NCMS President Visits NC Medical Board

This week, NCMS President Robert W. Monteiro, MD, attended the bi-monthly meeting of the North Carolina Medical Board (NCMB). Dr. Monteiro met with the Board’s new officers and members, toured the building and sat in on a number of meetings to gain a better understanding of Medical Board processes.

“The Medical Board plays an important role in the delivery of health care in North Carolina. Strong, pro-active oversight is essential to quality health care and vital for patient safety. I found the Board to be very thorough and fair while observing their meetings,” Dr. Monteiro said.

Below is an update of the Board’s actions:

• Position Statement on Self-Treatment and the Treatment of Family Members:  The Board reviews each of its position statements every four years; the statement on Self-Treatment has been up for discussion since last year.  While many drafts have been circulated in recent months, the Board’s Policy Committee finally gave approval to a set of revisions on Wednesday. This draft can be viewed here. The Board will vote on the proposed revision at a future meeting, to allow ample time for stakeholder feedback.
•  Continuing Medical Education: On Friday the Board gave approval to draft rules regarding the Continuing Medical Education requirements for licensees. The draft rules propose to reduce the number of CME hours required from 150 every three years to 60.  This change will bring the NC Medical Board standards more in line with other states by eliminating Category II, or physician-initiated, CME altogether. The NCMS successfully advocated against proposed language which would have required the Board to issue a $500 presumptive fine to any licensee who fails to comply with CME requirements.  This language was removed from the proposal and the Board will continue to address licensees that fail to comply with CME requirements as they do today – on an individualized basis, which may include administrative fines or disciplinary action depending on the circumstances of the case.

  The new CME rules (that can be viewed here) have been approved by the Medical Board but have yet to be filed with the Rules Review Commission. The change to the required number of CME hours will not take effect until after a public hearing is held and the rules are approved by the Rules Review Commission later this year.

Internist Cheryl Walker-McGill, MD, of Charlotte is the newest member of the NC Medical Board. She made her first appearance when the Board met Thursday in Raleigh. Governor Perdue named Dr. Walker-McGill to replace Edward Jablonski, DO, of Etowah, whose term expired last month. Dr. Walker-McGill received her medical degree from Duke University. She is a member of the American College of Physicians and the Old North State Medical Society.

Last week Governor Beverly Perdue appointed Shiva K. Rao, MD to the North Carolina Medical Board. Dr. Rao practices general surgery in Roanoke Rapids and is a 2004 graduate of the NCMS Leadership College.

He is a Fellow of the American College of Surgeons and a past chief of staff at Halifax Regional Medical Center. Dr. Rao is also a past president of the Halifax-Northampton County Medical Society. His term will expire on October 31, 2014.

In May 2010 the NC Board of Nursing established an APRN Advisory Committee charged with studying the licensure, accreditation, certification and education of advanced practice registered nurses in North Carolina.  The establishment of this committee came as a result of the adoption of the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education by the National Council of State Boards of Nursing (NCSBN).

Since the adoption of the national model in 2008, the NCSBN has pushed for adoption in all fifty states. North Carolina is next on this list.  The advisory committee in North Carolina was comprised of 16 members including 14 nurses and two public representatives.

The committee met four times and presented its recommendations to the NC Board of Nursing at the September 2011 meeting. These recommendations include:

• Sole regulation of all advanced practice registered nurses by the NC Board of Nursing, eliminating the shared regulatory role of the NC Medical Board over Nurse Practitioners (NP).
• Elimination of physician supervision requirements for Nurse Practitioners (NP) and Certified Nurse Midwives (CNM).
• Grant prescriptive authority to Certified Registered Nurse Anesthetists (CRNA) and Clinical Nurse Specialists (CNS).

The NCMS is watching this issue very closely and will continue to offer updates in the Bulletin as they become available.   NCMS policy supports the requirement of physician supervision of mid-level practitioners who perform medical acts, tasks, and functions (Physician Relationship With Mid-Level Practitioners).

Related legislation is expected to become a priority for the NCMS legislative team during the upcoming session of the NC General Assembly. Read the entire report from the APRN Advisory Committee here.

At its September meeting, the North Carolina Medical Board Policy Committee discussed at length its current position statement regarding Self-Treatment and Treatment of Family Members and Others with Whom Significant Emotional Relationships Exist. The committee reported receiving more than 1,000 comments from licensees regarding the position statement with concerns being expressed both in favor of and in opposition to revising the statement.

You can view the proposed changes to the position statement on page 8 of the Policy Committee agenda, by clicking here. However, after much discussion the committee agreed to table this item and re-write the proposed position statement for a second time. A new draft will be presented at the November 2011 committee meeting.

In the meantime the committee agreed to move forward in filing a rule prohibiting licensees from prescribing controlled substances for their own use or for the use of the licensee’s spouse, parent, child, sibling, parent-in-law, son or daughter-in-law, brother or sister-in-law, step-parent, step-child, step-sibling, or any other person living in the same residence as the licensee, or anyone with whom the physician is having a sexual relationship. 

As this proposal is filed and moved through the rule-making process, there will be additional opportunity for public comment – NCMS staff will notify members in the Bulletin when such opportunities become available.

At the September 21, 2011 meeting of the North Carolina Medical Board Licensing Committee, Board members discussed the creation of a new form of documentation to address licensee conduct referred to as the Letter of Advice (LOA). The LOA would serve as a mechanism for individual Board members to communicate with licensees regarding concerns they may have as a result of a licensee’s application or renewal – a concern that was not significant enough to warrant a Board interview or deny licensure or renewal.

While the currently proposed criteria for the new Letter of Advice state that this correspondence is in no way disciplinary or reportable, and is similar to verbal communication between a Board member and licensee – it is planned that the correspondence will be vetted by the Board’s legal department and will remain in a licensee’s file for future reference if necessary.

NCMS staff attended this meeting and spoke out against the creation of a Letter of Advice.  If you’d like to review the currently proposed criteria for the Letter of Advice, click here to view the agenda from this week’s meeting. 

The Board has tabled this discussion, to be continued at their November 2011 meeting in order to allow time for the LOA criteria to be revised.

On Thursday, September 22, from 3:30 to 4:30 pm, the NC Medical Board’s Policy Committee will revisit the issue of self-treatment and treatment of family members and others with whom significant emotional relationships exist.  This meeting is open to the public. The Board initially discussed this issue with stakeholders in June, read more about that meeting here. The Board has also solicited feedback from licensees on this issue and received a substantial number of comments for the Policy Committee to consider.

The Board’s current position statement on the issue will be reviewed and discussed, as will draft rules that would prohibit physicians, physician assistants, and nurse practitioners from prescribing controlled substances for themselves, members of their immediate family, any person living in the same residence, or any person with whom the physician, PA, or NP has a sexual relationship.

Any recommendations related to the position statement or the draft rules that are adopted by the Policy Committee will be sent to the NCMB’s Task Force on Self Treatment for further discussion and advisement. Amy Whited, health policy director for the NCMS, serves on the NCMB’s task force. Please direct any comments or concerns to Amy at awhited@ncmedsoc.org.

The North Carolina Medical Board has released draft disciplinary rules, published in the July 15, 2011 North Carolina Register.  These proposed rules attempt to fulfill the intent set forth by SB 958, passed by the North Carolina General Assembly in August of 2009. 

The NCMS was involved in many discussions with the Medical Board prior to the filing of these rules and will continue to voice any concerns that remain throughout the rule-making process.

The proposed effective date of these rules is December 1, 2011, with a public hearing to be held on September 13, 2011 at 10:00 AM in the Medical Board’s office in Raleigh.  If you would like to submit written comments to the Medical Board regarding the proposed rules please do so by writing to:

 
Rules Coordinator

NC Medical Board

P.O. Box 20007

Raleigh, NC  27619-0007

919-326-1100 phone

919-326-0036 fax

rules@ncmedboard.org

Janice Huff, MD, President of the North Carolina Medical Board has created a task force to review the Board’s Position Statement, “Self-treatment and Treatment of Family Members and Others with Whom Significant Emotional Relationships Exist” and has appointed Ralph Loomis, MD, chair. Also serving on the Task Force are Paul Camnitz, MD, and Judge Jack Lewis, a Public Member of the NCMB. 

The existing position statement was adopted in May 1991. It was last updated in September 2005. The position cautions against self treatment and the treatment of loved ones, except for minor, acute illnesses or in emergency situations.

The Task Force met on Tuesday, June 28 to discuss the position statement and suggest changes to its contents, as many have found it to be vague. The NCMS was represented at this meeting. The North Carolina Medical Board is now seeking feedback from our members regarding this statement with hopes of bringing additional clarity to the policy.

Email nancy.hemphill@ncmedboard.org if you would like to submit written comments to the Medical Board.

Read the existing position statement.

As of November 1, 2011, the NC Medical Board (NCMB) will have three openings for physician board members. One seat is directly appointed by the Governor and must be filled by a physician who meets certain statutory requirements (see Directly Appointed Seat). The two remaining seats must apply through the independent Review Panel established by the statute (see Review Panel Seats). The Review Panel shall recommend at least two candidates for each of the two open seats to the Governor, who makes the final selection.

Directly Appointed Seat

As of November 1, the NCMB will have an opening for a board member who, by statute, must be “a duly licensed physician who is a doctor of osteopathy or a full time faculty member of one of the medical schools in North Carolina who utilizes integrative medicine in that person’s clinical practice or a member of The Old North State Medical Society.” (N.C. Gen. Stat. § 90-2(a)(2)b). Applicants must have an active NC medical license.

Governor Beverly Perdue will appoint a physician to fill this Board seat. Any interested physician who meets the stated requirements should contact the Governor’s Office of Boards and Commissions at (919)715-0275. Click here to complete the application for appointment.

Review Panel Seats

As of November 1, the North Carolina Medical Board will have two openings for licensed NC physicians.  The selection process established by statute (N.C. Gen. Stat. § 90-2 and 90-3) requires anyone interested to apply though the Review Panel of the North Carolina Medical Board. This body screens applicants, conducts interviews, and makes recommendations to the Governor, who then makes the appointments.

Click here to complete or download the application. Applications are due by July 1. The Review Panel will interview all qualified applicants in late August. Both of the Board positions currently are occupied by Board members who will be eligible for reappointment, but those physicians also must go through the application and interview process.

For more information, call Dave Feild, the administrator for the Review Panel, at (919)414-4259.

The NC Medical Board has informed the NCMS that there is an opening for a cardiothoracic surgeon or a cardiovascular anesthesiologist on the Perfusionist Advisory Committee. The committee meets bimonthly, and most meetings are held via conference call.  Click here fore more information.

The North Carolina Medical Board has asked the NCMS to share this announcement with our members in hopes of recruiting physician mentors for re-entry programs:

“Physicians or physician assistants who have not actively practiced for the two-year period immediately preceding the filing of an application for initial license or license reinstatement are required to develop, and successfully complete, a reentry program approved by the Board as a condition of licensure.

Reentry programs typically involve a 3 step progressive program of patient care and responsibility generally lasting approximately 6-8 months. Occasionally other forms of comprehensive assessment may also be used in lieu of, or as a part of, the reentry plan. Once a reentry program is accepted by the Board reentry physicians or PAs are issued a license with a non-disciplinary consent order (“Reentry agreement”).  One provision of the reentry program is that, “An applicant shall identify a mentoring physician acceptable to the Board”. This requirement is often the greatest obstacle encountered by reentry applicants.

Mentoring physicians should be currently ABMS or AOA board certified in the applicable area of practice and have no recent public Medical Board actions.  Mentoring physicians provide oversight and direct supervision as outlined in the reentry agreement and periodic reports to the Board on the progress of the reentry licensee.

Mentors are considered “agents of the Board” and thus have certain legal protections from civil liability connected with their role as mentoring physicians. These legal protections are formalized in the reentry agreement. Financial arrangements, including possible compensation for mentoring responsibilities, can be arranged independently between the reentry applicant and the mentoring physician.”

If you have an interest in providing mentoring for physicians or physician assistants reentering clinical practice and would like additional information please contact:

Michael Sheppa, MD or Scott Kirby, MD
North Carolina Medical Board
1203 Front St
Raleigh, NC 27609
(919) 326-1100

The North Carolina Medical Board has posted notice that the physician seat on the NC Board of Electrolysis Examiners is vacant.

The Medical Board has the statutory responsibility for nomination of a physician to fill the position.

Below is a copy of the notice that curently appears on the Medical Board’s website.  The notice can also be accessed online at:  http://www.ncmedboard.org/notices/detail/board_of_electrolysis_examiners_seeks_physician_member/.

Interested candidates should submit their curriculum vitae to Nancy Hemphill at the Medical Board by January 17^th via email, nancy.hemphill@ncmedboard.org.

______________________________________________________________________________ 

North Carolina Medical Board  -  January 10, 2011 

Board of Electrolysis Examiners seeks physician member

The North Carolina Board of Electrolysis Examiners (NCBOEE) is seeking a NC-licensed physician to fill a vacant position. Under NCGS 88A-5 (see below), candidate(s) are nominated to the Governor by the the NC Medical Board for appointment to the NCBOEE. The physician candidate need not be in current practice.

The NCBOEE typically holds meetings in Greensboro four to five times per year. Meetings generally last a few hours, and members receive no reimbursement.  An ideal candidate would be a dermatologist, cosmetic or plastic surgeon or other physician who possesses working knowledge of Class IV laser technology.

Anyone interested in being nominated should send a letter of interest and CV by January 17, 2011. 

……………………………………………………………………………………….

§ 88A 5.  Creation and membership of Board.

(a) The North Carolina Board of Electrolysis Examiners is created. The Board shall consist of five members as follows:

(1) Three electrologists who have engaged in the practice of electrolysis for at least five years, one of whom shall be appointed by the General Assembly upon the recommendation of the Speaker of the House of Representatives, one of whom shall be appointed by the General Assembly upon the recommendation of the President Pro Tempore of the Senate, and one of whom shall be appointed by the Governor.

(2) A physician licensed under Chapter 90 of the General Statutes, who shall be nominated by the North Carolina Medical Board and appointed by the Governor.

3) A public member, appointed by the Governor, who has not practiced electrolysis, who is not in training to become an electrologist, and who is not related to anyone who would be prohibited by this subdivision from serving on the Board as a public member.

(b) Legislative appointments shall be made in accordance with G.S. 120 121. A vacancy in a legislative appointment shall be filled in accordance with G.S. 120 122.

(c) Each member shall be appointed for a term of three years and shall serve until a successor is appointed. Of the members initially appointed, one of the electrologist members shall serve a term of one year. The public member and the second electrologist member shall serve a term of two years. The physician member and the third electrologist member shall serve a term of three years. The terms of all initial appointments shall commence within 30 days of the effective date of this act. No member may serve more than two consecutive full terms.

(d) Vacancies shall be filled by the appropriate appointing authority within 30 days after the position is vacated. Appointees shall serve the remainder of the unexpired term and until their successors have been appointed and qualified.

(e) The Board may remove any of its members for gross neglect of duty, incompetence, or unprofessional conduct. A member subject to disciplinary proceedings shall be disqualified from all Board business until the charges are resolved. The Governor may also remove any member of the Board which he appoints.

(f) Each member of the Board shall receive per diem compensation and reimbursement for travel and subsistence in the amounts the Board votes upon and records in its minutes, provided the amounts do not exceed the amounts specified in G.S. 93B 5.

(g) The Board shall elect a Chairman, a Vice Chairman, a Treasurer, and such other officers as are deemed necessary by the Board. All officers shall be elected annually by the Board for one year terms and shall serve until their successors are elected and qualified.

(h) The Board shall hold at least two meetings each year to conduct its business, and shall adopt rules governing the calling, holding, and conducting of regular and special meetings. A majority of the members shall constitute a quorum. (1989 (Reg. Sess., 1990), c. 1033, s. 1; 1995, c. 94, s. 6.)

The North Carolina Medical Board has filed proposed rules related to re-entry into practice by physicians and physician assistants. These rules were published in the November 15^th edition of the N.C. Register and can be viewed at this link: http://www.ncoah.com/rules/register/Volume25Issue10November152010.pdf.

If approved, the rules will become effective on March 1, 2011. A public hearing to solicit stakeholder feedback is scheduled for Jan. 14, 2011 at the Medical Board’s offices in Raleigh.

In addition to new re-entry procedures, the filed rules propose to:

• Require a Federation Credential Verification Service (FCVS) profile for all international medical graduates.

• Require applicants to provide proof of U.S. citizenship.

• Bring nurse practitioner prescribing authority in line with physician assistant rules, meaning NPs cannot prescribe drugs that their supervising physician cannot also prescribe.

• Change current rules to prevent the Medical Board from publishing alcohol and drug related misdemeanors that occur prior to an applicant’s entrance into medical school.

The North Carolina Medical Board voted on November 19, 2010 to approve a Position Statement on Advertising and Publicity. This Position Statement was adopted in lieu of new rules that the Medical Board intended to approve earlier this year after convening a special work group on the issue. 

The Position Statement explains that advertising or publicity that is deceptive, false or misleading constitutes unprofessional conduct under the Medical Practice Act and provides examples of advertising to include oral, written and other types of communication disseminated by or at the direction of the licensee for the purpose of encouraging or soliciting the use of the licensee’s services.  Business letterhead, envelopes and cards are all considered advertising under this Position Statement.

Board Certification should only be advertised when a physician holds current certification by the American Board of Medical Specialties (ABMS), the Bureau of Osteopathic Specialists of the AOA, the Royal College of Physicians and Surgeons of Canada (RCPSC), or a board that meets a list of seven criteria outlined by the Position Statement.  Among these criteria are requirements that the organization requires satisfactory completion of a training program with training, documentation, and clinical requirements similar in scope and complexity to ACGME or AOA approved programs in the specialty or sub-specialty field of medicine in which the physician seeks certification.

The Medical Board also recommends that any advertisement of board certification should disclose in the advertisement the name of the board by which the physician was certified.

For more information and to view the entire Position Statement, click here.