North Carolina Medical Board | North Carolina Medical Board 1203 Front Street | Raleigh, NC | North Carolina Medical Board Subhash C. Gumber, M.D., Ph.D. Board Member AND Scott G. Kirby, MD Medical Director, NCMB Presented September 2014

North Carolina Medical Board | The Board’s mission The North Carolina Medical Board was established in 1859 by the General Assembly. NCGS 90-2(a) authorizes the Board to regulate the practice of medicine and surgery “for the benefit and protection of the people of North Carolina.”

North Carolina Medical Board | Board composition The NCMB is physician led and is composed of: 12 members appointed by the Governor, including: Eight physicians (currently 7 MDs and 1 DO) One physician assistant or nurse practitioner (currently, one NP) Three public members The full Board meets six times a year. Hearings are held in even-numbered months.

North Carolina Medical Board | How are physician members selected? By statute, candidates for 7 physician seats and the one PA/NP seat are nominated by an independent “Review Panel” Panel is made up of delegates from NC Med Society, NC Academy of PAs, DO group, Old North State, Nursing Assn’s Council of NPs and one public member of NCMB Panel must nominate two candidates for each open seat; NC Governor makes final selection

North Carolina Medical Board | Board’s Stakeholders

North Carolina Medical Board | About the Board NCMB is an independent public agency that operates outside of state government No taxpayer funding All operating funds generated from fees paid by licensees The Board has approx. 50 permanent staff members and an Exec Dir. Departments: Licensing, OMD, Legal, Investigation, Public affairs.

North Carolina Medical Board | North Carolina Medical Board | REGULATION

North Carolina Medical Board | REGULATION

North Carolina Medical Board | The Board’s role The Medical Board fulfills its mission by ensuring and monitoring: Character (truthfulness, past behavior) Competence (clinical knowledge and skill) Through: Initial Licensing (gatekeeper role)…lawsuites, disciplinary actions etc Monitoring current licensees-complaints/renewel

North Carolina Medical Board | Monitoring Licensee conduct NCMB gathers information about licensee conduct from two main sources: 1.Licensees themselves via annual renewal, incidences of reportable information 2.Complaints from patients, the public and other sources, including professional liability insurance carriers and hospitals

North Carolina Medical Board | Monitoring licensee conduct Each licensee must complete detailed online questionnaire during annual license renewal Information reported during renewal is reviewed by staff; MAY result in investigation Nondisclosure to the Board is a form of unprofessional conduct; Be forthcoming in all interactions with NCMB

North Carolina Medical Board | Items to report within 30 days ALL Arrests for DUI, DWI (alcohol or substance abuse related) ALL Arrests involving controlled substances (personal use or possession with intent to distribute)

North Carolina Medical Board | Items to report within 60 days Malpractice payments (settlements and judgments) Suspension or revocation of hospital privileges Action by another medical board or other agency (FDA, DEA, Medicare program, etc.) Convictions of any kind (misdemeanor, felony) Report ALL information in these categories; only info that meets statutory criteria will be public

North Carolina Medical Board | North Carolina Medical Board | COMPLAINTS

North Carolina Medical Board | COMPLAINTS

North Carolina Medical Board | Volume and sources of complaints In a typical year, the NCMB reviews about 2,500 matters, from sources including: Patients/family members/public Malpractice insurance carriers (payment reports) Pharmacists/pharmacies Board investigators (10 across the state) NCMB licensees and other health care professionals Hospital privilege reports News media reports

North Carolina Medical Board | Top concerns Substandard care Prescribing (inappropriate/to self) Alcohol/substance abuse/other impairment Communication issues Boundary violation/prof. sexual misconduct False/deceptive representations (to the Board, to patients, etc.)

North Carolina Medical Board | When a licensee is the subject of a complaint… Licensee is provided written notice from the Board when a complaint is received. Licensee will be asked to respond to the complaint allegations The licensee will be asked to respond in writing; in some cases, licensee will be interviewed by an investigator Board expects the licensee’s response to be timely, thorough and accurate

North Carolina Medical Board | Investigative process Complaint/ licensee response reviewed by staff Quality of care cases referred to Board’s Office of the Medical Director for review; Independent expert medical reviews obtained as needed Senior staff reviews/makes recommendation Recommendation forwarded to Board committee; Committee makes final recommendation for action Full Board vote

North Carolina Medical Board | Possible outcomes Cases are typically resolved in one of three ways: No formal action Information added to licensee’s private permanent file (60-62 %) Private action Example: confidential letter of concern (24-26 %) Public action Example: Revocation, suspension, reprimand, limitations on license, probation; Public letter of concern (10-12 %)

North Carolina Medical Board | North Carolina Medical Board | DISCIPLINE/REMEDIATION

North Carolina Medical Board | Discipline/Remediation

North Carolina Medical Board | DISCIPLINE/REMEDIATION

North Carolina Medical Board | NCMB Approach to Discipline NCMB seeks to rehabilitate licensees whenever it is possible and appropriate, and would not compromise public protection NCMB favors targeted remediation (addressing the area of practice that raises concern) that preserves the licensee’s ability to serve patients Licensees with prior NCMB disciplinary histories are dealt with more harshly

North Carolina Medical Board | NCPHP assesses and, where needed, refers for treatment licensees with alcohol/substance abuse and addiction problems, as well as behavioral issues To ensure confidentiality of anonymous NCPHP participants, sitting members of the NCMB no longer serve on NCPHP compliance committee NCMB will conduct periodic reviews of NCPHP to ensure that the organization continues to expand in- state assessment and treatment options Physician Health Program, PHP

North Carolina Medical Board | Quality of Care: Case Study MD inappropriately prescribed controlled substances to multiple patients for a variety of reasons, including chronic pain In addition, documentation of care was poor Board action: MD reprimanded. License limited and restricted such that MD may not prescribe controlled substances in Schedules II and III. In addition, MD must complete CME in medical record keeping and in controlled substances management and prescribing.

North Carolina Medical Board | Alcohol/substance abuse: Case Study PA had a positive urine test for cannabinoids, violating his NCPHP contract A substance abuse assessment determines that PA is safe to practice, provided he adheres to his NCPHP contract and obtains a workplace monitor Board action: PA is reprimanded; Must comply with NCPHP contract and obtain a workplace monitor

North Carolina Medical Board | Case study MD wrote several prescriptions, including scripts for controlled substances, to several close friends. MD failed to perform medical exams or keep a medical record of the treatment provided. Board action: MD is issued a non-disciplinary Public Letter of Concern; By accepting the letter, MD also agrees to complete a Category 1 CME course on record keeping

North Carolina Medical Board | DID YOU KNOW……..??

North Carolina Medical Board | It is the position of the Board that licensees have a professional responsibility to act if they have reason to believe that a colleague is incompetent or impaired such that he or she is not safe to practice. Appropriate response may include: referring to NCPHP, reporting to hospital peer review committee, reporting to the NCMB See Board Position statement entitled, “Professional obligations pertaining to incompetence, impairment or unethical conduct of licensees”

North Carolina Medical Board | Did you know….? Board’s position is that it is inappropriate to prescribe/treat yourself or close family members EXCEPT for minor, acute illnesses and emergencies A record of treatment provided must be kept Prescribing controlled substances to self/family is expressly prohibited Failure to comply with Board position/rules related to treatment of self and family may result in public action by the Board

North Carolina Medical Board | As of June 2014, NCMB adopted a new position statement on the use of opioids for the treatment of pain. ncmedboard.org A complete Guide for Closing your practice at NCMB website. Did You Know….?

North Carolina Medical Board | Delinquent Hospital Charts -- no more reported on the web-site Hospitals are still required, by law, to report after three delinquencies in a calendar year. NCMB requesting to change the Law. Did You Know….?

North Carolina Medical Board | INTERSTATE COMPACT The FSMB is working on an interstate compact esp with the spread of Telemedicine Possible regional compacts State Laws will need changes for uniformity

North Carolina Medical Board | North Carolina Medical Board | CURRENT REGULATORY ISSUES

North Carolina Medical Board | NEW BOARD INITIATIVES

North Carolina Medical Board | COLLATERAL CONSEQUENCES NCMB is aware that Board actions against licensees often have unintended consequences, such as loss of Board certification, loss of hospital privileges, inability to clear credentialing by insurance payers NCMB convened a roundtable to discuss collateral consequences in August 2013 FSMB adopted a resolution at NCMB’s request in spring 2014 to continue open discussions with certifying Board and other stakeholders

North Carolina Medical Board | OUTREACH NCMB established Outreach Committee in fall 2013Current initiatives include: Actively seeking opportunities to speak to professional groups Approaching residency programs and medical schools to find ways to work more closely Expanding published Board materials, including a comprehensive agency annual report Soliciting Forum articles on clinical topics of broad general interest

North Carolina Medical Board | TELEMEDICINE NCMB held a roundtable discussion to discuss telemedicine with stakeholders and other interested parties in August NCMB considered feedback from this forum as part of its review of the NCMB position statement on telemedicine Draft position statement expected at Sept. Board Meeting; Draft to be published on NCMB website and public comment sought before final approval

North Carolina Medical Board | North Carolina Medical Board | FINDING POSITION STATEMENTS NCMB Resources

North Carolina Medical Board | POSITION STATEMENTS

North Carolina Medical Board | Where to find more information The website: The Forum: Published four times a year; Sent to all licensees. Available via or regular mail Follow NCMB on Facebook. Search for North Carolina Medical Board and “Like” us to receive news and information Call the NCMB offices: Toll free at or

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North Carolina Medical Board | THANK YOU!

North Carolina Medical Board |