicians submitted by the North Carolina Medical
Society Executive Council. Any vacancy in the public membership of the Board
shall be filled by the Governor for the unexpired term.
§ 90-3. Medical Society nominates Board. — The Governor shall appoint as physi-cian
members of the Board physicians elected and nominated by the North Carolina
Medical Society.
§ 90-4. Board elects officers; quorum. — The Board of Medical Examiners is
authorized to elect all officers and adopt all bylaws as may be necessary. A majority of
the membership of the Board shall constitute a quorum for the transaction of business.
§ 90-5. Meetings of Board. — The Board of Medical Examiners shall assemble
once in every year in the City of Raleigh, and shall remain in session from day to day until
all applicants who may present themselves for examination within the first two days of
this meeting have been examined and disposed of; other meetings in each year may be
held at some suitable point in the State if deemed advisable.
§ 90-6. Regulations governing applicants for license, examinations, etc.; appoint-ment
of subcommittee. — The Board of Medical Examiners is empowered to prescribe
such regulations as it may deem proper, governing applicants for license, admission to
examinations, the conduct of applicants during examinations, and the conduct of examina-tions
proper.
The Board of Medical Examiners shall appoint and maintain a subcommittee to work
jointly with a subcommittee of the Board of Nursing to develop rules and regulations to
govern the performance of medical acts by registered nurses, including the determination
of reasonable fees to accompany an application for approval not to exceed one hundred
dollars ($100.00) and for renewal of such approval not to exceed fifty dollars ($50.00).
The fee for reactivation of an inactive incomplete application shall be five dollars ($5.00).
Rules and regulations developed by this subcommittee from time to time shall govern the
performance of medical acts by registered nurses and shall become effective when adopted
by both the Board of Medical Examiners and the Board of Nursing. The Board of Medical
Examiners shall have responsibility for securing compliance with these regulations.
§ 90-7. Bond of secretary. — The secretary of the Board of Medical Examiners
shall give bond with good surety, to the president of the Board, for the safekeeping and
proper payment of all moneys that may come into his hands.
§ 90-8. Officers may administer oaths, and subpoena witnesses, records and
other materials. — The president and secretary of the Board may administer oaths to all
persons appearing before it as the Board may deem necessary to perform its duties, and
may summon and issue subpoenas for the appearance of any witnesses deemed necessary
to testify concerning any matter to be heard before or inquired into by the Board. The
Board may order that any patient records, documents or other material concerning any
matter to be heard before or inquired into by the Board shall be produced before the Board
or made available for inspection, notwithstanding any other provisions of law providing
for the application or any physician-patient privilege with respect to such records, docu-ments
or other material. All records, documents, or other material compiled by the Board
are subject to the provisions of G.S. 90-16. Notwithstanding the provisions of G.S. 90-16,
in any proceeding before the Board, in any record of any hearing before the Board, and in
the notice of charges against any licensee, the Board shall withhold from public disclosure
the identity of a patient including information relating to dates and places of treatment, or
any other information that would tend to identify the patient, unless the patient or the rep-resentative
of the patient expressly consents to the disclosure. Upon written request, the
Board shall revoke a subpoena if, upon a hearing, it finds that the evidence the production
of which is required does not relate to a matter in issue, or if the subpoena does not
describe with sufficient particularity the evidence the production of which is required, or if
for any other reason in law the subpoena is invalid.
§ 90.9. Examination for license; scope; conditions and prerequisites. — It shall
be the duty of the Board of Medical Examiners to examine for license to practice medicine
or surgery, or any of the branches thereof, every applicant who complies with the follow-ing
provisions: He shall, before he is admitted to examination, satisfy the Board that he
has an academic education equal to the entrance requirements of the University of North
Carolina, or furnish a certificate from the superintendent of public instruction of the coun-ty
that he has passed an examination upon his literary attainments to meet the requirements
of entrance in the regular course of the State University. He shall exhibit a diploma or fur-nish
satisfactory proof of graduation from a medical college or an osteopathic college
approved by the American Osteopathic Association at the time of his graduation, which
time of graduation shall have been on January 1, 1960, or subsequent thereto and which
medical and osteopathic schools shall require an attendance of not less than four years or
for a lesser period of time approved by the Board, and supply such facilities for clinical
and scientific instruction as shall meet the approval of the Board. An applicant shall have
graduated from a medical college approved by the Liaison Commission on Medical
Education or osteopathic college that has been approved by the American Osteopathic
Association; or, if he was graduated from any other medical or osteopathic college, the
applicant shall be enrolled in a graduate medical education and training program in North
Carolina which has been approved by the Board. An applicant who has graduated from a
medical college not approved by the Liaison Commission on Medical Education or osteo-pathic
college that has not been approved by the American Osteopathic Association and
who has not enrolled in a graduate medical education and training program in North
Carolina which has been approved by the Board shall satisfy the Board that he has suc-cessfully
completed three years of graduate medical education in a training program
approved by the Board. No applicant from a medical or osteopathic college which has
been disapproved by the Board shall be eligible to take the examination.
The examination shall cover the branches of medical science and subjects which the
Board deems necessary to determine competence to practice medicine. The Board may
divide the examination into parts or components.
If the applicant successfully passes the examination, as determined by the Board, and if
the applicant satisfies the Board that he is of good moral character and that either, ( 1 ) if the
applicant is a graduate of a medical college approved by the Liaison Commission on
Medical Education or osteopathic college approved by the American Osteopathic
Association, he has successfully completed one year of training in a medical education
program approved by the Liaison Commission of Medical Education or osteopathic col-lege
that has not been approved by the American Osteopathic Association, he has success-fully
completed three years of training in a medical education program approved by the
Board after graduation from medical school, then the Board shall grant the applicant a
license authorizing him to practice medicine in any of its branches.
Applicants shall be examined by number only; names and other identifying informa-tion
shall not appear on examination papers.
§ 90-10. Provision in lieu of examination. — In lieu of the above examination, the
Board may grant a license to an applicant who is found to have passed the examination
given by the National Board of Medical Examiners, or who has passed such other exami-nation
which the Board deems to be equivalent to the examination given by the Board,
provided the applicant meets the other qualifications set forth in this Article.
§ 90-11. Qualifications of applicant for license. — Every applicant for a license to
practice medicine or for approval to perform medical acts in the State shall satisfy the
Board of Medical Examiners that such applicant is of good moral character and meets the
other qualifications for the issuance of such a license or for such approval before any such
license or approval is granted by the Board to such applicant.
§ 90-12. Limited license. — The Board may, whenever in its opinion the conditions
of the locality where the applicant resides are such as to render it advisable, make such
modifications of the requirements of G.S. 90-9, 90-10, and 90-11 as in its judgment the
interests of the people living in that locality may demand, and may issue to such applicant
a special license, to be entitled a "Limited License", authorizing the holder thereof to prac-tice
medicine and surgery within the limits only of the districts specifically described
therein. The holder of the limited license practicing medicine or surgery beyond the
boundaries of the districts as laid down in said license shall be guilty of a misdemeanor,
and upon conviction shall be fined not less than twenty-five dollars ($25.00) nor more than
fifty dollars ($50.00) for each and every offense; and the Board is empowered to revoke
such limited license, in its discretion, after due notice.
§ 90-13. When license without examination allowed. — The Board of Medical
Examiners shall in their discretion issue a license to any applicant to practice medicine and
surgery in this State without examination if said applicant exhibits a diploma or satisfacto-ry
proof of graduation from a medical or osteopathic college, approved as provided in G.S.
90-9 and requiring an attendance of not less than four years or for such lesser period of
time approved by the Board, and a license issued to him to practice medicine and surgery
by the Board of Medical Examiners of another state, and has successfully completed one
year or training after his graduation from medical college in a medical education and train-ing
program approved by the Board, in which program the Board may permit him to prac-tice
medicine. An applicant for licensing under this section who was graduated from a
medical college not approved by the Liaison Commission on Medical Education or osteo-pathic
college that has not been approved by the American Osteopathic Association shall
have successfully completed three years of training in a medical education and training
program approved by the Board for any period of time and with any conditions it deems
appropriate. No license may be granted to any applicant who was graduated from a med-ical
or osteopathic college which has been disapproved by the Board.
§ 90-14. Revocation, suspension, annulment or denial of license.
(a) The Board shall have the power to deny, annul, suspend, or revoke a license, or
other authority to practice medicine in this State issued by the Board to any per-son
who has been found by the Board to have committed any of the following
acts or conduct, or for any of the following reasons:
( 1
)
Immoral or dishonorable conduct;
(2) Producing or attempting to produce an abortion contrary to law;
(3) Made false statements or representations to the Board, or who has willfully
concealed from the Board material information in connection with his appli-cation
for a license;
(4) Repealed by Session Laws 1977, c. 838, s. 3.
(5) Being unable to practice medicine with reasonable skill and safety to patients
by reason of illness, drunkenness, excessive use of alcohol, drugs, chemicals,
or any other type of material or by reason of any physical or mental abnor-mality.
The Board is empowered an authorized to require a physician
licensed by it to submit to a mental or physical examination by physicians
designated by the Board before or after charges may be presented against
him, and the results of examination shall be admissible in evidence in a hear-ing
before the Board;
(6) Unprofessional conduct, including, but not limited to, any departure from or
the failure to conform to, the standards of acceptable and prevailing medical
practice, or the ethics of the medical profession, irrespective of whether or
not a patient is injured thereby, or the committing of any act contrary to hon-esty,
justice, or good morals, whether the same is committed in the course of
his practice or otherwise, and whether committed within or without North
Carolina;
(7) Conviction in any court of a crime involving moral turpitude, or the violation
of a law involving the practice of medicine, or a conviction of a felony; pro-vided
that a fe|ony conviction shall be treated as provided in subsection (c) of
this section;
(8) By false representations has obtained or attempted to obtain practice, money
or anything of value;
(9) Has advertised or publicly professed to treat human ailments under a system
or school of treatment or practice other than that for which he has been edu-cated;
(10) Adjudication of mental incompetency, which shall automatically suspend a
license unless the Board orders otherwise;
(11) Lack of professional competence to practice medicine with a reasonable
degree of skill and safety for patients. In this connection the Board may con-sider
repeated acts of a physician indicating his failure to properly treat a
patient and may require such physician to submit to inquiries or examina-tions,
written or oral, by members of the Board or by other physicians
licensed to practice medicine in this State, as the Board deems necessary to
determine the professional qualifications of such licensee;
(12) Promotion of the sale of drugs, devices, appliances or goods for a patient, or
providing services to a patient, in such a manner as to exploit the patient for
financial gain of the physician; and upon a finding of the exploitation for
financial gain, the Board may order restitution be made to the payer of the
bill, whether the patient or the insurer, by the physician; provided that a
determination of the amount of restitution shall be based on credible testimo-ny
in the record;
(13) Suspension or revocation of a license to practice medicine in any other state,
or territory of the United States, or other country.
(14) The failure to respond, within a reasonable period of time and in a reasonable
manner as determined by the Board, to inquiries from the Board concerning
any matter affecting the license to practice medicine.
For any of the foregoing reasons, the Board may deny the issuance of a license to an
applicant or revoke a license issued to him, may suspend such a license for a period of
time, and may impose conditions upon the continued practice after such period of suspen-xix
sion as the Board may deem advisable, may limit the accused physician's practice of medi-cine
with respect to the extent, nature, or location of his practice as the Board deems advis-able.
The Board may, in its discretion and upon such terms and conditions and for such
period of time as it may prescribe, restore a license so revoked or rescinded.
(b) The Board shall refer to the State Medical Society Physician Health and
Effectiveness Committee all physicians whose health and effectiveness have been
significantly impaired by alcohol, drug addiction or mental illness.
(c) A felony conviction shall result in the automatic revocation of a license issued by
the Board, unless the Board orders otherwise or receives a request for a hearing
from the person within 60 days of receiving notice from the Board, after the con-viction,
of the provisions of this subsection. If the Board receives a timely
request for a hearing in such a case, the provisions of G.S. 90-14.1 shall be fol-lowed.
(d) The Board and its members and staff may release confidential or nonpublic infor-mation
to any health care licensure board in this State or another state about the
issuance, denial, annulment, suspension, or revocation of a license, or the volun-tary
surrender of a license by a Board-licensed physician, including the reasons
for the action, or an investigative report made by the Board. The Board shall
notify the physician within 60 days after the information is transmitted. A sum-mary
of the information that is being transmitted shall be furnished to the physi-cian.
If the physician requests, in writing, within 30 days after being notified that
such information has been transmitted, he shall be furnished a copy of all infor-mation
so transmitted. The notice or copies of the information shall not be pro-vided
if the information relates to an ongoing criminal investigation by any law-enforcement
agency, or authorized Department of Human Resources personnel
with enforcement or investigative responsibilities.
(e) The Board and its members and staff shall not be held liable in any civil or crimi-nal
proceeding for exercising, in good faith, the powers and duties authorized by
law.
§ 90-14.1 Judicial review of Board's decision denying issuance of a license. —
Whenever the Board of Medical Examiners has determined that a person who has duly
made application to take an examination to be given by the Board showing his education,
training and other qualifications required by said Board, or that a person who has taken
and passed an examination given by the Board, has failed to satisfy the Board of his quali-fications
to be examined or to be issued a license, for any cause other than failure to pass
an examination, the Board shall immediately notify such person of its decision, and indi-cate
in what respect the applicant has so failed to satisfy the Board. Such applicant shall
be given a formal hearing before the Board upon request of such applicant filed with or
mailed by registered mail to the secretary of the Board at Raleigh, North Carolina, within
10 days after receipt of the Board's decision, stating the reasons for such request. The
Board shall within 20 days of receipt of such request notify such applicant of the time and
place of a public hearing, which shall be held within a reasonable time. The burden of sat-isfying
the Board of his qualifications for licensure shall be upon the applicant.
Following such hearing, the Board shall determining whether the applicant is qualified to
be examined or is entitled to be licensed as the case may be. Any such decision of the
Board shall be subject to judicial review upon appeal to the Superior Court of Wake
County upon the filing with the Board of a written notice of appeal with exceptions taken
to the decision of the Board within 20 days after service of notice of the Board's final deci-sion.
Within 30 days after receipt of notice of appeal, the secretary of the Board shall cer-tify
to the clerk of the Superior Court of Wake County the record of the case which shall
include a copy of the notice of hearing, a transcript of the testimony and evidence received
at the hearing, a copy of the decision of the Board, and a copy of the notice of appeal and
exceptions. Upon appeal the case shall be heard by the judge without a jury, upon the
record, except that in cases of alleged omissions or errors in the record, testimony may be
taken by the court. The decision of the Board shall be upheld unless the substantial rights
of the applicant have been prejudiced because the decision of the Board is in violation or
law or is not supported by any evidence admissible under this Article, or is arbitrary or
capricious. Each party to the review proceeding may appeal to the Supreme Court as here-inafter
provided in G.S. 90-14.1 1.
§ 90-14.2. Hearing before revocation or suspension of a license. — Before the
Board shall revoke, restrict or suspend any license granted by it, the licensee shall be given
a written notice indicating the general nature of the charges, accusation, or complaint made
against him, which notice may be prepared by a committee or one or more members of the
Board designated by the Board, and stating that such licensee will be given an opportunity
to be heard concerning such charges or complaint at a time and place stated in such notice,
or at a time and place to be thereafter designated by the Board, and the Board shall hold a
public hearing not less than 30 days from the date of the service of such notice upon such
licensee, at which such licensee may appear personally and through counsel, may cross
examine witnesses and present evidence in his own behalf. A physician who is mentally
incompetent shall be represented at such hearing and shall be served with notice as herein
provided by and through a guardian ad litem appointed by the clerk of the court of the
county in which the physician has his residence. Such licensee or physician may, if he
desires, file written answers to the charges or complaints preferred against him within 30
days after the service of such notice, which answer shall become a part of the record but
shall not constitute evidence in the case.
§ 90-14.3. Service of notices. — Any notice required by this Chapter may be served
either personally or by an officer authorized by law to serve process, or by registered mail,
return receipt requested, directed to the licensee or applicant at his last known address as
shown by the records of the Board. If notice is served personally, it shall be deemed to
have been served at the time when the officer delivers the notice to the person addressed.
Where notice is served by registered mail, it shall be deemed to have been served on the
date borne by the return receipt showing delivery of the notice to addressee or refusal of
the addressee to accept the notice.
§ 90-14.4. Place of hearings for revocation or suspension of license. — Upon writ-ten
request of the accused physician to the secretary of the Board within 20 days after ser-vice
of the charges or complaints against him, a hearing for the purpose of determining
revocation or suspension of his license shall be conducted in the county in which such
physician maintains his residence, or at the election of the Board, in any county in which
the act or acts complained of occurred. In the absence of such request, the hearing shall be
held at a place designated by the Board, or as agreed upon by the physician and the Board.
§ 90-14.5. Use of trial examiner or depositions. — Where the licensee requests that
the hearing herein provided for be held by the Board in a county other than the county des-ignated
for the holding of the meeting of the Board at which the matter is to be heard, the
Board may designate in writing one or more of its members to conduct the hearing as a
trial examiner or trial committee, to take evidence and report a written transcript thereof to
the Board at a meeting where a majority of the members are present and participating in
the decision. Evidence and testimony may also be presented at such hearings and to the
Board in the form of depositions taken before any person designated in writing by the
Board for such purpose or before any person authorized to administer oaths, in accordance
with the procedure for the taking of depositions in civil actions in the superior court.
§ 90-14.6. Evidence admissible. — In proceedings held pursuant to this Article the
Board shall admit and hear evidence in the same manner and form as prescribed by law for
civil actions. A complete record of such evidence shall be made, together with the other
proceedings incident to such hearing.
§ 90-14.7. Procedure where person fails to request or appear for hearing. — If a
person who has requested a hearing does not appear, and no continuance has been granted,
the Board or its trial examiner or committee may hear the evidence of such witnesses as
may have appeared, and the Board may proceed to consider the matter and dispose of it on
the basis of the evidence before it. For good cause, the Board may reopen any case for
further hearing.
§ 90-14.8. Appeal from Board's decision revoking or suspending a license. — A
physician whose license is revoked or suspended by the Board may obtain a review of the
decision of the Board in the Superior Court of Wake County or in the superior court in the
county in which the hearing was held or upon agreement of the parties to the appeal in any
other superior court of the State, upon filing with the secretary of the Board a written
notice of appeal within 20 days after the date of the service of the decision of the Board,
stating all exceptions taken to the decision of the Board and indicating the court in which
the appeal is to be heard.
Within 30 days after the receipt of a notice of appeal as herein provided, the Board
shall prepare, certify and file with the clerk of the superior court in the county to which the
appeal is directed the record of the case comprising a copy of the charges, notice of hear-ing,
transcript of testimony, and copies of documents or other written evidence produced at
the hearing, decision of the Board, and notice of appeal containing exceptions to the deci-sion
of the Board.
§ 90-14.9. Appeal bond; stay of Board order. — The person seeking the review
shall file with the clerk of the reviewing court a copy of the notice of appeal and an appeal
bond of two hundred dollars ($200.00) at the same time the notice of appeal is filed with
the Board. At any time before or during the review proceeding the aggrieved person may
apply to the reviewing court for an order staying the operation of the Board decision pend-ing
the outcome of the review, which the court may grant or deny in its discretion.
§ 90-14.10. Scope of review. — Upon the review of the Board's decision revoking
or suspending a license, the case shall be heard by the judge without a jury, upon the
record, except that in cases of alleged omissions or errors in the record, testimony thereon
may be taken by the court. The court may affirm the decision of the Board or remand the
case for further proceedings; or it may reverse or modify the decision if the substantial
rights of the accused physician have been prejudiced because the findings or decisions of
the Board are in violation of substantive or procedural law, or are not supported by compe-tent,
material, and substantial evidence admissible under this Article, or are arbitrary or
capricious. At any time after the notice of appeal has been filed, the court may remand the
case to the Board for the hearing of any additional evidence which is material and is not
cumulative and which could not reasonably have been presented at the hearing before the
Board.
§ 90-14.11. Appeal; appeal bond. — Any party to the review proceeding, including
the Board, may appeal from the decision of the superior court under rules of procedure
applicable in other civil cases. No appeal bond shall be required of the Board. The
appealing party may apply to the superior court for a stay of that court's decision or a stay
of the Board's decision, whichever shall be appropriate, pending the outcome of the
appeal.
§ 90-14.12. Injunctions. — The Board may appear in its own name in the superior
courts in an action for injunctive relief to prevent violation of this Article and the superior
courts shall have power to grant such injunctions regardless of whether criminal prosecu-tion
has been or may be instituted as a result of such violations. Actions under this section
shall be commenced in the superior court district or set of districts as defined in G.S. 7A-
41.1 in which the respondent resides or has his principal place of business or in which the
alleged acts occurred.
§ 90-14.13. Reports of disciplinary action by health care institutions; immunity
from liability. — The chief administrative officer of every license hospital or other health
care institution in the State shall, after consultation with the chief of staff of such institu-tion,
report to the Board any revocation, suspension, or limitation of a physician's privi-leges
to practice in that institution. Each such institution shall also report to the Board res-ignations
from practice in that institution by persons licensed under this Article. The
Board shall report all violations of this subsection known to it to the licensing agency for
the, institution involved.
The chief administrative officer of each insurance company providing professional
liability insurance for physicians who practice medicine in North Carolina, the administra-tive
officer of the Liability Insurance Trust Fund Council created by G.S. 1 16-220, and the
administrative officer of any trust fund operated by a hospital authority, group, or provider
shall report to the Board within 30 days:
(1) Any award of damages or settlement affecting or involving a physician it
insures, or
(2) Any cancellation or nonrenewal of its professional liability coverage of a
physician, if the cancellation or nonrenewal was for cause.
The Board may request details about any action and the officers shall promptly furnish
the requested information. The reports required by this section are privileged and shall not
be open to the public. The Board shall report all violations of this paragraph to the
Commissioner of Insurance.
Any person making a report required by this section shall be immune from any crimi-nal
prosecution or civil liability resulting therefrom unless such person knew the report
was false or acted in reckless disregard of whether the report was false.
§ 90-15. License fee; salaries, fees, and expenses of Board. — Each applicant for a
license by examination shall pay to the treasurer of the Board of Medical Examiners of the
State of North Carolina a fee which shall be prescribed by said Board in an amount not
exceeding the sum of four hundred dollars ($400.00) plus the cost of test materials before
being admitted to the examination. Whenever any license is granted without examination,
as authorized in G.S. 90-13, the applicant shall pay to the treasurer of the Board a fee in an
amount to be prescribed by the Board not in excess of two hundred fifty dollars ($250.00).
Whenever a limited license is granted as provided in G.S. 90-12, the applicant shall pay to
the treasurer of the Board a fee not to exceed one hundred fifty dollars ($150.00), except
where a limited license to practice in a medical education and training program approved
by the Board for the purpose of education or training is granted, the applicant shall pay a
fee of twenty-five dollars ($25.00). A fee of twenty-five dollars ($25.00) shall e paid for
the issuance of a duplicate license. All fees shall be paid in advance to the treasurer of the
Board of Medical Examiners of the State of North Carolina, to be held by him as a fund
for the use of said Board. The compensation and expenses of the members and officers of
the said Board and all expenses proper and necessary in the opinion of the Board to the
discharge of its duties under and to enforce the laws regulating the practice of medicine or
surgery shall be paid out of said fund, upon the warrant of the said Board and all expenses
proper and necessary in the opinion of the officers and members of said Board shall be
fixed by the Board but shall not exceed one hundred dollars ($100.00) per day per member
for time spent in the performance and discharge of his duties as a member of said Board,
and reimbursement for travel and other necessary expenses incurred in the performance of
his duties as a member of said Board. Any unexpended sum or sums of money remaining
in the treasury of said Board at the expiration of the terms of office of the members thereof
shall be paid over to their successors in office.
For the initial and annual registration of an assistant to a physician, the Board may
require the payment of a fee not to exceed a reasonable amount.
§ 90-15.1. Registration every two years with Board. — Every person heretofore or
hereafter licensed to practice medicine by said Board of Medical Examiners shall, during
the month of January, 1958, and during the month of January in every even-numbered year
thereafter, register with the secretary-treasurer of said Board his name and office and resi-dence
address and such other information as the Board may deem necessary and shall pay
a registration fee fixed by the Board not in excess of one hundred dollars ($100.00). In the
event a physician fails to register as herein provided he shall pay an additional amount of
twenty dollars ($20.00) to the Board. Should a physician fail to register and pay the fees
imposed, and should such failure continue for a period of 30 days, the license of such
physician may be suspended by the Board, after notice and hearing at the next regular
meeting of the Board. Upon payment of all fees and penalties which are due, the license of
the physician may be reinstated, subject to the Board requiring the physician to appear
before the Board for an interview and to comply with other licensing requirements.
§ 90-16. Board to keep record; publication of names of licentiates; transcript as
evidence; receipt of evidence concerning treatment of patient who has not consented
to public disclosure. — The Board of Examiners shall keep a regular record of its pro-ceedings
in a book kept for that purpose, together with the names of the members of the
Board present, the names of the applicants for license, and other information as to its
actions. The Board of Examiners shall cause to be entered in a separate book the name of
each applicant to whom a license is issued to practice medicine or surgery, along with any
information pertinent to such issuance. The Board of Examiners shall publish the names of
those licensed in three daily newspapers published in the State of North Carolina, within
30 days after granting the same. A transcript of any such entry in the record books, or cer-tificate
that there is not entered therein the name and proficiency or date of granting such
license of a person charged with the violation of the provisions of this Article, certified
under the hand of the secretary and the seals of the Board of Medical Examiners of the
State of North Carolina, shall be admitted as evidence in any court of this State when it is
otherwise competent.
The Board may in an executive session receive evidence involving or concerning the
treatment of a patient who has not expressly or impliedly consented to the public disclo-sure
of such treatment as may be necessary for the protection of the rights of such patient
or of the accused physician and the full presentation or relevant evidence. All records,
papers and other documents containing information collected and compiled by the Board,
or its members or employees as a result of investigations, inquiries or interviews conduct-ed
in connection with a licensing or disciplinary matter shall not be considered public
records within the meaning of Chapter 132 of the General Statutes; provided, however,
that any notice or statement of charges against any licensee, or any notice to any licensee
of a hearing in any proceeding shall be a public record within the meaning of Chapter 132
of the General Statutes, notwithstanding that it may contain information collected and
compiled as a result of any such investigation, inquiry or interview; and provided, further,
that if any such record, paper or other document containing information theretofore col-lected
and compiled by the Board, as hereinbefore provided, is received and admitted in
evidence in any hearing before the Board, it shall thereupon be a public record within the
meaning of Chapter 132 of the General Statutes.
In any proceeding before the Board, in any record of any hearing before the Board, and
in the notice of the charges against any licensee (notwithstanding any provision herein to
the contrary) the Board may withhold from public disclosure the identity of a patient who
has not expressly or impliedly consented to the public disclosure of treatment by the
accused physician.
§ 90-17: Repealed by Session Laws 1967, c.691, s.59.
§ 90-18. Practicing without license; practicing defined; penalties. — No person
shall practice medicine or surgery, or any of the branches thereof, nor in any case prescribe
for the cure of diseases unless he shall have been first licensed and registered so to do in
the manner provided in this Article, and if any person shall practice medicine or surgery
without being duly licensed and registered, as provided in this Article, he shall not be
allowed to maintain any action to collect any fee for such services. The person so practic-ing
without license shall be guilty of a misdemeanor, and upon conviction thereof shall be
fined not less than fifty dollars ($50.00) nor more than one hundred dollars ($100.00), or
imprisoned at the discretion of the court for each and every offense.
Any person shall be regarded as practicing medicine or surgery within the meaning of
this Article who shall diagnose or attempt to diagnose, treat or attempt to treat, operate or
attempt to operate on, or prescribe for or administer to, or profess to treat any human ail-ment,
physical or mental, or any physical injury to or deformity of another person:
Provided, that the following cases shall not come within the definition above recited:
(1) The administration of domestic or family remedies in cases of emergency.
(2) The practice of dentistry by any legally licensed dentist engaged in the practice of
dentistry and dental surgery.
(3) The practice of pharmacy by any legally licensed pharmacist engaged in the prac-tice
of pharmacy.
(4) The practice of medicine and surgery by any surgeon or physician of the United
States army, navy, or public health service in the discharge of his official duties.
(5) The treatment of the sick or suffering by mental or spiritual means without the
use of any drugs or other material means.
(6) The practice of optometry by any legally licensed optometrist engaged in the
practice of optometry.
(7) The practice of midwifery as defined in G.S. 90-178.2.
(8) The practice of chiropody by any legally licensed chiropodist when engaged in
the practice of chiropody, and without the use of any drug.
(9) The practice of osteopathy by any legally licensed osteopath when engaged in the
practice of osteopathy as defined by law, and especially G.S. 90-129.
(10) The practice of chiropractic by any legally licensed chiropractor when engaged in
the practice of chiropractic as defined by law, and without the use of any drug or
surgery.
(11) The practice of medicine and surgery by any reputable physician or surgeon in a
neighboring state coming into this State for consultation with a resident registered
physician.
§ 90-18.1. Limitations on physician assistants. —
(a) Any person who is approved under the provisions of G.S. 90-18(13) to perform
medical acts, tasks or functions as an assistant to a physician may use the title
"physician assistant". Any other person who uses the title in any form or holds
out to be a physician assistant or to be so approved, shall be deemed to be in vio-lation
of this Article.
(b) Physician assistants are authorized to write prescriptions for drugs under the fol-lowing
conditions:
(1) The Board of Medical Examiners has adopted regulations governing the
approval of individual physician assistants to write prescriptions with such
limitations as the Board may determine to be in the best interest of patient
health and safety;
(2) The physician assistant has current approval from the Board;
(3) The Board of Medical Examiners has assigned an identification number to
the physician assistant which is shown on the written prescription; and
(4) The supervising physician has provided to the physician assistant written
instructions about indications and contraindications for prescribing drugs and
a written policy for periodic review by the physician of the drugs prescribed.
(c) Physician assistants are authorized to compound and dispense drugs under the
following conditions:
(1) The function is performed under the supervision of a licensed pharmacist;
and
(2) Rules and regulations of the North Carolina Board of Pharmacy governing
this function are complied with.
(d) Physician assistants are authorized to order medications, tests and treatments in
hospitals, clinics, nursing homes and other health facilities under the following
conditions:
(1) The Board of Medical Examiners has adopted regulations governing the
approval of individual physician assistants to order medications, tests and
treatments with such limitations as the Board may determine to be in the best
interest of patient health and safety;
(2) The physician assistant has current approval from the Board;
(3) The supervising physician has provided to the physician assistant written
instructions about ordering medications, tests and treatments, and when
appropriate, specific oral or written instructions for an individual patient with
provision for review by the physician of the order within a reasonable time,
as determined by the Board, after the medication, test or treatment is ordered;
and
(4) The hospital or other health facility has adopted a written policy, approved by
the medical staff after consultation with the nursing administration, about
ordering medications, tests and treatments, including procedures for verifica-tion
of the physician assistants' orders by nurses and other facility employees
and such other procedures as are in the interest of patient health and safety.
(e) Any prescription written by a physician assistant or order given by a physician
assistant for medications,tests and treatments shall be deemed to have been autho-rized
by the physician approved by the Board as the supervisor of the physician
assistant and such supervising physician shall be responsible for authorizing such
prescription or order.
(f) Any registered nurse or licensed practical nurse who receives an order from a
physician assistant for medications, tests or treatments is authorized to perform
that order in the same manner as if it were received from a licensed physician.
§ 90-18.2. Limitations on nurse practitioners. —
(a) Any nurse approved under the provisions of G.S. 90-18(14) to perform medical
acts, tasks or functions may use the title "nurse practitioner". Any other person
who uses the title in any form or holds out to be a nurse practitioner or to be so
approved, shall be deemed to be in violation of this Article.
(b) Nurse practitioners are authorized to write prescriptions for drugs under the fol-lowing
conditions:
(1) The Board of Medical Examiners and Board of Nursing have adopted regula-
tions developed by a joint subcommittee governing the approval of individual
nurse practitioners to write prescriptions with such limitations as the boards
may determine to be in the best interest of patient health and safety;
(2) The nurse practitioner has current approval from the boards;
(3) The Board of Medical Examiners has assigned an identification number to
the nurse practitioner which is shown on the written prescription; and
(4) The supervising physician has provided to the nurse practitioner written
instructions about indications and contraindications for prescribing drugs and
a written policy for periodic review by the physician of the drugs prescribed.
(c) Nurse practitioners are authorized to compound and dispense drugs under the fol-lowing
conditions:
(1) The function is performed under the supervision of a licensed pharmacist;
and
(2) Rules and regulations of the North Carolina Board of Pharmacy governing
this function are complied with.
(d) Nurse practitioners are authorized to order medications, tests and treatments in
hospitals, clinics, nursing homes and other health facilities under the following
conditions:
(1) The Board of Medical Examiners and Board of Nursing have adopted regula-tions
developed by a joint subcommittee governing the approval of individual
nurse practitioners to order medications, tests and treatments with such limi-tations
as the boards may determine to be in the best interest of patient health
and safety;
(2) The nurse practitioner has current approval from the boards;
(3) The supervising physician has provided to the nurse practitioner written
instructions about ordering medications, tests and treatments, and when
appropriate, specific oral or written instructions for an individual patient,
with provision for review by the physician of the order within a reasonable
time, as determined by the Board, after the medication, test or treatment is
ordered; and
(4) The hospital or other health facility has adopted a written policy, approved by
the medical staff after consultation with the nursing administration, about
ordering medications, tests and treatments, including procedures for verifica-tion
of the nurse practitioners' orders by nurses and other facility employees
and such other procedures as are in the interest of patient health and safety.
(e) Any prescription written by a nurse practitioner or order given by a nurse practi-tioner
for medications, tests or treatments shall be deemed to have been autho-rized
by the physician approved by the boards as the supervisor of the nurse prac-titioner
and such supervising physician shall be responsible for authorizing such
prescription or order.
(f) Any registered nurse of licensed practical nurse who receives an order from a
nurse practitioner for medications, tests or treatments is authorized to perform
that order in the same manner as if it were received from a licensed physician.
§ 90-19, 90-20: Repealed by Session Laws 1967, c. 691, s.59.
§ 90-21. Certain offenses prosecuted in superior court; duties of Attorney
General. — In case of the violation of the criminal provisions of G.S. 90-18, the Attorney
General of the State of North Carolina, upon complaint of the Board of Medical Examiners
of the State of North Carolina, shall investigate the charges preferred, and if in his judg-ment
the law has been violated, he shall direct the district attorney of the district in which
the offense was committed to institute a criminal action against the offending persons. A
district attorney's fee of five dollars ($5.00) shall be allowed and collected in accordance
with the provisions of G.S. 6-12. The Board of Medical Examiners may also employ, at
their own expense, special counsel to assist the Attorney General or the district attorney.
Exclusive original jurisdiction of all criminal actions instituted for the violations of
G.S. 90-18 shall be in the superior court, the provisions of any special or local act to the
contrary notwithstanding.
§ 90.21.22. Peer review agreements. —
(a) The Board of Medical Examiners may, under rules adopted by the Board in com-pliance
with Chapter 150B of the General Statutes, enter into agreements with the
North Carolina Medical Society and its local medical society components for the
purpose of conducting peer review activities. Peer review activities to be covered
by such agreements shall include investigation, review, and evaluation of records,
reports, complaints, litigation and other information about the practices and prac-tice
patterns of physicians licensed by the Board, and shall include programs for
impaired physicians.
(b) Peer review agreements shall include provisions for the society to receive rele-vant
information from the Board and other sources, conduct the investigation and
review in an expeditious manner, provide assurance of confidentiality of nonpub-lic
information and of the review process, make reports of investigations and
evaluations to the Board, and to do other related activities for promoting a coordi-nated
and effective peer review process. Peer review agreements shall include
provisions assuring due process.
(c) Each society which enters a peer review agreement with the Board shall establish
and maintain a program for impaired physicians licensed by the Board for the
purpose of identifying, reviewing, and evaluating the ability of those physicians
to function as physicians and to provide programs for treatment and rehabilita-tion.
The Board may provide funds for the administration of impaired physician
programs and shall adopt rules with provisions for definitions of impairment;
guidelines for program elements; procedures for receipt and use of information of
suspected impairment; procedures for intervention and referral; monitoring treat-ment,
rehabilitation, post-treatment support and performance; reports of individ-ual
cases to the Board; periodic reporting of statistical information; assurance of
confidentiality of nonpublic information and of the review process.
(d) Upon investigation and review of a physician licensed by the Board, or upon
receipt of a complaint or other information, a society which enters a peer review
agreement with the Board shall report immediately to the Board detailed informa-tion
about any physician licensed by the Board if:
(1) | The physician constitutes an imminent danger to the public or to himself;
(2) The physician refuses to cooperate with the program, refuses to submit to
treatment, or is still impaired after treatment and exhibits professional incom-petence;
or
(3) It reasonably appears that there are other grounds for disciplinary action.
(e) Any confidential patient information and other nonpublic information acquired,
created, or used in good faith by a society pursuant to this section shall remain
confidential and shall not be subject to discovery or subpoena in a civil case. No
person participating in good faith in the peer review or impaired physician pro-grams
of this section shall be required in a civil case to disclose any information
acquired or opinions, recommendations, or evaluations acquired or developed
solely in the course of participating in any agreements pursuant to this section.
(f) Peer review activities conducted in good faith pursuant to any agreement under
this section shall not be grounds for civil action under the laws of this State and
are deemed to be State directed and sanctioned and shall constitute State action
for the purposes of application of antitrust laws.
NORTH CAROLINA ADMINISTRATIVE CODE
TITLE 21
OCCUPATIONAL LICENSING BOARDS
CHAPTER 32
BOARD OF MEDICAL EXAMINERS
SUBCHAPTER 32A —ORGANIZATION
.0001 LOCATION
.0002 PURPOSE (REPEALED)
.0003 STRUCTURE (REPEALED)
.0004 MEETINGS
.0005 REQUIREMENT EXCEPTION
.0006 PROVISIONS FOR PETITION FOR A RULE CHANGE
.0007 DECLARATORY RULINGS
.0008 RECORDS ON FILE (REPEALED)
.0009 FORMS (REPEALED)
.0010 DISCARDING APPLICATION MATERIAL (REPEALED)
SUBCHAPTER 32B—LICENSE TO PRACTICE MEDICINE
SECTION .0100—GENERAL
.0101 DEFINITIONS
.0102 DISCARDING APPLICATION MATERIAL
.0103 FORMS
SECTION .0200—LICENSE BY WRITTEN EXAMINATION
.020 1 MEDICAL EDUCATION
.0202 ECFMG CERTIFICATION
.0203 CERTIFICATION OF GRADUATION
.0204 CERTIFIED PHOTOGRAPH
.0205 CITIZENSHIP (REPEALED)
.0206 APPLICATION FORMS
.0207 LETTERS OF RECOMMENDATION
.0208 MILITARY STATUS (REPEALED)
.0209 FEE
.0210 DEADLINE
.0211 PASSING SCORE
.02 1
2
TIME AND LOCATION
.02 1
3
GRADUATE MEDICAL EDUCATION AND TRAINING FOR
LICENSURE
.0214 PERSONAL INTERVIEW
SECTION .0300—LICENSE BY ENDORSEMENT
.030 1 MEDICAL EDUCATION
.0302 ECFMG CERTIFICATION
.0303 CITIZENSHIP (REPEALED)
.0304 APPLICATION FORMS
.0305 EXAMINATION BASIS FOR ENDORSEMENT
.0306 LETTERS OF RECOMMENDATION
.0307 CERTIFIED PHOTOGRAPH AND CERTIFICATION OF
GRADUATION
.0308 FEE
.0309 PERSONAL INTERVIEW
.0310 DEADLINE
.03 1
1
ENDORSEMENT RELATIONS
.03 1
ROUTINE INQUIRIES
.0313 GRADUATE MEDICAL EDUCATION AND TRAINING
.03 14 PASSING FLEX SCORE
.03 1
5
TEN YEAR QUALIFICATION
.0316 SPEXFEE
SECTION .0400—TEMPORARY LICENSE BY ENDORSEMENT OF
CREDENTIALS
.0401 CREDENTIALS
.0402 FEE
.0403 HARDSHIP (REPEALED)
.0404 CITIZENSHIP (REPEALED)
.0405 STATE BOARD INQUIRIES (REPEALED)
.0406 AMA REPORT (REPEALED)
.0407 DEA REPORT (REPEALED)
.0408 MILITARY STATUS (REPEALED)
.0409 FOREIGN MEDICAL GRADUATES (REPEALED)
.0410 FEE (REPEALED)
.04 1
HARDSHIP (REPEALED)
.04 1
2
PERSONAL APPEARANCE (REPEALED)
.04 1
3
BOARD INTERVIEW (REPEALED
)
.0414 POSTGRADUATE TRAINING (REPEALED)
.0415 PASSING FLEX SCORE (REPEALED)
SECTION .0500—RESIDENT'S TRAINING LICENSE
.0501 APPLICATION FORM
.0502 CERTIFICATION OF GRADUATION
.0503 CERTIFIED PHOTOGRAPH
.0504 LETTERS OF RECOMMENDATION
.0505 APPOINTMENT LETTER
.0506 FEE
.0507 ECFMG CERTIFICATION
.0508 MEDICAL EDUCATION
SECTION .0600—SPECIAL LIMITED LICENSE
.060
1
APPLICATION AND LIMITATION
.0602 CERTIFICATION OF GRADUATION
.0603 CERTIFIED PHOTOGRAPH
.0604 LETTERS OF RECOMMENDATION
.0605 DIPLOMA OF PSYCHOLOGICAL MEDICINE
.0606 FEE
.0607 ECFMG CERTIFICATION
.0608 PERSONAL INTERVIEW
SECTION .0700—CERTIFICATE OF REGISTRATION
FOR VISITING PROFESSORS
.070
REQUEST FOR THE CERTIFICATE OF REGISTRATION
.0702 MEDICAL LICENSURE
.0703 LIMITATION
.0704 DURATION
.0705 PERSONAL INTERVIEW
.0706 FEE
.0707 CERTIFIED PHOTOGRAPH
SUBCHAPTER 32C — PROFESSIONAL CORPORATIONS
.0001 AUTHORITY AND DEFINITIONS (REPEALED)
.0002 NAME OF PROFESSIONAL CORPORATION
.0003 PREREQUISITES FOR INCORPORATION
.0004 CERTIFICATE OF REGISTRATION
.0005 STOCK AND FINANCIAL MATTERS
.0006 CHARTER AMENDMENTS AND STOCK TRANSFERS
.0007 DOCUMENTS
.0008 FEES
SUBCHAPTER 32D—APPROVAL OF ASSISTANT TO PHYSICIAN
(REPEALED)
.0001 DEFINITIONS
.0002 APPLICATION FOR APPROVAL
.0003 REQUIREMENTS FOR APPROVAL
.0004 MORAL CHARACTER
.0005 REQUIREMENTS FOR RECOGNITION OF TRAINING
PROGRAMS
.0006 TERMINATION OF APPROVAL
.0007 METHOD OF PERFORMANCE
.0008 FEES
.0009 FORMS
SUBCHAPTER 32E—APPROVAL OF REGISTERED NURSE
PERFORMING MEDICAL ACTS (REPEALED)
.0001 DEFINITIONS
.0002 APPLICATION FOR APPROVAL
.0003 REQUIREMENTS FOR APPROVAL
.0004 MORAL CHARACTER
.0005 TERMINATION OF APPROVAL
.0006 ANNUAL APPROVAL
.0007 FEES
.0008 FORMS
SUBCHAPTER 32F—BIENNIAL REGISTRATION
.0001 TIME (REPEALED)
.0002 REQUIRED INFORMATION (REPEALED)
.0003 FEE
.0004 FAILURE TO REGISTER (REPEALED)
.0005 FORMS
SUBCHAPTER 32G—MOBILE INTENSIVE CARE (REPEALED)
.0001 AUTHORITY: INTENT AND GOALS
.0002 DEFINITIONS
.0003 HOSPITAL UTILIZATION
.0004 TRAINING PROGRAMS
.0005 MOBILE INTENSIVE CARE TECHNICIAN
.0006 EMERGENCY MEDICAL TECHNICIAN: I.V.
.0007 EMERGENCY CHILDBIRTH
.0008 REQUIREMENTS FOR CERTIFICATION
.0009 FORMS
SUBCHAPTER 32H—MOBILE INTENSIVE CARE
SECTION .0100—GENERAL INFORMATION
.0101 AUTHORITY: INTENT AND GOALS
.0102 DEFINITIONS
SECTION .0200—PROGRAM STANDARDS AND APPROVAL
.020 1 MOBILE INTENSIVE CARE PROGRAM CRITERIA
.0202 PROGRAM APPROVAL
SECTION .0300—HOSPITAL UTILIZATION
.0301 HOSPITAL INVOLVEMENT
.0302 PLAN FOR PARTICIPATING HOSPITALS
.0303 SPONSOR HOSPITAL
.0304 RESOURCE HOSPITAL (REPEALED)
SECTION .0400—TRAINING AND PERFORMANCE OF MOBILE
INTENSIVE CARE PERSONNEL
.0401 TRAINING PROGRAMS
.0402 EMERGENCY MEDICAL TECHNICIAN: PARAMEDIC
PERFORMANCE
.0403 EMERGENCY MEDICAL TECHNICIAN: INTERMEDIATE
PERFORMANCE
.0404 MOBILE INTENSIVE CARE NURSE PERFORMANCE
.0405 TECHNICIAN PERFORMANCE IN THE PRESENCE OF A
PHYSICIAN
.0406 EMERGENCY MED TECHNICIANS: ADVD INTERMEDIATE
PERFORMANCE
.0407 EMERGENCY MEDICAL TECHNICIAN: DEFIBRILLATION
PERFORMANCE
SECTION .0500—CERTIFICATION AND APPROVAL REQUIREMENTS FOR
MOBILE INTENSIVE CARE PERSONNEL
.0501 CERTIFICATION REQUIREMENTS: EMT-PARAMEDIC
.0502 CERTIFICATION REQUIREMENTS: EMT-INTERMEDIATE
.0503 APPROVAL REQUIREMENTS: MOBILE INTENSIVE CARE
NURSE
.0504 CERTIFICATION REQUIREMENTS: EMT-ADVANCED
INTERMEDIATE
.0505 CERTIFICATION REQUIREMENTS: EMT-DEFIBRILLATION
SECTION .0600—ENFORCEMENT
.0601 GROUNDS FOR DENIAL: SUSPENSION: OR REVOCATION
.0602 PROCEDURES FOR DENIAL; SUSPENSION OR REVOCATION
.0603 EFFECTIVE DATE (REPEALED)
SECTION .0700—EXCEPTIONS
.0701 CONDITIONS
.0702 REQUESTS
SECTION .0800—FORMS
.0801 REQUIRED FORMS
.0802 SOURCE OF FORMS
SECTION .0900—STUDY PROJECTS
.0901 CONDITIONS
.0902 STUDY PROJECT APPROVAL
.0903 STUDY RECOMMENDATIONS
SECTION .1000—MEDICAL CONTROL
. 1 00 1 MEDICAL CONTROL PROCEDURES
.1002 MEDICAL CONTROL FROM HOSPITAL OUTSIDE SERVICE
AREA
. 1 003 MEDICAL CONTROL FOR TRANSPORTS BETWEEN
FACILITIES
.1004 AIR AMBULANCE PROGRAM CRITERIA
SUBCHAPTER 321—EPINEPHRINE FOR ADVERSE REACTIONS
TO INSECT STINGS
.0001 REQUIREMENTS FOR APPROVAL
.0002 TRAINING PROGRAMS
.0003 APPROVAL
.0004 FORMS
SUBCHAPTER 32J—REINSTATEMENT OF SUSPENDED LICENSE
.0001 APPLICATION FOR REINSTATEMENT
.0002 CONSIDERATION BY BOARD
.0003 HEARING UPON DENIAL
SUBCHAPTER 32K—IMPAIRED PHYSICIAN PROGRAMS
SECTION .0100—GENERAL INFORMATION
.0101 DEFINITIONS
.0102 AUTHORITY
.0 1 03 PEER REVIEW AGREEMENTS
.0104 DUE PROCESS
SECTION .0200—GUIDELINES FOR PROGRAM ELEMENTS
.020 1 RECEIPT AND USE OF INFORMATION OF SUSPECTED
IMPAIRMENT
.0202 INTERVENTION AND REFERRAL
.0203 MONITORING TREATMENT
.0204 MONITORING REHABILITATION AND PERFORMANCE
.0205 MONITORING POST-TREATMENT SUPPORT
.0206 REPORTS OF INDIVIDUAL CASES TO THE BOARD
.0207 PERIODIC REPORTING OF STATISTICAL INFORMATION
.0208 CONFIDENTIALITY
SUBCHAPTER 32L—APPROVAL OF PHYSICIAN ASSISTANTS
.0001 DEFINITIONS
.0002 PHYSICIAN ASSISTANT APPLICANT STATUS
.0003 REQUIREMENTS FOR PA APPROVAL
.0004 APPLICATION FOR PA APPROVAL
.0005 PRESCRIBING PRIVILEGES
.0006 REQUIREMENTS FOR RECOGNITION OF PA TRAINING
PROGRAMS
.0007 TERMINATION OF PA APPROVAL
.0008 METHOD OF IDENTIFICATION
.0009 SUPERVISION OF A PA
.00 1 ANNUAL REGISTRATION OF PA APPROVAL
.0011 FEES
.0012 PA FORMS
SUBCHAPTER 32M—APPROVAL OF NURSE PRACTITIONERS
.0001 DEFINITIONS
.0002 NURSE PRACTITIONER APPLICANT STATUS
.0003 REQUIREMENTS FOR NP APPROVAL
.0004 APPLICATION FOR NP APPROVAL
.0005 REQUIREMENTS FOR RECOGNITION OF NP EDUCATION
PROGRAMS
.0006 PRESCRIBING PRIVILEGES
.0007 TERMINATION OF NP APPROVAL
.0008 METHOD OF IDENTIFICATION
.0009 SUPERVISION OF NP
.0010 ANNUAL RENEWAL OF NP APPROVAL
.0011 FEES
.0012 NP FORMS
SUBCHAPTER 32N—FORMAL AND INFORMAL PROCEEDINGS
.000
1
INITIATION OF FORMAL HEARINGS
.0002 CONTINUANCES
.0003 DISQUALIFICATION FOR PERSONAL BIAS
.0004 DISCOVERY
.0005 INFORMAL PROCEEDINGS
CHAPTER 32—BOARD OF MEDICAL EXAMINERS
SUBCHAPTER 32A—ORGANIZATION
.0001 LOCATION
The location of the office of the Board of Medical Examiners is 1203 Front Street,
Raleigh, North Carolina 27609. The phone number is (919) 828-1212.
.0002 PURPOSE (REPEALED)
.0003 STRUCTURE (REPEALED)
.0004 MEETINGS
The Board customarily meets at regularly scheduled intervals as appropriate to carry
out Board business. Other meetings may be called by the President of the Board or upon
written request of the majority of the members of the Board.
.0005 REQUIREMENT EXCEPTION
When the Board finds that an applicant is unable to comply with the requirements for
proof of qualification for licensure because of circumstances beyond his control, the Board
may accept in lieu of the requirements such other evidence or information which will satis-fy
the Board that the applicant is qualified for licensure or approval as required by law.
.0006 PROVISIONS FOR PETITION FOR A RULE CHANGE
Each person desiring to petition for the adoption, amendment or repeal of a rule should
submit the following information to the Board:
( 1
)
draft of the proposed rule or amendment to rule;
(2) reasons for the proposal;
(3) effect of the existing rule;
(4) data supporting the proposal;
(5) effect on existing practices in the area involved, including costs;
(6) names of those most likely to be affected, with addresses if known; and
(7) the name and address of the petitioner.
The Executive Secretary shall consult with Board members as appropriate to render a
decision regarding the denial of a petition or the initiation of rule-making proceedings.
.0007 DECLARATORY RULINGS
The Board will consider a request to make a declaratory ruling on the validity of a rule
only when the petitioner shows that circumstances are so changed since adoption of the
rule that such a ruling would be warranted, or that the rule-making record for the rule evi-dences
a failure by the agency to consider specified relevant factors. The petitioner shall
state in his request the consequences of a failure to issue a ruling.
.0008 RECORDS ON FILE (REPEALED)
.0009 FORMS (REPEALED)
.0010 DISCARDING APPLICATION MATERIAL (REPEALED)
SUBCHAPTER 32B —LICENSE TO PRACTICE MEDICINE
SECTION .0100—GENERAL
.0101 DEFINITIONS
The following definitions apply to Rules within this Subchapter:
(1) ACGME - Accreditation Council for Graduate Medical Education.
(2) AOA - American Osteopathic Association.
(3) Board - Board of Medical Examiners of the State of North Carolina.
(4) ECFMG - Educational Commission for Foreign Medical Graduates.
(5) Fifth Pathway - an avenue for licensure as defined in the Directory of
Accredited Residencies 1977-1978, American Medical Association, pp. 30-
32.
(6) FLEX - Federation Licensing Examination.
(7) LCME - Liaison Commission on Medical Education.
(8) SPEX - Special Purpose Examination.
(9) AMA - Physician's Recognition Award - American Medical Association
recognition of achievement by physicians who have voluntarily completed
programs of continuing medical education.
(10) American Specialty Boards - specialty boards approved by the American
Board of Medical Specialties.
.0102 DISCARDING APPLICATION MATERIAL
Applications must be completed within one year of the date requirements are mailed
from the Board's office. If not completed within one year, any application materials
received will be discarded.
.0103 FORMS
All forms and lists of requirements referred to in this Subchapter may be obtained from
the Board's office.
SECTION .0200—LICENSE BY WRITTEN EXAMINATION
.0201 MEDICAL EDUCATION
Applicants for the written examination must have the medical education required by
G.S. 90-9. To be eligible for the written examination, an applicant must have the follow-ing
medical education:
(1) be a graduate of a medical school approved by either LCME or AOA; or
(2) be a graduate of a medical school not approved by LCME or AOA and either:
(a) be currently enrolled in a graduate medical education and training program in
North Carolina approved by ACGME or AOA; or
(b) have satisfactorily completed three years of graduate medical education and
training after graduation from medical school which is approved by the
ACGME or AOA.
No applicant graduated from a medical school which has been disapproved by the
Board shall be eligible for examination or licensure in North Carolina. The burden of proof
of medical education is on the applicant.
.0202 ECFMG CERTIFICATION
To be eligible for the written examination, applicants who are graduates of medical
schools other than those approved by LCME or AOA must furnish a photocopy of a cur-rently
valid standard certificate of ECFMG. ECFMG certification may be waived by the
Board if the applicant has either:
(1) passed the ECFMG examination and successfully completed an approved Fifth
Pathway Program; or
(2) been licensed in another state on the basis of written examination prior to the
establishment of ECFMG in 1958.
.0203 CERTIFICATION OF GRADUATION
An applicant for written examination must submit a statement from the dean or other
official of the applicant's medical school certifying the applicant's date of graduation from
medical school. This certification must bear the signature of the dean or other official of
the medical school and the seal of the medical school. This certification may be contained
on the certified photograph under Rule .0204 of this Section or on a separate document.
.0204 CERTIFIED PHOTOGRAPH
An applicant for written examination must submit a recent photograph, at least 2 1/2
inches by 3 1/4 inches, certified on the back as a true likeness of the applicant by the dean
or other official of the applicant's medical school. This certification must bear the signa-ture
of the dean or other official of the medical school and the seal of the medical school.
.0205 CITIZENSHIP (REPEALED)
.0206 APPLICATION FORMS
An applicant for written examination must complete the following application forms
which request information regarding the applicant's personal, educational, and profession-al
background:
(1) the Board's questionnaire; and
(2) the Federation of State Medical Board's application form.
.0207 LETTERS OF RECOMMENDATION
An applicant for written examination must request that three letters of recommendation
be submitted to the Board on his behalf. The letters must be originals addressed to the
Board and must contain the original signature of the author. One of the letters must be
from someone who has known the applicant for a period of ten years and two of the letters
must be from physicians.
.0208 MILITARY STATUS (REPEALED)
.0209 FEE
(a) The fee for both components of the written examination taken together is two
hundred and fifty dollars ($250.00), plus the cost of test materials, due at the time
of application.
(b) If the two components are taken separately, the fee for each component is due at
the time of application for that component as follows:
(1) for the first component, two hundred and fifty dollars ($250.00) plus the cost
of test materials;
(2) for the second component, one hundred and fifty dollars ($150.00) plus the
cost of test materials.
(c) In the event the applicant fails to make a passing score on both components taken
together or either component taken separately, the fee will not be refunded.
(d) In the event the applicant does not appear for the regularly scheduled examination
or the application is withdrawn, no portion of the fee will be refunded.
.0210 DEADLINE
All application materials must be in the Board's office at least 75 days prior to the written
examination. The 75 day deadline may be waived on the certification of graduation
requirement, Rule .0203 of this Section, if the applicant is either in attendance at a medical
school approved by LCME or AOA located in North Carolina or is a citizen of the State of
North Carolina. However, before the examination, the applicant must satisfy the certifi-cate
of graduation requirement as follows:
(1) Not less than 75 days before the date of the examination, the Board must receive
a letter from the dean of the applicant's medical school stating that the applicant
is expected to complete all requirements for graduation prior to the date of the
examination.
(2) Prior to the date of the examination, the Board must receive a letter from the dean
of the medical school stating that the applicant has completed all requirements
for, and will receive, the M.D. degree from the medical school.
(3) After the applicant's graduation, the Board must receive a letter from the appli-cant's
medical school certifying the date on which the applicant received the
M.D. degree. This certification must bear the signature of the dean or other offi-cial
and the seal of the medical school.
.0211 PASSING SCORE
To pass the written examination, the applicant is required to attain a score of at least 75
on FLEX Component I and a score of a least 75 on FLEX Component II. Components
may be taken in tandem. Any component that is failed may be retaken; however,
Component II may not be taken alone unless the applicant has passed Component I within
the last seven years. Both components must be passed within seven years of the date of
taking the initial examination.
.0212 TIME AND LOCATION
The Board holds two examinations each year, one in June and one in December, in
Raleigh, North Carolina.
.0213 GRADUATE MEDICAL EDUCATION AND TRAINING FOR LICENSURE
Before licensure, physicians who pass the written examination must furnish proof of
graduate medical education and training taken after graduation from medical school as fol-lows:
(1) Graduates of medical schools approved by LCME or AOA must have satisfacto-rily
completed one year of graduate medical education and training approved by
ACGME or AOA.
(2) Graduates of medical schools other than those approved by LCME or AOA must
have satisfactorily completed three years of graduate medical education and train-ing
approved by ACGME or AOA.
.0214 PERSONAL INTERVIEW
To be eligible for the written examination, applicants who are graduates of medical
schools not approved by the LCME or AOA must appear before the Executive Secretary
for a personal interview upon completion of all credentials. This interview must be con-ducted
at least 75 days prior to the date of the examination.
SECTION .0300 — LICENSE BY ENDORSEMENT
.0301 MEDICAL EDUCATION
Applicants for license by endorsement of credentials must have the medical education
required by G.S. 90-9. To be eligible for license by endorsement of credentials, an appli-cant
must have the following medical education:
( 1
)
be a graduate of a medical school approved by either LCME or AOA and meet
the requirements regarding graduate medical education and training under Rule
.0313 of this Section;
(2) be a graduate of a medical school not approved by LCME or AOA and meet the
requirements regarding:
(a) graduate medical education and training under Rule .0313 of this Section,
and
(b) ECFMG certification under Rule .0302 of this Section.
No applicant graduated from a medical school which has been disapproved by the
Board shall be eligible for licensure in North Carolina. The burden of proof of medical
education is on the applicant.
.0302 ECFMG CERTIFICATION
To be eligible for license by endorsement of credentials, applicants who are graduates
of medical schools other than those approved by LCME or AOA must furnish a photocopy
of a currently valid standard certificate of ECFMG. ECFMG certification may be waived
by the Board if the applicant has either:
(1) passed the ECFMG examination and successfully completed an approved Fifth
Pathway Program; or
(2) been licensed in another state on the basis of written examination prior to the
establishment of ECFMG in 1958.
.0303 CITIZENSHIP (REPEALED)
.0304 APPLICATION FORMS
An applicant for license by endorsement of credentials must complete the Board's
application form which requests information regarding an applicant's personal, education-al,
and professional background.
0305 EXAMINATION BASIS FOR ENDORSEMENT
(a) To be eligible for license by endorsement of credentials, graduates of medical
schools approved by the LCME or AOA must supply certification of passing
scores on one of the following written examinations:
(1) National Board of Medical Examiners;
(2) FLEX - under Rule .03 1 2 of this Section;
(3) Written examination other than FLEX from the state board which issued the
original license by written examination;
(4) National Board of Osteopathic Examiners, all parts taken after January 1,
1990.
(b) Graduates of medical schools not approved by LCME or AOA must supply certi-fication
of passing scores on one of the following written examinations:
( 1
)
FLEX - under Rule .03 1 4 of this Section; or
(2) Written examination other than FLEX from the state board which issued the
applicant's original license by written examination together with American
Specialty Board certification.
(c) A physician who has a valid and unrestricted license to practice medicine in
another state, based on a written examination testing general medical knowledge,
and who within the past five hears has become, and is at the time of application,
certified or recertified by an American Specialty Board, is eligible for license by
endorsement.
(d) Applicants for license by endorsement of credentials with FLEX scores that do
not meet the requirements of Rule .0314 of this Section must meet the require-ments
of Paragraph (c) in this Rule.
.0306 LETTERS OF RECOMMENDATION
An applicant for license by endorsement of credentials must request that three letters of
recommendation be submitted to the Board on his behalf. The letters must be originals
addressed to the Board and must contain the original signature of the author. One of the
letters must be from someone who has known the applicant for a period of ten years and
two of the letters must be from physicians.
.0307 CERTIFIED PHOTOGRAPH AND CERTIFICATION OF GRADUATION
An applicant for license by endorsement of credentials must submit a recent photo-graph,
at least 2 1/2 inches by 3 1/4 inches, certified on the back as a true likeness of the
applicant by the dean or other official of the applicant's medical school indicating the
applicant'sdate of graduation from medical school. This certification must bear the signa-ture
of the dean or other official of the medical school and the seal of the medical school.
.0308 FEE
A fee of two hundred and fifty dollars ($250.00) is due at the time of application. In
the event the applicant does not appear for a scheduled personal interview, no portion of
the fee may be refunded. In the event licensure is denied or the application is withdrawn,
no portion of the fee may be refunded.
.0309 PERSONAL INTERVIEW
To be eligible for license by endorsement of credentials, applicants must appear before
the Executive Secretary, a Board member, an agent of the Board, or the full Board for a
personal interview upon completion of all credentials.
.0310 DEADLINE
For an applicant to be eligible for license by endorsement of credentials at a given
Board meeting, all application material must be in the Board's office at least 15 days prior
to the meeting.
.0311 ENDORSEMENT RELATIONS
The Board does not grant a license by endorsement of credentials on the basis of prac-tice
in any government service nor on the basis of licensing by medical boards outside the
United States and its territories.
.0312 ROUTINE INQUIRIES
An applicant for license by endorsement must request that the following reports be
submitted to the Board:
(1) If affiliated with a county or state medical society, a letter of current standing
must be submitted on the applicant's behalf.
(2) Reports from all states in which the applicant has ever been licensed to practice
medicine indicating the status of the applicant's license and whether or not the
license has been revoked, suspended, surrendered, or placed on probationary
terms must be mailed directly from other state boards to the Board.
An AMA Physician Profile is requested of AMA by the Board.
.0313 GRADUATE MEDICAL EDUCATION AND TRAINING
To be eligible for license by endorsement of credentials, applicants must furnish proof
of graduate medical education and training taken after graduation from medical school as
follows:
(1) Graduates of medical schools approved by LCME or AOA must have satisfacto-rily
completed one year of graduate medical education and training approved by
ACGME or AOA.
(2) Graduates of medical schools other than those approved by LCME or AOA must
have satisfactorily completed three years of graduate medical education and train-ing
approved by ACGME or AOA.
.0314 PASSING FLEX SCORE
Physicians who have taken the FLEX examination may be eligible to apply for a
license by endorsement of credentials if they meet the following score requirements:
(1) FLEX taken before January 1, 1983 - A FLEX weighted average of 75 or more
on a single three day examination is required.
(2) FLEX taken after January 1, 1983 - A FLEX weighted average of 75 or more on
a single three day examination, with a score not less than 70 on Day I, a score not
less than 75 on Day II, and a score not less than 75 on Day III, is required.
(3) FLEX taken after January 1, 1985:
(a) A score of at least 75 on FLEX Component I and a score of at least 75 on
FLEX Component II is required.
(b) Components may be taken in tandem. Any component that is failed may be
retaken; however, Component II may not be taken alone unless the applicant
has passed Component I within the last seven years.
(c) Both components must be passed within seven years of the date of taking the
initial examination.
.0315 TEN YEAR QUALIFICATION
(a) To be eligible for license by endorsement of credentials, an applicant who has not
met one of the following qualifications within the past ten years of the date of the
application to the Board, must take the SPEX, or other examination as determined
by the Board, and attain a score of at least 75:
(1) National Board of Medical Examiners certification;
(2) FLEX scores as required under Rule .03 14 of this Section;
(3) SPEX score of at least 75;
(4) certification or re-certification from a specialty board recognized by the
American Board of Medical Specialties; or
(5) completion of formal postgraduate medical education as required under Rule
.0313 of this Section.
(b) The SPEX requirement may be waived upon receipt of a current AMA
Physician's Recognition Award.
(c) This requirement is in addition to all other requirements for licensure and may be
applied as the Board deems appropriate.
.0316 SPEX FEE
(a) The fee for taking SPEX, or other examination as determined by the Board, will
be the Board's cost of the test materials and is due at the time of application.
(b) In the event the applicant fails to make a passing score, the fee will not be refund-ed.
(c) In the event the applicant does not appear for the regularly scheduled examination
or the application is withdrawn, no portion of the fee will be refunded.
SECTION .0400—TEMPORARY LICENSE BY
ENDORSEMENT OF CREDENTIALS
.0401 CREDENTIALS
Applicants for a temporary license by endorsement of credentials must meet all
requirements listed under Section .0300, LICENSE BY ENDORSEMENT OF CREDEN-TIALS,
with the exception of the fee requirement.
.0402 FEE
Fee of fifty dollars ($50.00) is to be paid at time of application. This fee is not applica-ble
to full licensure and is not refundable.
.0403 HARDSHIP (REPEALED)
.0404 CITIZENSHIP (REPEALED)
.0405 STATE BOARD INQUIRIES (REPEALED)
.0406 AMA REPORT (REPEALED)
.0407 DEA REPORT (REPEALED)
.0408 MILITARY STATUS (REPEALED)
.0409 FOREIGN MEDICAL GRADUATES (REPEALED)
.0410 FEE (REPEALED)
.0411 HARDSHIP (REPEALED)
.0412 PERSONAL APPEARANCE (REPEALED)
.0413 BOARD INTERVIEW (REPEALED)
.0414 POSTGRADUATE TRAINING (REPEALED)
.0415 PASSING FLEX SCORE (REPEALED)
SECTION .0500 — RESIDENT'S TRAINING LICENSE
.0501 APPLICATION FORM
An applicant for a resident's training license must complete an application form sup-plied
by the Board regarding the applicant's personal, educational, and professional back-ground.
.0502 CERTIFICATION OF GRADUATION
An applicant for a resident's training license must submit a statement from the dean or
other official of the applicant's medical school certifying the applicant's date of graduation
from medical school. This certification must bear the signature of the dean or other offi-cial
of the medical school and the seal of the medical school. This certification may be
contained on the certified photograph, under Rule .0503 of this Section, or on a separate
document.
.0503 CERTIFIED PHOTOGRAPH
An applicant for a resident's training license must submit a recent photograph, at least
2 1/2 inches by 3 1/4 inches, certified on the back as a true likeness of the applicant by the
dean or other official of the applicant's medical school. This certification must bear the
signature of the dean or other official of the medical school and the seal of the medical
school.
.0504 LETTERS OF RECOMMENDATION
An applicant for a resident's training license must request that two letters of recom-mendation
be submitted to the Board on his behalf by physicians. The letters must be
originals addressed to the Board and must contain the original signature of the author.
.0505 APPOINTMENT LETTER
An appointment letter must be submitted from the chief of service of the residency pro-gram,
or his appointed representative, verifying the applicant's residency appointment and
the commencement date of residency into which the applicant is entering.
.0506 FEE
A fee of twenty-five dollars ($25.00) is due at the time of application. No portion of
the application fee is refundable.
xl
.0507 ECFMG CERTIFICATION
To be eligible for a resident's training license, applicants who are graduates of medical
schools other than those approved by LCME or AOA must furnish a photocopy of a cur-rently
valid standard certificate of the ECFMG. Upon passing the ECFMG examination
and successfully completing an approved Fifth Pathway Program, ECFMG certification
may be waived by the Board.
.0508 MEDICAL EDUCATION
Applicants for resident's training license must have the medical education required by
G.S. 90-9.
(1) To be eligible for a resident's training license, an applicant must have the follow-ing
medical education:
(a) be a graduate of a medical school approved by either LCME or AOA; or
(b) be a graduate of a medical school not approved by either LCME or AOA and
meet the requirement regarding ECFMG under Rule .0507 of this Section.
(2) If a graduate of a medical school not approved by either LCME or AOA has
taken clinical clerkships in the U.S.A., the applicant must:
(a) meet the requirement regarding ECFMG under Rule .0507 of this Section;
(b) furnish evidence that he has satisfactorily completed clinical clerkships at
teaching hospitals in the U.S.A. with ACGME or AOA approved graduate
medical education and training programs in the areas of the specific clerk-ships;
or
(c) if clerkships do not meet the requirement in (2)(b) of this Rule, remedy the
deficiencies as follows:
(i) re-apply to medical school so that the school may arrange for the appli-cant
to complete approved clinical clerkships as required; or
(ii) apply for admission to advanced standing at a medical school approved
by the LCME or AOA to repeat one year of clinical clerkship.
(3) A graduate of a medical school not approved by either LCME or AOA whose
clinical clerkships do not meet the requirements in (Z)(b) of this Rule who has
satisfactorily completed three years of graduate medical education and training
after graduating from a medical school which is approved by the ACGME or
AOA, must submit proof of the three years of graduate medical education and
training.
The burden of proof of medical education is on the applicant.
SECTION .0600 — SPECIAL LIMITED LICENSE
.0601 APPLICATION AND LIMITATION
An applicant for a special limited license must complete an application form supplied
by the Board regarding the applicant's personal, educational, and professional background.
The practice of a physician granted a special limited license is limited to the institution
listed on the application.
.0602 CERTIFICATION OF GRADUATION
An applicant for a special limited license must submit a statement from the dean or
other official of the applicant's medical school certifying the applicant's date of graduation
from medical school. This certification must bear the signature of the dean or other offi-cial
of the medical school and the seal of the medical school. This certification may be
contained on the certified photograph, under Rule .0603 of this Section, or on a separate
document.
.0603 CERTIFIED PHOTOGRAPH
An applicant for a special limited license must submit a recent photograph, at least 2
1/2 inches by 3 1/4 inches, certified on the back as a true likeness of the applicant by the
dean or other official of the applicant's medical school. This certification must bear the
signature of the dean or other official of the medical school and the seal of the medical
school.
.0604 LETTERS OF RECOMMENDATION
An applicant for a special limited license must request that two letters of recommenda-tion
be submitted to the Board on his behalf by physicians. The letters must be originals
addressed to the Board and must contain the original signature of the author.
xli
.0605 DIPLOMA OF PSYCHOLOGICAL MEDICINE
An applicant for a special limited license must furnish a photocopy of Ocertificate of
the British Diploma of Psychological Medicine or the Canadian equivalent.
.0606 FEE
A fee of one hundred and fifty dollars ($150.00) is due at the time of application. No
portion of the application fee is refundable.
.0607 ECFMG CERTIFICATION
In order to be eligible for a special limited license, applicants who are graduates of
medical schools other than those approved by LCME or AOA must furnish a photocopy of
a currently valid standard certificate of the ECFMG. Upon passing the ECFMG examina-tion
and successfully completing an approved Fifth Pathway Program, ECFMG certifica-tion
may be waived by the Board.
.0608 PERSONAL INTERVIEW
An applicant for special limited license is required to appear in person before the Board
at a regular meeting.
SECTION .0700 — CERTIFICATE OF REGISTRATION
FOR VISITING PROFESSORS
.0701 REQUEST FOR THE CERTIFICATE OF REGISTRATION
A written request for the Certificate of Registration for a Visiting Professor shall come
from the dean of the medical school to which the applicant is seeking appointment. This
request shall state the qualifications, position, responsibilities, and length of appointment
of the visiting professor for whom the request is made.
.0702 MEDICAL LICENSURE
The visiting professor applicant must furnish proof of medical licensure in another
state or foreign country by submitting a letter from the licensing agency indicating the sta-tus
of the applicant's license.
.0703 LIMITATION
The practice of the visiting professor is limited to the institution requesting the
Certificate of Registration.
.0704 DURATION
The Certificate of Registration shall be valid for one year.
.0705 PERSONAL INTERVIEW
The visiting professor applicant is required to appear in person before the Executive
Secretary, a Board member, or the full Board.
.0706 FEE
A fee of fifty dollars ($50.00) is due at the time of application. No portion of the fee is
refund