North Carolina Medical Board | info@ncmedboard.org North Carolina Medical Board 1203 Front Street |...

North Carolina Medical Boardwww.ncmedboard.org | info@ncmedboard.org

North Carolina Medical Board1203 Front Street | Raleigh, NC 27609

www.ncmedboard.org | info@ncmedboard.org800.253.9653

North Carolina Medical Board

Subhash C. Gumber, M.D., Ph.D.Board Member ANDScott G. Kirby, MDMedical Director, NCMB

Presented September 2014

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.”

Board compositionThe 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.

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

Board’s Stakeholders

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.

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

COMPLAINTS

Volume and sources of complaintsIn 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

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.)

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

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

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 %)

DISCIPLINE/REMEDIATION

NCMB Approach to DisciplineNCMB seeks to rehabilitate licensees whenever it is possible and appropriate, and would not compromise public protectionNCMB favors targeted remediation (addressing the area of practice that raises concern) that preserves the licensee’s ability to serve patientsLicensees with prior NCMB disciplinary histories are dealt with more harshly

• 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

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 poorBoard 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.

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

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

DID YOU KNOW……..??

• 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….?

• 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….?

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

NEW BOARD INITIATIVES

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

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

POSITION STATEMENTS

THANK YOU!

North Carolina Medical Board | info@ncmedboard.org North Carolina Medical Board 1203 Front Street |...

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