Aug
292014

Copies of NCMB Annual Report now available

Newsletter: Forum, No. 3 2014
Categories: Bulletin Board,

This year the NCMB published its first agency annual report, reflecting the Board’s work during calendar year 2013. The Board has published a limited number of paper copies, which are available upon request. To request a hard copy, email your name and mailing address to public.affairs@ncmedboard.org

The NCMB has a long history of publishing annual data regarding the public actions taken by the Board each year. The annual report continues this tradition, while substantially increasing the scope of data released about the Board’s activities. The Board thinks this format offers a more complete summary of its work in a given year.

The Annual Report features data on complaints and other investigative information received by the Board, data on malpractice reports received by specialty area of practice and information on the number of private actions taken by the Board. The new report also includes information about policy initiatives and licensing program activity, as well as demographic information about the Board’s licensees.

To view online, visit www.ncmedboard.org/disciplinary_reports and select the tab labeled "Annual Reports."


Aug
292014

Quarterly Board Actions Report, February-April 2014


View recent Board actions for the months of February, March and April 2014 below. Interested in more recent actions? Visit Recent Board Actions or sign up to receive notification when new actions are posted via the RSS Feed subscription service.

Quarterly Board Actions Report | February-April 2014

Aug
282014

Towards ensuring continued competence: where the Board stands on MOL and CME

Newsletter: Forum, No. 3 2014
Categories: Bulletin Board,

The topic of how best to ensure the continued competence of medical professionals over the course of their careers remains an area of active and, at times, heated discussion among stakeholders nationally and in North Carolina.

For many years, the NCMB, like other state medical boards, has encouraged ongoing competence among its licensees through requirements that compel physicians and physician assistants to earn a certain number of hours of practice relevant continuing medical education (CME). Over the last several years, however, discussion among leaders in medical regulation has turned toward a different approach that emphasizes continuing education linked to specific areas of practice, assessment of knowledge gaps and measurement of improvement and outcomes. This approach is generally known as maintenance of licensure (MOL).

Although it has no plans to establish an MOL-based program in North Carolina, the NCMB has participated in national conversations regarding MOL in the past and has thoroughly considered the proper place, if any, it has in medical regulation. Many licensees are understandably concerned at the prospect of new, rigorous MOL requirements being adopted in North Carolina, and the NCMB continues to field occasional questions on the Board’s current position on the matter.

This article is offered as clarification of the Board’s current position on MOL and CME.

Maintenance of Licensure
What is maintenance of licensure? As defined by the Federation of State Medical Boards, MOL is “a system of continuous professional development for physicians that supports, as a condition for license renewal, a physician’s commitment to lifelong learning that is relevant to their area of practice and contributes to improved health care.” The FSMB adopted an MOL framework in 2010 to guide state medical boards interested in adopting MOL programs.

What would an MOL program consist of? At the most basic level, MOL programs require licensees to demonstrate their commitment to lifelong learning and continued professional development. States that pursue MOL are free to determine the specific ways for licensees to do this. The FSMB has established an MOL resource center that state medical boards may, but are not required to, access as they make adjustments to their efforts to ensure continued competence among licensees.

Will the NCMB establish MOL requirements for licensees?
Establishing MOL, either as a condition of initial licensure or license renewal, is not under consideration in North Carolina. In the years leading up to and shortly after the adoption of the FSMB’s MOL framework, the NCMB studied, considered and discussed whether MOL made sense for North Carolina. In Nov. 2011 the Board voted not to pursue MOL in the state, and the issue has not been reopened since that time.

Current continued competence requirements in NC
North Carolina continues to encourage licensees to maintain their competence through earning CME hours. The Board amended regulations regarding CME in 2012, eliminating the obligation to report Category 2 CME hours while maintaining the requirement for physician licensees to complete a minimum of 60 Category 1 hours relevant to the licensee’s area of practice.

The 2012 CME rule changes established exemptions for certain licensees, including those physicians who are currently engaged in a program of recertification or maintenance of certification (MOC) through an ABMS, AOA or RCPSC specialty board. These licensees are exempt from reporting CME to the NCMB for the three year cycle in which they are involved in recertification/MOC. Physicians who have been “grandfathered” or awarded lifetime certification by an ABMS, AOA or RCPSC specialty board do not qualify for the exemption and will be required to report CME.

This exemption was created to reduce the administrative burden on physicians who choose to participate in a recognized MOC program. At no time has the Board contemplated requiring participation in a MOC program as a condition of licensure.

Aug
282014

Need a speaker?

Newsletter: Forum, No. 3 2014
Categories: Bulletin Board,

The North Carolina Medical Board is pleased to provide Board Members and/or Board staff to speak to professional groups and other audiences: medical students, residents, professional meetings and conferences, hospital grand rounds, and practice meetings or retreats.

Most programs provide a general overview of the Board's structure, mission and responsibilities as well as in depth discussion around important issues in medical regulation. The Board is also able to develop programs tailored to specific audiences and events upon request.

If you are interested in scheduling a speaker, please contact the Board's Public Affairs Director: Jean Fisher Brinkley, Director, 919-326-1109 x230 or jean.brinkley@ncmedboard.org

Aug
282014

DEA makes tramadol a Schedule IV drug

Newsletter: Forum, No. 3 2014
Categories: Bulletin Board,

The U.S. Drug Enforcement Administration has published a Final Rule that switches tramadol from a legend drug to a Schedule IV controlled substance, effective August 18, 2014.

As of the effective date, all drug manufacturers will be required to print the designation “C-IV” on every bottle of medication and it will be unlawful for commercial containers of tramadol to be distributed without that designation. In addition, all DEA registrants will be required to take an inventory of all tramadol stock.

Tramadol’s new status may have implications for some licensees who may prescribe the drug to family members or to themselves.

According to administrative rules 32B .1001, 32s .0212, and 32M .0109 licensees are expressly prohibited to prescribe controlled substances to themselves or to immediate family members. The Board’s position statement entitled, “Self-treatment and treatment of family,” cautions against treating and prescribing for oneself and for immediate family members except in emergencies or for minor, acute illnesses. Licensees who may have self-prescribed tramadol in such circumstances should be advised that doing so will be prohibited once the drug’s new status is in effect.

To read the DEA’s Final Rule regarding tramadol, visit http://www.deadiversion.usdoj.gov/fed_regs/rules/2014/fr0702.htm

What is a Schedule IV drug?
Schedule IV drugs, substances, or chemicals are defined as drugs with a low potential for abuse and low risk of dependence.

Some examples of Schedule IV drugs are: Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien

Source: U.S. Drug Enforcement Administration

Aug
282014

Update your licensee information page with a photo

Newsletter: Forum, No. 3 2014
Categories: Bulletin Board,

Log in to your Licensee Information page to upload your picture. Visit www.ncmedboard.org and select Update Licensee Info Page from the green Quick Links box at the right of the home page to log in. Photos submitted for inclusion on the licensee information page must comply with the following guidelines. The NCMB reserves the right not to post photographs that do not meet guidelines.

1. The photo should be a color head shot (head, neck and shoulders in frame) that is in focus. The individual pictured should not be wearing sunglasses, a hat or any other item that obscures the face or alters his or her normal appearance.

2. The licensee should be the only individual in the photograph. The licensee should be looking straight ahead, with both eyes open and a natural facial expression.

3. The licensee should be in professional dress equivalent to his or her everyday attire for work in a clinical setting.

Aug
282014

Hepatitis C: everyone deserves a chance at cure


Image for Hepatitis C: everyone deserves a chance at cure To view a referenced article, please click here.

New all-oral therapies for hepatitis C can permanently cure over 90 percent of infections in the United States. Health care providers in North Carolina must recognize patients who should be screened for hepatitis C infection, counseled about lifestyle interventions, and then linked to appropriate care for possible treatment with these remarkable new medications.

Many North Carolinians suffer from hepatitis C
It is estimated that nearly 2 percent of the U.S. population, or 3-4 million individuals, have been infected with hepatitis C. In North Carolina, approximately 150,000 people may be living with hepatitis C infection. These figures likely underestimate the actual incidence of hepatitis C infection, since certain at-risk populations were not included in the major national epidemiologic studies. For many years, the impact of hepatitis C on morbidity and mortality has also been underestimated. Complications of hepatitis C include progression to cirrhosis, liver failure, and hepatocellular carcinoma (HCC). Chronic hepatitis C infection is driving the increased incidence of hepatocellular carcinoma in the U.S. The importance of hepatitis C as a public health concern is highlighted by recent data demonstrating that the annual age-adjusted mortality rate for hepatitis C is higher than for HIV infection.

All Baby Boomers should be tested for HCV
Even more striking is that over half of the patients infected throughout the U.S. are unaware that they have hepatitis C, despite the availability for more than 20 years of sensitive and specific tests for the diagnosis of this chronic viral disease. Until recently, screening strategies for hepatitis C focused on ascertainment of risk factors for infection (prior history of injecting drug use or blood transfusion prior to 1992 as the major risks for infection). However, the CDC and the U.S. Preventative Services Task Force have augmented this risk-based screening strategy with additional recommendations based upon the high prevalence of hepatitis C in the “Baby Boomer” generation: Any person born between 1945 and 1965 should have a one-time anti-HCV screening test for hepatitis C. Patients testing positive should then be tested for HCV RNA to determine if the viral infection is still present. An alcohol assessment and counseling regarding the detrimental effects of alcohol use should be provided concurrent with linkage to HCV care.

Hepatitis C should be cured in order to improve patient outcomes
Sustained virological response (SVR) is defined as the absence of HCV RNA in blood when measured 12 weeks after the end of treatment and is considered as evidence of cure of HCV infection. Long-term follow-up studies have demonstrated that this short-term surrogate endpoint used in clinical trials of antiviral drugs is durable and that the likelihood of HCV relapse beyond this time frame is nil. The benefits of achieving SVR are myriad.

Hepatitis C can be cured with all-oral regimens and minimal side effects
Treatments for hepatitis C have evolved rapidly over the last several years with new drugs developed specifically to inhibit replication of the hepatitis C virus. These direct acting antiviral agents (DAAs) are focused on three specific regions of the hepatitis C virus that are critical to viral functions. Thus, NS3 protease inhibitors, NS5A replication complex inhibitors, and NS5B polymerase inhibitors have been combined with or without ribavirin in order to achieve all oral therapeutic with high rates of sustained virological response. Combining drugs from different classes is very important in order to hit multiple targets to increase the efficacy of these drugs and also to diminish the risk of viral resistance. These drugs should never be used as single agents due to the immediate risk of selecting for resistant virus.

It is anticipated that two all-oral regimens will be approved in the last quarter of 2014. Sofosbuvir is a nucleotide polymerase inhibitor that has been combined with ledipasvir (NS5A inhibitor) to achieve a once-daily single pill regimen for the treatment of hepatitis C. SVR was achieved in 94 to 99 percent of patients who were treated for only 12 weeks in phase III clinical trials of sofosbuvir and ledipasvir,. Another regimen that combined ABT-450 (protease inhibitor, boosted with ritonavir), with ombitasvir (NS5A inhibitor), dasabuvir (non-nucleoside polymerase inhibitor), and ribavirin, yielded SVR rates between 92 and 96 percent. At least two other all-oral regimens are in late stage clinical trials but are not expected for FDA approval until sometime in 2015.

These all-oral therapies are extremely well tolerated with low rates of generally mild adverse events (headache, fatigue, nausea, possibly anemia with ribavirin) or treatment discontinuations and represent major advances in HCV therapeutics. Indeed, few patients will have contraindications to this new generation of antiviral therapy, in glaring contrast to the rigorous interferon-based regimens for which many patients were not suitable candidates or preferred not to experience the harsh adverse effects.

Evidence continues to accrue about the substantial improvements in hepatic and non-hepatic outcomes among patients who are cured from chronic hepatitis C. The availability of simplified all-oral regimens that minimize adverse events and achieve near universal SVR will encourage health care providers to screen appropriate patients for HCV infection and will lead to more patients undergoing successful, and potentially life-saving, antiviral therapy.

Hepatitis C (HCV) screening recommendations
All adults born during 1945 through 1965 should be tested once (without prior ascertainment of HCV risk factors)
HCV-testing is recommended for those who:

    Currently inject drugs

    Ever injected drugs, including those who injected once or a few times many years ago

    Have certain medical conditions, including persons:

    who received clotting factor concentrates produced before 1987

    who were ever on long-term hemodialysis

    with persistently abnormal alanine aminotransferase levels (ALT)

    who have HIV infection

    Were prior recipients of transfusions or organ transplants, including persons who:

    were notified that they received blood from a donor who later tested positive for HCV infection

    received a transfusion of blood, blood components or an organ transplant before July 1992

    HCV-testing based on a recognized exposure is recommended for:

    Healthcare, emergency medical, and public safety workers after needle sticks, sharps, or mucosal exposures to HCV-positive blood

    Children born to HCV-positive women


Note: For persons who might have been exposed to HCV within the past 6 months, testing for HCV RNA or follow-up testing for HCV antibody is recommended.

Persons for Whom Routine HCV Testing is of uncertain need
    Recipients of transplanted tissue (e.g., corneal, musculoskeletal, skin, ova, sperm)

    Intranasal cocaine and other non-injecting illegal drug users

    Persons with a history of tattooing or body piercing

    Persons with a history of multiple sex partners or sexually transmitted diseases

    Long-term steady sex partners of HCV-positive persons


Persons for Whom Routine HCV Testing is Not Recommended (unless other risk factors present)
    Health-care, emergency medical, and public safety workers

    Pregnant women

    Household (nonsexual) contacts of HCV-positive persons

    General population


Source: U.S. Centers for Disease Control and Prevention

Disclosures: Dr. Fried receives research grants and serves as ad hoc consultant to AbbVie, Bristol-Myers Squibb, Genentech, Gilead, Janssen, Merck, and Vertex

Footnotes:
1. Thomas DL. Global control of hepatitis C: where challenge meets opportunity. Nature medicine 2013;19:850-8.
2. Denniston MM, Jiles RB, Drobeniuc J, et al. Chronic hepatitis C virus infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010. Ann Intern Med 2014;160:293-300.
3. Ly KN, Xing J, Klevens RM, Jiles RB, Ward JW, Holmberg SD. The increasing burden of mortality from viral hepatitis in the United States between 1999 and 2007. Ann Intern Med 2012;156:271-8.
4. Rein DB, Smith BD, Wittenborn JS, et al. The cost-effectiveness of birth-cohort screening for hepatitis C antibody in U.S. primary care settings. Ann Intern Med 2012;156:263-70.
5. Van der Meer AJ, Veldt BJ, Feld JJ, et al. Association between sustained virological response and all-cause mortality among patients with chronic hepatitis C and advanced hepatic fibrosis. JAMA 2012;308:2584-93.
6. Backus LI, Boothroyd DB, Phillips BR, Belperio P, Halloran J, Mole LA. A sustained virologic response reduces risk of all-cause mortality in patients with hepatitis C. Clin Gastroenterol Hepatol 2011;9:509-16 e1.
7. Afdhal N, Reddy KR, Nelson DR, et al. Ledipasvir and sofosbuvir for previously treated HCV genotype 1 infection. N Engl J Med 2014;370:1483-93.
8. Afdhal N, Zeuzem S, Kwo P, et al. Ledipasvir and sofosbuvir for untreated HCV genotype 1 infection. N Engl J Med 2014;370:1889-98.
9. Feld JJ, Kowdley KV, Coakley E, et al. Treatment of HCV with ABT-450/r-ombitasvir and dasabuvir with ribavirin. N Engl J Med 2014;370:1594-603.
10. Zeuzem S, Jacobson IM, Baykal T, et al. Retreatment of HCV with ABT-450/r-ombitasvir and dasabuvir with ribavirin. N Engl J Med 2014;370:1604-14.

Aug
282014

Board elects officers to serve in 2014-2015

Newsletter: Forum, No. 3 2014
Categories: Board News,

Image for Board elects officers to serve in 2014-2015 The NC Medical Board elected officers for the coming year at the July meeting of the Board. Officers begin their terms November 1. Cheryl Lynn Walker-McGill, MD, of Charlotte, will serve as president; Pascal Osita Udekwu, MD, of Raleigh will serve as president-elect and Eleanor Greene, MD, of High Point will act as secretary/treasurer. Two at-large members have also been named: Timothy E. Lietz, MD of Charlotte, and Michael J. Arnold, a public member, from Raleigh. Together, the officers serve on the NCMB’s Executive Committee, which sets Board priorities and handles governance responsibilities. Officer terms expire October 31, 2015.

Cheryl Lynn Walker-McGill, MD, MBA, President
Dr. Walker-McGill, MD, is a Medical Director for Daimler Trucks, NC, Gastonia and Mt. Holly facilities. Previously on faculty at the Northwestern University School of Medicine and the University of North Carolina School of Medicine, Dr. Walker-McGill is currently an adjunct professor at the Wingate Graduate School of Business in Charlotte, North Carolina. Her current activities include corporate health and wellness, developing strategies for improving quality of healthcare delivery in targeted populations and healthcare provider education.

Dr. Walker-McGill serves on the board of the Mecklenburg County Medical Society and the Old North State Medical Society. Dr. Walker-McGill is a Fellow of the American Academy of Allergy, Asthma and Immunology and the American College of Physician Executives.

Dr. Walker-McGill earned her undergraduate and medical degrees from Duke University. She completed her residency and subspecialty training at Northwestern University and she received her MBA from the University of Chicago. Dr. Walker-McGill resides in Charlotte, NC and she is married to Dr. Paul A. McGill.

Pascal Osita Udekwu, MD
Dr. Udekwu has practiced at WakeMed Health & Hospitals in Raleigh since 1991. He completed residency training in pediatrics and in general surgery at the University of Chicago, a fellowship in trauma and surgical critical care at the University of Pittsburgh, and earned a master’s degree in business administration and health administration from Pfeiffer University in Misenheimer, NC.

Dr. Udekwu holds multiple leadership roles including Director of Trauma, Vice Chairman of Medical Staff Quality Improvement and Director of Surgical Critical Care, all at WakeMed Health & Hospitals. He is also Associate Director of the Surgical Residency Program at the University of North Carolina, Chapel Hill.

Dr. Udekwu currently serves as an adjunct professor at UNC-Chapel Hill and is an adjunct professor at Campbell University’s College of Pharmacy and Health Sciences. He is triple-board certified with certifications from the American Board of Pediatrics, the American Board of Surgery and the American Board of Surgery—Surgical Critical Care.

Dr. Udekwu has authored numerous papers and abstracts for scholarly journals and is a member of several professional organizations. He is a fellow of both the American College of Surgeons and of the American College of Chest Physicians and is actively interested in regional and national Health Policy.

In addition, Dr. Udekwu served in the United States Army Reserve from 1988-2005 deploying to Bagram Afghanistan as Chief of Surgery in 2003. He currently serves as a Colonel in the United States Air Force Reserve at Joint Base Andrews, Maryland.

Eleanor E. Greene, MD, MDH
Dr. Greene, MD, of High Point, earned a BS degree in medical technology from the former Bowman Gray School of Medicine (now Wake Forest University School of Medicine) in Winston-Salem, NC. She received her MD and a Master of Public Health in Maternal and Child Health from the University of North Carolina, Chapel Hill, and completed residency in obstetrics and gynecology at the Ohio State University in Columbus, OH. She currently practices with Bethany Medical Center in High Point.

Dr. Greene is a member of the North Carolina Medical Society, Doctors for America, North Carolina Obstetrics and Gynecology Society, and the National Medical Association, where she served on the Board of Directors, Finance and Health Policy Committees. She serves on the Piedmont Health Services and Sickle Cell Agency. She served on the North Carolina Advisory Committee on Cancer Coordination and Control, on the Board of Directors of the Healthy Start Foundation, completing two terms on each. Dr. Greene is past president of the Old North State Medical Society, and continues to serve on its current Executive Committee. She is a fellow of the American College of Obstetrics and Gynecology.

Dr. Greene is the first physician from High Point, NC, and the first African American female physician to serve on the NC Medical Board. She speaks on the topic of Women’s Health and Women in Medicine at numerous church and community forums. Dr. Greene recently served as moderator for a conversation on Women’s Health and the Affordable Care Act featuring the Department of Health and Human Services Director, Secretary Kathleen Sebelius.

Dr. Greene was appointed to the Board in 2010. She serves on the Review, Executive and Policy Committees.

Timothy E. Lietz, MD
Dr. Lietz currently practices with Mid-Atlantic Emergency Medical Associates in Charlotte and serves as President and CEO and is a member of the practice’s Board of Directors. He is former Chairman of the Department of Emergency Medicine for the Southern Piedmont Region of Novant Health.

Dr. Lietz earned his medical degree from the Ohio State University School of Medicine in Columbus, Ohio. He completed an internship with the Eastern Virginia Medical School Department of Internal Medicine and residency training with the same institution’s Department of Emergency Medicine. He served one year as chief resident.

Dr. Lietz is certified by the American Board of Emergency Medicine. He is a member of the North Carolina Medical Board and of the NC Academy of Emergency Physicians (ACEP).

Michael J. Arnold, MBA
Mr. Arnold, of Wake Forest, has worked as a policy, research and public affairs professional at high levels of state government for more than two decades, first serving nine years as a university administrator and on faculty at the University of North Carolina at Wilmington and then later as a high-ranking senior official in the Executive branch of state government.

In addition to his on-going role as an adjunct faculty member at Duke University’s Sanford School of Public Policy, Mr. Arnold currently serves as Senior Advisor for Policy & Government Relations to Secretary of State Elaine Marshall. Prior to that, Mr. Arnold served as Senior Advisor for Policy and Research with Governor Beverly Perdue. He also served in the same role during Perdue’s term as Lt. Governor.

Mr. Arnold has also worked as Senior Research Director for the NC Health and Wellness Trust Fund, which was one of three entities created by the NC General Assembly to invest North Carolina’s portion of the Tobacco Master Settlement Agreement. Prior to that, he served in a public affairs and development role for the Alice Aycock Poe Center for Health Education in Raleigh, one of the state’s largest health education centers.

Mr. Arnold earned a bachelor’s degree in Communication Studies from the University of North Carolina, Wilmington, and a master of business administration from the same institution. He also earned a certification in Nonprofit Management, with an emphasis on communications and strategic planning from Duke University.

Aug
272014

“For the benefit and protection of the people of North Carolina…”


Image for “For the benefit and protection of the people of North Carolina…” As you know, the Medical Board’s mission is to protect the public. One of the most important ways it does this is by intervening to protect unsuspecting patients from treatments that are outside accepted standards of care and, at times, risky.

This may not sound controversial, but it can quickly become so when we delve into specifics. In this article, I will give you my personal take on how the Board attempts to balance challenging and sometimes competing interests when considering cases that involve nonstandard treatments.

Medicine by its nature is constantly evolving and new treatments and modalities are developed on an almost daily basis. The best of these are hailed as innovations that extend and improve life – and some even live up to their promise. The worst are eventually denounced as snake oil that, at best, empty patients’ pockets while filling them with false hopes and, at worst, harm or kill them.

Often, though, things are not so black and white. Some cases the Board reviews involve treatments that are apparently without scientific basis, yet relatively benign and, at times, anecdotally effective. When reviewing these situations, Board Members must ask this important and difficult question: When should the Board interfere with a patient’s freedom to choose in order to protect them from financial exploitation or false hope when the potential for harm is low?

The HCG example
In 2013, the Policy Committee of the Board amended its position statement entitled, “The treatment of obesity,” to indicate that the Board does not consider human chorionic gonadotropin (HCG) to be an appropriate treatment for obesity. The decision, which the full Board approved, was based on two main factors: 1. The Board’s belief that there is no proven scientific basis for the treatment of obesity with HCG and 2. Some evidence of risks associated with the therapy.

Months after the amended position statement was approved, the Board reviewed a complaint regarding a licensee who prescribed HCG for weight loss. This prompted a reexamination of information about the treatment. And while nothing changed the Board’s view of the efficacy of this treatment, upon further review of the risks, the Board concluded that the potential for patient harm is not as significant as initially perceived. The Board voted to strike the language referring to using HCG for weight loss as inappropriate from the Board position statement.

It’s somewhat unusual for the Board to reverse course on an issue in such a relatively short period of time. But the case of HCG is an excellent example of the type of issue the Board is required to make decisions about on a regular basis.

Should patients be free to consent to treatments that we, as trained medical professionals, find to be entirely without scientific basis? Should patients and their medical providers have total freedom to decide what treatments are used? Or are some controls acceptable? For example, should the Board give its blessing for providers to give patients their treatments of choice as long as they are adequately informed that the care falls outside of accepted standards? How does risk factor into the Board’s obligation to protect? How much risk is acceptable for the patient to assume?

Treatment cost is yet another consideration. Current law gives the Board the authority to protect patients from financial exploitation by licensees. A review of cases over the years provides numerous examples of situations where the Board has stopped licensees from benefiting from the aggressive marketing of costly therapies of unproven clinical value. Should the Board always step in to protect patients’ pocketbooks? Only when large sums of money change hands? Only when there is no informed consent or there is a vulnerable patient?

The issues the Board considers go well beyond whether a particular weight loss treatment safely melts pounds. The Board has made difficult decisions in cases involving nonstandard treatments in the fields of oncology, infectious disease and mental health, just to name a few.

These decisions are never made lightly or easily. And, the Board is rarely of one mind at the outset of these discussions. At times, some Board members are strongly motivated to act to protect patients not only from physical harm or financial exploitation but also from the false hopes promised by a treatment in which the Board has no confidence. Others on the Board are inclined to stay out of such situations, provided the threat of patient harm is minimal. Regardless of Board members’ individual views, the NCMB employs the same objective framework when evaluating these difficult cases. At minimum, the Board weighs the following factors:

1. Does it work? In evaluating any case that involves clinical medicine, the Board considers accepted and prevailing standards of care and, in the specific instance of care that is experimental or otherwise unestablished, available evidence that demonstrates the treatment’s safety and efficacy. The Board acknowledges that many, many treatments and modalities are used successfully and on a routine basis without the benefit of placebo controlled double blind clinical trials. That said, we look to published research and authoritative consensus statements when considering any therapy.

2. What are the risks? All medical care, at the end of the day, is a balance between the potential benefits and the recognized risks. When considering the appropriateness of any treatment under review, the Board always considers known risks to the patient as well as information regarding potential benefits and clinical efficacy.

3. Is the cost exploitive? The cost of treatments under review is often an important consideration, particularly in situations where care may be outside accepted standards and/or those where care is not covered by medical insurance. In the past, the Board has taken action to intervene when it determines that licensees have exploited patients financially by recommending costly treatments that either don’t conform to the standard of care or have been used in an overaggressive manner.

4. Is the patient informed? As part of its review of any case involving experimental or nonstandard treatments, the Board carefully examines the licensee’s process for obtaining informed consent from patients. It is the Board’s position that any patient who is considering a nonstandard treatment should be clearly and thoroughly informed that the treatment falls outside of the norm well in advance of making a final decision. The licensee should clearly explain all potential benefits and all recognized risks of treatment. In numerous cases the Board has reviewed, the Board has permitted licensees to continue offering nonstandard therapies as long as a robust informed consent process is in place – especially when the nonstandard therapy is used in combination with other established treatments.

These factors provide a solid framework for evaluating and making decisions in cases that involve new and nonstandard treatments that come to the Board’s attention. These cases are rarely easy, and I don’t see that changing. Options for complementary and alternative therapies abound and Internet access plus the general tendency and expectation for patients to take greater command of their health keeps patient demand for these treatments soaring. Add to this the economic realities of medicine, which motivate licensees to provide treatments that are in demand and, often, more lucrative than established therapies since they are usually not covered by health insurance. These factors, along with innovation in medicine, will keep the Board busy well into the future.

Now, I’d like to hear what you think. How far does the Board’s obligation to protect the public from nonstandard treatments and modalities extend?

Jun
112014

New NCMB Annual Report offers more depth

Categories: Announcements,

The North Carolina Medical Board has published its first agency annual report, covering program activities for 2013. This document can be accessed here.

The NCMB has a long history of publishing annual data regarding the public actions taken by the Board each year. The annual report will continue this tradition, while substantially increasing the scope of data released about the Board’s activities. The Board thinks this format offers a more complete summary of its work in a given year.

For example, the new format reports data on complaints and other investigative information received by the Board, data on malpractice reports received by specialty area of practice and information on the number of private actions taken by the Board. The new report also includes information about policy initiatives and licensing program activity, as well as demographic information about the Board’s licensees.

Please take a few minutes to read the 2013 Annual Report. As this is a new publication, the Board is especially interested in receiving feedback on the report, so don’t miss the opportunity to tell us what you think. Send comments via email to forum@ncmedboard.org


Jun
112014

Quarterly Board Actions Report, November 2013-January 2014


View recent Board actions for the months of November, December 2013 and January 2014 below. Interested in more recent actions? Visit Recent Board Actions or sign up to receive notification when new actions are posted via the RSS Feed subscription service.

Quarterly Board Actions Report | November 2013-January 2014

Jun
112014

NCMB, individual staff members win accolades

Categories: Board News,

The NCMB and two Board staff members were honored recently by the Administrators In Medicine (AIM) – the national professional organization for medical board executives and staff.

The Board won a “Best in Boards” award for consumer resources developed by the NCMB’s Public Affairs Department. The entry included a downloadable brochure that describes the NCMB’s complaint process and other resources available to patients and the public, as well as an online tutorial that offers guidance to individuals who are considering filing a complaint. This campaign was produced entirely in house. View the brochure, “A Consumer’s Guide to the NC Medical Board” here and view the online tutorial here. The tutorial will begin playing automatically so be sure that the computer’s speakers are turned on and up to hear the audio.

AIM also awarded Don Pittman, a Senior Investigator with the NCMB, with the 2014 Ronald K. Williamson Memorial Award for Board Investigators. This award recognizes excellence in the public protection work of board investigators. Pittman joined the staff of the NCMB as an investigator in 1981. Despite the difficult circumstances under which he is typically in contact with licensees, complainants and others involved in disciplinary cases under investigation by the Board, Pittman is known for his professionalism and kindness and has been a frequent recipient of letters of compliment during his years at the Board.

Thom Mansfield, the Director of the Legal Department, received the John Ulwelling Special Recognition Award from AIM. Mansfield joined the NCMB’s staff in 2001. His advocacy and litigation efforts on behalf of the Board have played an integral role in improving the NCMB’s funding and operations, as well as the laws and rules governing the Medical Board and its work.

Jun
112014

Walker secures spot on FSMB committee

Categories: Board News,

Image for Walker secures spot on FSMB committee Barbara E. Walker, DO, who was appointed to the North Carolina Medical Board in November, won election to a national post during the 102nd meeting of the Federation of State Medical Boards held in Dallas in April.

Dr. Walker, of Kure Beach, NC, was elected to serve on the Nominating Committee of the FSMB’s Board of Directors. The committee is responsible for evaluating and selecting candidates to serve on Federation committees and work groups. Dr. Walker ran on her years of experience mentoring and nurturing leaders through her work as a physician with the U.S. Army Medical Corps, as residency faculty and as an osteopathic family medicine program director.

Dr. Walker is a contracted family physician with the Southeast Area Health Education Center (SEAHEC), where she teaches family medicine residents. She currently serves as a trustee of the American Osteopathic Association and of Campbell University. She served as president of the North Carolina Osteopathic Medical Association from June 1990 until September 1999.

Jun
112014

NCMB publishes guide to closing a medical practice

Categories: Bulletin Board,

Closing a medical practice, whatever the reason, is a complicated process with many specific professional obligations. The NCMB often receives inquiries from licensees who are leaving practice and need guidance on how best to meet these obligations. In response, the Board has published a comprehensive guide, “The doctor is out: a physician’s guide to closing a practice.”

The guide, which can be accessed via the NCMB’s website under Special Topics in the Professional Resources section, provides advice on meeting one’s professional obligations to patients and others when closing or departing a practice. The advice reflects relevant information as set down in formal Board position statements and state law. Topics covered include the obligation to communicate to patients, making provisions for medical records, requirements for practicing at indigent clinics in retirement and reactivating one’s medical license if the licensee chooses to return to active clinical practice. The guide also includes a section on the need to close a practice due to disciplinary action by the Board.

The Board hopes the new guide will be useful to individuals and practices planning for departures, closures and retirements, or those who are required to leave practice due to illness or regulatory reasons.

To view the guide, click here.

Jun
112014

Picture this: add a photo to your licensee information page

Categories: Bulletin Board,

The NCMB is now offering physician and physician assistant licensees the opportunity to add photographs to their licensee information pages on the Board’s website.

Licensee information pages provide comprehensive information about physicians and physician assistants with active North Carolina licenses. Certain information, such as current licensure status, information about professional education, postgraduate training, areas of practice and current hospital privileges (if applicable) is required under state law.

The Board also offers licensees the ability to include optional information on their information pages. Photographs are the newest optional category added to the licensee information page. Other types of optional content include practice website address, whether the licensee participates with Medicare and Medicaid insurance and whether new patients with this coverage are being accepted, the chance to state one’s “practice philosophy” and the ability to list non-English languages spoken by the licensee or by individuals working at the practice.

To upload a photo, licensees may login to their licensee information page and select General Information from the menu. Follow instructions to upload your photo. All pictures must be submitted electronically in accordance with the NCMB’s photo guidelines. The NCMB reserves the right not to post photographs that do not conform to its guidelines (see below).

The Board hopes licensees will take advantage of the latest opportunity to enhance their NCMB licensee information pages. LI pages are the most used feature on the NCMB’s website and are used by both current and prospective patients, as well as medical professionals and health care institutions.

.........................................................

Photo submission guidelines
Photos submitted for inclusion on the licensee information page must comply with the following guidelines. The NCMB reserves the right not to post photographs that do not meet guidelines.

1. The photo should a color head shot (head, neck and shoulders in frame) that is in focus. The individual pictured should not be wearing sunglasses, a hat or any other item that obscures the face or alters his or her normal appearance.
2. The licensee should be the only individual in the photograph. The licensee should be looking straight ahead, with both eyes open and a natural facial expression.
3. The licensee should be in professional dress equivalent to his or her everyday attire for work in a clinical setting.
4. All photos must be submitted electronically in JPEG format and should not exceed 2 MB in size.
5. The photo should be recent and representative of the licensee’s current appearance and should be replaced regularly (e.g. biannually or whenever physical appearance changes materially).

Jun
112014

Year in Review: A look back at data from 2013

Categories: Bulletin Board,

Data reflects information for the calendar year beginning Jan. 1, 2013 and ending Dec. 31, 2013.

2013 year in review

Jun
112014

More problems with death certificates Some certifiers missing new requirements


Image for More problems with death certificates Some certifiers missing new requirements The North Carolina Medical Board has noted an increasing number of inquiries and complaints from families and funeral homes about improper and delayed completion of death certificates. It appears that many of the problems with improperly completed certificates arise from the certifying physician, PA or NP failing to complete new required sections of the official death certificate used in North Carolina.

The NC Department of Vital Records, the state branch that registers and maintains records of deaths, adopted the new death certificate form effective January 1. The new form requires additional information that was not previously requested on death certificates. This new information must be recorded by ticking the appropriate boxes in a section immediately following the section where cause of death is provided. Individuals who complete death certificates should also be aware that cause of death is now referred to as “medical certification” on the new form. All required information must be completed for the certificate to be valid.

I have written on the licensee’s professional obligation to complete death certificates in a timely manner before, but it is worth repeating. Properly certifying a patient’s death is a final service licensees can, and should, perform for patients when it is needed. State law (NCGS §130A 115) requires that death certificates be completed within three days of receiving the request.

Failing to complete a death certificate because one is not absolutely certain about the cause of death is unacceptable. In these situations, remember that the licensee completing the death certificate is only asked to provide a cause of death “to the best of [his or her] knowledge,” not to a medical certainty (which may not be possible in all instances.) As I have stated before, the Medical Board has no interest in pursuing disciplinary action against licensees who certify deaths in good faith and to the best of their abilities.

The best remedy for licensees’ apparent confusion regarding death certificates, particularly regarding the requirements and layout of the new form, is education. Please take a few minutes to complete the free online training offered through the NC Department of Vital Records. The training thoroughly explores the new death certificate form and covers the new required information. See the box below for instructions on accessing the training. If you still have questions, after completing the training, contact Sharon Montour at Vital Records by email, Sharon.montour@dhhs.nc.gov, or by telephone at 919-792-5818.

Vital Records is able to provide on-site training session to certifiers in group practices. To schedule a workshop or lunch-and-learn on the new death certificate form, contact Tamma Hill at tamma.hill@dhhs.nc.gov or by telephone at 919-792-5832.

Finally, in the interest of helping licensees with their obligations to correctly complete the new death certificate form, we have dedicated the opposite page to showing the new form. Sections that must be completed by the individual certifying the death are highlighted. The section where new required information must be provided is circled.

I hope this information helps to dispel confusion regarding the new form, and assists licensees with the task of properly certifying deaths.

This document highlights the new required section on the NC death certificate form.

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Death certificate training
This free online training is designed to familiarize medical certifiers with the new form, including new required information. To access the training:
1. Click here
2. Enter user ID “vrdeath” and password “death” (do not use quotation marks when entering user name and password)
3. Click on the “Medical Certifiers” tab to begin the training

Jun
112014

NCMB Job Opening: Assistant Medical Director

Categories: Announcements,

The North Carolina Medical Board is hiring an assistant medical director. This position is responsible for assisting the Medical Board staff, the medical director, and the Board in investigating, reviewing and providing detailed written reports on a wide range of matters that involve quality of care, ethical and professionalism concerns, and making recommendations to the Board regarding those matters.

Qualified applicants must possess a Medical (MD) or Doctor of Osteopathy (DO) degree and a current ABMS or AOA board certification. A minimum of 15 years recent clinical patient care experience, with a minimum of 5 years recent clinical patient care in North Carolina is required.

The successful candidate will replace Dr. Michael C. Sheppa, who came to the Board as assistant medical director in February 2006. He assumed the role of medical director in September of 2006, serving in that capacity until July 2010 when he reduced his role to part time and transitioned to an associate medical director role. Before joining the Board's staff, Dr. Sheppa was a partner in and president of Raleigh Emergency Medical Associates.

To submit an application for the assistant medical director position, please forward your resume and letter of interest to Shannon McGowan at shannon.mcgowan@ncmedboard.org

The NCMB offers a competitive salary and complete benefits package. We are an Equal Opportunity Employer.

Jun
112014

Interested in serving on the Medical Board?

Categories: Announcements,

The terms of four sitting Medical Board members expire October 31, so now is the time to apply if you have ever considered serving the state of North Carolina and the medical profession in this capacity.

Applicants are needed for three physician seats on the Board and one seat for a member of the public. The public member seat and one physician seat will be directly filled by the Governor’s appointees. The two remaining physician seats must be filled by the process set down in statute (N.C. Gen. Stat. § 90-2 and 90-3), which requires interested parties to apply via the Review Panel, the independent body that nominates candidates for consideration by the Governor. By law, the Review Panel must nominate two candidates for each open seat for the Governor’s consideration. All Board Member terms are three years, beginning Nov. 1 and ending October 31, 2017.

Instructions for applying via either pathway (Review Panel or direct gubernatorial) are below.

Review Panel-nominated openings
Under North Carolina law, interested parties must apply through the Review Panel. This independent body screens applicants, conducts interviews and makes recommendations to the Governor, who then appoints physicians to the Medical Board. The Review Panel will only consider physicians (MDs or DOs) who hold active, unrestricted NC medical licenses. Applicants must be actively practicing clinical medicine at least part time and must have no history of disciplinary action within the past five years. Applications are due by July 1.

The Review Panel will interview all qualified applicants in Raleigh on August 23. One of the positions for which applicants are sought currently is held by a Board member who is eligible for reappointment; however, that physician also must go through the application and interview process.

For more information, visit the Review Panel's website or call Aaron White, the Review Panel Administrator, at (919) 861-4545.

Direct gubernatorial appointments
Applicants are needed for one physician Board Member seat and one public member seat. The current Board Member in the physician seat is eligible for reappointment, but must reapply and win appointment by the Governor. The person in the public member seat is not eligible for reappointment. The public member position is open to anyone except a licensed health care professional, or the spouse of one. Public members are appointed directly by Governor Pat McCrory. Visit this website for instructions on how to apply.

If you would like more information about the workload or other aspects of serving on the Medical Board, contact nancy.hemphill@ncmedboard.org

Jun
102014

Board adopts extensive new policy on prescribing controlled substances for pain

Categories: Board News,

The NCMB has adopted a comprehensive new position statement on the subject of treating pain with prescription opioid medications. This position statement, “Policy for the use of opiates for the treatment of pain,” replaces the former NCMB position entitled, “Policy for the use of controlled substances for the treatment of pain.” The latter had been in place since September 2008. The new pain policy is in effect as of June 2014.

The new pain policy breaks ground for Board position statements in that it provides far more specific clinical guidance and information about Board expectations for patient management than is typically conveyed in a position statement. Most position statements convey general guidelines or principles, which licensees are then expected to interpret and apply to their specific circumstances.

With regard to opioid prescribing, however, the Board determined that more specific and detailed guidance would benefit patient safety and the licensees who prescribe these medications.

Deaths from opioid overdose have reached epidemic proportions in North Carolina and across the nation. Analyses of overdose deaths have shown that, in most situations, the drugs involved in overdose deaths were originally obtained with a valid prescription from a licensed physician, physician assistant or other authorized prescriber. Inappropriate prescribing of opioid medications is one of the most serious quality of care issues the Board addresses, accounting for a significant percentage of adverse public actions each year. It is the Board’s hope that making more comprehensive guidelines available to licensees who are treating pain will encourage responsible prescribing, reduce deaths from accidental overdose and avoid regulatory problems for prescribers.

The new Position Statement is organized in three sections. The first section includes general information and a statement of the Board’s goals; The second, and longest, section provides detailed guidelines linked to the principles articulated in section one; The final section includes a glossary of terms. Also included in the Position Statement: an extensive reference list of all resources used to create the new pain policy. The NCMB’s pain policy draws heavily on the Federation of State Medical Board’s 2013 Model Policy on the Use of Opioid Analgesics in the Treatment of Chronic Pain. It also borrows content, with permission, from “First Do No Harm, The Indiana Healthcare Providers Guide to the Safe, Effective Management of Chronic Non-Terminal Pain.”

Read the NCMB’s new pain policy online here.

Recently reviewed position statements
Board position statements are reviewed on a periodic basis and revised as needed. In recent months, the Board has reviewed the following position statements. Where applicable, changes to the position statement are noted.

Retention of medical records: Reviewed July 2013; No changes necessary
Capital punishment: Reviewed July 2013; No changes necessary
Professional obligations pertaining to incompetence, impairment or unethical conduct of licensees: Reviewed Sept. 2013; No changes necessary
Unethical agreements in complaint settlements: Reviewed Sept. 2013; No changes necessary
Guidelines for avoiding misunderstandings during physical examinations: Reviewed Jan. 2014; No changes necessary
Departures from or closings of medical practices: Reviewed May 2014; No changes necessary
Treatment of Obesity: Reviewed May 2014 and revised; Deleted reference to use of hCG for weight loss and reaffirms NCMB’s intention to continue to investigate, when reported to the Board, treatment modalities that are not based on sound scientific evidence.

Jun
102014

Making the tough calls: inside the NCMB’s case review process


Image for Making the tough calls: inside the NCMB’s case review process A theme is emerging in my columns for this newsletter, perhaps even for my term as President of the Board: giving insight into how the NCMB does what it does. It’s my hope that doing so will foster more understanding and faith in the Board’s work, even when licensees and others may not agree with a specific decision.

In this article I will discuss the process by which members of the Board, with input from the NCMB’s staff, resolve cases when there is a lack of consensus.

This subject occurred to me during a recent Board Meeting, as I listened to the deliberations of the NCMB’s Disciplinary Committee. The Disciplinary Committee is made up of six Board Members that review and make recommendations to the full Board in cases after Board staff recommends either public or private action. The President is an ad hoc member of all Board committees, and therefore non-voting. The President does, however, often attend and participate in committee discussions.

The normal process for Disciplinary Committee cases is to have the senior staff of the Board review and come to a consensus recommendation to the Committee. If the consensus is that the case should be closed with no action, the matter ends there. This happens in well over half of all cases. When there is no consensus, or if the staff feels action is indicated (either private or public) the case is forwarded to the Disciplinary Committee for consideration. Sometimes the Committee is unable to come to a consensus; in these situations, the full Board decides without the benefit of a committee recommendation.

During the most recent Board Meeting, the Disciplinary Committee discussed a handful of complaint cases in which the senior staff had been unable to agree whether the cases should be closed with no action, or the licensees in question should be sent private letters. Private letters of concern state the Board’s specific concerns and suggest ways the licensee should improve. The Committee had reviewed the complaint cases, including the licensee responses. Licensees are asked to respond in writing to the allegations in almost all complaint cases and do so in 100 percent of complaint cases reviewed by the Disciplinary Committee. These responses are critically important for the Board to make a fair decision.

As the Committee grappled with the issues in each complaint case, a discussion unfolded regarding the decision making process and the factors the Committee members should consider in reaching their recommendations to the full Board. The following viewpoints were presented:

It was suggested that the Committee should consider the portion of the Medical Practice Act that authorizes the NCMB to take action and not issue a private letter of concern unless the case involved a clear (if only minor) violation of the law. Absent a demonstrable violation, wouldn’t it be most prudent for the Board to close the case with no action?

The next point of view expressed noted that the case involved areas in which the licensee could do better. It was suggested that the Board has a role to play in helping licensees provide good quality care even when perceived deficiencies may not rise to the level of violations of law. Doesn’t the Board’s mission to regulate medicine for the benefit and protection of North Carolinians include offering assistance to licensees who show a need for improvement?

Another perspective expressed urged the Committee to remember its obligation to the patient. Sending the licensee a letter of concern, even a private one, is one way for the Board to demonstrate to the complainant that his or her concerns were taken seriously and that the complaint made a difference. Taking no action gives the patient the opposite impression, it was argued. Shouldn’t the Board consider the impact of sending the patient a message that the Board “didn’t do anything” about his or her complaint?

As I listened, it occurred to me how very valuable – indeed, essential – it is for the NCMB to include all of these different points of view in its deliberations.

We start with the complaint itself, and the licensee’s response. Then there is the law. We have the impulse to diagnose and attempt to treat the problems presented by the case. And, not least, we have the impact on the patient or family member making the complaint, reminding us that the Board’s actions, or lack thereof, speak volumes to the patients and other members of the public who trust the NCMB to act in their best interests. We have the Committee itself, both physicians and public members, adding their unique perspectives. Finally, there is discussion at the full Board level where a decision is rendered.

Therefore, we have the maximum number of perspectives weighing into decisions. Considering these different viewpoints is the Board’s greatest strength, as well as one of its greatest challenges.

I believe weighing these varying views allow us to come to the fairest conclusions for our licensees and the patients they serve.

This infographic illustrates the Board's process for making decisions about a case.

Jun
062014

Free CME on Safe Prescribing of Extended-Release and Long-Acting Opioids


Over the last two decades, the use of opioids for the treatment of chronic, non-cancer pain has increased significantly. Opioids are very potent analgesics that may work when other approaches to treating a patient’s pain have failed. But the use of these drugs introduces risks, which include misuse, abuse, addiction, overdose, diversion, and death.

A growing body of evidence suggests that physicians and other prescribers must be extremely vigilant about these risks, should they choose to prescribe ER/LA opioids.

To provide prescribers with comprehensive, up-to-date training and educational resources, a free CME activity for prescribing ER and LA opioid medications is now available online. The "Extended-Release and Long-Acting Opioids: Assessing Risks, Safe Prescribing" activity is offered FREE and qualifies for Continuing Medical Education AMA PRA Category 1 Credit(s)™ and AOA Category 2B Credit(s).

Developed and implemented by the University of Nebraska Medical Center, Center for Continuing Education, Federation of State Medical Boards (FSMB) and the FSMB Foundation, CECity, and The France Foundation, “ER/LA Opioids: Assessing Risks, Safe Prescribing” provides the help clinicians need.

About the program:

• Content based on the work of the nation’s leading experts in opioid prescribing and patient risk assessment
• FREE, user-friendly online webinar and other resources that can be accessed at any time
• Strong emphasis on better understanding opioid prescribing and building risk assessment into prescribing practices
• Six clinical-practice modules offer a consistent and reliable approach to safe prescribing

What you’ll learn:

• How to appropriately assess patients for the treatment of pain with ER/LA opioid analgesics, including analyzing risks versus potential benefits
• How to assess patients’ risk of abuse, including substance use and psychiatric history
• How to identify state and federal regulations on opioid prescribing
• Effective strategies for starting therapy, modifying dosing or discontinuing use of ER/LA opioid analgesics in patients with pain
• New ways of managing ongoing therapy with ER/LA opioid analgesics
• How to incorporate effective counseling of patients and caregivers
• Valuable product-specific drug information related to ER/LA opioid analgesics

Who should participate:

ER/LA Opioids: Assessing Risks, Safe Prescribing is available for ANY health care provider who prescribes opioids, but its educational content is focused particularly on the needs of clinicians who are:

• Registered with the U.S. Drug Enforcement Administration
• Eligible to prescribe Schedule 2 and 3 drugs
• Have written at least one ER/LA opioid prescription in the past year

How to participate:

Visit this website to participate in this FREE online CME activity.

May
162014

Call for applicants: Serve on the North Carolina Medical Board


The terms of four sitting Medical Board members expire October 31, so now is the time to apply if you have ever considered serving the state of North Carolina and the medical profession in this capacity.

Applicants are needed for three physician seats on the Board and one seat for a member of the public. The public member seat and one physician seat will be directly filled by the Governor’s appointees. The two remaining physician seats must be filled by the process set down in statute (N.C. Gen. Stat. § 90-2 and 90-3), which requires interested parties to apply via the Review Panel, the independent body that nominates candidates for consideration by the Governor. By law, the Review Panel must nominate two candidates for each open seat for the Governor’s consideration. All Board Member terms are three years, beginning Nov. 1 and ending October 31, 2017.

Instructions for applying via either pathway (Review Panel or direct gubernatorial) are below.

Review Panel-nominated openings

Under North Carolina law, interested parties must apply through the Review Panel. This independent body screens applicants, conducts interviews and makes recommendations to the Governor, who then appoints physicians to the Medical Board. The Review Panel will only consider physicians (MDs or DOs) who hold active, unrestricted NC medical licenses. Applicants must be actively practicing clinical medicine at least part time and must have no history of disciplinary action within the past five years. Applications are due by July 1.

The Review Panel will interview all qualified applicants in Raleigh on August 23. One of the positions for which applicants are sought currently is held by a Board member who is eligible for reappointment; however, that physician also must go through the application and interview process.

For more information, visit the Review Panel's website or call Aaron White, the Review Panel Administrator, at (919) 861-4545.

Direct gubernatorial appointments

Applicants are needed for one physician Board Member seat and one public member seat. The current Board Member in the physician seat is eligible for reappointment, but must reapply and win appointment by the Governor. The person in the public member seat is not eligible for reappointment. The public member position is open to anyone except a licensed health care professional, or the spouse of one. Public members are appointed directly by Governor Pat McCrory. Visit this website for instructions on how to apply.

If you would like more information about the workload or other aspects of serving on the Medical Board, contact nancy.hemphill@ncmedboard.org.

Apr
252014

Board publishes guide to closing medical practices


The NCMB has published a guide to assist licensees who must close their practices, due to retirement or other circumstances such as illness or loss of authority to practice due to disciplinary action. This resource is intended to help licensees meet their professional obligations to patients upon closing a practice.

Read the guide

Apr
232014

Board seeks feedback on revised chronic pain policy


The NCMB is seeking feedback from licensees and other interested parties on a draft position statement on the use of controlled substances for the treatment of chronic pain. The draft position statement was tentatively adopted by the Board at its March meeting. After receiving comments from stakeholders, the Board will reconsider the position statement and all feedback before finally approving the policy. Comments must be submitted to the Board on or before May 23.

To submit a comment, please send an email to painpolicy@ncmedboard.org

Individuals or organizations submitting feedback should identify themselves and clearly state the interest they represent (eg, prescriber or other healthcare worker, Project Lazarus, palliative care, addiction specialist, member of the public, patient, etc.) Medical professionals should include their license type (eg MD, RN, NP, PA, etc.) and, where appropriate, their specialty (eg, internist, anesthesiologist, family medicine, psychiatry etc.) and area of practice (eg, pain medicine, family medicine, urgent care, etc.) When referencing specific portions of the position statement, commentators should indicate the page number and line item in the draft policy that their comment addresses.

Read the POLICY FOR THE USE OF OPIATES FOR THE TREATMENT OF PAIN

Feb
282014

Brochure offers assistance to ACA health insurance seekers

Newsletter: Forum, Winter 2014
Categories: Bulletin Board,

Individuals who currently do not have health insurance must enroll no later than March 31 or pay a penalty fee under the federal Affordable Care Act.

The physician assistant section of the North Carolina Medical Society and the NC Academy of Physician Assistants have jointly produced an brochure that offers in-depth guidance on insurance options under the ACA, as well as an explanation of the enrollment process. The groups are encouraging physicians, physician assistants and other medical professionals to tell their patients about this resource.

The brochure is available as a download in both English and Spanish versions.

Feb
282014

Save the date and tell your patients: Drug take-back day set for April 26

Newsletter: Forum, Winter 2014
Categories: Bulletin Board,

The U.S. Drug Enforcement Administration has scheduled the eighth DEA National Prescription Drug Take-Back Day for Saturday, April 26. On this day, thousands of authorized collection sites across the country will accept unneeded and expired prescription medications, including controlled substances, for safe and legal disposal. Since 2010, DEA’s Take-Back Day initiative has collected 3.4 million pounds of prescription medications, helping to prevent diversion, misuse and abuse of these drugs.

DEA is in the process of arranging collection sites for the April 26 Take-Back Day now. As the day of the event draws closer, the DEA website will offer an online tool that lets visitors find an authorized drug collection location near them.

Patients often wonder what to do with unused, unneeded and expired medications. Encourage them to get rid of them the right way by dropping them off for proper disposal on April 26.

Feb
282014

Quarterly Board Actions Report, Aug-Oct 2013


View recent Board actions for the months of August, September and October 2013 below. Interested in more recent actions? Visit Recent Board Actions or sign up to receive notification when new actions are posted via the RSS Feed subscription service.

DiscReptAugSeptOct2013.pdf
Feb
282014

NCMB bids farewell to former long-serving Board Member; Col. Hector Henry II, MD

Newsletter: Forum, Winter 2014
Categories: Announcements,

Col. Hector Himel Henry II, MD, a Concord urologist and former member of the Board, died on November 28 from complications from a form of blood cancer, myelodysplastic syndromes. He was 75.

Dr. Henry practiced adult and pediatric urology for more than 40 years. He was a urology professor at the Duke University School of Medicine for 33 years and at Wake Forest University for seven. Dr. Henry served for more than 40 years in the U.S. Army Reserves Medical Corps, reaching the rank of Colonel. His combat deployments included Vietnam, Operation Desert Storm, the Second Gulf War and Operation Enduring Freedom.

A dedicated public servant, Dr. Henry served in various appointed and elected positions. At the time of his death, he was in his 17th year on the Concord City Council. He was first appointed to the North Carolina Medical Board in 1987, serving two years. He was reappointed to the Board in 1994 and served continuously until rotating off the NCMB in 2000. With nine years of service, Dr. Henry was the Board’s longest serving member. Dr. Henry remained in contact with the Board’s administrative staff and often remarked that serving on the Medical Board was one of the highlights of his professional career.

Dr. Henry earned his Bachelor of Science in Chemistry and a Master of Public Health from UNC Chapel Hill. He earned his medical degree with honors from Tulane University. He completed his surgical internship at Charity Hospital, surgical and urological residencies at Ochsner Foundation Hospital and Clinic and Fellowship in Pediatric Urology at the Pediatric Urological Institute and Great Ormond Street Hospital in London, England.

Dr. Henry is survived by his wife, Marjorie Benbow, three sons and three grandchildren.

Feb
282014

Meet the newest additions to the NCMB

Newsletter: Forum, Winter 2014
Categories: Announcements,

The NCMB welcomed three new physician Board members and one new public member in November. They are: Debra A. Bolick, MD, of Hickory, Timothy E. Lietz of Charlotte, Barbara E. Walker, DO, of Kure Beach and A. Wayne Holloman of Greenville. Each member is appointed to serve for a three year term ending October 31, 2016.

Debra A. Bolick, MD

Dr. Bolick, of Hickory, currently practices adult general psychiatry. She is Acting Section Chief of Outpatient Mental Health for the Hickory and Winston Salem Community-Based Outpatient Clinics (CBOCS) and is on the active medical staff of the Veterans Affairs Medical Center in Salisbury. She was in private practice for 17 years prior to joining the VA.

Dr. Bolick earned her medical degree from the University of Colorado Health Sciences Center in Denver. She completed an internship and residency training in psychiatry at the University of North Carolina, Chapel Hill, and served as chief resident of UNC’s Psychiatry Outpatient Department. Dr. Bolick is certified in general psychiatry by the American Board of Psychiatry
and Neurology, completing recertification in 2005. In addition she is certified in geriatric psychiatry, completing recertification in 2006.

Dr. Bolick is a Distinguished Fellow of the American Psychiatric Association and represents North Carolina on the Assembly of the APA. Dr. Bolick is also an active member of the North Carolina Psychiatric Association (NCPA), serving on its Executive Council. She is a member of numerous other professional organizations, including the North Carolina Medical Society and the Catawba County Medical Society.

Timothy E. Lietz, MD

Dr. Lietz currently practices with Mid-Atlantic Emergency Medical Associates in Charlotte and is a member of the practice’s Board of Directors. He is Chairman of the Department
of Emergency Medicine for the Southern Piedmont Region of Novant Health. In addition, he is Chairman of the Department of Emergency Medicine for Novant’s Matthews Medical Center Emergency Department, where he is also Medical Director.

Dr. Lietz earned his medical degree from the Ohio State University School of Medicine in Columbus, Ohio. He completed an internship with the Eastern Virginia Medical School Department of Internal Medicine and residency training with the same institution’s Department of Emergency Medicine. He served one year as chief resident.

Dr. Lietz is certified by the American Board of Emergency Medicine. He is a member of the North Carolina Medical Board and of the NC Academy of Emergency Physicians (ACEP).


Barbara E. Walker, DO

Dr. Walker is a contracted Family Physician with Southeast Area Health Education Center (SEAHEC). Prior to that, she spent more than 14 years teaching medical students and performing various administrative roles at the Family Medicine Residency Program at New Hanover Regional Medical Center in Wilmington, ultimately serving as Program Director of the Osteopathic Family Medicine Residency. Dr. Walker has also held numerous other academic appointments, including an associate professorship in family medicine at the University of North Carolina at Chapel Hill, and an associate professorship in family medicine at the Edward Via College of Osteopathic Medicine—Virginia Campus in Blacksburg, Va.

Dr. Walker has had a distinguished military career spanning more than 20 years in the U.S. Army. She served active duty in Operation Desert Shield/Desert Storm, Saudi Arabia. She was attached to the 307th Medical Battalion, 82nd Airborne Division and has the distinction of being the first female physician ever to deploy with the 82nd Airborne (and the only grandmother physician with the 82nd Airborne in Desert Shield/Desert Storm). Dr. Walker retired from the U.S. Army in 2006 with the rank of Colonel.

Dr. Walker completed undergraduate studies at Santa Ana College in Santa Ana, Ca., and the University of California at Irvine, where she earned an associate’s degree of Arts/Sciences and a bachelor’s degree in Biological Science, respectively. She earned her Doctor of Osteopathy (DO) at the College of Osteopathic Medicine of the Pacific in Pomona, California. She had a United States Army Health Profession Scholarship, and began active duty at graduation entering an internship at William Beaumont Army Medical Center in El Paso, Texas. She completed a residency in Family Practice at Womack Army Community Hospital at Fort Bragg and did a fellowship in Academic Family Medicine at the University of North Carolina at Chapel Hill.

Dr. Walker is certified by the American Board of Family Medicine and the American Osteopathic Board of Family Physicians, completing AOBFP recertification in 2013. Over the course of her career, she has been a vocal advocate for the osteopathic medical profession. She has been an active member of the American Osteopathic Association, of which she is currently a trustee, as well as the American Academy of Osteopathy and American College of Osteopathic Family Physicians, since 1980.


A. Wayne Holloman

Mr. Holloman currently owns and manages Holloman Properties and Investments in Greenville. Formerly, he owned and operated Holloman Apparel, a business that marketed ladies apparel,
dresses and sportswear across the southeastern United States.

Mr. Holloman earned a bachelor’s degree in psychology from East Carolina University. He currently serves on the board of the East Carolina University Foundation, where he serves on the Real Estate and Audit committees. In addition, he is chairman of the Pitt-Greenville Airport Authority, guiding the authority’s recent $10 million expansion.

Mr. Holloman is married to Sherry McKee and they are the proud parents of seven children: three East Carolina University graduates, two University of North Carolina, Chapel Hill, graduates, one North Carolina State University graduate and one Pitt County Community College graduate.



Feb
282014

2013 physician assistant site visits find most in compliance, but serious violations persist

Newsletter: Forum, Winter 2014
Categories: Bulletin Board,

An unprecedented 86 percent of physician assistants selected for compliance review visits in 2013 were in full compliance with state law and related Board rules. The site visits resulted in no public actions being issued against PAs for the first time since 2005, when the Board began conducting random site visits of PA practice locations. The Board commends these licensees.

The Board did issue private letters of concern to some PAs who were found to be out of compliance. Areas of noncompliance included: no evidence of Quality Improvement Meetings being held and/or documented; no periodic review of written instructions for prescribing drugs; no Scope of Practice document; no back-up supervising physician list; failure to timely file the required Intent to Practice with the Board; and supervising physician’s name and phone number not documented on the practice’s prescription blank. The Board has already selected PAs for site visits to be conducted in 2014. PAs will be contacted by a Board field investigator, who will schedule the site visit. During the visit, PAs will be asked to produce certain documents that are required
to be kept on file at each of the PA’s practice locations.

Highlights of information PAs will be expected to produce include:

• Written Supervisory Arrangement Statement: Rule NCAC 32S .0213 (c) requires a signed written Supervisory Arrangement statement to be kept on file at all practice sites and be available upon request by the Board.

• Intent to Practice Form: Rule NCAC 32S .0203 mandates that a notification of intent to practice form be submitted to the Board prior to the performance of any medical acts, tasks, or functions under the supervision of a primary supervising physician. Such form is located on the Board’s website. The rule further reads that the physician assistant shall not commence practice until he/she receives acknowledgment from the Board that the Board has received and processed the Intent to Practice Form.

• Quality Improvement Meetings: Rule NCAC 32S .0213 (d) requires the primary supervising physician and physician assistant in a new practice arrangement to meet monthly for the first six months to discuss practice relevant clinical issues and quality improvement measures and thereafter, meet at least once every six months. A written record of these meetings shall be signed and dated by both the supervising physician and physician assistant and shall be available for inspection upon request by the Board agent.

• Prescriptive authority: Rule NCAC 32S .0212 requires that each prescription issued by the physician assistant contains the physician assistant’s name, practice address,and telephone number; the physician assistant’s license number and, if applicable, the physician assistant’s DEA number; and the responsible supervising physician’s (primary or back-up) name and telephone number. Be aware that when using an electronic prescription, this same information is required to be on that prescription format as well.

• Instructions for Prescribing, Ordering, and Administering Drugs and Medical Devices and a Policy for Periodic Review by the Physician of These Instructions and Policy: Rule NCAC 32S .0212 (2) requires each supervising physician and physician assistant team to incorporate within his or her written supervisory arrangements instructions for prescribing, ordering, and administering drugs and medical devices and a policy for periodic review by the physician of these instructions/policy. The periodic review should occur at least annuallybetween the physician and physician assistant.

• Back-up Supervising Physicians: Each physician assistant needs to maintain an ongoing list of back-up supervising physicians, if any are used. This document must be signed and dated by all involved and retained as part of the Supervisory Arrangement. At a minimum, it should be updated yearly; more often if a new physician agrees to serve as the physician assistant’s back-up.

Are you in compliance?

Don’t wait to be selected for a site review to make sure you are in full compliance with supervisory rules. Review the PA rules and regulations. A complete description of the information PAs should expect to provide during a compliance review is available on the PA Site Visit Checklist, which is available online in the Professional Resources section of the Board’s website under “Physician Assistant Forms”. The Board publishes this information on its website in an effort to encourage compliance.

PA site visits: How they work

PAs selected for review are notified in advance by a Board investigator, who schedules a face-to-face meeting. The PA is asked to produce certain documents that must be kept on file at the PA’s practice location. The Board investigator also asks the PA a series of questions regarding his or her practice arrangement, such as how frequently he or she has one-on-one direct contact with the supervising physician.

Feb
282014

NCMB Position Statements as of 12/31/2013


The Board annually publishes its full catalogue of Position Statements as a service to licensees.

The Board’s Policy Committee reviews the content of the statements regularly, making necessary revisions to address changes in medical
practice, new, innovative methods and procedures or matters of policy. In 2013, the Board adopted a new position statement on using social
media, and revised and reviewed several other statements. In an effort to make this guide more user friendly, we have employed a color-coding
system to identify position statements that were adopted, reviewed or revised in 2013. New statements are identified in green, statements
that were revised are coded purple; statements that were reviewed with no changes are marked in blue.

PositionStatements.pdf
Feb
282014

NC Vital Records offers free training on new death certificate form

Newsletter: Forum, Winter 2014
Categories: Announcements,

Effective Jan. 1, physicians and others who complete death certificates in North Carolina have been using a new form to certify the deaths of patients who die from natural causes. The new form differs from the previously used death certificate in important ways, and the NC Department of Vital Records wants physicians and authorized physician assistants and nurse practitioners who certify causes of death to know how to use it.

Vital Records, the NC Division of Public Health branch that registers and maintains records of NC births, deaths, marriages and certain other events, has created an online guide to the new form for use by clinicians. The online training covers items on the new death certificate form that have either changed or are new. Log in with user ID “vrdeath” and password “death” to gain access to the guide (do not use quotation marks when entering user name and password). After logging in, physicians and other certifiers should click on the “Medical Certifiers” tab to review guidance on the new form. Clinicians who still have questions after viewing the online information may contact Sharon Montour at Vital Records via email Sharon.montour@dhhs.nc.gov, or by
telephone at 919-792-5818.

Vital Records staff members are also available to conduct on-site training sessions for group practices or hospital medical staff. To schedule a workshop or lunch-and-learn session on the new death certificate form, contact Tamma Hill at tamma.hill@dhhs.nc.gov, or by telephone at 919-792-5832.

Access Online Training

Feb
282014

“Good Samaritan” law offers protection for prevention of overdose deaths

Newsletter: Forum, Winter 2014
Categories: Announcements,

A drug overdose prevention law that took effect in April 2013 provides broad protection from criminal prosecution to any medical professional who prescribes the opioid-antagonist drug naloxone. Physicians are important partners in efforts to reduce deaths caused from unintentional drug overdose, which have reached epidemic proportions nationally. In North Carolina, more
than 1,100 people die annually from unintentional drug overdose.

The “Good Samaritan/Naloxone Access Law” explicitly states that any practitioner who prescribes naloxone in good faith to an individual at risk of opioid overdose, or to a friend or family member of such an individual, shall be immune from any civil or criminal liability. The Medical Board amended its position statement, Drug overdose prevention, in March 2013 in anticipation of the law’s passage to encourage licensees to participate with programs that seek to get naloxone into the hands of individuals who may be at risk of overdose. Such programs are becoming much more active in North Carolina as deaths from drug-related overdose continue to rise. Community Care of NC (CCNC) is leading one of the most significant efforts, including multiple trainings for clinicians across the state. In addition, CCNC has developed toolkits for use by prescribers in hospital and primary care settings that may be accessed online.

The Good Samaritan/Naloxone Access law also provides limited immunity to individuals who seek medical attention for a person who is experiencing symptoms of possible drug-related overdose. Specifically, the law states that individuals who call for help will not be prosecuted for felony or misdemeanor possession of heroin or cocaine, provided they are in possession of less than one gram of drugs. The law also grants limited immunity to individuals under the age of 21 who seek medical attention for a person suffering possible alcohol poisoning. It is believed that fear of criminal prosecution is the main reason individuals fail to seek help when a companion needs it.

Feb
282014

What moves the needle? Factors that influence NCMB decisions and policy


One thing I’ve learned in more than five years of service on the North Carolina Medical Board is that EVERYONE has an opinion—often a strong one—about the Board and how it goes about its work. Let’s face it, as the regulator of more than 40,000 physicians, physician assistants and other medical professionals, the NCMB holds their livelihoods in its hands and that isn’t something that endears the Board to the typical licensee. Many naturally prefer an arms-length relationship with the Board that involves little beyond their license. The less contact with the Medical Board the better, right?

Unfortunately, this approach often means that licensees remain in the dark about important aspects of the Board’s work, which can lead to wrong and even damaging assumptions. I’ve heard colleagues opine that the Board is unfair, overly aggressive, or that its handling of disciplinary matters does not always seem consistent. Sometimes, the individuals raising concerns do not have accurate or complete information. In this article, I want to pull back the curtain and give you a glimpse into how the Board approaches it disciplinary and policy work in hopes of clearing some misconceptions.

The primary influences on Board decisions are:

1. The Board’s makeup
2. Precedent
3. Licensee input
4. The law

First and foremost, it’s essential to understand that the Medical Board is not a static institution. Members are appointed by the Governor for a three-year term, with the possibility to “re-up” for a second consecutive term, or six years of total service. Moreover, Board Member terms are staggered so that the Board always has a mix of more experienced members and less experienced members. In other words the membership of the Board is constantly evolving, which of course influences the collective Board’s perspective—on disciplinary matters, on policy matters and on subtler points such as the appropriate role of the Medical Board’s staff. Simply put, different Board Members have different priorities and sensitivities. Matters that are of the utmost significance to one Board Member may be of less interest to others. This is one reason Board priorities shift over time, as Board leadership changes and as members come and go. If you don’t agree with the Board’s decisions and priorities, you might consider applying for a seat on the NCMB yourself. With physician members rotating on and off every few years, opportunities to serve arise with some frequency.

Conversely, the staff of the Medical Board is quite stable. Many staff members have served the Board for 10, 20 or, in a few instances, even 30 years. As such, the staff is an essential source of institutional memory and, in the context of disciplinary cases, the keepers of Board “precedent.” In evaluating and discussing disciplinary cases, Board Members often call upon members of the staff to summarize how similar matters have been handled in the past. Now, that doesn’t mean the Board always adheres to precedent, but it is an important starting point for many disciplinary matters. After considering precedent, the Board typically then considers both aggravating (harm caused to others, prior occurrences of similar behavior or prior disciplinary history) and mitigating (corrective action taken, no prior history of problems) factors before coming to a decision about how to resolve a particular case.

A third factor that influences decisions is various types of input from licensees. You are most likely aware that the Board routinely solicits feedback from licensees with regard to matters of policy. This feedback includes testimony and other input from the North Carolina Medical Society, the NC Academy of Physician Assistants and other professional groups, roundtable discussions that include representatives from stakeholder groups, and direct surveys of licensees such those conducted in connection with the recent policy changes pertaining to treating and prescribing to self or family.

Licensees who are the subject of Board investigations are also provided ample opportunity to tell “their side” of the story. When the Board investigates complaints from patients or others, licensees are contacted and asked to provide a detailed response (there are some exceptions — licensees are typically not required to respond to cases when the conduct alleged does not violate the Medical Practice Act, though they are notified of the complaint.) During the investigative process, licensees may be invited to the Board offices to participate in a confidential interview with members of the Board. Even when the Board votes to issue charges against a licensee, the licensee in question has the right to a conference with one or more members of the Board prior to the issuance of those charges. Each of these opportunities for contact between licensee and Board represent a chance for the licensee to defend his or her actions and conduct.

Finally, Board actions and decisions must stay within the framework set forth by our legislature. This can be fraught with conflict since the law is frequently open to interpretation. Grey zones abound, but the Board’s mission as prescribed by law remains clear—We stand for the benefit and protection of the people of North Carolina.

As our environment evolves, we must evolve as well — electronic medical records, telemedicine, distance learning, hospitalists, urgent care centers and concierge medicine all present unique challenges and questions. The Board is actively pondering some of these issues now. It is natural, when you are part of an institution such as the North Carolina Medical Board, to defend the status quo. I pledge to do my best not to fall into that trap. And with that pledge, I offer a challenge to you: To be an active part of your Medical Board. Send us your suggestions and together we will find solutions to our knottiest issues.


Facts about your new Board president

City: Greenville, NC
Appointed: Nov. 1, 2008 | Term ends: Oct. 31, 2014
Specialty: Otorhinolaryngology (ENT surgery)
Certification: American Board of Otolaryngology; American
Academy of Facial Plastic and Reconstructive Surgery
Personal: Married to Jill Camnitz, Dr Camnitz has two adult children, a daughter and a son.

Feb
042014

State offers free training on new death certificate form


Effective Jan. 1, physicians and others who complete death certificates in North Carolina have been using a new form to certify the deaths of patients who die from natural causes. The new form differs from the previously used death certificate in important ways, and the NC Department of Vital Records wants physicians and authorized physician assistants and nurse practitioners who certify causes of death to know how to use it.

Vital Records, the NC Division of Public Health branch that registers and maintains records of NC births, deaths, marriages and certain other events, has created an online guide to the new form for use by clinicians. The online training covers items on the new death certificate form that have either changed or are new. Use user ID “vrdeath” and password “death” to gain access to the guide (do not use quotation marks when entering user name and password). After logging in, physicians and others who complete death certificates should click on the “Medical Certifiers” tab to review guidance on the new form.

Clinicians who still have questions after viewing the online information may contact Sharon Montour at Vital Records via email Sharon.montour@dhhs.nc.gov, or by telephone at 919-792-5818.

Vital Records staff members are also available to conduct on-site training sessions for group practices or hospital medical staff. To schedule a workshop or lunch-and-learn session on the new death certificate form, contact Tamma Hill at tamma.hill@dhhs.nc.gov, or by telephone at 919-792-5832.

Access Death Certificate Form Training

Nov
152013

Professional Corps and LLCs: Renew by year’s end

Newsletter: Forum, Fall 2013
Categories: Announcements,

Medical professional corporations and limited liabilities companies are required to renew their corporate registration annually with the Board no later than Dec. 31. The Board emails or mails a renewal notification to the email or business address on file with the NCMB during the fourth quarter of the y ear. Failure to renew may result in suspension of the corporate registration pursuant to NCGS 55B-13. If suspended by the NCMB, a business may no longer provide professional services to the public under the protections afforded by PC or LLC status.

All medical professional businesses must renew online. Paper renewals are not accepted. Be prepared to update and verify for accuracy the following:

  • Mailing address, phone numbers and email address for PC or PLLC

  • Current Registered Agent listed with NCMB and the Secretary of State

  • Current approved shareholders or members of the PC/PLLC (You will have the opportunity to request approval of a newly added shareholder/member during the renewal process)

Nov
152013

Quarterly Board Actions Report, May-July 2013


View recent Board actions or sign up to receive notification when new actions are posted via the RSS Feed subscription service.

Quarterly Board Actions Report | May-July 2013

Nov
152013

Physician obligation to complete death certificates

Newsletter: Forum, Fall 2013
Categories: Special Features,

Refusals or delays in certifying patient deaths have real consequences
The North Carolina Medical Board frequently receives phone calls and complaints from patients’ families, EMS directors, funeral home personnel and others about refusals and/or unacceptable delays in physician completion of death certificates. Most often these concerns relate to an unattended death from natural causes. Most of these decedents have an established relationship with a physician, but for a variety of reasons, the identified physician is reluctant to
certify the death. For example, the decedent may not have seen the physician for several months, or the physician may have been providing treatment for stable, conditions that posed no apparent immediate threat to the patient’s life (hypertension, diabetes, etc.). Or, the physician may simply feel he or she has no exact idea why the patient died.

Regardless of the reason, delaying the completion of a death certificate or refusing to sign a death certificate creates unnecessary complications with funeral arrangements, estate proceedings, and other legal and personal matters.This makes an already difficult time for surviving family members and other loved ones even more so.

This article will discuss a clinician’s professional obligation to certify deaths in a timely manner. And, while I do not intend for this article to serve as an authoritative guide to completing death certificates, I will also offer some basic guidance on certifying deaths. Finally, I want to allay licensees’ unwarranted concerns about completing and signing death certificates for deaths from natural causes or in cases where the exact cause of death may be unknown but reasonably deduced.

Whose responsibility is it to complete death certificates?
Under North Carolina law, death certificates must be completed by a licensed physician or, thanks to changes that took effect in fall 2011, a physician assistant or nurse practitioner who has been specifically authorized by his or her supervising physician to certify deaths. In situations where a person dies at home and is brought by ambulance to a hospital emergency department, it is common practice for hospital staff to check the person’s medical records to determine if he or she had an established relationship with a primary care doctor or other physician. If so, the hospital will generally ask the decedent’s physician to certify the death. It is the Board’s view that this is a reasonable practice, as physicians or other professionals who have examined and treated a patient in the past are arguably in the best position to make an educated guess about the likely cause of death, even if the patient had not been seen recently.

As noted, PAs and NPs may now lawfully share the responsibility of certifying deaths. Amendments to NCGS 90-18.1 require that PAs and NPs be specifically authorized to complete death certificates by the supervising physician under the terms of their written supervisory arrangement or collaborative practice agreement. As with any other delegated tasks, the supervising physician is ultimately responsible for ensuring that death certificates are properly filled out and filed.

Clinicians may not decline to sign a certificate because they are uncertain of the exact cause of death. Clinicians are merely expected to exercise their best clinical judgment under the circumstances, just as they would in diagnosing treatment for a patient. Deaths should not be referred to the medical examiner's office because a clinician involved in a patient's care is not comfortable attributing a cause of death or believes it is another person’s responsibility to complete the death certificate. Understand that, before the attending physician is contacted about signing the death certificate, an assessment of the circumstances has almost always been made by EMS, law enforcement, or the medical examiner.

If the death falls within the medical examiner’s jurisdiction, it will be referred accordingly. Natural deaths are referred to the medical examiner only in extremely limited circumstances. Refusing to sign a death certificate and forcing the case to be accepted by the medical examiner: 1) Does NOT mean that an autopsy will be done. (It probably will not be.) and 2) Will initiate a chain of events that requires additional time, creates unnecessary expense and hassle for the family, and costs the county about $300.00.

Basics of completing death certificates
It’s important to understand that a death certificate is a legal and not a scientific document. As such, physicians are not required to establish a specific anatomical reason causing the death. If that were the case, postmortem studies (autopsies) would be necessary in all deaths. Obviously, performing autopsies on a routine basis would be unmanageable and beyond the resources of both the medical examiner and hospital-based pathologists.

The requirement for death certification is a statement of the condition most likely responsible for death. Clinicians may be uncertain about the exact cause of death, even if they have been treating the patient for one or more stable chronic conditions. The physician, PA or NP may feel that the death is unexplained and believe the decedent should be referred to the medical examiner to determine a specific anatomical diagnosis. This is NOT the case. The patient’s medical history should provide adequate information to state a reasonable cause of death that meets legal requirements.

It is acceptable to use “probable” to identify a suspected final cause of death. If a specific anatomic cause of death is desired a clinician may request permission for a private autopsy from the family after clearing the death with the medical examiner. Remember, the cause of death is a medical opinion and is based on the preponderance of medical evidence, which includes the cumulative effects of multiple risk factors for particular disease processes. Cause of death is the disease process that sets in motion the chain of events that lead to death. For detailed guidance on completing death certificates, I recommend the U.S. Centers for Disease Control and Prevention booklet, "The Physician’s Handbook of Medical Certification of Death."

Licensees should know that the Board is not interested in pursuing disciplinary action against individuals who complete death certificates in good faith and to the best of their abilities. The chance of facing investigation by the Board, or other adverse legal consequences, related to the completion of a death certificate in good faith is remote and should not deter a physician from performing this duty.

How quickly must death certificates be completed?
State law (NCGS §130A 115) specifies that death certificates must be completed within three days of receipt of the request. Based on the calls and complaints the Board receives, this does not always happen. The Board has received reports of families waiting for several weeks to have a loved one’s body released due to a physician’s unwillingness to certify the death.

The reporting of vital events is an integral part of patient care. The Board requests that licensees (physicians, physician assistants, and nurse practitioners) accept the professional responsibility to complete death certificates for patients (current, recent, and remote) who die of natural causes (manner), regardless of whether the death occurs in or out of the hospital.

Licensees can, and should, perform this final aspect of patient care promptly and with consideration for the decedent and his or her loved ones.

Nov
152013

Did you know?

Newsletter: Forum, Fall 2013
Categories: Bulletin Board,

Licensees are required to report changes in certain information, such as practice address and phone number or current area of practice, to the Board within 60 days. Many licensees wait to report this information during their annual renewal.

However, this can result in incomplete or inaccurate information appearing on the Board’s public website. In some situations, it may mean that the Board does not have up-to-date contact information for licensees who select their practice address as their mailing address.

Clip and save this guide to reporting required information to the Board to make sure you are in compliance.

New or changed information in the following categories must be reported within 60 days:

  • Board certifications (Only certifications conferred by boards approved by the American Board of Medical Specialties, Bureau of Osteopathic Specialists of the American Osteopathic Association or the Royal College of Physicians and Surgeons of Canada)

  • Area(s) of practice

  • Hospital privileges (within NC)

  • Address and telephone number of the primary practice setting

  • Medical licenses, active or inactive, granted by another state or country

  • Final suspensions or revocations of hospital privileges

  • Final disciplinary orders or actions of any regulatory board or agency, including other state medical boards, the U.S. Food and Drug Administration, the U.S. Drug Enforcement Administration, Medicare or the NC Medicaid program

  • Felony convictions

  • Misdemeanor convictions

  • Malpractice payments


Information in the following categories, by law, must be reported to the Board within 30 days:
  • Arrests related to alcohol or substance use/abuse (DUI, DWI, etc.)

  • Arrests related to controlled substances offenses

  • Any felony arrest


Updating your information is easy
1. Visit www.ncmedboard.org
2. Select “Update Licensee Info Page” from the green Quick Links box at the right of the Home Page. Log in to report/update your information. You will need the fileID# assigned to you by the Board. If you do not have this number, you will be able to log in via an alternate means.

Nov
152013

Board welcomes new Investigations Department director

Newsletter: Forum, Fall 2013
Categories: Announcements,

Image for Board welcomes new Investigations Department director Jerry D. Weaver took over as the NCMB’s Investigations Department director on September 1. He leads a staff of 14, including 10 investigators deployed across North Carolina.

Weaver replaces Curt Ellis, who retired in August after 10 years as the Board’s Director of Investigations.

Weaver, a native of Alleghany County, graduated Magna Cum Laude from Appalachian State University with a degree in Criminal Justice. He began his career as a Special Agent with the North Carolina State Bureau of Investigation in 1982 and was assigned to the Hickory District as the resident criminal agent for Caldwell and Watauga counties. During this period, Weaver conducted hundreds of criminal and drug investigations and was assigned to multiple task force cases and other sensitive investigations. In 1987 he transferred to the Fayetteville District where he served as District Polygraph Examiner. In 1994 Weaver was promoted to the position of Statewide Coordinator for the SBI Polygraph Unit supervising all Bureau Polygraph Examiners. In addition, he was the Chief Instructor for the SBI Academy specializing in Interrogation techniques.

In 1998 Weaver was promoted to the position of Assistant Special Agent in Charge of the 9-county Fayetteville District and in 2002 he was promoted to Special Agent in Charge responsible for supervising 25 agents and a staff of 2 on-sworn personnel. Weaver retired from the SBI in 2009. In 2010 he was hired by the Cumberland County Sheriff’s Office and assigned to the Fraud Unit. While there, Weaver investigated embezzlements, false pretenses and other financial crimes. He joined the NCMB in 2011 as a Board investigator.

Nov
152013

The NCMB’s growing PA population

Newsletter: Forum, Fall 2013
Categories: Bulletin Board,

Physician assistants are the NCMB’s fastest growing licensee group. Since 2009, their ranks have increased by 2,000 to just over 5,000 PAs – an increase of approximately 40 percent over five years. Over the same time period, the much larger physician licensee population has increased by nearly 3,000 (an increase of about 10 percent.) And there are no signs that the PA growth rate is slowing. PAs are frequently mentioned as critical to addressing the state’s developing shortage of primary care doctors. However, data show that PAs, like physicians, tend to settle mostly in the state’s population centers.
PA population infographic

PA population

Nov
152013

Board elects officers to lead in 2014

Newsletter: Forum, Fall 2013
Categories: Board News,

Image for Board elects officers to lead in 2014 The NC Medical Board officers for the coming year begin their terms November 1. Paul S. Camnitz, of Greenville, will serve as president; Cheryl Walker-McGill, MD, of Charlotte, will serve as president-elect and, Pascal Osita Udekwu, of Raleigh, will act as secretary/treasurer. Two at-large members have also been named: Eleanor Greene, MD, of High Point, and Michael J. Arnold, a public member, from Raleigh. Together, the officers serve on the NCMB’s Executive Committee, which sets Board priorities and handles governance responsibilities. Officer terms expire October 31, 2014.

Paul S. Camnitz, MD, President
Dr. Camnitz attended the University of North Carolina, Chapel Hill, where he earned bachelor’s degrees in both English and Chemistry. He earned his medical degree at the UNC School of Medicine in Chapel Hill and did his residency in Otolaryngology-Head and Neck Surgery at the same institution, finishing in 1979.

Dr. Camnitz is certified by the American Board of Otolaryngology and the American Academy of Facial Plastic and Reconstructive Surgery. He currently practices at Eastern Carolina Ear, Nose & Throat/Head and Neck Surgery in Greenville. He is also a Clinical Professor of Surgery and Head of the Division of Otolaryngology at the Brody School of Medicine at East Carolina University, where he has been selected by the graduating medical school class as "Outstanding Teacher” 12 times and in 2003 was named a "Master Educator" by the faculty. He received the Outstanding Professor Award from the Family Medicine Department in 2004 and the Bernie Vick Outstanding Professor Award from the Department of Surgery in 2003. Dr. Camnitz has received many other honors,including the Distinguished Service Award of the School of Medicine at the University of North Carolina, Chapel Hill, which was bestowed in 2006.

Dr. Camnitz is a fellow of the American College of Surgeons and of its North Carolina chapter and a fellow of the American Academy of Otolaryngology-Head and Neck Surgery. He is a member of numerous professional groups, including the Alpha Omega Alpha Honor Medical Society, the American Medical Association and the North Carolina Medical Society, among others. Dr. Camnitz has served as chief of staff at Pitt County Memorial Hospital and has served on the boards of numerous other health care and civic organizations in Pitt County.

Dr. Camnitz was appointed to the Board in 2008.

Cheryl L. Walker-McGill, MD, MBA
Dr. Cheryl Lynn Walker-McGill earned her undergraduate and medical degrees from Duke University, and completed her residency and subspecialty training at Northwestern University, in Illinois. She received an MBA from the University of Chicago. She is board certified in internal medicine and allergy-immunology.

Previously on faculty at the Northwestern University School of Medicine and the UNC School of Medicine in Chapel Hill, Dr. Walker-McGill is currently an adjunct professor at the Wingate Graduate School of Business in Charlotte. She has significant experience in clinical medicine, quality improvement, qualitative and quantitative research, physician education, and community health education. She also is a medical director for Daimler Trucks North America, Gastonia and Mt Holly North Carolina Facilities.

Honored as a pioneer by the Duke University Baldwin Scholars Program, Dr. Walker-McGill is a recipient of the Chicago Public School System Distinguished Achievement in Asthma Education Award and the 2007 NMA Floyd J. Malveaux Award in Allergy, Asthma and Immunology.

Dr. Walker-McGill is a Fellow of the American Academy of Allergy, Asthma and Immunology (AAAAI). She serves on the board of the Mecklenburg County Medical Society and the Old North State Medical Society. She is chair of the Committee for the Underserved of the American Academy of Allergy, Asthma and Immunology and she is the immediate past chair of the Asthma, Allergy and Immunology Section of the National Medical Association.

Dr. Walker-McGill has authored articles on asthma, asthma and clinical trials and she has been published in peer review journals. She is a nationally recognized speaker and she has been featured in The American Medical Association News, The New York Times and on The View.

Dr. Walker-McGill was appointed to the Board in 2011.

Pascal Osita Udekwu, MD
Dr. Udekwu has practiced at WakeMed Health & Hospitals in Raleigh since 1991. He completed residency training in pediatrics and in general surgery at the University of Chicago, a fellowship in trauma and surgical critical care at the University of Pittsburgh, PA and earned a master’s degree in business administration and health administration from Pfeiffer University in Meisenheimer, NC.

Dr. Udekwu holds multiple leadership roles including Director of Trauma, Vice Chairman of Medical Staff Quality Improvement and Director of Surgical Critical Care, all at WakeMed Health & Hospitals. He is also associate director of the Surgical Residency Program at the University of North Carolina, Chapel Hill.

Dr. Udekwu currently serves as associate professor at UNC-Chapel Hill and is an adjunct professor at Campbell University’s College of Pharmacy and Health Sciences. He is triple-board certified with certifications from the American Board of Pediatrics, the American Board of Surgery and the American Board of Surgery—Surgical Critical Care.

Dr. Udekwu has authored numerous papers and abstracts for scholarly journals and is a member of several professional organizations. He is a fellow of both the American College of Surgeons and of the American College of Chest
Physicians.

In addition, Dr. Udekwu served in the United States Army Reserve from 1988-2005 deploying to Bagram Afghanistan as Chief of Surgery in 2003. He currently serves as a Colonel in the United States Air Force Reserve at Joint Base Andrews, Maryland.

Dr. Udekwu was appointed to the Board in 2012.

Michael J. Arnold, MBA
Michael J. Arnold, of Wake Forest, has worked as a policy, research and public affairs professional at high levels of state government for nearly two decades, first serving nine years as a university administrator and on faculty at the University of North Carolina at Wilmington and then later as a high-ranking senior official in the Executive branch of state government.

Mr. Arnold was recently appointed as Senior Advisor for Policy and Intergovernmental Affairs with Secretary of State Elaine Marshall. Prior to that, Mr. Arnold served as Senior Advisor for Policy and Research with Governor Beverly Perdue. He also served in the same role during Perdue’s term as Lt. Governor.

Mr. Arnold has also worked as Senior Research Director for the NC Health and Wellness Trust Fund, which was one of three entities created by the NC General Assembly to invest North Carolina’s portion of the Tobacco Master Settlement Agreement. Prior to that, he served in a public affairs and development role for the Alice Aycock Poe Center for Health Education in Raleigh, one of the state’s largest health education centers. Mr. Arnold earned a bachelor’s degree in Communication Studies from the University of North Carolina, Wilmington, and a master of business administration from the same institution. He also earned a certification in Nonprofit Management, with an emphasis on communications and strategic planning from Duke University.

Mr. Arnold was appointed to the Board in 2012. He currently serves on the Federation of State Medical Boards Telemedicine Work Group.

Eleanor E. Greene, MD, MPH
Eleanor E. Greene, MD, of High Point, earned a BS degree in medical technology from the former Bowman Gray School of Medicine (now Wake Forest University School of Medicine) in Winston-Salem, NC. She received her MD and a Master of Public Health in Maternal and Child Health from the University of North Carolina, Chapel Hill, and completed residency in obstetrics and gynecology at the Ohio State University in Columbus, OH. She currently practices with Cone Health Medical Group at Triad Women’s Center in High Point.

Dr. Greene is a member of the North Carolina Medical Society, Doctors for America, North Carolina Obstetrics and Gynecology Society, and the National Medical Association, where she served on the Board of Directors, Finance and Health Policy Committees. She serves on the Piedmont Health Services and Sickle Cell Agency. She served on the North Carolina Advisory Committee on Cancer Coordination and Control, on the Board of Directors of the Healthy Start Foundation, completing two terms on each. Dr. Greene is past president of the Old North State Medical Society, and continues to serve on its current Executive Committee. She is a fellow of the American College of Obstetrics and Gynecology.

Dr. Greene is the first physician from High Point, NC, and the first African American female physician to serve on the NC Medical Board. She speaks on the topic of Women’s Health and Women in Medicine at numerous church and community forums. Dr. Greene recently served as moderator for a conversation on Women’s Health and the Affordable Care Act featuring the Department of Health and Human Services Director, Secretary Kathleen Sebelius.

Nov
152013

Bliss

Newsletter: Forum, Fall 2013
Categories: A Special Message,

Image for Bliss Joseph Campbell said, “Follow your bliss.” I am sure blissful is not how I would describe the state of my fellow physicians and other healthcare professionals. You would have to live in a cave to miss the plethora of articles and discussions about “physician burnout.” Too numerous to recite, I will mention two.

The first is from the Archives of Internal Medicine, August 20, 2012, titled “Burnout and Satisfaction with Work-Life Balance Among U.S. Physicians Relative to the General U.S. Population.” As this article states, burnout is not a recognized psychological disorder but an “experience.” The ICD-10 code describes it as “a problem related to life-management difficulty.” Burnout among nearly 7,000 doctors was measured using the Maslach Burnout Inventory (MBI).

Authors describe it as “a syndrome characterized by a loss of enthusiasm for work (emotional exhaustion), feelings of cynicism (depersonalization) and a low sense of personal accomplishment.” Emergency medicine, internal medicine, neurology and family medicine had the highest rates of burnout. Among their conclusions was the fact that almost one in two (45.8 percent) U.S. physicians has symptoms of burnout implies that the origins of this problem are rooted in the environment and care delivery system rather than in the personal characteristics of a few susceptible individuals.

The second article is from the 2013 Medscape Physician Lifestyle Report1. It includes some fascinating statistics and suggestions for individuals to consider about burnout. Two observations are particularly pertinent for dealing with the larger “system” issue. In his Medscape interview, Paul Griner, MD, said “Physicians should participate actively in health reforms that return a greater level of control to their patients and themselves. Embracing the concept of team care is important. Moving from a philosophy of ‘I am responsible’ or ‘I am in charge’ to ‘we are responsible’ or ‘we are in charge’ is an important step.”

In the Medscape Primary Roundtable on burnout interventions, Roy Poses, MD, made the following observation: “Although extensive literature suggests that contributors (to burnout) include excessive workload, loss of autonomy, inefficiency due to excessive administrative burdens, a decline in the sense of meaning that physicians derive from work, and difficulty integrating personal and professional life, few interventions have been tested. Most of the available literature focuses on individual interventions centered on stress reduction training rather than organizational interventions designed to address the system factors that result in high burnout rates. Most interventions meant to improve burnout have treated it like a psychiatric illness, not a rational response to a badly led, dysfunctional healthcare system.”

So, this is my plea to everyone (physicians, CEOs, politicians, healthcare companies, medical education organizations and anyone else in between) to advocate for an improved healthcare system for all of us — physicians, other healthcare professionals and patients alike.

What do we do while we fix the system?
As Warren Pendergast, MD, medical director of the North Carolina Physicians Health Program (NCPHP) said in his article “Whither Physician Wellness” in NCPHP Metamorphosis (Fall-Winter 2012), “We have not ‘gotten around to’the concept of physician wellness. It’s often difficult to get patients to take care of themselves in all the ways they need to … and it may be even more difficult to think about holding ourselves accountable to an abstract standard of wellness.” But things are finally changing. Medical schools and residency programs are developing “wellness” and “resiliency” curriculums. Skills include mindfulness meditation, guided imagery, creative expression, journaling, laughter yoga, biofeedback, social support and others. Employers and healthcare organizations are starting to realize the value of “physician wellness” to prevent compassion fatigue and decreased productivity and to help retain the physicians in whom they have invested time and energy.

Fortunately, there are many resources available to healthcare professionals across North Carolina. While we all need to work to “fix the system,” there is help now for you and your colleagues/friends. Remember, sometimes we (or they) are the last to know there is something wrong. Don’t be afraid to ask for help or ask someone else if they need help.

(Does MD have to stand for malignant denial?) Take the Maslach Burnout Inventory or the Adult Apgar (S.S. Bintliff, Wellness Book for Emergency Physicians, ACEP, 2004). Other excellent reading materials and resources are listed at the end of this article. The North Carolina Medical Board (NCMB) Forum, July 2012 articles, “Preserving a Scarce Human Resource: Healthy Physicians” by John-Henry Pfifferling, PhD, from the Center for Professional Well-Being in Durham, and “Practicing Self-Care: Resources for Physician Well-Being” by Christopher Snyder, MD, are a good place to start. The NCMB site, www.ncmedboard.org, has many other references, as well (under Professional Resources to Links and then Physician Well-Being).

Many employers have Employee Assistance Programs (EAP) that are confidential and inexpensive. CMC-Charlotte Metro facilities, has a Physician Health Committee chaired by William Bockenek, MD. This is a committee of the joint medical staff from CMC-Main/Pineville/Mercy/University/CR and is available to all physicians credentialed at any of these facilities regardless of their employer. All medical directors in the Carolinas HealthCare System Medical Group know what resources are available to help any of their physicians/PAs/NPs who would like any help with substance abuse/mental health issues/burnout, and should be contacted directly. Anyone with access to CHS Physician Connect can check the Medical Staff Resources: Work/Life Balance page, as well. Novant Health Medical Group has the Physicians Health and Effectiveness Committee, chaired by Stephen Ezzo, MD. Novant Health hospital system has a Practitioner Health and Effectiveness Committee, which can be accessed by contacting each department chair or chief of staff. The NCPHP, whose mission is “improving the health and wellness of medical professionals with compassion, support, accountability and advocacy,” is available to help all physicians and physician assistants licensed in North Carolina.

Beyond its traditional role in secondary and tertiary prevention and treatment, NCPHP is interested in helping physicians and others proactively take better care of themselves, and would partner with any organization toward that goal. This may be trite, but as a family physician, I am going to say it anyway, “An ounce of prevention is worth a pound of cure!”

What can I do?
As individuals, there are many things we can do to “be well.” We should practice what we preach to our patients and develop a sense of balance in all areas, including physical, emotional, spiritual, relationships, community and work/career. Consider one thing daily you are grateful for, or one person you love, or one thing you did that helped someone else. Take advantage of physician wellness activities offered by your employer, specialty societies and community organizations. Educate yourself about the causes of burnout and the opportunities for wellness. Do something nice for yourself — it is okay! It doesn’t always have to be about someone else. I thought about this recently on a trip we took to Yellowstone National Park. The Mecklenburg County Medical Society has an initiative to “get kids outdoors and into nature” and that certainly applies to adults, as well. Out in nature, it really is possible to forget about EHR inboxes, meetings, texts (especially when there are no satellite towers) and the Affordable Care Act. You realize your partners really can take care of your patients just fine. President Teddy Roosevelt and John Muir had great insight about the benefits, beauty and inspirations of nature, so I will close with this one by Muir (and you don’t even have to go to Yellowstone — Our state has many parks, greenways and great neighborhoods to enjoy). “Everybody needs beauty as well as bread, places to play in and pray in, where nature may heal and give strength to body and soul.”

Would a seminar on physician burnout or wellness be beneficial?
Comment on this article, send an email or reach out to your local medical society and ask them to plan an event.

Footnotes:
1. Carol Peckham, Lifestyle and Burnout: A Bad Marriage. Medscape. March 27, 2013.

Resources:

  • Maslach C. and Leiter M. The Truth about Burnout: How Organizations Cause Personal Stress and What to Do About It. Jossey-Bass Publishers; 1997.

  • Lipsenthal L. Finding Balance in a Medical Life. California: Finding Balance, Inc., 2007

  • Lipsenthal L. Enjoy Every Sandwich: Living Each Day as If It Were Your Last. New York: Crown Archetype, 2011.

  • Remen R. Kitchen Table Wisdom. New York: Riverhead Books, 2007.

  • Nedrow A., Steckler N., Hardman J. Physician Resilience and Burnout: Can you Make the Switch? Family Practice Management, Jan/Feb 2013.

  • Germer C. The Mindful Path to Self-Compassion: Freeing Yourself from Destructive Thoughts and Emotions. New York: Guildford Press, 2009.

  • Rock D. Your Brain at Work: Strategies for Overcoming Distraction, Regaining Focus, and Working Smarter All Day Long. New York: Harper Business, 2009. www.thehappyMD.com

  • Center for Professional Well-Being: 919-489-9167, www.cpwb.org

  • NCPhysicians Health Program: 919-870-4480, www.ncphp.org

  • Mecklenburg County Park and Recreation

Nov
152013

That black and white thing on your NCMB wallet card…

Newsletter: Forum, Fall 2013
Categories: Announcements,

Image for That black and white thing on your NCMB wallet card… The next time you complete your annual license renewal, you may notice something different about the wallet card included on your printable renewal certificate.

In October, the NCMB began imprinting these cards with QR codes – scrambled-crossword puzzle-like symbols that point to digital content when scanned with a smartphone’s barcode scanner. Each licensee is issued a unique code that points to his or her Licensee Information page on the NCMB’s website. This feature will enable licensees to quickly verify that they have an active medical license. The Board adopted this idea after seeing examples of how other state medical boards have used QR codes at the annual meeting of the Federation of State Medical Boards.

Other enhancements that are in the works include giving licensees the option to upload a recent photograph (a professional headshot or passport-style photo, for example) to their Licensee Information pages. Licensees who wish to post a photo to their pages will be able to do so via the Board’s Licensee Information portal on the NCMB website.

The Board hopes licensees will take advantage of this opportunity to further personalize their Licensee Information pages. These pages are the most popular feature on the Board’s website, receiving up to 3,000 “hits” each week day.

...................................................................................................................

Print a duplicate copy of your renewal certificate/receipt
Licensees may print on-demand copies of their renewal certificate/receipt by visiting the NCMB website.
Here’s how:
1. Visit www.ncmedboard.org
2. Select “Download Renewal Certificate/Receipt”
3. Log in to print your certificate. You will need the fileID# issued to you by the Board. If you do not know your fileID#, you will have an alternative means to login.

Nov
152013

Survey results: Controlled substance prescribing

Newsletter: Forum, Fall 2013
Categories: Announcements,

Survey results

Nov
152013

The NCMB and you: forging a better relationship between Board and licensee


Image for The NCMB and you: forging a better relationship between Board and licensee As the end of not only my year as Board president but my six years of Board membership drew near, I wondered what would make a fitting subject for my final President’s Message. It struck me that I have not really addressed the positive relationship the Board has with the vast majority of physicians, physician assistants and others the NCMB licenses and regulates.

Some years ago, three Board members interviewed me in Raleigh regarding a patient complaint that did not result in formal action. Having personally been on the receiving end of such an “invitation” to visit the Board, I understand the raised eyebrow now present on some readers’ faces. As if looking in the rearview mirror and seeing the flashing blue lights is ever a “positive” experience, right?

Well, as Board members and Board staff often observe, the vast majority of the Board’s work is not related to discipline. Only a small percentage of physicians are the subject of complaints and an even smaller number ever receives a public action. Although it gets little attention, the Board spends a significant amount of time and resources thinking of ways to better serve licensees and contribute to the safe evolution of medical practice in North Carolina. I’d like to share some of what the Board does in this regard.

Streamlining our processes
The NCMB is the only agency in the state of North Carolina with the authority to issue medical licenses. While obtaining a license does take time, the Board is constantly working to speed up the process. We understand physicians are keen to get new partners on-board, facilities want to get staff working and individuals are eager to start work. To reduce unnecessary delays, the Board authorized the NCMB’s Licensing Department to issue licenses to physicians and others with problem-free applications without a Board vote, which has substantially reduced the turnaround time from receipt of a complete application to issuance of the license. We also reviewed applications that remained open for months and learned that the vast majority of delays relate to a missing piece of inform ation that the applicant hasn’t provided or that hasn’t been supplied by a third party, such as a medical school or residency training program. The Board reviewed its application requirements and today no longer asks applicants to obtain license verification from other states where they currently hold licenses, since the NCMB can obtain this information from other sources. Additionally, the Board established an expedited license application for applicants who have practiced in another state for at least five years, are Board certified, and have a “clean” history (no disciplinary actions, malpractice payments or other issues that require Board review). Applicants who qualify for the expedited license application need not provide verification of medical school, residency training or test scores (since these items have been verified by the other state licensing board and the specialty board), enabling licenses to be issued in a few weeks. The Board has embraced the digital age and provides online, 24/7, access to most license application processes including the physician and physician assistant application forms, payment, application status check and email notification of license issuance. Annual renewals are also online and we’ve eliminated the requirement to report Category 2 CME. If you participate in Maintenance of Certification (MOC), you fulfill all CME requirements and simply attest to participation. We’ll continue to look at processes and technologies to further improve the licensing and renewal experience.

Including stakeholders in the Board’s policy work
In my time on the Board, the Board has moved to broader inclusion and transparency in NCMB policymaking. In the past few years, we have routinely sought stakeholder input and participation in work groups and task forces assigned to study specific policy issues. We have successfully used this approach to examine advertising of Board certification, treating oneself and one’s family members, and physician scope of practice or “practice drift,” to name a few. After receiving information that even minor actions by the Board can result in serious collateral consequences (loss of Board certification, for example), the NCMB hosted a roundtable discussion this summer that brought together numerous organizations. We strove to help organizations better understand how their actions affect our licensees’ professional lives and to better define what certain Board actions actually mean. I believe participants now have a better sense of the relative seriousness of certain Board actions and may be in a position to take more rational and proportionate actions in future.

Supporting a critical resource for licensees
When I started my Board membership, I didn’t realize the vital partnership that exists between the Board and the NC Physicians Health Program (PHP). While many physicians will never come in contact with PHP, this organization performs an invaluable service by helping medical professionals with substance abuse and other problems return to healthy and productive professional and personal lives. Nothing has been more impressive and uplifting to me during my service on the Board than to see an impaired physician whose very life is at risk and whose professional and private life is in complete and utter disarray return to his or her profession and to a healthy personal life. Please remember PHP if you know of someone who might need their help and be brave enough to help by speaking with that colleague. Thanks to the fees you pay, the Board is able to offer significant annual financial support to this excellent group to help your colleagues and our licensees.

Maintaining a financially stable NCMB
Speaking of fees, did you know that fees paid by license applicants and licensees are the NCMB’s only source of revenue? The NCMB receives no funding from the state. Currently, the annual registration fee for physicians is $175.00 – a rate that has been in place since 2005. In comparison, attorneys pay $375 annually and dentists pay $329 annually.

Since obtaining a fee increase is a significant undertaking, the Board has had to work hard to do more with less. For instance, in spite of a 22 percent increase in the licensee population, we’ve added no annual renewal staff. With judicious investment in technology, as noted earlier, the Board has provided better service to more people with the same amount of renewal staff. The Board has tightly controlled growth in other departments as well, despite a steadily increasing workload. The Board added just three additional licensing staff since 2005 while absorbing a 73 percent increase in physician license applications and a 200 percent increase in PA license applications. Last year, an independent team from the Administrators in Medicine (the national professional group for medical board staff) conducted an intensive review of the NCMB and confirmed our high functioning and efficient processes in spite of a relatively limited budget.

In the last few years, however, the Board has reached the limit of what it can accomplish with its current budget. This fall, for the third year in a row, the Board approved a deficit budget. Now, in the short term, the NCMB has adequate reserves to employ investigators, staff, outside reviewers and incur other expenses necessary to insure the Board has the very best objective evidence when it makes decisions that impact licensees. However, to continue this excellent work, we will need to seek a fee increase.

The small amount of additional money we’ll request from the legislature will allow the Board to maintain its independence. I believe that a strong medical board that holds the profession accountable in a fair and reasoned manner benefits us all. In some states where medical boards have lost the public trust, the government response has been to put non-physicians in control. Imagine having someone with no medical training or understanding of the complexity of medical care making decisions about the appropriateness of your care. Please support the Board to preserve our privilege of self-regulation.

Having written many documents and editorials in my time on the Board, I can’t say I’ll miss the deadlines and the need to come up with the next topic. What I will miss is the honor and privilege of serving with two of the finest groups
of people I’ve ever worked with: the staff of the NCMB and my fellow Board members in supporting the practice of medicine in North Carolina.

Oct
182013

Updated Project Lazarus Controlled Substances CME list


Community Care of North Carolina (CCNC) is expanding the Project Lazarus approach to the management of chronic pain statewide through multiple initiatives, including community-based trainings for clinicians. The program’s goals include decreasing mortality due to unintentional poisonings; to decrease inappropriate utilization of ED for pain management; and to decrease inappropriate ED utilization of imaging with diagnosis of chronic pain. Additional goals include increasing use of CCNC’s Provider Portal and the North Carolina Controlled Substances Reporting System.

CCNC will conduct trainings on the medical assessment and treatment of chronic pain in 40 sites across the state, including the following.

Boone, NC - October 30
Franklin, NC - November 19
Reidsville, NC - November 19
Asheville, NC - December 2
Pinehurst, NC - January 23
Concord, NC - January 30

Program
All trainings will be held from 5:30 PM to 9:00 PM.
5:30-6:00: Registration and Dinner
6:00-6:10: Introduction to Seminar Objectives
6:10-6:30: Nature of Pain/Role of Opioids
6:30-7:00: Risk Stratification and Initiating Treatment
7:00-7:30: Case discussion 1: Getting started (involving local pain management experts)
7:30-7:45: Break
7:45-8:15: Monitoring, Intervening and When to Stop
8:15-8:45: Case discussion 2: Monitoring and adapting the treatment plan
8:45-9:00: Wrap up/Next steps

*All dates are subject to change. Visit http://projectlazarustrainings.eventbrite.com/ for more information and to register for trainings.

Additional resources
CCNC has also developed chronic pain toolkits to guide treating providers in Emergency Room, primary care providers and care managers. The kits provide decision support and other tools for providers identifying and addressing each patient’s specific care needs. Toolkits can be accessed online.

Aug
062013

Controlled substances CME event set for Raleigh: October 25

Newsletter: Forum, Summer 2013
Categories: Announcements,

The NCMB has partnered with the North Carolina Medical Society and other health care organizations to give licensees the opportunity to participate in high quality continuing medical education on the subject of appropriate opioid prescribing.
Register now to complete SCOPE (Safe and Competent Opioid Prescribing Education) of Pain training, held Friday, October 25, in conjunction with the NCMS Annual Meeting at the Raleigh Marriott City Center. SCOPE of Pain, developed by the Boston University School of Medicine and funded by an unrestricted educational grant from the manufacturers of ER/LA opioid analgesics, is designed to help physicians and other practitioners safely and competently manage patients with chronic pain. The FDA has mandated that manufacturers of extended release/long acting (ER/LA) opioid analgesics make available comprehensive prescriber education in the safe use of these medications, as part of a comprehensive Risk Evaluation and Mitigation Strategy (REMS).

During the afternoon-long program, attendees will learn how to:

  • Decide on appropriateness of opioid analgesics

  • Assess for opioid misuse risk

  • Counsel patients about opioid safety, risks and benefits

  • Competently monitor patients prescribed opioids for benefit and harm

  • Make decisions on continuing or discontinuing opioid analgesics, and

  • Safely discontinue opioids when there is too little benefit or too much risk and harm.

The program will also include a panel discussion among national and North Carolina experts on the subject of controlled substances and the treatment of pain.

..........................................................................

What: SCOPE of Pain CME in opioid prescribing
When: Friday, October 25, 12pm-4:15pm
Where: Raleigh Marriott City Center, 500 Fayetteville St., Raleigh
CME: qualifies for 4 AMA PRA Category 1 Credits
Tuition: $25
Register

Aug
062013

CCNC’s Project Lazarus initiative provides additional CME opportunities in the area of chronic pain

Newsletter: Forum, Summer 2013
Categories: Announcements,

Community Care of North Carolina (CCNC) is expanding the Project Lazarus approach to the management of chronic pain statewide through multiple initiatives, including community-based trainings for clinicians. The program’s goals include decreasing mortality due to unintentional poisonings; to decrease inappropriate utilization of ED for pain management; and to decrease inappropriate ED utilization of imaging with diagnosis of chronic pain. Additional goals include increasing use of CCNC’s Provider Portal and the North Carolina Controlled Substances Reporting System.

CCNC will conduct trainings on the medical assessment and treatment of chronic pain in 40 sites across the state, including the following.
Wilmington, NC - August 29th
Hickory, NC - September 10th
Boone, NC - October 30th
Raleigh, NC - October 8th
Reidsville, NC - November 19th

Program
All trainings will be held from 5:30 PM to 9:00 PM.
5:30-6:00: Registration and Dinner
6:00-6:10: Introduction to Seminar Objectives
6:10-6:30: Nature of Pain/Role of Opioids
6:30-7:00: Risk Stratification and Initiating Treatment
7:00-7:30: Case discussion 1: Getting started (involving local pain management experts)
7:30-7:45: Break
7:45-8:15: Monitoring, Intervening and When to Stop
8:15-8:45: Case discussion 2: Monitoring and adapting the treatment plan
8:45-9:00: Wrap up/Next steps

*All dates are subject to change. Visit http://projectlazarustrainings.eventbrite.com/ for more information and to register for trainings.

Additional resources
CCNC has also developed chronic pain toolkits to guide treating providers in Emergency Room, primary care providers and care managers. The kits provide decision support and other tools for providers identifying and addressing each patient’s specific care needs. Toolkits can be accessed online.

Aug
062013

Quarterly Board Actions report, February-April 2013


View recent Board actions or sign up to receive notification when new actions are posted via the RSS Feed subscription service.

Quarterly Board Actions report | February-April 2013

Aug
062013

Position Statement Update

Newsletter: Forum, Summer 2013
Categories: Board News,

The NCMB regularly adopts new position statements and reviews and, where appropriate, revises the existing official position statements of the Board to ensure that they remain relevant. We periodically publish a summary of recent revisions to position statements to help licensees stay abreast of changes. Full positions statements may be found online in the Professional Resources section of the Board’s website.

Statement: Treatment of obesity
Date revised: May 2013
Changes: The statement is revised to add a cautionary note regarding the use of HCG in the treatment of obesity. The following has been added to the full version of the position statement:
Treatment modalities and prescription medications that have not been proven to have beneficial effects should not be used. For example, it is the Board’s position that the use of HCG for the treatment of obesity is not appropriate.

Statement: Contact with patients before prescribing
Date revised: May 2013
Changes: Revisions include the addition of consistent references to opiate vs. opioid as well as the insertion of language that included, as an exception, the prescribing of an opioid antagonist. The following selection from the position statement has been revised to include the underlined portion:
Prescribing for a patient whom the licensee has not personally examined may be suitable under certain circumstances. These may include admission orders for a newly hospitalized patient, prescribing for a patient of another licensee for whom the prescriber is taking call, continuing medication on a short-term basis for a new patient prior to the patient’s first appointment, or prescribing an opioid antagonist to someone in a position to assist a person at risk of an opiate-related overdose.

Statement: Medical Record Documentation
Date revised: May 2013
Changes: This statement was reviewed and no changes were necessary.

Aug
062013

Complying with the HIPAA final Omnibus Rule; Many aspects of the law have changed since its initial


Image for Complying with the HIPAA final Omnibus Rule; Many aspects of the law have changed since its initial HIPAA has been with us for more than a decade, but the federal agencies responsible for writing and enforcing this complex law have only recently published final rules that reflect the current, official government position on how various aspects of the law should be interpreted and implemented. The Omnibus Final Rule was published in the Federal Register in January 2013 and took effect March 23rd. “Covered entities”—including medical providers/practices, health plans and healthcare clearinghouses that transmit protected health information electronically, Business Associates, and subcontractors of Business Associates (i.e. Agents) are required to be in full compliance by September 23.

The Omnibus Final Rule modifies HIPAA Privacy, Security and Enforcement Rules, Breach Notification Rules under the HITECH Act of 2009, and the Genetic Information Nondiscrimination Act. It implements statutory amendments under the HITECH Act of 2009, strengthens privacy and security protection for individuals’ health information, modifies the definition of a “breach,” and strengthens privacy protections for genetic information, among other changes.

Durham practice management consultant Marjorie Satinsky tells Forum readers what they need to know.

What is HIPAA?
In 1996, the federal government passed the Health Insurance Portability and Accountability Act (HIPAA). Its purpose was to provide assurances that the healthcare system would keep personal health information private. The Administrative Simplification portion of the law had five parts: the Privacy Rule, Transactions and Code Sets Standards, the Security Rule, the Employer Identifier Standard, and the National Provider Identifier Standards. The HITECH Act of 2009, part of the American Recovery and Reinvestment Act (ARRA), both modified some of the provisions of the Privacy and Security Rules and added requirements. Other relevant statutes are the Interim Final Regulations on implementation of Breach Notification; Federal Trade Commission (FTC) Final Regulations on implementation of Breach Notification; the Interim Final Rule addressing Breach Notification and monetary penalties; the 2010 Notice of Proposed Rule Making; and the Genetic Information Nondiscrimination Act of 2008. The intent of the Final Omnibus Rule is to eliminate inconsistencies among some of these statutes and bring everything together.

We’re a small medical practice. Do we really have to bother with all the steps needed to comply with the Privacy and Security Rules?
Yes! When HIPAA first passed, the Department of Health and Human Services (DHHS), and its enforcement arm, the Office of Civil Rights (OCR), focused on education and voluntary compliance rather than on enforcement. That situation has changed, and an active enforcement audit program is now in effect. If you are a covered entity or Business Associate, small size does not mean you are under the radar screen. When I give presentations on HIPAA, the question I hear most often (usually from smaller practices) is whether or not practices really have to take HIPAA compliance seriously. Now that the federal government’s HIPAA enforcement audit program has begun in earnest, many small entities have already faced stiff fines for incidents that meet the definition of a Breach. Here’s an example: On January 2, 2013, DHHS announced its first HIPAA breach settlement involving fewer than 500 patients. The Hospice of North Idaho agreed to a settlement of $50,000. The agency had reported a theft of a laptop computer containing electronic personal health information (PHI) for 441 patients, and during the course of its investigation, OCR discovered that the Hospice had not conducted a risk analysis to safeguard PHI. Practices should understand that ignorance is not a valid defense and know that, if “willful neglect” is demonstrated, the financial penalties are even stiffer.

How has enforcement changed since HIPAA went into effect?
DHHS now does a preliminary investigation of every complaint. If the preliminary review indicates a possible violation of HIPAA rules due to willful neglect, the investigation automatically proceeds. If the preliminary review does not show willful neglect, DHHS has the option of trying to achieve voluntary corrective action.

A 30-day cure period factors into the determination of the size of the penalty. The clock starts running at the time the entity (i.e., Covered Entity, Business Associate, or Subcontractor) learns of, or should reasonably know of, the problem. DHHS has a formal and proactive audit program in place in order to identify noncompliance with HIPAA. Practices and other covered entities should take heed and act now to ensure that they are meeting the requirements of the law. I am aware of several medical practices that attested to being HIPAA compliant when they applied for financial incentives under Meaningful Use and are now targets for audit. Questionable HIPAA compliance may jeopardize their receipt of the federal subsidy.

How does the Omnibus Final Rule enhance the rights of individuals with respect to PHI?
The Omnibus Final Rule strengthens limitations on the use and disclosure of PHI for marketing and fundraising purposes. Individuals can now request electronic copies of PHI, and Covered Entities must provide it in the form requested by the individual if readily producible, or in a readable form and format agreed to by the Covered Entity. Individuals can request transmission of a copy of PHI directly to a designated person. In such cases, the Covered Entity must verify the identity of the individual making the request and take reasonable steps to ensure that the email address of the recipient is correct. Individuals who pay out of pocket in full for a service can restrict disclosure of that information to a health plan. To help parents and guardians, Covered Entities now have an easier process for disclosing proof of immunization to schools in those states that have school entry and other similar laws. There’s more clarity in the procedures for notifying individuals of a Breach. When individuals request PHI, Covered Entities must provide the requested information within 30 days, with a one-time 30-day extension.

How has the definition of a Breach changed, and what are the guidelines for determining and reporting a Breach?
The manner of determining whether or not a Breach has occurred remains more subjective than many in the health industry would like it to be. Still, the Omnibus Rule modifies and clarifies the definition of Breach and the risk assessment approach. Under the Omnibus Final Rule, a Breach is defined as: an impermissible use or disclosure of PHI unless the Covered Entity or Business Associate, as applicable, demonstrates that there is a low probability that the PHI has been compromised. Rather than focusing on potential harm to the individual, as in the HITECH Act of 2009, the new language speaks to the responsibility of a risk assessment, performed by the Covered Entity or Business Associate, to assess the nature and extent of the PHI, the unauthorized person who used the PHI or to whom it was disclosed, whether or not the PHI was actually acquired or viewed, and the extent to which the risk has been mitigated. A common example of a possible Breach is a lost or stolen laptop computer. The loss or theft itself does not necessarily mean a Breach. If the owner can retrieve the laptop and forensically show that there was no Breach, then there’s nothing to report. But if the laptop can’t be retrieved, there is a Breach that must be reported to the individuals affected and possibly to the media and to the Centers for Medicare and Medicaid Services (CMS).

How does the Omnibus Rule modify the HIPAA Privacy Rule to protect genetic information as required by the Genetic Information Nondiscrimination Act (GINA) of 2008?
GINA prohibits discrimination based on an individual’s genetic information in health coverage and employment contexts. Genetic information is defined as the genetic tests of an individual or an individual’s family members and about diseases or disorders manifested in an individual’s family members. A distinction is made between genetic tests and medical tests such as HIV tests, complete blood work, cholesterol testing, and liver function tests. This particular provision applies primarily to health plans.

Should my practice revise its (NPP) and redistribute it to patients?
The Notice of Privacy Practices (NPP) must be revised. There have been many changes since the initial passage of the HIPAA Privacy and Security Rules. For example, the NPP now must have language regarding patient authorization for most uses and disclosures of psychotherapy notes, uses and disclosures of PHI for marketing purposes, and disclosures regarding the sale of PHI. There must also be a statement regarding patient authorization for uses and disclosures not specifically described in the NPP. New language must mention an individual’s right to opt out of fundraising communications. Healthcare providers must clearly acknowledge their obligation to restrict use and disclosure to a health plan upon request by an individual who has paid out-of-pocket in full for a specific service.

Healthcare providers are not required to print and distribute a hard copy of the revised NPP to every patient. However, within a year after the new NPP goes into effect, they must make the revised NPP available for patients to read. They can use a summary version, provided that the full NPP is readily available. As has been the case from the outset, providers must document the patient’s acknowledgment of the right to review the NPP or refusal to exercise it. Providers should also post the new NPP in a clear and prominent location. Again, they can post a summary, provided that the full version is available. Providers should also post the new NPP on their websites. If patients have granted permission to receive practice information by email, the practice can send the revised NPP electronically.

What are good resources for additional information?


Aug
062013

Changes to the NCCSRS New law makes improvements, eases access


Image for Changes to the NCCSRS  New law makes improvements, eases access Governor Pat McCrory signed legislation on June 19 that will strengthen and improve the North Carolina Controlled Substances Reporting System (CSRS) and make it a more easily accessible and useful tool for health care providers. Provider input led to one of the most significant changes in Senate Bill 222 (Session Law 2013-152), a provision to allow prescribers and dispensers to delegate the task of querying the system to approved delegates. Additional changes allow for more complete and timely information going into the CSRS and increased communication from DHHS to prescribers, dispensers and licensing boards.

The CSRS was established in 2007 as an important tool for prescribers and dispensers of controlled substances, allowing them to provide safer care for their patients. The CSRS helps to combat the deaths, emergency department visits and diversion of controlled substances occurring as we experience an epidemic of prescription drug misuse. The CSRS provides a database that allows DHHS registered prescribers and dispensers of controlled substances to have Web access to review the controlled substance prescriptions their patients have received in an effort to provide safer care.

Portions of the law go into effect immediately while other portions become effective January 1, 2014. Provisions that have already become law will take time to implement and will be phased in.

Specific provisions enacted
The following provides a brief summary of the provisions. Further details will be posted on the CSRS website (www.nccsrs.org) as they become available.

  • Prescribers and Dispensers may delegate the task of querying to others under their supervision provided DHHS registers and approves the delegates. The delegator must be registered with the CSRS and the delegates will be linked to the prescriber or dispenser who will be responsible for their activities and the handling of confidential information. Fines for misuse of the CSRS or information from the CSRS are increased to up to $10,000 per instance. It is important to note that the delegation is only for querying and obtaining the information. Interpreting the information continues to be the responsibility of the prescriber or dispenser.

  • Physician dispensed medication in excess of a 48 hour supply must be reported to the CSRS starting January 1, 2014. This closes an information gap that currently exists. Further information on how this requirement may be met will be disseminated in the near future to Board of Pharmacy permitted dispensaries.

  • Effective January 1, 2014, all required prescriptions dispensed by pharmacies and required dispensed medication must be reported to the CSRS not later than the close of business three business days after the delivery of the medication to the patient. In addition, dispensers are encouraged to report the information no later than 24 hours after the prescription is delivered. Dispensers will also be required to report the method of payment to the CSRS.

  • DHHS may alert prescribers and dispensers of patients who have obtained prescriptions in a manner that may represent abuse, diversion of controlled substances, or an increased risk of harm to the patient. These “unsolicited alerts” will usually come via email and direct the practitioner to consult a specific query number in the CSRS. Although all prescribers may receive an alert, only registered prescribers will be able to view the query prepared for them in their account. Non-registered prescribers will be encouraged to register and will be provided a link to obtain an application.

  • DHHS may alert licensing boards of prescribing or dispensing practices in accordance with rules established by the respective board.

  • DHHS must provide information to sheriffs, designated deputy sheriff’s, police chiefs or their designated investigators assigned to investigate diversion and illegal use of prescription medications or pharmaceutical products identified as controlled substances who are engaged in a bona fide investigation and pursuant to a court order.

Independent of the recent statutory changes, the CSRS is working with the Medical Board to make it easier to register for access to the reporting system while enabling the CSRS to maintain more complete information. These improvements are currently in the developmental stages. Among them are:
  • A streamlined registration process whereby a prescriber could register for Web access to the CSRS via a portal on the NCMB’s website. A notarized signature would not be required for this avenue of registration. The prescriber would sign into a secure Medical Board portal. A link would be provided for them to register for the CSRS. The plan is to ask licensees of the Medical Board for information not currently stored by the Board (such as DEA number and proposed password) but required to access the reporting system. This additional information will be combined with the information on record with the NCMB and sent electronically to the CSRS office for registration. Prior to transmitting the data the prescriber will sign the privacy statement and give consent for the transmission.

  • An upgrade to the language format that pharmacies report into the CSRS is planned. (changing from ASAP 1995 to ASAP 4.2). This change will allow CSRS to capture more information including the ID of the person picking up a prescription for a Schedule II and/or Schedule III opioid analgesic.

  • We are hopeful that these changes and improvements will enable more prescribers to begin using this valuable tool. Routine use of the CSRS is quickly becoming the standard of care when providing treatment that includes prescribing controlled substances.

Contact Devon Scott or William Bronson with the Department of Health and Human Services at 919-733-1765 if you have any questions.

Charts illustrating leading cause of death and unintentional deaths in NC due to controlled substances.

Aug
062013

Get engaged: Board seeks licensee input as part of chronic pain position statement review

Newsletter: Forum, Summer 2013
Categories: Announcements,

The Federation of State Medical Boards (FSMB) recently adopted a completely revised “Model Policy on the Appropriate Use of Opioid Analgesics in the Treatment of Chronic Pain.” State medical boards are not obligated to accept an FSMB model policy as their own policy, but they are invited and encouraged to use the policy as a basic framework that may be customized to the particular needs of the individual regulatory boards and their licensees. The NCMB used the Federation’s 2004 policy on the treatment of chronic pain as a guide when revising its own position statement on the use of controlled substances for the treatment of chronic pain in 2005. The NCMB is beginning the process of reviewing and revising the 2005 version of its policy soon and expects to use the Federation’s new model policy as a blueprint once again.

The Board also wants to know what you, its licensees, think. If you prescribe controlled substances to treat chronic pain in your practice, or if there is a chance you might start doing so in the future, please take the time to look over the Board’s existing position statement. There have been important developments related to the treatment of chronic pain in the last several years and the Board expects to make significant changes to the position statement.

The Board will hold a public forum to receive comments from interested parties, orally and/or in writing on August 21 from 4-6 p.m. at the Board’s administrative offices in Raleigh.

To help licensees get up to speed on this important issue, we are publishing the full text of the Board’s existing “Policy for the use of controlled substances for the treatment of pain,” as well as an excerpt from the FSMB’s proposed model policy that provides a summary of topics covered. We hope you will take advantage of this opportunity to communicate your thoughts and concerns to the Board. What subjects should be addressed in the Board’s new position? What specific areas related to the use of controlled substances for the treatment of chronic pain would you like Board guidance on?

Licensees may submit comments in writing in advance of the public hearing by emailing them to forum@ncmedboard.org

Board position statement
Policy for the use of controlled substances for the treatment of pain

Federation of State Medical Boards
Model policy on the appropriate use of opioid analgesics in the treatment of chronic pain

Aug
062013

Doing our part to encourage responsible prescribing of controlled substances


Image for Doing our part to encourage responsible prescribing of controlled substances Safe and appropriate prescribing of controlled substances remains a top concern of the North Carolina Medical Board. In each of the past five years, about 30 percent of all public actions taken against licensees related to prescribing problems. The vast majority of these involved controlled substances. As the number of prescriptions for controlled substances prescribed in North Carolina continues to rise, it seems likely that the number of Board actions will also increase.

Sometimes the prescribing we review is clearly excessive and inappropriate. Last year, for example, the Board indefinitely suspended the license of a physician whose prescribing led multiple pharmacists and other professionals to report the physician to the Board.

The Board’s investigation found that the physician wrote prescriptions for Diazepam, Hydrocodone, Oxycodone, Oxycodone ER, Temazepam, Alprazolam and Tussionex liquid over a period of 16 months to a single patient. The patient used multiple pharmacies to obtain these drugs. A NC Controlled Substances Reporting System (NCCSRS) query of the patient’s prescription history found 117 separate entries (each entry representing a prescription for controlled substances dispensed) for the 16-month period reviewed. In a second instance, the physician prescribed 360 Oxycodone HCL 15mg tablets to a patient and then, just two days later, prescribed 720 Oxycodone HCL 30mg tablets to the same person. A third example of the physician’s excessive prescribing involved a high school student who was being prescribed Xanex and Vynase. A school social worker reported the student often slurred his words and would sometimes fall asleep in the middle of a conversation. The same student allegedly sold some of the medications prescribed by the physician. When the school refused to continue to administer the student’s medications, the physician sent the school a letter stating there was “no risk” in giving the student the prescribed drugs.

Cases like this one, where prescribing is clearly substandard (as confirmed by independent expert medical reviewers) and the physician appears not to recognize or acknowledge problems with care are rare. Far more often, issues with prescribing are more subtle and the licensees in question are well meaning medical professionals who have ventured into the treatment of chronic pain out of a genuine desire to help patients. Problems arise when these licensees don’t know appropriate standards of care and then engage in potentially unsafe prescribing.

The Board’s duty to protect the public obligates it to not only to stop unsafe prescribing practices, but also to promote safe and appropriate prescribing. Some of our efforts to encourage proper prescribing include publishing informational articles in this newsletter. We post information about obtaining free or low-cost CME in the area of prescribing controlled substances for chronic pain on the Board’s website. The Board also frequently recommends “Responsible Opioid Prescribing: A Clinician’s Guide” by M. Scott Fishman, MD, which is considered the national gold standard publication for prescribing opioids. In NC, however, the foundation for safely prescribing controlled substances is the Board’s position statement, “Policy for the use of controlled substances for the treatment of pain.”

The Board adopted this position statement in July 1996 and completely revised it in July 2005 based on the “model policy” on the treatment of chronic pain developed by the Federation of State Medical Boards (FSMB). Given the rapid changes occurring in controlled substance use and prescribing, the Board is currently reviewing and revising the position statement again.

Over the past few years, the Board has sought opinions from its licensees and others when revising position statements and rules. To continue this outreach, the NCMB will host a public forum on the subject of prescribing controlled substances for the treatment of pain at its offices in Raleigh on August 21st, between 4 and 6 p.m. The Board will consider these comments and suggestions as it develops the latest revision of its position statement. If you are unable to attend, you may submit comments by August 30 to forum@ncmedboard.org

To help licensees understand this important policy discussion, we have dedicated most of this issue of the Forum to the subject of controlled substances. We have published the full text of the Board’s existing position statement. We’ve also published a draft of the FSMB’s new “Model Policy on the Appropriate Use of Opioid Analgesics in the Treatment of Chronic Pain,” which will be an important resource for the Board during the review and revision process. A distinguished panel of physicians and recognized experts in the field developed the draft FSMB policy after a months-long study of current issues as well as trends and standards of care in the treatment of chronic pain I’m proud to say that two North Carolina physicians—Janelle Rhyne, MD, a past president of this Board and past chair of the FSMB, and the NCMB’s Associate Medical Director C. Michael Sheppa, MD,—participated in this workgroup. State medical boards often use FSMB’s model policies as starting points when tackling complex issues such as the use of opioids in the treatment of pain.

Finally, I am happy to report that this summer’s legislative session improved the NC Controlled Substances Reporting System law (NCCSRS). The NCCSRS allows licensees to appropriately review their patients’ controlled substances prescription histories. Prior to the revision, the law required the prescriber to personally conduct all queries. In June, Governor McCrory signed Senate Bill 222 into law. As adopted, the law authorizes physicians and other registered users of the NCCSRS to delegate queries to designated persons in the practice, provided those persons register for access to the database. Although the change will take several months to implement, when completed, obtaining reports from the NCCSRS will be much easier and faster.

To promote responsible prescribing, the NCMB encourages licensees to register with the NCCSRS and use it regularly. The NCCSRS helps physicians and PAs avoid prescribing controlled substances to patients who may have received multiple prescriptions from other providers. Please read the article on the pending changes to the NCCSRS on P. 7.

I urge you to take the time to learn more about controlled substance prescribing. Participating in the Board’s policy discussion around appropriate prescribing of controlled substances for pain allows you to have a voice in creating Board policy. If you are treating pain in your practice, make sure you have current and complete information about controlled substance prescribing. Don’t be a well-meaning but uninformed prescriber who unintentionally adds to the epidemic of prescription drug misuse and abuse.

Send comments to forum@ncmedboard.org

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Public forum
Where: NCMB offices, 1203 Front Street, Raleigh, NC 27609
When: Wednesday, August 21, 4-6 p.m.
Why: NCMB is reviewing and revising its position statement on treating chronic pain
Who should attend: Licensees and other interested parties

Complete a one-question survey.
How often do you prescribe controlled substances to treat chronic pain?


May
022013

Apply no later than July 1 to serve on the NCMB

Newsletter: Forum, Spring 2013
Categories: Announcements,

Three physician members of the NC Medical Board will complete their second and final terms this year. The independent panel that nominates candidates for the Board is now seeking physicians to fill these seats, for terms beginning Nov. 1. Are you interested in serving the public and the medical profession in this challenging, dynamic role? Do you know someone who might be?

Candidates must have an active North Carolina medical license and must be practicing clinical medicine at least part time. Candidates must have no history of public discipline for the past 10 years. Candidates should also be aware that serving on the Board requires a significant commitment of time and possess both the ability and willingness to dedicate this level of service.

The process established by state law (N.C. Gen. Stat. § 90-2 and 90-3) requires anyone interested in serving on the Board to apply though the Review Panel for the NC Medical Board. This body screens applicants, conducts interviews, and makes recommendations to the Governor, who then makes appointments to the Board. The Medical Board is not involved in the review of applications or the selection of nominees.

Applications must be submitted by close of business on Monday, July 1. All qualified applicants will be invited to participate in a face-to-face interview with the Review Panel on August 24 & 25, 2013, at the Hampton Inn & Suites in Cary, NC.
.............................................................
Apply online
Access the Board Member application online:
www.ncmedboardreviewpanel.com

For more information:
Dave Feild
Administrator for the Review Panel
919-861-4533

May
022013

Quarterly Board Actions Report | November 2012-January 2013


View recent Board actions or sign up to receive notification when new actions are posted via the RSS Feed subscription service.

Board Actions Report Nov. 2102 - Jan. 2013

May
022013

Year in review: A look back at data from 2012

Newsletter: Forum, Spring 2013
Categories: Bulletin Board,

It’s that time again: Year in Review time. This feature highlights a selection of Board data in a two-page graphic spread that, we hope, illustrates some interesting facts about the NCMB’s work and licensee population.

Back by request (really, we get frequent inquiries) is the Physician Population by County table. This data is also available for Physician Assistants (our space is limited here, so it is not published—look for it online in the Data Center). PAs are currently the NCMB’s fastest growing licensee group. Notable: PAs account for 11.5 percent of the total licensee population in 2012 but made up more than 14 percent of licenses issued for the year.

And, for the first time, we took a look at fines issued by the NCMB in 2012. Fines are a relatively recent addition to the range of tools used by the Board to address disciplinary and administrative matters. Good to know: the NCMB does not benefit financially from the issuance of fines. All funds go to the NC Department of Education.

2012 year in review

May
022013

NCMB on the road: At the Federation of State Medical Boards Annual Meeting, April 18-20

Newsletter: Forum, Spring 2013
Categories: Announcements,

Each year members of the Board and a delegation of Board staff attend the annual meeting of the Federation of State Medical Boards (FSMB) to discuss current and emerging issues in medical regulation. This year’s meeting found Board Members and staff in Boston, just days after the bombing at the city’s iconic Boston Marathon. A day into the meeting, law enforcement put the city on lockdown as they circled in on the surviving bombing suspect. The NCMB delegation was confined to the hotel for almost two days.

Fortunately, there was no shortage of medical regulatory business to attend to. Ralph C. Loomis, MD, a recent former Board member and past president of the Board, continued the proud NCMB tradition of service on the Federation’s Board of Directors by winning a seat on that board. Loomis, an Asheville neurosurgeon who completed his final term on the NCMB in October, is one of many former NCMB members to serve in this capacity.

North Carolinians, including members of the NCMB staff and others who work closely with the Board, led and participated in panels at the FSMB meeting, and at the annual meeting of the Administrators in Medicine (the professional organization for medical board executives and staff). The AIM meeting took place in Boston on April 17.

• Michael C. Sheppa, MD, the NCMB’s associate medical director, led the Medical Board Staff Roundtable, which brings together staff from medical boards across the nation and territories to discuss the scope of their administrative work, issues they may have in common and challenges that they face.

• Warren Pendergast, MD, medical director of the NC Physicians Health Program, participated in a panel offered as part of a Joint Session of the FSMB and the Federation of State Physicians Health Programs, of which Pendergast is the current president. The panel discussion, entitled “Aging and Misbehaving: Two Special Topics in Physician Health” explored trends related to the aging of the physician workforce and the rise in “disruptive” behavior among physicians. The emphasis of the panel was on how PHPs can assist with aging and disruptive physician licensees.

• Thom Mansfield, the director of the NCMB’s Legal Department and its primary liaison to the NC legislature, co-presented a session on the Federal Trade Commission’s emerging interest in licensing board regulatory practices to attendees of the AIM annual meeting. The FTC has a particular interest in licensing boards’ efforts to limit unauthorized practice (In FTC’s view, potential “restraint of trade” activity). The session explored lessons from the recent FTC action against the North Carolina Board of Dental Examiners, which is currently under appeal. The session provided practical advice on steps boards can take to minimize the risk of FTC scrutiny and tips on re

May
022013

Position statement update

Newsletter: Forum, Spring 2013
Categories: Announcements,

The NCMB regularly adopts new position statements and reviews and, where appropriate, revises the existing official position statements of the Board to ensure that they remain relevant. We periodically publish a summary of recent revisions to position statements to help licensees stay abreast of changes. Full position statements may be found online in the Professional Resources section of the Board’s website.

Statement: Advance directives and patient autonomy
Date revised: November 2012
Changes: Minor changes only (changing physician to licensee throughout).

Statement: Referral fees and fee splitting
Date revised: January 2013
Changes: Changed physician to licensee throughout; The statement is revised to address licensee use of voucher advertising programs (e.g. Groupon, Living Social, etc.) The new section on voucher advertising reads:

It is the Board’s position that, so long as certain conditions are followed, advertising involving the utilization of vouchers does not constitute unethical fee-splitting or a prohibited solicitation or referral fee under North Carolina law. Those conditions include: (1) ensuring that the negotiated fee between the voucher advertising company and the licensee represents reasonable compensation for the cost of advertising; and (2) incorporating the following terms and conditions in a clear and conspicuous manner in all advertisements:

(a) A description of the discounted price in comparison to the actual cost of services;
(b) A disclosure that all patients may not be eligible for the advertised medical service and that ecisions about medical care should not be made in haste. Determinations regarding the medical indications for individual patients will be made on an individual basis by applying accepted and prevailing standards of medical practice; and
(c) A disclosure to prospective patients that, if it is later decided that the patient is not a candidate for the previously purchased medical service, the patient’s purchase price will be refunded in its entirety. If the patient does not claim the service, then the patient’s purchase price must still be refunded in its entirety. In the event that the voucher advertising company does not refund the purchase price in its entirety, it will be the sole obligation of the licensee to refund the entire purchase price.

Statement: End-of-life responsibilities and palliative care
Date revised: January 2012
Changes: Revises definition of palliative care; changes physician to licensee throughout.

Statement: Drug overdose prevention
Date revised: March 2013
Changes: Broadens the scope of the position statement to indicate Board support of all programs that attempt to prevent deaths from drug overdose through making available or prescribing an opioid antagonist such as naloxone to someone in a position to assist a person at risk of an opiate related overdose.

New Position Statement: Professional Use of Social Media
Date adopted: March 2013

Professional Use of Social Media
The Board recognizes that social media has increasing relevance to professionals and supports its responsible use. However, health care practitioners are held to a higher standard than others with respect to social media because health care professionals, unlike members of the lay public, are bound by ethical and professional obligations that extend beyond the exam room.

The informality of social media sites may obscure the serious implications and long term consequences of certain types of postings. The Board encourages its licensees to consider the implications of their online activities including, but not limited to, the following:

• Licensees must understand that the code of conduct that governs their face to face encounters with patients also extends to online activity. As such, licensees interacting with patients online must maintain appropriate boundaries in accordance with professional ethical guidelines, just as they would in any other context.
• Licensees have an absolute obligation to maintain patient privacy and must refrain from posting identifiable patient information online.
• A licensee’s publicly available online content directly reflects on his or her professionalism. It is advisable that licensees separate their professional and personal identities online (maintain separate email accounts for personal and professional use; establish a social media presence for professional purposes and one for personal use, etc.).
• Because privacy is never absolute, considerations of professionalism should also extend to a licensee’s personal accounts. Posting of material that demonstrates, or appears to demonstrate, behavior that might be considered unprofessional, inappropriate or unethical should be avoided. The online use of profanity, disparaging or discriminatory remarks about individual patients or types of patients is unacceptable.
• Licensees should routinely monitor their own online presence to ensure that the personal and professional information on their own sites is accurate and appropriate.

The Board also endorses the Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice adopted by the Federation of State Medical Boards. Further discussion of this issue by the Board’s Medical Director.

May
022013

ENTER NOW and win!

Newsletter: Forum, Spring 2013
Categories: Bulletin Board,

Win a chance to be featured in an upcoming NCMB campaign with the Licensee Information Challenge.

The NCMB challenges licensees to make the most of their Licensee Information pages by providing content for the many optional categories available to them. This information helps patients and others who use the NCMB’s website to look up physicians and physician assistants get a better sense of a licensee’s unique professional background, education and training. Besides, it’s free marketing—why wouldn’t you want to take advantage of that?

Our goal :
To encourage more licensed physicians and physician assistants to provide optional content for their Licensee Information pages.

How to enter:
Update your Licensee Info Page
Log in and provide content for applicable optional categories (practice philosophy, memberships, languages spoken, etc.) When you have finished entering information, email forum@ncmedboard.org with your full name and indicate you are entering the contest. Entrants must complete updates by end of business July 1.

Rules:
Licensed physicians and PAs may enter. You must have an active license, be practicing medicine at least part time and have no history of public discipline for at least 10 years. Information reported in optional Licensee Information categories must be accurate and relevant to each individual category for which information is provided. Winning entries will be determined at the sole discretion of the NCMB’s Public Affairs department.

Prizes:
Depending on the number and quality of entries, the NCMB’s Public Affairs department will select up to 10 licensees, who will be offered the opportunity to be featured in an upcoming NCMB public awareness campaign. Examples of upcoming campaigns include print media/display advertisements, radio spots and/or video public service announcements. Winners will also be featured in the Forum.

Questions ?
Contact Jean Fisher Brinkley, Director, Public Affairs at jean.fisher@ncmedboard.org or 919-326-1109 x230.
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Psst. . .We still care about the required information too
North Carolina law requires physicians and physician assistants to state their area of practice. Many licensees responded with enthusiasm and listed multiple areas of practice. Trouble is, nearly 40 percent did not indicate a PRIMARY area of practice as requested. The Board needs licensees to do this to enable the NCMB to accurately measure the number of licensees practicing in each primary AOP.

Make sure we have your primary AOP. Update Licensee Info Page.
Thank you for your help in making the NCMB’s licensee information accurate and complete

May
022013

How complete is your LI page?

Newsletter: Forum, Spring 2013
Categories: Bulletin Board,

An in depth look at who's reporting optional information on the NCMB's expanded Licensee Information pages.

Who's reporting and what are they saying?

May
022013

Out and about

Newsletter: Forum, Spring 2013
Categories: Board News,

The North Carolina Medical Board regularly sends Board Members and staff to speak to and engage with licensees, community organizations and other groups. Here are some of the venues our speakers have visited recently.

PRESENTATIONS TO PROFESSIONAL GROUPS

American Association of Physicians of Indian Origin, Carolinas Chapter
Spring Governing Meeting in Charlotte, NC | March 22-24

Board Member Subhash C. Gumber, MD, a Cary gastroenterologist, and Board President William A. Walker, MD, a Charlotte colorectal surgeon, presented a general overview of the Board and spoke about current and future initiatives.

North Carolina Academy of Family Physicians
Spring Family Physicians Weekend in Greensboro, NC | April 4-7

Board President William A. Walker, MD, presented a talk entitled, “Fear Factor—Myths and Reality about the NC Medical Board.” The talk featured a special emphasis on the Board’s disciplinary work related to inappropriate prescribing of controlled substances and provided practical advice to attendees on avoiding problems.

PRESENTATIONS TO CONSUMER AND COMMUNITY GROUPS/ORGANIZATIONS

The Leisurettes, National Association of University Women
Raleigh, NC | February 28 | April 27

Jean Fisher Brinkley, the NCMB’s director of public affairs, presented talks to two Raleigh-area groups, a group of retired teachers, the Leisurettes, and a Raleigh chapter of the NAUW. The talks gave an overview of the NCMB’s mission/duties and emphasized how the Board protects the public.

Citizen Advocacy Center
Public Outreach Meeting in Washington, D.C. | April 9

Dena Konkel, the NCMB’s assistant director of public affairs, presented on the Board’s public outreach efforts. The Citizen Advocacy Center (CAC) is dedicated to improving the efficacy of health regulatory oversight boards by offering training and resources to public members, Board staff and other interested parties.

May
022013

Hospital suspensions related to failure to complete medical records (yes, those are actions too)

Newsletter: Forum, Spring 2013
Categories: Board News,

Image for Hospital suspensions related to failure to complete medical records (yes, those are actions too) Since the fall of 2009, the NCMB has been implementing and refining the expanded licensee information system mandated by the North Carolina General Assembly. As part of this work, last fall the Board began posting on its website hospital privilege suspensions related to failure to timely complete medical records. Hospitals are currently required by state law to report these actions to the Board when a licensee receives three suspensions of this type in a calendar year. These actions have been available to the public through the NCMB for several years. Until relatively recently, however, the NCMB did not post them on the Board’s website. Only privilege suspensions and revocations that stemmed from concerns about clinical competence or willful misconduct were posted to the site.

This column will discuss the recent change in Board policy regarding suspensions related to failure to complete medical records and highlight some resulting changes to how those actions are displayed on the NCMB’s website.

What changed?
Last year, the NCMB spent some time carefully considering its handling of hospital privilege suspensions related to failure to timely complete medical records. The Board analyzed the seriousness of these suspensions compared to others. Part of the analysis included a discussion of how the NCMB might differentiate medical records-related suspensions from those related to competence or misconduct.

Ultimately, it was decided that suspensions for failure to complete medical records should be published on the Board’s website and the relevant staff were directed to come up with a means of differentiating between adverse actions and administrative actions such as the records-related hospital suspensions. Staff began posting newly reported hospital privilege actions in this category in the fall. To be fair, and to ensure the accuracy and completeness of information on each individual’s Licensee Information (LI) page, the Board staff also began the process of reviewing all privilege actions that had been previously reported to ensure that all actions that meet criteria are posted.

As Board staff began posting records-related suspensions from the last few years, it notified licensees of the changes. We quickly heard back from a number of licensees who weren’t happy to see a suspension for failure to timely complete medical records on their otherwise clean public record.

As a former hospital-based physician (before joining the Board’s staff, I practiced emergency medicine in Raleigh) I can understand licensees’ frustrations. The vast majority of suspensions related to late medical records are temporary —many are resolved within a day or two—and they rarely, if ever, involve concerns about patient care. Yet a public report of a hospital “suspension” can have adverse effects on a physician or PA that may include real or perceived dings to professional reputation or difficulties with recredentialing.

Why records are important
I don’t want to minimize in any way the importance of timely completion of medical records. The Board believes that accurate, current and complete medical records are an essential component of patient care. Significant delays in the completion of medical records diminish both the accuracy and credibility of the records, and may create confusion among others treating the patient. The Board expects licensees to properly document medical care in an accurate and timely manner.

When the Board receives information that a licensee’s hospital privileges have been limited, suspended or revoked (a Change in Staff Privileges or CISP), it has a duty to investigate. Depending on the seriousness of the allegation and corresponding level of concern, the Board may conduct a field investigation or require the licensee to respond in writing with an explanation that provides their side of the story. The licensee conduct that led to a CISP may or may not result in a disciplinary action by the Board (most often it does not). In the case of a CISP related to failure to timely complete medical records, the licensee is expected to notify the Board, in writing, within 30 days that all delinquent medical records have been completed and that privileges have been restored.

NCMB’s duty to publish
Pursuant to NCGS 90-5.2 (a) (8), (b) the Medical Board is required to publish actions by health care institutions that suspend or revoke a licensee’s privileges. Corresponding rules state that these actions are to be displayed on the Board’s website (they appear on the individual’s LI page) for a period of 7 years.

The rules do not differentiate between hospital actions related to medical records as opposed to actions related to clinical competence or quality of care. However, the Board recognizes that there is a qualitative difference between them. Consequently, the Board recently modified how these actions are displayed on licensee information pages. The revised page layout now includes a section for administrative actions, including hospital suspensions related to failure to timely complete medical records. The administrative actions section is labeled to indicate that the actions listed are considered non-disciplinary by the Board and involve issues such as failure to meet certain statutory requirements or failure to follow correct administrative procedures. The Board and its staff hope that these changes will prevent confusion about the nature of posted actions and prevent undue negative consequences to licensees. Note to hospitals Finally, it must be noted that it is clear to the Board that some CISP reporting requirements are being unevenly applied by health care institutions. In reviewing suspensions related to failure to timely complete medical records, it quickly became apparent that some hospitals are reporting these suspensions in accordance with the law and some, it seems, are not. If you are a hospital administrator or chief of staff reading this article, please understand that the Board expects you to equitably and fairly comply with reporting requirements as outlined in this article. The Board accepts change in staff privilege (CISP) reports via its website.
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Licensee Tip
Licensees are sometimes confused about what information they are required to disclose to the Board regarding hospital actions. Licensees are required to report ANY limitation, suspension, revocation or other action by a hospital or health care institution at the time of annual renewal. This is true even if the licensee is aware that the hospital has already reported the action to the Board.

May
022013

Teamwork: In medicine, more than ever, patient safety demands it


Image for Teamwork: In medicine, more than ever, patient safety demands it In 2009, The Joint Commission (TJC) called attention to the “disruptive physician” and required hospitals
to develop a process for identifying and dealing with doctors who seemed to have problems working with others.

As usual, TJC did not dictate how hospitals should do this. Rather, TJC simply required hospitals to create procedures to deal with the problem. As a result, licensees and others contacted the NCMB to ask it to issue a formal position on “disruptive physicians.” In response, the Board published the osition entitled, “Collaborative care within the health care team” on January 1, 2010.

The position statement outlines the Board’s expectation for licensee conduct (among physicians and others such as PAs) in the context of working with others to provide patient care. We purposefully avoided the term “disruptive physician” in the title, choosing to emphasize the most important part of our professional lives—care of the patient—by everyone involved. We did define disruptive behavior, noted that the behavior may result from other underlying causes, and indicated that such behavior may be grounds for discipline.

Almost always, it is physicians who are singled out as “disruptive” and it’s not terribly difficult to understand why. In medicine, physicians have traditionally been at the top of the power structure and, consequently, have the greatest potential to impact those around them, including patients and other members of the health care team. This phenomenon is commonly referred to as “power distance.” Defined simply, power distance occurs when individuals in positions of less power are reluctant to challenge those with greater authority. In some environments, such as the battlefield, there are very good reasons for strict adherence to the established power structure. But in other environments, power distance may actually result in harm.

The aviation industry is rife with examples that tragically demonstrate this. If the captain intimidates crew members or the culture of the airline allows the captain an absolute authority, crew members may not speak up appropriately. Examples of this include the 1977 KLM crash in Tenerife, in which hundreds of people lost their lives essentially because the flight crew did not contest a poor decision made by the captain. Similarly, the crash of Korean Air Flight 801 in 1997 was attributed primarily to the rigidly hierarchical power structure in the cockpit, which prevented crew from speaking up until it was too late
to avoid catastrophe.

Similarly hierarchical cultures exist in medicine, and the implications are clear. If a physician or surgeon (the captain) intimidates or disrespects others who help care for the patient (the crew), bad or even fatal outcomes may occur. In an airplane crash, however, the captain and flight crew often perish with the passengers. In the context of health care, only the patient suffers the consequences.

Just as in the aviation industry, health care organizations such as TJC and the Accreditation Council for Graduate Medical Education have started to understand the effects of poor team performance. Still, not everyone agrees that personal behavior can impact care.

During a confidential interview at the NCMB that I helped conduct, an attorney for a physician argued that his client was an excellent physician and that his behavior had no effect on the quality of care he provided. I felt compelled to explain that physician behavior can have a very large impact on quality. If a nurse has been verbally abused by a physician, that nurse will be understandably reluctant to call the physician when concerns arise. Who would, knowing that the likely result would be a rude, belittling response? So in ambiguous circumstances, a nurse might wait until a patient’s condition has worsened further before alerting the physician, potentially increasing the risk of complications. It was a simple but compelling example that I hope helped the attorney understand that medicine is more than just technical knowledge.

In 2003, the Institute for Safe Medication Practices surveyed 1,565 nurses and 354 pharmacists about their experiences with physicians. Eighty-eight percent of respondents reported that a physician had spoken to them with condescending language or tone; 87 percent reported that physicians had been impatient with questions; and 79 percent said physicians had demonstrated reluctance to, or had
refused to, answer questions or phone calls. In other words, a significant majority of nurses and pharmacists had experienced this treatment. Nearly half of those surveyed—48 percent—said they had experienced strong verbal abuse from a physician; and 42 percent reported they had experienced threatening body language. Aside from the potential for patient harm, how many of us would want our sons, daughters or other family members to be treated in such a fashion?

We’ve all heard the same excuses to explain poor behavior by physicians, but in reality, there are no excuses. Treating people poorly is never right, especially if there is even a chance that our patients might suffer as a result. While physicians have certainly seen a substantial change in their roles over the last several years, they remain the leaders of the team. As such, the physician must set the example and welcome the engagement of the other team members.

How do physicians successfully lead the team? Most physicians can probably appreciate the value of a calm, professional, deliberate atmosphere. But many of us don’t remember that we play a huge part in setting that tone. As team leaders, physicians should encourage communication from all members of the team, regardless of level of training or role. Many of my surgical colleagues have questioned the
part of the surgical checklist that requires team members to introduce themselves. It might seem unnecessary, since many of us have worked with the same nurses, techs and nurse anesthetists for years, but the action of actually speaking up empowers people to continue speaking if concerns arise. Physicians should encourage members of the team to express concerns without fear of retribution, sarcasm or bullying. It sounds pretty fundamental, but we’ve all seen those behaviors from our colleagues. Some of us may even have participated in them. By engaging everyone on the team, we support each other and make errors much less likely.

At a session presented by the health care safety consulting firm HPI, the speaker quoted data published in 2004 about perceptions of teamwork. In a survey of operating room personnel about teamwork, 75 percent of surgeons rated teamwork as “high” (e.g. surgeons felt the team worked well together.) You may be reading this thinking, ‘I’ve seen bad behavior in others but I’m one of the good ones—my team works like a well-oiled machine.’ Just remember that we are not always the best and most accurate judges of how we are perceived by others. The responses of other team members to the same survey question are telling. Thirty-nine percent of anesthesiologists surveyed reported that teamwork was “high.” Just 28 percent of surgical nurses rated teamwork as “high” and nurse anesthetists came in at a slightly less enthusiastic 25 percent. Surgical residents were the toughest critics, with just 10 percent of residents describing the level of teamwork as “high.”

The same study gives some hints as to what might influence team members’ perceptions of the team. The survey found that 50 percent of surgeons felt junior team members should not question senior physicians (though, as a surgeon, it pains me to share this finding.) That attitude probably reflects the failure of physicians to understand that working as part of a team doesn’t mean rule by committee. No one suggests that surgery should be done by consensus after discussion by all members of the team. Teamwork does require mutual trust and respect and a shared expectation that any member of the team has an obligation to speak up if he or she believes an error is imminent or sees some potential for patient harm. It should be clear to all that good communication is not a challenge to anyone’s authority.

While I hope I’ve argued persuasively that physicians play a critical role in nurturing true collaboration, I also want to be clear that I think it’s time to move beyond simplistic and pejorative terms such as “disruptive physician.” Anyone can disrupt the smooth functioning of the team and potentially harm the patient, and anyone disrupting good care should be held accountable. No individual has all the knowledge required to take care of patients in an exceedingly complex medical care environment. Rather than resenting suggestions about care or questions that clarify issues, we should all welcome support from our teammates and offer such support in kind.
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Collaborative care within the health care team
Created: January 1, 2010

The North Carolina Medical Board (“the Board”) recognizes that the manner in which its licensees interact with others can significantly impact patient care.

The Board strongly urges its licensees to fulfill their obligations to maximize the safety of patient care by behaving in a manner that promotes both professional practice and a work environment that ensures high standards of care. The Accreditation Council for Graduate Medical Education highlights the importance of interpersonal/communication skills and professionalism as two of the six core competencies required for graduation from residency. Licensees should consider it their ethical duty to foster respect among all health care professionals as a means of ensuring good patient care.

Disruptive behavior is a style of interaction with physicians, hospital personnel, patients, family members, or others that interferes with patient care. Behaviors such as foul language; rude, loud or offensive comments; and intimidation of staff, patients and family members are commonly recognized as detrimental to patient care. Furthermore, it has become apparent that disruptive behavior is often a marker for concerns that can range from a lack of interpersonal skills to deeper problems, such as depression or substance abuse. As a result, disruptive behavior may reach a threshold such that it constitutes grounds for further inquiry by the Board into the potential underlying causes of such behavior.
Behavior by a licensee that is disruptive could be grounds for Board discipline.

The Board distinguishes disruptive behavior from constructive criticism that is offered in a professional manner with the aim of improving patient care. The Board also reminds its licensees of their responsibility not only to patients, but also to themselves. Symptoms of stress, such as exhaustion and depression, can negatively affect a licensee’s health and performance. Licensees suffering such symptoms are encouraged to seek the support needed to help them regain their equilibrium.

Finally, licensees, in their role as patient and peer advocates, are obligated to take appropriate action when observing disruptive behavior on the part of other licensees. The Board urges its licensees to support their hospital, practice, or other health care organization in their efforts to identify and manage disruptive behavior, by taking a role in this process when appropriate.

Feb
072013

New Corporation/PLLC “home” lets users manage NCMB corporate files online

Newsletter: Forum, Winter 2013
Categories: Announcements,

The NCMB is pleased to introduce a new online home for professional corporations and professional limited liability companies. The Board’s corporate registrants can use this portal to manage many tasks online, including changes of address, changes of registered agent, changes in shareholder roster and requests for certification for new shareholders. The Board hopes automating these tasks will make it easier for corporations to manage their businesses and ensure they are in compliance with corporate rules, laws and filing requirements.

Access the corporations portal

Feb
072013

Quarterly Board Actions Report | August-October 2012


The Board actions listed below are published in an abbreviated format. The report does not include non-prejudicial actions such as reentry agreements and non-disciplinary consent orders. View recent Board actions or sign up to receive notification when new actions are posted via the RSS Feed subscription service.

Quarterly Board Actions Report | August-October 2012

Feb
072013

Thank you!


Quality expert medical reviews are an essential component of the Board’s disciplinary work. They help to establish whether care was within accepted and prevailing standards in North Carolina and thus play a critical role in determining the outcome of cases. More than 350 licensees have registered with the Board as reviewers, and more than 100 completed reviews in 2012. The NCMB extends its sincere thanks to these men and women for their service to the public and to the profession.

Interested in completing reviews for the Board? .(JavaScript must be enabled to view this email address), the NCMB’s Medical Director or (919) 326-1109 ext. 247

Feb
072013

NCMB welcomes four new Board members

Newsletter: Forum, Winter 2013
Categories: Announcements,

The North Carolina Medical Board is pleased to welcome four new Board members and to welcome back Dr. Eleanor E. Greene, who was recently reappointed as a physician member of the Board. The Board’s four newest members include a Cary gastroenterologist, a Raleigh trauma surgeon, a Wilmington family nurse practitioner and a former senior advisor to Gov. Beverly Perdue. Perdue made the appointments before completing her term as Governor in January.

“The current Board and its staff are delighted to welcome each of the new Board members,” said R. David Henderson, executive director of the North Carolina Medical Board. “Serving on the Medical Board is a tremendous commitment of attention and time. We appreciate each new member’s dedication to North Carolinians and to the medical profession and look forward to working with each of them.”

“The Board is also extremely pleased that Dr. Greene will continue her tenure on the Board,” Mr. Henderson said. “She is a valued member of the Board and a dedicated public servant.”

Board member terms run from November 1, 2012 to October 31, 2015.

Subhash C. Gumber, MD, PhD
Dr. Gumber, who lives and practices in Cary, is a partner in the Wake Endoscopy Center and Raleigh Medical Group, both in Raleigh. He is the practice’s director of Gastroenterology and also serves on its Board.

Dr. Gumber earned his medical degree from the University of Massachusetts Medical School. He completed an internship and residency in Internal Medicine at Boston University Medical Center and a fellowship in Gastroenterology at Beth Israel Hospital, Harvard Medical School. Before training as a physician, Dr. Gumber earned a doctoral degree from the Institute of Biological Chemistry, Washington State University, and a master’s degree, with honors, in biochemistry from Punjab Agricultural University, Ludhiana, India.

Dr. Gumber is certified by the American Board of Gastroenterology. He is a fellow of the American College of Gastroenterology and is an active member of the North Carolina Medical Society and of the American Association of Physicians of Indian Origin. He has authored numerous articles and abstracts for scholarly journals.

Helen Diane Meelheim, F-NP
Ms. Meelheim, of Beaufort, NC, is a family nurse practitioner at East Carteret Family Practice in Beaufort. She earned a bachelor of science in nursing from the University of North Carolina, Chapel Hill, and completed the family nurse practitioner program and earned a master’s in nursing administration from East Carolina University. After a decade of clinical practice and teaching, she returned to Chapel Hill, where she earned a law degree from the UNC School of Law. She is the first NP to serve on the Board.

Ms. Meelheim served as an adjunct clinical instructor at the ECU School of Nursing, and as a nursing administrator and clinical instructor in surgery for the Department of Surgery at the Brody School of Medicine at ECU. After earning her law degree, she served as assistant executive director of the North Carolina Medical Board from 1992-2002. She has also practiced law.

Ms. Meelheim served active duty in the United States Army in the 1990s, as a clinic family nurse practitioner at Womack Army Hospital in Fort Bragg, NC, and then as acting head nurse and family nurse practitioner in support of OIF, in Germany. Ms. Meelheim has served for 28 years in the US Army Reserve, where her current rank is Colonel. Most recently, she served as Command Surgeon/FNP-BC for the 1st Sustainment Command (Theater) Forward Command Post at Camp Arifjan Kuwait.

Ms. Meelheim is a recipient of several awards, including the Army Commendation Medal for excellence as a family nurse practitioner and the Legion of Merit (2010) for excellence as a family nurse practitioner and command surgeon for Kuwait, Afghanistan, Iraq Task Force Sinai, Qatar and Ft. Bragg.

Pascal Osita Udekwu, MD
Dr. Udekwu has practiced at WakeMed Health & Hospitals in Raleigh since 1991. He completed residency training in pediatrics and in general surgery at the University of Chicago, a fellowship in trauma and surgical critical care at the University of Pittsburgh, PA and earned a master’s degree in business administration and health administration from Pfeiffer University in Meisenheimer, NC.

Dr. Udekwu holds multiple leadership roles including Director of Trauma, Vice Chairman of Medical Staff Quality Improvement and Director of Surgical Critical Care, all at WakeMed Health & Hospitals. He is also Associate Director of the Surgical Residency Program at the University of North Carolina, Chapel Hill.

Dr. Udekwu currently serves as associate professor at UNC-Chapel Hill and is an adjunct professor at Campbell University’s College of Pharmacy and Health Sciences. He is triple-board certified with certifications from the American Board of Pediatrics, the American Board of Surgery and the American Board of Surgery—Surgical Critical Care.

Dr. Udekwu has authored numerous papers and abstracts for scholarly journals and is a member of several professional organizations. He is a fellow of both the American College of Surgeons and of the American College of Chest Physicians.

In addition, Dr. Udekwu served in the United States Army Reserve from 1988-2005 deploying to Bagram Afghanistan as Chief of Surgery in 2003. He currently serves as a Colonel in the United States Air Force Reserve at Joint Base Andrews, Maryland.

Michael J. Arnold, MBA
Mr. Arnold, of Wake Forest, has worked as a policy, research and public affairs professional at high levels of state government for nearly two decades, first serving nine years as a university administrator and on faculty at the University of North Carolina at Wilmington and then later as a high-ranking senior official in the Executive branch of state government.

Mr. Arnold was recently appointed as Senior Advisor for Policy and Intergovernmental Affairs with Secretary of State Elaine Marshall. Prior to that, Mr. Arnold served as Senior Advisor for Policy and Research with Governor Beverly Perdue. He also served in the same role during Perdue's term as Lt. Governor.

Mr. Arnold has also worked as Senior Research Director for the NC Health and Wellness Trust Fund, which was one of three entities created by the NC General Assembly to invest North Carolina's portion of the Tobacco Master Settlement Agreement. Prior to that, he served in a public affairs and development role for the Alice Aycock Poe Center for Health Education in Raleigh, one of the state's largest health education centers.

Mr. Arnold earned a bachelor’s degree in Communication Studies from the University of North Carolina, Wilmington, and a master of business administration from the same institution. He also earned a certification in Nonprofit
Management, with an emphasis on communications and strategic planning from Duke University.

Eleanor E. Greene, MD, MPH
Eleanor E. Greene, MD, of High Point, earned a BS degree in medical technology from the former Bowman Gray School of Medicine (now Wake Forest University School of Medicine) in Winston-Salem, NC. She received her MD and a Master of Public Health in Maternal and Child Health from the University of North Carolina, Chapel Hill, and completed residency in obstetrics and gynecology at the Ohio State University in Columbus, OH. She currently practices with Cone Health Medical Group at Triad Women’s Center in High Point.

Dr. Greene is a member of the North Carolina Medical Society, Doctors for America, North Carolina Obstetrics and Gynecology Society, and the National Medical Association, where she served on the Board of Directors, Finance and Health Policy Committees. She serves on the Piedmont Health Services and Sickle Cell Agency. She served on the North Carolina Advisory Committee on Cancer Coordination and Control, on the Board of Directors of the Healthy Start Foundation, completing two terms on each. Dr. Greene is past president of the Old North State Medical Society, and continues to serve on its current Executive Committee. She is a fellow of the American College of Obstetrics and Gynecology.

Dr. Greene is the first physician from High Point, NC, and the first African American female physician to serve on the NC Medical Board. She speaks on the topic of Women’s Health and Women in Medicine at numerous church and community forums. Dr. Greene recently served as moderator for a conversation on Women’s Health and the Affordable Care Act featuring the Department of Health and Human Services Director, Secretary Kathleen Sebelius.

Dr. Greene was appointed to the Board in 2010. She serves on the Review, Executive and Policy Committees.

Feb
072013

Serve on the North Carolina Medical Board

Newsletter: Forum, Winter 2013
Categories: Bulletin Board,

Three physician members of the North Carolina Medical Board will complete their second and final terms this year. The independent panel that nominates candidates for the Board will soon be seeking candidates to fill these seats, for terms beginning Nov. 1.

Candidates must have an active North Carolina medical license and must be practicing clinical medicine at least part time. Candidates must have no history of public discipline for the past 10 years. Candidates should also be aware that serving on the Board requires a significant commitment of time and possess both the ability and willingness to dedicate this level of service to people of North Carolina, as well as the medical profession.

The process established by state law (N.C. Gen. Stat. § 90-2 and 90-3) requires anyone interested in serving on the Board to apply though the Review Panel for the North Carolina Medical Board. This body screens applicants, conducts interviews, and makes recommendations to the Governor, who then makes appointments to the Board. The application will be available on the Review Panel’s website by mid-February and will be due in July. The Review Panel will interview all qualified applicants in Raleigh in late August.

Visit the Review Panel online. For more information, call Dave Feild, the administrator for the Review Panel, at 919-861-4533.

Feb
072013

Prescribe Suboxone? Register to comply with state law

Newsletter: Forum, Winter 2013
Categories: Bulletin Board,

Image for Prescribe Suboxone? Register to comply with state law Licensees who prescribe buprenorphine and certain combination drugs such as Suboxone for the treatment of opioid addiction are required to register annually with the North Carolina Department of Health and Human Services. Licensees who are not currently registered are out of compliance with state law. Please take swift action to obtain a Controlled Substance Registration for "Office Based Treatment."

There is no fee at this time to register. Contact the DHHS Drug Control Unit at 919-733-1765 to request a registration application, or for more information regarding the registration requirement. The U.S. Drug Enforcement Agency has mailed letters to advise DEA-registered prescribers of their legal obligation to register with the state.

About buprenorphine and other synthetic opioids
Buprenorphine and Suboxone are drugs approved by the FDA and DEA for the treatment of opioid addiction. These drugs may be prescribed for this purpose by physicians who have completed specific training approved by Center for Substance Abuse Treatment (CSAT) and who have received special permission from the Drug Enforcement Administration (DEA) under the DATA 2000 Federal Legislation. Physicians approved under this section, known as DATA 2000 waiver physicians, are limited to 30 patients during the first year. After reapplying to CSAT for an increase, they may increase their patient load to 100 total patients in aggregate (regardless of the number of locations in which they practice).

Additional NC requirements
North Carolina Law (NC GS §90-101 (a1) also states that physicians must provide written documentation of a plan to engage or refer patients to qualified providers to receive counseling and case management as appropriate and must acknowledge the application of Federal confidentiality regulations under 42 CFR to patient information. DHHS Drug Control Inspectors will consult with applicants to achieve compliance with these provisions either through an onsite visit or a telephone consultation and desk review. Dispensers of buprenorphine must also follow other Federal and State regulations related to the ordering, storage, dispensing and record keeping of controlled substances.

Feb
072013

NCMB Positions Statements as of 12/31/2012


Each year, the NCMB publishes its complete position statements as a guide for all licensees. Learn more about the Board's position statements.

The Board’s Policy Committee reviews the content of the statements regularly, making necessary revisions to address changes in medical practice, new, innovative methods and procedures or matters of policy. In 2012, the Board amended 11 position statements and reviewed one statement, making no changes. In an effort to make this guide more user friendly, we have employed a color-coding system to identify position statements that were adopted, reviewed or revised in 2012. New statements are identified in green, statements that were revised are coded purple; statements that were reviewed with no changes are marked in blue.

NCMB position statements as of 12/31/2012

Feb
072013

Is (NCMB) justice blind? Board processes designed to remove bias


Image for Is (NCMB) justice blind? Board processes designed to remove bias In the five-plus years I’ve served on the North Carolina Medical Board, the agency has taken remarkable steps to improve both the quality and quantity of information provided to the public and the profession.

Over the past few years, the Board revamped its website, introduced an email version of this newsletter and established a presence on Facebook. To allow the public to follow Board business more easily, the Board posts meeting agendas—including committee agendas—on the Web. The Board also provides notices, disciplinary reports and numerous other items via automated subscriptions, as well as on the Board’s website. Significantly, the Board now routinely includes non-Board member stakeholders on work groups and task forces to help shape Board policy. The Board has never been more transparent or engaging.

Yet despite all of the progress and emphasis on transparency, many licensees still believe that the Board is “out to get” licensees or use its disciplinary authority to unfairly bully and boss. For example, the Board recently fielded a public information request that wondered whether the Medical Board might take public action against African American licensees at a greater rate than white licensees.

Race, ethnicity and/or sex never enter into our deliberations, so we’d never reviewed the numbers in quite that way, but we were more than willing to take a look. Analysis of Board actions found that in 2011 about 11 percent of complaints made against African Americans resulted in public action, while 10 percent of complaints against whites resulted in public action. Our analysis, which included five years of data, found that those rates have been relatively constant over time. Based on these findings, we found no evidence of racial bias in Board decisions regarding public actions.

Most licensees will never be the subject of a Medical Board investigation, let alone receive disciplinary action, so it’s not surprising there are so many misconceptions about the disciplinary process. Put simply, I believe the Board has taken all reasonable measures to ensure that the review process is colorblind and resistant to most forms of bias. Very little identifying information is provided to Board members and staff who review cases. Each case summary is labeled with the licensee’s name, location (city, state), date of birth, date of licensure and specialty. Aside from what can be inferred from a licensee’s name, there is no opportunity for the reviewer to know the licensee’s race or ethnicity. In relatively rare situations, the licensee under investigation is a personal or professional acquaintance of a Board member (and therefore his or her race is known). In those situations, the ethical rules we follow require the Board member to decide whether he or she can remain objective while participating in discussions and decisions regarding that licensee. If not, the Board member must recuse him- or herself.

Some regulatory Boards have chosen to make the entire case review process blind. This is done by using case numbers to identify the licensee, not a name. However, a completely blind review system makes identifying potential conflicts of interest difficult and creates a huge administrative burden to redact medical records and other documents. In the absence of any evidence that using a licensee name results in unfair treatment, the NCMB has seen no reason to proceed with such a system.

So how does the Board decide when to pursue public action against a licensee? First of all, many issues that come before the Board do not rise to the level of public action. In fact, more than 60 percent of disciplinary cases opened by the Board in a given year are closed with no formal action. To determine if public action might be appropriate, each member of the Board and staff who takes part in the multistep case review process forms his or her best recommendation based on the evidence available. Patient statements, medical records, licensee statements, outside peer reviews and other investigative findings comprise the evidence. After all evidence is reviewed and any additional information is gathered to resolve questions that arise, the senior staff of the Board makes a recommendation to the Board’s Disciplinary Committee. The case is then completely and thoroughly reviewed by a Board member who serves on this committee and this Board member determines whether the case should be discussed by the entire committee or if the recommendation of the senior staff is acceptable. Any other member of the Disciplinary Committee may also put the case into discussion. The Committee then makes a recommendation to the entire Board. Additional discussion may occur at the full Board level and then a final Board action is taken to pursue, or not, a public action against the licensee.

I’m well aware that a public action embarrasses a licensee and may have other professional ramifications. Believe me, the Board derives no pleasure from taking these actions. Nonetheless, there are dozens of situations each year in which the Board determines that public action is necessary and appropriate to protect the public and preserve the integrity of the profession. Should the Board fail to meet these obligations, the profession may lose its privilege of self-regulation. Every Board member understands the grave responsibility we have to ensure both protection for the people of North Carolina and fairness to our licensees.

Human nature being what it is, there will always be skepticism about the Board’s motives and actions. Perhaps the presentation of additional details about the public outcomes of the Board’s disciplinary work will help illuminate the process. On the facing page, you’ll find a selection of statistics gleaned from an analysis of five years’ worth of Board actions data. Demographics do not relate to licensee behavior or performance, so we have no intention to use this information in any official capacity. For now, I hope you’ll think there’s some value in having the Board open yet another window into how it does business.

This infographic is a graphic representation of data collected by the Board, including demographic data for total physician and physician assistant population as of January 2013, and disciplinary data for physicians and PAs with public Board actions in the past five years (2007-2011). Keep in mind, about 3 percent of the active licensee population has one or more public actions.

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William A. Walker, MD

Facts about your new Board president
City: Charlotte, NC
Appointed: Nov. 1, 2007 | Term ends: Oct. 31, 2013
Specialty: Colon and Rectal Surgery
Certification: American Board of Colon & Rectal Surgery;
American Board of Surgery
Personal: Wife, Lynn; two adult children

Jan
042013

Buprenorphine prescribers must register with state


Image for Buprenorphine prescribers must register with state Licensees who prescribe buprenorphine and certain combination drugs such as Suboxone for the treatment of opioid addiction are required to register annually with the North Carolina Department of Health and Human Services. If you are not registered, please take swift action to obtain a Controlled Substance Registration for "Office Based Treatment."

There is no fee at this time to register. Contact the DHHS Drug Control Unit at 919-733-1765 to request a registration application, or for more information regarding the registration requirement.

About buprenorphine and other synthetic opioids

Buprenorphine and Suboxone are drugs approved by the FDA and DEA for the treatment of opioid addiction. These drugs may be prescribed for this purpose by physicians who have completed specific training approved by CSAT (Center for Substance Abuse Treatment) and who have received special permission from the Drug Enforcement Administration (DEA) under the DATA 2000 Federal Legislation. Physicians approved under this section, known as DATA 2000 waiver physicians, are limited to 30 patients during the first year. After reapplying to CSAT for an increase, they may increase their patient load to 100 total patients in aggregate (regardless of the number of locations in which they practice)..

Additional NC requirements
North Carolina Law (NC GS §90-101 (a1) also states that physicians must provide written documentation of a plan to engage or refer patients to qualified providers to receive counseling and case management as appropriate and must acknowledge the application of Federal confidentiality regulations under 42 CFR to patient information. DHHS Drug Control Inspectors will consult with applicants to achieve compliance with these provisions either through an onsite visit or a telephone consultation and desk review. Dispensers of buprenorphine must also follow other Federal and State regulations related to the ordering, storage, dispensing and record keeping of controlled substances.

Dec
142012

NCMB guide aims to assist with mandatory reporting requirements

Newsletter: 2012, No. 4
Categories: Bulletin Board,

Communicable diseases. Deaths. Deaths from communicable diseases. Blindness. Child abuse. Pesticide-related illness or injury.

It can be overwhelming, if not impossible, for physicians and other clinicians to keep track of the myriad events and circumstances that must be reported to certain state agencies or other groups when they arise in the course of practice. To help licensees comply, the NC Medical Board has compiled a comprehensive guide to mandatory reporting requirements.Thanks to Medical Mutual Insurance Co. for its assistance with research.

The guide lists all mandatory reporting requirements that apply to health care workers, including a description of the requirement and the corresponding statutory reference.

Access the guide online

Dec
142012

Medical-Legal Partnerships: When medicine and self-care aren’t enough


Medical professionals have long understood that patients' wellbeing is influenced by many factors that are outside of the traditional purview of medical and self-care. "We know that psychosocial stress has a significant impact on our patients' health,” notes Meggan Goodpasture, MD, Assistant Professor of Pediatrics at Wake Forest Baptist Medical Center. “Too often our efforts to help our patients are limited because we can't address the underlying problems that they're experiencing outside of the medical office."

A growing network of Medical-Legal Partnerships (MLPs), which team hospitals and clinics, clinicians, patients and families with lawyers, is helping to change that. These partnerships represent a valuable resource that clinicians may call on to help address some of the social and environmental determinants of health. These include substandard housing conditions; domestic violence; food, income and housing insecurity; improper denials of Medicaid and other public benefits; failure to provide children special education services to which they are entitled; and end-of-life issues.

When a clinician becomes aware of social and environmental factors that threaten a patient’s health, he or she makes a referral to a medical-legal partnership. A legal team is assigned to the case and intervenes on the patient’s behalf to resolve problems. For example, an MLP might be contacted to help a cancer patient overcome bureaucratic hurdles with a Food Stamps application (see case studies). Services are made available to patients at no charge.

The Medical-Legal Partnership model has been endorsed by the American Bar Association, the American Medical Association, the American Academy of Pediatrics and numerous other national organizations. During 2010, more than 80 MLPs nationwide partnered in 235 hospitals and health centers to provide legal assistance to more than 34,000 individuals and families. MLPs fostered cooperation among 23 medical schools and 29 law schools as well as legal services organizations and
hundreds of private law firms and other pro bono partners who provided more than $13 million in in-kind services to medicallegal partnerships.

In North Carolina, Medical-Legal Partnerships have been established in seven locations, including Durham, Chapel Hill, Winston-Salem, Greensboro, Charlotte, Asheville and Prospect Hill (see chart pg. 11). Each MLP is designed to address the particular
needs and capacity of the local partners. However, they all share common components, including:

  • Basic legal training for health care providers to help them screen and refer patients who may benefit from legal assistance;

  • Regular presence of legal staff in clinic settings to conduct outreach to staff and to allow for patients to be screened for eligibility for legal assistance;

  • Formal referral mechanisms between medical providers and legal partners; and,

  • Direct legal assistance to patients-clients.

Medical-Legal Partnerships make sense. Health care providers are more likely to screen patients about problems when they know that they can refer patients for services to address those concerns. Lawyers can often get better results for a client when a
medical professional is on the team. And, by collaborating with lawyers, medical professionals are gratified to see that they can often improve the health of their shared patients/clients. Michael Steiner, MD, Chief of the Division of Pediatrics and Adolescent Medicine at UNC Health Care’s North Carolina Children's Hospital said being part of an MLP has been positive for staff and patients.

"We see children for about 20 minutes, three or four times a year, at the most,”Steiner said. “But outside of that time is where their lives are truly happening. Since forming the MLP, our staff feels more empowered to help families with issues that we cannot reach. Through partnerships like MLPs, medical providers can broaden our impact and go much further to improve the health and wellbeing of the patients and families that we care for."

Get in touch with medical-legal partnerships in NC by contacting Madlyn Morreale at (919) 226.5912 or madlynm@legalaidnc.org.

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Medical-Legal Parnership Programs in North Carolina
Dec
142012

Quarterly Board Actions Report May-July 2012


The Board actions listed below are published in an abbreviated format. The report does not include non-prejudicial actions such as reentry agreements and non-disciplinary consent orders. Recent Board actions are also available at www.ncmedboard.org. Go to “Professional Resources” to view current disciplinary data or to sign up to receive notification when new actions are posted via the RSS Feed subscription service.

Board actions for May-July 2012

Dec
142012

Avoiding common pitfalls in PA practice

Newsletter: 2012, No. 4
Categories: Bulletin Board,

Physician assistants and their supervising physicians often face a variety of challenging issues when obtaining and maintaining a license to practice medicine in North Carolina. The appropriate course of action is not always apparent, and unintentional missteps can sometimes land PAs, and/or their supervising physicians, in trouble with the Medical Board.

This article will review a selection of scenarios that involve common issues related to PA practice in NC and provide guidance on how to proceed in an appropriate manner. Becoming educated about these issues and their remedies may help both new and seasoned PAs avoid some of the common pitfalls of successful practice in North Carolina.

Scenario 1: No license, no practice – period
A new PA graduate is offered a job before successfully passing the PA National Certifying Examination (PANCE), a requirement for licensure in North Carolina. As the PA is preparing to begin practice, he is notified that he did not pass the PANCE. The PA’s well-intentioned employer extends an offer to the PA to shadow in the office while preparing for a second attempt on the exam. The practice offers a small stipend to the PA to offset living expenses, which the PA accepts. Meanwhile, the NC Medical Board receives information that an unlicensed, uncertified PA is “practicing” with the medical group. A Board investigation determines that the PA did, in fact, perform medical tasks. The Board issues the PA a nondisciplinary Public Letter of Concern, which is a public document posted on his information page on the NCMB website. The letter will remain on the PA’s record for the rest of his career and will likely need to be disclosed on all future license applications, hospital privilege applications, health insurance credential applications, etc.

Determining what a PA graduate can and cannot lawfully do before obtaining licensure in North Carolina is a frequent area of confusion for PAs and supervisors.

To obtain a license in North Carolina, PAs must complete an accredited PA program, and if applying for initial licensure, must successfully complete the PANCE and meet all other requirements. Once licensed, a PA cannot perform medical acts until he or she completes the Intent to Practice form on the Board’s website and confirms that the Board has received and processed the PA’s submission (an easy way to do this is to look up the supervising physician using the “Look Up a Licensee” tool on the Board’s website. If the PA’s name appears under that physician’s name as a supervisee, the ITP has been processed).

If any medical tasks are performed by the PA before he or she is licensed and listed as a supervisee, it constitutes practicing without a license and may result in discipline by the Board. Peggy Robinson, PA-C, a member of the faculty at Duke University’s PA Program who completes her second term on the Medical Board in October, has said that it’s best for new PA graduates to “keep their hands in their pockets” until they are fully licensed. In other words, the PA should refrain from performing any duties that can lead to practicing without a license or even giving the appearance of doing so. Remember, an unlicensed new graduate actually has less privilege than a current PA student to perform medical acts, because PA regulations do not apply to students. The Board recommends that PAs wait until they are “official” to avoid problems.

Scenario 2: Suddenly supervisor-less
A licensed PA with several years of clinical practice places an urgent call to the Board. She explains that her primary supervising physician has developed a sudden illness that will make it impossible for the physician to continue as her supervisor. The PA does not have a suitable backup physician who can take over as her primary supervising physician. The PA works in a busy primary care practice, where she carries an active caseload of more than 2,000 patients. She is concerned about a possible interruption in her ability to continue to care for her patients due to the loss of her primary supervising physician. NC law authorizes PAs to practice medicine only under the oversight of a primary supervising physician. Situations arise, however, when a PA loses a primary supervising physician due to circumstances out of his or her control. The Board has a policy to address these situations. When a primary supervisor is unable to continue supervision, the PA shall notify the Board within two (2) business days of the emergency situation by first calling the Board and then following up with a letter describing the emergency situation. The PA then has 30 days to submit an Intent to Practice for a new primary supervising physician.

Scenario 3: Shadowing before resuming practice
A PA who had been out of clinical practice for eight years asks a physician colleague if he can shadow the physician as the PA prepares to reenter the workforce. Under some circumstances it is permissible for a non-licensee to shadow a physician. However, it is recommended that a PA whose ultimate goal is to regain licensure wait until the license is issued before shadowing or observing in a clinical setting. While lay and unlicensed people may perform delegated tasks in a physician’s office, PAs are not allowed to perform medical acts under any circumstances without an active PA license. In the Board’s view, it is too easy for an unlicensed PA who begins shadowing with the best of intentions to slip into performing medical acts (practicing without a license).
Any applicant who has been out of active clinical practice for two or more years (eight years in this example) would be required to complete a program of reentry to clinical practice, which consists of a period of mentoring under the supervision of a Board-approved physician mentor. Typically, the first phase of a reentry program involves having the reentering applicant shadow his or her physician mentor. The reentry process is designed to ensure that the reentering licensee has ample time to reacclimate to clinical practice before they are cleared for a full and unrestricted license.

Katharine D. Kovacs PA-C is the staff physician assistant in the NCMB’s Office of the Medical Director. Jane Paige is a physician assistant licensing coordinator at the Board.

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More Information

  • PAs are expected to be familiar with applicable laws, rules and position statements, all of which are available on the Board’s website. Review this information at least annually, perhaps when renewing your license.

  • Answers to the questions raised in this article, and many others, are provided in the PA “Frequently Asked Questions” or FAQs on the Board’s website.

  • If you, your supervising physician or employer are confused about any aspect of PA licensure and acceptable conduct or practice, call 919-326-1000 or 1-800-253-9653 and ask to speak to the PA liaison or PA license coordinator.

Dec
142012

Recognizing and responding to suspected child abuse and neglect

Author: Sarah Currier
Newsletter: 2012, No. 4
Categories: Special Features,

Image for Recognizing and responding to suspected child abuse and neglect If our society is to prosper in the future, we must make sure our children have safe, supportive environments where they can grow socially, emotionally and physically. When children are abused or neglected their opportunity for healthy development is undermined by toxic stress that damages the developing architecture of their brains. This damage weakens the foundation that future development is built on and is traumatic and long term, resulting in physical, mental and behavioral problems later in life. Understanding of child maltreatment and its impact has resulted in heightened awareness about the responsibility of adults to respond. When we take the time to respond to suspicions of abuse and neglect, we ensure families get the support they need and children’s basic foundation for future success is solid. A solid foundation will reap many rewards later on as children grow into successful, contributing members of our community.

Physicians and physician assistants have relatively limited access to children. They may see their pediatric patients annually or just a few times a year, usually for no more than 15 minutes. Nonetheless, clinicians can be an important means of identifying potential abuse and neglect . It is important to remember that sometimes a physician is the only professional involved in the life of a young child and may have the opportunity to perform comprehensive evaluations of a child’s health and well-being. Non-pediatric physicians also treat other family members—parents or guardians—who may disclose information about a child’s environment and experiences.

The Impact of Child Maltreatment
In 2005, the Centers for Disease Control and Prevention and insurer Kaiser Permanente released the most comprehensive research to date on the impact of child abuse and neglect. The Adverse Childhood Experiences (ACE) Study, surveyed 17,000 adults about their childhood experiences and compared them with their health histories. The research found that children who suffered severe adversity in childhood—violence, abject poverty, substance abuse in the home, child abuse and neglect—were far more likely to suffer long-term intellectual, behavioral and physical and mental health problems.

Problems now concretely linked to child abuse and neglect include behavioral and achievement problems in school; heart, lung and liver disease; obesity and diabetes; depression, anxiety disorders and increased suicide attempts; increased criminal behaviors, illicit drug use and alcohol abuse; increased risky sexual behavior and unintended pregnancies; and other problems.

What is Child Maltreatment?
North Carolina General Statutes define child abuse as any nonaccidental or substantial risk of injury or pattern of injuries to a child inflicted or allowed to be inflicted by a parent, guardian, caretaker or custodian. Child maltreatment includes:

  • Physical Abuse - Any non-accidental physical injury to the child; Can include striking, kicking, burning or biting the child, or any action that results in a physical impairment of the child. Signs of possible physical abuse can include physical injuries that are not likely to have occurred as described; nervousness, hyperactivity, aggressiveness; disruptive and destructive behaviors; unusual wariness of physical contact or fear of a parent or caretaker.

  • Sexual Abuse - Any sexual behavior imposed on a juvenile. Sexual abuse can include fondling the genital area, masturbation, oral sex or vaginal or anal penetration by a finger, penis or other object. It also includes exhibitionism, child pornography and suggestive behaviors or comments. Signs of possible sexual abuse can include reversion to behaviors such as bed-wetting, speech loss and thumbsucking; sleep disturbances or nightmares; pain, itching, bruising or bleeding in the genital area; frequent urinary tract infections; or venereal disease established.

  • Emotional Abuse - Includes attitudes or behaviors toward a child that create serious emotional or psychological damage. Signs of possible emotional abuse include very low self-esteem; antisocial and destructive behaviors; depressed or suicidal tendencies; or, in some cases, delayed development.

  • Neglect - The failure of a parent or other person with responsibility for the child to provide needed food, clothing, shelter, medical care or supervision such that the child's health, safety and well-being are at risk. Signs of possible neglect include consistent hunger, inappropriate dress and poor hygiene; self-destructive behaviors; or unattended medical needs
.
Abuse is rarely one isolated incident. Often, there is a pattern of behavior that emerges over a period of time. Children often have difficulty talking about the abuse. This leads to many children “acting out” as a way of expressing their hurt or anger. It is important to remember that even if you see signs, they do
not necessarily mean that a child has been abused. The signs will vary according to the type of abuse, its intensity and the developmental age of the child. Some children who are abused display no signs. For this reason, it is important to listen carefully to any child who tells you about an act of maltreatment.

Child maltreatment is not the result of a single cause but of complex interactions between individuals and their environment that influence both development and behavior. Child maltreatment can be examined through a social-ecological model that presents a continuum of risk and protective factors that can either increase resilience or vulnerability to specific behaviors or conditions. Society, community, families and individuals all contribute to the health and well-being of families and children.

Referring a Family to the Department of Social Services
If you suspect child abuse or neglect, you are required by law to refer the family by calling, writing or visiting your county Department of Social Services—Child Protective Services Unit. County contact information can be found at www.dhhs.state.nc.us/dss/local/. You can also call the CARE LINE at 1-800-662-7030 to speak with a counselor who can refer you to the appropriate contact. An intake social worker at the local Child Protective Services Unit will listen to you, ask questions and record all the information provided.

Remember that you do not need to prove that abuse has taken place; you only need reasonable grounds for suspicion. While you may choose to include the parent or caregiver in the referral process, you do not need their permission. You also do not need permission from your workplace; ultimately, you are responsible for making sure the referral has been made. If you make a referral in good faith, you will receive immunity from civil or criminal liability.

North Carolinians also bear an ethical responsibility to make referrals in cases of suspected maltreatment. Child abuse rarely stops without intervention and help. By making a referral, you are helping the family get the services and support that they need to end the cycle of abuse. Abused children carry the trauma associated with abuse throughout their lives. These childhood experiences result in higher risk of poor health outcomes—a risk that is compounded by each additional negative experience.

What Happens After a Referral Has Been Made?
After you have discussed your concerns with a social worker at Child Protective Services, a determination is made as to whether or not the Department of Social Services will complete an assessment.

If intervention is warranted, Child Protective Services may use either an investigative assessment or a family assessment to determine future actions and supports needed for the child and family. The Department of Social Services is required to initiate an assessment within 24 hours for abuse and within 72 hours for neglect.

The assessment may include a visit to the child’s home and school along with interviews of those who are in regular contact with the child. The safety of the child is the top priority at all times.

North Carolina’s Multiple Response System (MRS) is the state’s on-going effort to reform the entire continuum of child welfare services in order to make child welfare more family centered and to keep children safe. MRS begins with the first referral of concerns about a child and his/her family and continues all the way through finding a permanent home for those children who enter foster care. As a reform effort, MRS is not one single program. Rather, MRS is comprised of seven separate strategies delivered to families through a practice model grounded in the use of family-centered practice and system of care principles.

Referred families may have access to counseling, referrals to other agencies and supports, intensive in-home services, as well as help with housing, finances, medical needs and child care. A Child and Family Team will be developed to build a support network for the family. If necessary, emergency foster care services can be established.

Get More Information
Prevent Child Abuse North Carolina has developed a free online self-guided training module that educates viewers in recognizing and responding to suspected child abuse and maltreatment.

In addition, Prevent Child Abuse North Carolina will host a statewide summit on advancing child well-being through prevention of abuse and maltreatment March 4-6, 2013. The meeting will be held at the Raleigh Convention Center. Dr. Vincent Felitti, co-principal investigator for the Adverse Childhood Experiences Study, will open the summit with an inside look into the study and discuss its relevance to the everyday practice of medicine and mental health, as well as its impact on healthcare costs.

Thank you for your commitment to child safety and wellbeing. Your efforts make a difference in lives of countless children.

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Statewide Summit Focuses on Effective Prevention
What: Learning and Leadership Summit on Advancing Child Well-Being through Effective Prevention (AMA PRA Category 1 Credits available)
When: March 4-6, 2013; Registration opens December 2012
Where: Raleigh Convention Center, 500 South Salisbury Street, Raleigh, NC
Get more information

Free Online Training sharpens ability to respond when abuse is suspected
Prevent Child Abuse North Carolina offers a free Web-based self-guided training module,Recognizing and Responding to Suspicions of Child Maltreatment. The training provides a comprehensive overview of the signs and symptoms of maltreatment, related North Carolina law and the child protection system.
Access training. You will be asked to register to complete the training

Dec
142012

Board elects officers to lead in 2013

Newsletter: 2012, No. 4
Categories: Board News,

The NC Medical Board officers for the coming year begin their terms November 1. William A. Walker, MD, of Charlotte, will serve as president; Paul S. Camnitz, MD, of Greenville, will serve as president-elect and Cheryl Walker-McGill, MD, of Charlotte, will act as secretary/treasurer. Two at-large members have also been named: Eleanor Greene, MD, of High Point, and Thelma C. Lennon, a public member, from Raleigh. Together, the officers serve on the NCMB’s Executive Committee, which sets Board priorities and handles governance responsibilities. Officer terms expire October 31, 2013.

William A. Walker, MD, President
William A. Walker, MD, of Charlotte, earned his BA in chemistry and psychology and his MD from the University of North Carolina, Chapel Hill. He completed his internship and residency training in general surgery at the University of Michigan in Ann Arbor. He also completed a fellowship in colon and rectal surgery at the University of Minnesota in Minneapolis.

Throughout his career, Dr. Walker has served in a number of administrative and professional positions, including as president of the Mecklenburg County Medical Society. He currently serves on the North Carolina Medical Society’s Physician-Hospital Relations Committee, is Medical Director of the operating room at Presbyterian Hospital and is president of Charlotte Colon and Rectal Surgery Associates. Dr. Walker served on the Federation of State Medical Boards Editorial Committee from 2009-2011, and currently serves on the FSMB’s Audit Committee.

Dr. Walker is a fellow of the American College of Surgeons and the American Society of Colon and Rectal Surgeons. He is an active member of the Mecklenburg County Medical Society and the North Carolina Medical Society. He is the recipient of the Mecklenburg County Medical Society’s President’s Award. He has coauthored numerous publications and given presentations across the United States.

Dr. Walker was appointed to the Medical Board in 2007. In 2011, he was named president elect of the NCMB. In the past, he has chaired the Board’s Licensing, Allied Health, Policy and Disciplinary Committees in addition to serving on a number of other board committees.

Paul S. Camnitz, MD, President Elect
Dr. Camnitz attended the University of North Carolina, Chapel Hill, where he earned bachelor’s degrees in both English and Chemistry. He earned his medical degree at the UNC School of Medicine in Chapel Hill and did his residency in Otolaryngology-Head and Neck Surgery at the same institution, finishing in 1979.

Dr. Camnitz is certified by the American Board of Otolaryngology and the American Academy of Facial Plastic and Reconstructive Surgery. He currently practices at Eastern Carolina Ear, Nose & Throat/Head and Neck Surgery in Greenville. He is also a Clinical Professor of Surgery and Head of the Division of Otolaryngology at the Brody School of Medicine at East Carolina University, where he has been selected by the graduating medical school class as “Outstanding Teacher” 12 times and in 2003 was named a "Master Educator" by the faculty. He received the Outstanding Professor Award from the Family Medicine Department in 2004 and the Bernie Vick Outstanding Professor Award from the Department of Surgery in 2003. Dr. Camnitz has received many other honors, including the Distinguished Service Award of the School of Medicine at the University of North Carolina, Chapel Hill, which was bestowed in 2006.

Dr. Camnitz is a fellow of the American College of Surgeons and of its North Carolina chapter and a fellow of the American Academy of Otolaryngology-Head and Neck Surgery. He is a member of numerous professional groups, including the Alpha Omega Alpha Honor Medical Society, the American Medical Association and the North Carolina Medical Society, among others. Dr. Camnitz has served as chief of staff at Pitt County Memorial Hospital and has served on the boards of numerous other health care and civic organizations in Pitt County.

Dr. Camnitz was appointed to the Board in 2008. In the past, he was chairman of the Board’s Continued Competence Committee and Review Committees. He currently chairs the Policy Committee and serves on the Disciplinary and Continued Competence Committees.

Cheryl Walker-McGill, MD, Secretary/Treasurer
Cheryl Walker-McGill, MD, MBA earned her undergraduate and medical degrees from Duke University. She completed a residency in internal medicine and a fellowship in allergy-immunology at Northwestern University. In addition, she earned a master of business administration from the University of Chicago. Dr. Walker-McGill is certified by the American Board of Internal Medicine and by the American Board of Allergy and Immunology and she is a Fellow of the American Academy of Allergy, Asthma and Immunology.

Dr. Walker-McGill is president of American Health Strategy and Quality Improvement Institute in Charlotte, an organization dedicated to developing strategies for improving health and healthcare outcomes in high-risk, high-cost patient populations. In addition, Dr. Walker-McGill is medical director for Daimler rucks, NC, with oversight of the Gastonia and Mount Holly facilities. She has significant experience in clinical medicine, physician education, community health education and health economics.

Dr. Walker-McGill is currently an assistant professor of clinical medicine at the University of North Carolina School of Medicine, and an adjunct professor at the Wingate Graduate School of Business.. Previously, she served on the faculty at the Northwestern University School of Medicine. She was honored as a pioneer by the Duke University Baldwin Scholars Program. Dr. Walker-McGill is a recipient of the Chicago Public School System Distinguished Achievement in Asthma Education Award and of the National Medical Association Floyd J. Malveaux Award in Allergy, Asthma and Immunology.

Dr. Walker-McGill is chair of the Allergy, Asthma and Immunology Section of the National Medical Association. She is immediate past president of the Charlotte Medical, Dental and Pharmaceutical Society and chair-elect of the Committee for the Underserved of the American Academy of Allergy, Asthma and Immunology.

Dr. Walker-McGill was appointed to the Board in 2011. She currently serves on the Continued Competence, Allied Health and Review Committees.

Eleanor E. Greene, MD, MPH, At-large member
Eleanor E. Greene, MD, of High Point, earned a BS degree in medical technology from the former Bowman Gray School of Medicine (now Wake Forest University School of Medicine) in Winston-Salem, NC. She received her MD and a Master of Public Health in Maternal and Child Health from the University of North Carolina, Chapel Hill, and completed residency in obstetrics and gynecology at the Ohio State University in Columbus, OH. She currently practices with Cone Health Medical Group at Triad Women’s Center in High Point.

Dr. Greene is a member of the North Carolina Medical Society, Doctors for America, North Carolina Obstetrics and Gynecology Society, and the National Medical Association, where she served on the Board of Directors, Finance and Health Policy Committees. She serves on the Piedmont Health Services and Sickle Cell Agency. She served on the North Carolina Advisory Committee on Cancer Coordination and Control on the Board of Directors of the Healthy Start Foundation, completing two terms on each. Dr. Greene is past president of the Old North State Medical Society, and continues to serve on its current Executive Committee. She is a fellow of the American College of Obstetrics and Gynecology.

Dr. Greene is the first physician from High Point, NC, and the first African American female physician to serve on the NC Medical Board. She speaks on the topic of Women’s Health and Women in Medicine at numerous church and community forums. Dr. Greene recently served as moderator for a conversation on Women’s Health and the Affordable Care Act featuring the Department of Health and Human Services Director, Secretary Kathleen Sebelius.

Dr. Greene was appointed to the Board in 2010. She currently serves on the Disciplinary, Licensing and Policy Committees.

Thelma C. Lennon, At-large member
Ms. Lennon earned her undergraduate degree from North Carolina Central University. She earned her master’s degree from Boston University in guidance and counseling and did further study of the subject at Harvard University. She also completed graduate study in adult education at North Carolina State University. During her professional career, Ms. Lennon served in education as an instructor and dean of students at a number of academic institutions. Before retiring, she worked as director of guidance and counseling for the North Carolina Department of Education.

Since her retirement, Ms. Lennon has devoted much of her time to volunteer activities focusing on health and education. She has served as a counselor at the North Carolina Department of Insurance’s Senior Health Insurance Information Program (SHIIP), a member of the Board of Directors of the Carolinas Center for Medical Excellence, and as chairman for the Alliance for Medical Excellence. She is also a member of the Wake County Community Advisory Council for Nursing Homes and the Governor’s Advisory Council on Aging. From 1996 to 2012, Ms Lennon was the first North Carolina state president for AARP and was selected as an alternate delegate to the White House Conference on Aging.

Dec
142012

Board reviews, revises five Position Statements

Newsletter: 2012, No. 4
Categories: Board News,

The Policy Committee of the NC Medical Board regularly reviews and, as needed, amends its position statements to ensure they remain current and relevant to the situations licensees face in day-to-day practice. During its meetings in July and September, the Policy Committee reviewed and the full Board approved changes to five position statements. The titles of the revised statements appear below, along with a brief summary of changes approved.

View the complete collection of Board position statements.

Care of the Patient Undergoing Surgical or Other Invasive Procedure: Changes simplify language in the second and third sentences of the statement.

Writing of prescriptions: Changes modify statement to address electronic prescribing of controlled substances position on Self-Treatment and Treatment of Family Members.

Medical Testimony: No substantive changes; the word “physician” is changed to “licensee” throughout.

The physician-patient relationship: Italicizes, for emphasis, the line that reads: The Board believes the interests and health of the people of North Carolina are best served when the physician-patient relationship remains inviolate. In addition, statement is amended to say that its fundamental principles apply to all licensees.

The retired physician/licensee: No substantive changes; the word “physician” is changed to “licensee” throughout.

Dec
142012

Accountability and equity for all

Newsletter: 2012, No. 4
Categories: President's Message,

Image for Accountability and equity for all A patient undergoes surgery to have a brain tumor removed. Although the surgeon believes the tumor was successfully excised he did not, in fact, remove it. The surgeon does not review post-operative imaging studies that show that the tumor is intact. Months later the patient returns to her primary care doctor with worsening headaches, blurred vision and other symptoms. A scan reveals the tumor the patient thought had been removed. The patient files a complaint with the Medical Board, which investigates the case and takes public action against the surgeon.

Now imagine that the patient is the spouse of a soldier on active military duty and that the surgery and followup care took place in a military hospital. It might go something like this:

The patient files a complaint with the Medical Board. The Board contacts the surgeon and the military hospital where he is employed to request the patient’s records, as well as an account of the surgeon’s handling of the case. The surgeon provides his account of the patient encounter. The military hospital, however, declines to release the records to the Board, citing federal law. The Board is unable to proceed with an investigation.

North Carolina law authorizes the Medical Board to regulate medicine and surgery for the benefit and protection of North Carolinians. It seems to me that the protections afforded by the law ought to apply to everyone in our great state. But in point of fact, this isn’t the case. The Board is often unable to proceed with investigations related to physicians and physician assistants who are licensed in NC but employed by federal facilities or the US military. When the Board receives complaints about these professionals, its investigators and legal staff always try to obtain the records and other information needed to proceed with an investigation of the alleged misconduct. The Board has a skilled staff and is sometimes successful, with considerable effort, at obtaining medical records from federal institutions. More often than not, however, the records are out of reach.

Why does this matter? First and foremost, it means that NC licensed physicians and PAs who work in federal institutions are not subject to the same rigorous standards and processes that all non-federal physicians and PAs are held to by the NCMB. From the licensee perspective, it’s a question of fairness: shouldn’t all licensees be accountable for their actions, regardless of where they happen to work? Second, but certainly no less important, it shortchanges patients who are treated in federal institutions because they do not have access to the same protections as North Carolinians treated in non-federal settings.

Another situation the Board is sometimes faced with involves privileging actions taken against NC licensed physicians or PAs working in federal institutions. When a federal institution revokes or suspends a NC licensee’s clinical privileges, the institution sometimes reports the action to the Medical Board. The Board has an obligation to investigate the actions, since the conduct that led to the privilege suspension or revocation may represent a threat to patient safety. In these situations, we face the same problems obtaining medical records and are usually unable to complete an investigation.

Situations in which a licensee of the Board has lost privileges at a federal institution are especially troubling. Where do these clinicians go when they can no longer practice in the federal system? They set up in private practice in North Carolina or get a job at the local urgent care. Meanwhile, the Board is limited in its ability to assess whether that licensee is competent and safe to practice.

This isn’t just a North Carolina issue, by the way. You may or may not know that clinicians working in federal institutions are required to hold a state medical license to practice in a federal facility, but the license does not necessarily have to be issued from the state in which they are working. Many, if not most, clinicians working in federal facilities in NC do, in fact, hold NC medical licenses. Some hold licenses in other states, in which case those state boards would have an interest in investigating alleged misconduct.

The difficulties the Board has had getting medical records from federal institutions has always troubled me. In my six years on the Board, I’ve helped to review complaint cases that involved serious allegations of substandard practice or misconduct on the part of federal medical practitioners (military, Veterans Administration, federal prison). It is a hard pill to swallow when it becomes clear that, despite our best efforts, the Board will be unable to conduct an appropriate investigation to resolve what appears to be a legitimate allegation of misconduct or substandard care. The national Federation of State Medical Boards has intervened on state boards’ behalf to persuade federal health care facilities to be more forthcoming, with little success.

I have worked in the VA system. I have friends and colleagues who still work in federal institutions and I know them to be competent and caring practitioners. I certainly don’t wish to malign the professionals who choose to practice in federal facilities or suggest that their care is categorically inferior. Indeed, they perform an essential and often thankless service.

As a former fulltime member of a VA facility’s medical staff, however, I feel strongly that the federal government’s process for holding its clinicians accountable is inferior to the process the NCMB guarantees to North Carolina patients. When patients file a complaint, the Medical Board investigates and comes to a decision, after a careful, multistep review of the facts, on how to resolve it. Patients and family members who file complaints aren’t always satisfied with their outcomes. I am confident, nonetheless, that their concerns get a fair and thorough review. I am proud of the Board’s high standard for transparency.

The NCMB informs the complainant, in writing, of the outcome of his or her case, whether no formal action is taken, private action is taken or some type of public action is taken. Cases that are resolved with public actions are publicly available in a variety of formats. Public documents are posted in their entirety on the information page of the licensee receiving the action. In addition, public actions are listed chronologically on the Board’s website and are published quarterly in the NCMB’s newsletter.

I acknowledge that I’m not fully informed about the federal government’s means of investigating and ad-dressing patient complaints. I do know that some of the patients who have filed complaints with the Board indicate that they have not been advised whether their concerns were seriously considered by the federal institution or told what action, if any, was taken. I also know I’d feel a lot more comfortable if the Medical Board were able to do its job when it receives complaints aboutlicensees working in federal settings.

The Board could do this if federal law and policies were amended to require the federal government to release the relevant medical records to the relevant state medical boards. That’s what I think needs to happen.

Aug
282012

NCPHP medical director assumes national post


Image for NCPHP medical director assumes national post The NC Medical Board congratulates Dr. Warren Pendergast, medical director of the NC Physicians Health Program, on his recent election as president of the Federation of State Health Programs (FSPHP).

The FSPHP is a national organization that provides education to and facilitates the exchange of information among state physician health programs. It also develops common goals and standards and enhances issues related to physician health and impairment.

Dr. Pendergast, a psychiatrist, is the first PHP medical director from North Carolina to serve as the organization's president. He will serve a two-year term while continuing his role as Medical Director and CEO of NCPHP. Dr. Pendergast has been an active member of FSPHP since 1999 and has served in various roles including Regional Director, Board of Directors, Executive Committee and on multiple committees including the Task Force on Guidelines. He also chaired the FSPHP Ethics Committee and was co-chair of the Citizen Advocacy Center Task Force.

A current project of the FSPHP involves looking at challenges faced by recovering physicians, including specialty board certification issues.

Jul
312012

Rule change alert

Newsletter: 2012, No. 3
Categories: Board News,

Three sets of rule changes won final approval in July, including significant revisions to the rules governing the Board’s continuing medical education (CME) requirements.

Revised CME rules (21 NCAC 32R - .0101 - .0105) take effect August 1 and include the following changes:

  • The rule eliminates the requirement to document any Category 2 CME hours but maintains the requirement to earn at least 60 Category 1 CME hours over a three-year period. The Board encourages licensees to participate in CME, whether Category 1 or 2, above and beyond the minimum required hours, as their time permits.

  • The rule exempts licensees who can document participation in an ABMS- or AOA-approved Maintenance of Certification (MOC) program from reporting any CME hours to the NCMB. This change reflects the Board’s acknowledgement of the significant effort and investment in practice-relevant training/education involved in pursuing MOC.

Additional rule changes that take effect August 1 include:
  • Revisions to 21 NCAC 32B .1001 and 21 NCAC 32S .0212 (prescribing rules for physicians and for physician assistants) prohibits physicians and PAs from prescribing controlled substances to themselves or to members of their immediate families.

  • A revision to the Resident Training License (RTL) application rules (21 NCAC 32B .1402) eliminates the requirement for RTL applicants to submit letters of recommendation. The Board has determined that it very rarely receives useful information via recommendation letters. In addition, this rule change makes the RTL application requirements consistent with requirements for applicants for a full medical license.

Jul
312012

Quarterly Adverse Actions Report | February - April 2012

Newsletter: 2012, No. 3

The Board actions listed below are published in an abbreviated format. The report does not include non-prejudicial actions such as reentry agreements and non-disciplinary consent orders. Recent Board actions are also available at www.ncmedboard.org. Go to “Professional Resources” to view current disciplinary data or to sign up to receive notification when new actions are posted via the RSS Feed subscription service.

Adverse_Actions_Report_February_April_2012.pdf

Jul
312012

FSMB Foundation publishes second edition of prescribing book

Newsletter: 2012, No. 3
Categories: Board News,

The Federation of State Medical Boards (FSMB) Foundation recently released a revised and expanded second edition of the popular prescribing manual, Responsible Opioid Prescribing: A Clinician’s Guide. The book presents clinicians with effective strategies for reducing the risk of addiction, abuse and diversion of opioids that they prescribe for their patients in pain. Written by pain medicine specialist Scott M. Fishman, MD, the revised and expanded edition features important new material, including research on opioid prescribing that was not available when the first edition was published in 2007, and updated recommendations for prescribers.

The NC Medical Board has distributed hundreds of the first edition book to licensees with identified deficiencies or other problems with prescribing of controlled substances. It is proud to recognize NCMB Medical Director Scott G. Kirby, MD, as a member of the advisory board that reviewed the second edition of the book.

The expanded Clinician's Guide translates best-practice guidelines from leading pain medicine societies and the FSMB into pragmatic steps for risk reduction and improved patient care, including:

  • Patient evaluation, including risk assessment

  • Treatment plans that incorporate functional goals

  • Informed consent and prescribing agreements

  • Periodic review and monitoring of patients

  • Referral and patient management

  • Documentation

  • Compliance with state and federal law

  • Patient education on safe use, storage and disposal of opioid medication

  • Termination strategies for chronic opioid therapy

Since publication of the first edition in 2007, Responsible Opioid Prescribing has been widely used and supported in the medical and regulatory communities as the leading continuing medical education (CME) activity for prescribers of opioid medications. For the first time, the FSMB Foundation has released CME activities designed to accompany the book.

.................................................................

BUY THE BOOK, CLAIM THE CME
In order to receive credit, participants will need to obtain a copy of the book, which can be ordered at www.fsmb.org/cme/index.html ($16.95 plus shipping; volume discounts available). The content of the CME activity is divided into three modules that together comprise 7.25 AMA PRA Category 1 Credits. In order to receive credit, participants should:
  • Read the chapters included in each module

  • Go online to www.fsmb.org/CME

  • Click the link to “Claim Credit for Responsible Opioid Prescribing: A Physician’s Guide”

  • Enter the access code included in the book

  • Select the module you would like to claim credit for and complete the online registration process (participants only need to register once to complete all three modules)

Jul
312012

Position statement update; latest revisions

Newsletter: 2012, No. 3
Categories: Board News,

The NC Medical Board voted to adopt revisions to two positions statements during its meeting in May. The Board approved changes to the position statements: Availability of licensees to their patients and Sexual exploitation of patients. A summary of the revisions appears below. View the revised statements, as well as a complete collection of Board position statements.

Availability of licensees to their patients
The Board voted to change the word ‘physicians’ to licensees throughout the position statement. Significant changes include the addition of a new paragraph that more explicitly informs licensees of their responsibility to provide clear instructions and information to patients on how to seek after-hours care when necessary. Another new paragraph makes clear that the position statement applies to licensees practicing telemedicine as well as traditional medicine.

Sexual exploitation of patients
The Board voted to accept significant changes to the position statement on sexual exploitation of patients. The position statement is now based, in part, upon the Federation of State Medical Board’s guidelines regarding sexual boundaries. The statement now distinguishes between two types of professional sexual misconduct: sexual impropriety and sexual violation. More detailed descriptions of each behavior type are also now provided.

Jul
312012

NCMB honors Watauga County physician

Newsletter: 2012, No. 3
Categories: Board News,

Image for NCMB honors Watauga County physician The NC Medical Board spends much of its resources licensing physicians and disciplining or correcting those who practice poorly. Too rarely does the Board have an opportunity to applaud a physician for showcasing
the true definition of professionalism.

The Board did just that recently, when it honored William A. Derrick, MD, of Boone, for his invaluable assistance to the patients of a physician who abruptly closed his practice in July 2011 and left the country. Dr. Derrick, a retired family physician who was a longtime director of Student Health Services at Appalachian State University, stepped forward and offered to take temporary custody of the abandoned patient records. Working with a Board investigator and attorney, Dr. Derrick arranged for the records to be moved to Blowing Rock Hospital. With the help of his wife, Liz, he worked for several months, often under less than ideal conditions, to locate patient records and get them to their owners. Their efforts helped hundreds of patients who would otherwise have lost their records obtain their files.

NCMB President Ralph C. Loomis, MD, and R. David Henderson, the NCMB’s executive director, attended a meeting of the Watauga County Medical Society in May to surprise Dr. Derrick with a plaque recognizing his service to the Board, the profession and the patients of the high country.

The NC Medical Board is grateful to Dr. Derrick for his efforts and his commitment to North Carolina patients.

Jul
312012

Preserving a scarce human resource: Healthy physicians


Image for Preserving a scarce human resource: Healthy physicians The exhausted and tense man in my office at the Center for Professional Wellbeing hardly fit the role of compassionate caregiver. I listened as he described his attitudes about his work in a busy internal medicine practice. “I was angry, discouraged and unmotivated,” he said. “I saw patients as enemies and all paperwork demands as intrusive.” He looked across the desk at me, eyes flashing. “I worked hard, I passed my Boards and now I have to settle for substandard fees. I have to justify every test. I’m forced to swear that I didn’t lie about procedures I ordered. And on top of it all, I have to deal with hostility from staff, patients and health plan representatives.”

Worse still, this physician went on, peers and practice partners seemed oblivious or indifferent to his suffering. Colleagues always wanted him to see just one more case. If he objected, some even made derogatory remarks suggesting that he didn’t have the “right stuff” to make it as a physician— “Can’t you take the heat?” they’d chide. “That’s what practicing is all about.”

The client described above displays the hallmark characteristics of physician “burnout.”

The physician couldn’t easily describe what aspects of his work were triggers for his anger and exhaustion. He couldn’t begin to imagine how to make his work environment better. He just wanted to leave medicine.

Our job at the Center was to help him rekindle his desire to practice. We showed him this was possible only through the judicious practice of self-care. We helped him learn strategies for “burnout-proofing” his practice. As part of this process, he was asked to become more assertive and stop enabling a system that left him personally depleted. After completing a guided analysis of his current work situation and stressors, this physician even asked for— and got— a medical scribe to help with documentation and paperwork. Today he is practicing with a muchrenewed spirit and with far more enjoyment than he would have dreamed possible.

This article will provide an overview of burnout and describe its devastating effect on medical practitioners’ professional and personal lives. It will define the qualities of a healthy, well-functioning (not burned-out) clinician. It will provide the reader with tools for assessing risk for burnout and describe the often severe consequences of allowing oneself to become burned out. Finally, it will share some strategies for “burnout-proofing” one’s practice environment.

Burnout: An unrelenting problem
Burnout among physicians has reached epidemic proportions since it was first described among human services workers in the 1970s. When physicians experience overload, loss of control (autonomy) and a lack of reward (perceived or real) for their contributions, their risk for emotional exhaustion, otherwise known as the burnout syndrome, is astronomical. When physicians begin the downward spiral into burnout, they no longer contribute with their leadership and motivational energy. Instead, they become needy and unintentionally sap energy away from the group. Worse, this syndrome is highly contagious and can systematically infect a whole practice or clinic by reducing meaningful contact among its individual members.

The burnout process is similar to the process of grieving. Grieving occurs when there is loss or change. Some losses are significant (death of a child, spouse or parent) and result in more profound episodes of grief. Some are negligible (favorite sports team loses a game) and might be experienced as little more than disappointment. Burnout closely mimics the type of grief experienced after a serious loss.

Physicians who suffer burnout typically grieve for the loss of a life dream—no question a significant loss. Most physicians enter practice with the hope of fulfilling a caring, supportive, challenging and rewarding role. They expect reasonable work requests, relative autonomy and a commensurate reward for their efforts. What they get is unrelenting pressure to see more patients in less time, limited control over how medical care is delivered, constant scrutiny and quality “assessments” and increasing demands from patients. The path to burnout begins when these professionals suffer a clash of expectations and recognize the serious mismatch between their actual day-to-day job and their deep-seated internal expectations (Cf.,Maslach and Leiter, 1997. The Truth About Burnout.)

Some evidence suggests that the incidence of burnout is rising among physicians and is striking earlier in their careers. Most recent data see an increase in burnout scores, derived from the MBI (Maslach Burnout Inventory) among residents and new practitioners. These are professionals who, in theory, should be at their most motivated and idealistic stage of practice. Instead, they report that they are increasingly cynical, with burnout percentages of up to 80 percent upon entry to practice.

Burnout: What it looks like
Burnout is characterized by:

  • An erosion of engagement with the job presenting as exhaustion, cynicism and ineffectiveness; and an erosion of positive emotions, particularly loss of enthusiasm and idealism (Maslach & Leiter)

  • The discrepant fit between the person and the job, experiences as personal imbalance and not recognized as unrealistic job demands

  • The betrayal of expectations or the clash between the “spirit” (core passion, values and purpose) and the demands of the work environment

Common “Emotional” symptoms
  • Recurrent sense of sadness

  • Decreased interest in work and personal life

  • Increased incidence of anxiety dreams

  • Recurrent sense of helplessness and hopelessness

  • Decreased control of anger

  • Difficulty in self-motivation

  • Decreased creativity, can’t give anymore

  • Increased fear and terror

  • Increased anticipatory anxiety

  • Increased agitation and sluggishness

  • Severe self-criticism

Common physical symptoms
  • Sleep changes; No resilience from rest

  • Increased physical distress (generalized)

  • Digestive difficulties

  • Decreased immunity to prevalent illnesses

  • Increased “heart-pains” that, upon medical workup are not physiological

Common “transpersonal” or spiritual symptoms
  • Increased hopelessness

  • Withdrawal from community involvement

  • Withdrawal from faith and social relations

  • Difficulty concentrating (including prayer/meditation)

  • Obsession with transgressions and failures

  • Enhanced sense of isolation and loneliness

  • Increased anger at suffering, God, other people

  • Inability to empathize

  • Lessened access to experiencing “making a difference”

  • Anticipating work as exhausting and going home exhausted

  • Nagging feelings (guilt; self-criticism) when treating patients as objects/diseases

Consequences of Burnout
Burnout takes a toll not just on the person experiencing it, but on each person, group and “system” that person interacts with on a daily basis. Spouses of burned-out physicians describe feeling as though they live with a stranger or a robot. Nurses and other subordinates admit to avoiding contact with the burned-out physician to avoid unpleasant outbursts, even when failure to speak up or ask questions may result in errors or less than optimal care. Alternatively, burning-out individuals may withdraw, viewing contact with others as yet another demand on their time. At best, the burned-out physician is a “weak link” who hurts productivity because he or she is unable to contribute fully. At worst, the burned-out individual is a destructive force who threatens practice morale and may even imperil patient care.

Some specific consequences of burnout include:
  • Less ability to perceive the patient is a whole person

  • Less energy to “go the extra mile”

  • Diagnosing quickly out of a belief that such speed will “get me off of the treadmill”

  • Less likely to follow preventive cardiology or healthy habits

  • Anger at how medicine only gives lip service to healthy habits

  • Increased mal-occurrences, errors or mistakes

  • Likelihood to blame the system

  • Greater depression

  • Poorer work and personal relationships

  • Increased tendency to practice defensive medicine due to pessimism-induced litigation fears

  • Less team-oriented; Views each interaction with team members as a drain on time

  • Taking short cuts in care delivery (while hating the pressure that makes short-cuts seem necessary)

  • Lessened ability to dispense hope to patients

  • Earlier retirement, or changing careers

  • Leaving or selling practice

Physicians: Hardwired for burnout?
The U.S. system for educating and training physicians in many ways sets young doctors up for burnout. Modeling by peers and teachers rewards always going “the extra mile” and labeling as weak those who cannot keep pace. Individuals who ask for help are perceived as incompetent or insecure. Peers fear intimacy or constructive feedback, so social tension is high and feedback is low. Perhaps most important, physicians are routinely rewarded for not setting boundaries and failing to say “no.”

The risk appraisal tool below is designed to help clinicians identify their level of risk for burnout. Note how many risk factors are also behaviors traditionally rewarded or praised among physicians.

How to score: Mark a Y or N beside each of the following statements. The greater the number of “Ys,” the higher your risk for burnout. Four or more positives indicate you are at high risk.

Burnout Risk Appraisal
  • You tend to avoid setting and maintaining boundaries

  • You only grudgingly ask for/accept help

  • You often make excuses, such as, “It’s faster to do it myself than to show or tell someone”

  • Given a choice, you always prefer to work alone

  • You do not have a close confident with whom you feel safe discussing problems

  • You tend to blame external factors for problems in your work environment (It’s not me…it’s my nurse, it’s the OR staff, it’s the hospital pharmacy, it’s the insurance company, etc.)

  • Your work relationships are asymmetrical. E.g., you are always giving, but never receive needed assistance/support

  • Your personal identity is tightly bound to your work role or professional identity (Your worth/value is strongly tied to your role as a clinician)

  • You do not value commitments to yourself such as exercise or down time as much as you value the commitments you make to others

  • You often overload yourself and have a difficult time saying “no”

  • You have few opportunities for positive and timely feedback outside of your work role

  • You easily become frustrated, sad or angry when performing your regular work tasks

  • It is harder now for you to easily establish warmth with your peers and/or clients/patients

  • You feel guilty when you “play” or rest

  • You get almost all of your needs met through helping others

  • You continually put others’ needs before or above your own needs

Avoiding burnout: Keep the candle burning
Virtually all medical practitioners working in today’s high-pressure environment are at risk of burnout at some phase of their careers. To prevent burnout, physicians and organizations that employ physicians must work proactively to spread awareness of the problem and encourage attitudes and behaviors that promote health and balance. This is no small task. Nonetheless, it is a wise and necessary investment in one of society’s most precious and scarce human resources: physicians.

Organizations that employ or otherwise rely on physicians (hospitals, surgery centers, medical practices) have a vested interest in spending the time, energy and resources needed to keep doctors well.
As the process of burnout progresses, the affected individual can no longer give to patients or the practice; They are so depleted that they can only guard against their own fatigue. In fact, people who are burning out can negatively impact productivity and morale by sapping energy from the organization. Organizations can guard against this by “burnout proofing” through positive changes to work practices and professional environments. Doing so has an important side benefit of demonstrating to physicians and other clinicians that the organization is committed to preserving medical professionals as whole people. As such, “burnout proofing” is useful as a retention strategy.

What organizations can to do “burnout proof”
Cultivate a work culture that emphasizes and/or makes readily available the following:
  • Unconditional respect for the professional from peers: honest PRAISE

  • Regular timely feedback so corrections/adjustments can be made

  • Collective thinking/problem solving and a collaborative approach to devise and implement solutions

  • Acceptance of transition/change as reality, with visible reinforcement by management

  • Workshops on chaos and transition to help clinicians develop a comfort level with being “out of control”

  • Workshops that acknowledge burnout as a risk of clinical practice, with de-stigmatization of burnout as a primary goal

  • Avenues and/or training for constructive conflict management/dispute settlement

  • Leadership training, including effective mentoring as a skill

  • Parent effectiveness training (problems at home increase stress at work and vice versa)

  • Availability and access to trained independent mediators (from outside the organization)

  • A willingness at the organizational/ management level to acknowledge that the system may create or exacerbate stress not primarily individuals

  • “Juggling” workshops, especially peer-led, that let thriving practitioners share how they balance personal and professional life; Sharing by senior professionals of how they coped with disappointment, dilemmas and stress

  • Availability of curricular (CLE/CME or otherwise) training in stress management

  • General availability of peer support groups and peer coaching

  • Availability of counseling on career fits that do not conform to the workaholic model

  • Periodic creativity exercises and retreats

Conclusion
A physician who is burning out is not weak — he or she is simply human. Acknowledging and de-stigmatizing burnout is an important first step towards addressing risks and building professional environments that support well being and, over the long term, physician satisfaction.

What is patently clear is that the work environment and expectations for the practice of medicine are unrealistic. Demands are often unmanageable and overwhelming. Outside and inside pressures to do more with less deny a sense of control in the role. Reward systems often emphasize productivity and efficacy and clash with humane values. System pressure against physician community-building denies a sense of community, reinforcing the individual “lone wolf” culture modeled during training. Responses to reduce burnout must come from assertive physician wellbeing programs and systems that recognize interdependence to promote lifelong vitality.

Jul
312012

Practicing self-care: Resources for physician wellbeing


As medical professionals, we spend our lives and careers focused on the health and welfare of others. For the health of the profession, and the good of society, we must not forget to look after ourselves, as well.

As physicians, we have been taught to do it all by ourselves, to do it perfectly, to never say “no” and to deny, sometimes, our most basic needs. Imagine that a patient has acknowledged driving him- or herself in this fashion on a regular basis. What would you say to that patient? Relax. Slow down. Start taking better care of yourself.

Unfortunately physicians are far better at giving medical and lifestyle advice than we are at following it ourselves. The end result is a healthcare system in which doctors feel isolated, fatigued, overburdened and unable to render the care they wish they could provide. This pattern of self-neglect is not sustainable. Society needs physicians well able to care for patients in a professional and capable manner. It doesn’t need any more bitter and cynical physicians.

I have been interested in physician wellness for some time. Through my involvement in the NC Academy of Family Physicians, I have led efforts to offer CME related to physician wellbeing, and the NCAFP’s Council on Health of the Public has taken up the charge to continue these efforts.

In this article, I have gathered a repository of resources that may help physicians and other clinicians become more attuned to their personal and professional needs. Some physicians may need guidance in some aspect of their careers. Some of us just need a reminder of the good and noble aspects of the practice of medicine. Some may sense that they are fraying at the seams and need ideas for how to recharge and repair. Many doctors won’t need any of these resources. If you are one of those few, I bet you know someone who could benefit. The NC Medical Board has agreed to add the resources listed in this article to the “Links” section in the Professional Resources portion of the NCMB’s website.

I’ll close with a favorite quote, from Brian Dyson, who was CEO of Coca Cola Enterprises from 1959-1994: “Imagine life as a game in which you are juggling five balls in the air. You name them—work, family, health, friends, spirit—and you are keeping all of these in the air. You soon discover that work is a rubber ball. If you drop it, it will bounce back. But the other four balls—family, health, friends, spirit—are made of glass. If you drop one of these, they will be irrevocably scuffed, marked, nicked, damaged, or even shattered. They will never be the same. You must understand that and strive for balance in your life.”

Be well.

Dr. Snyder, a family physician, is Medical Director of Patient Centered Medical Home Development for Novant Medical Group and is a past president of the NC Academy of Family Physicians.

The list below is by no means complete, and you are invited to add to it. Please .(JavaScript must be enabled to view this email address)your favorite resources, books, pearls and comments.
Disclaimer: Neither the NCMB nor Dr. Snyder endorses the organizations or individuals listed below or represents them in any way.

PHYSICIAN WELLBEING
NC Physicians Health Program
Center for Professional Wellbeing
Finding Balance in a Medical Life | Finding Balance in a Medical Life, Lee Lipsenthal, 2007
Center for Professional and Personal Renewal
Kitchen Table Wisdom | Rachel Naomi Remen, M.D. Riverhead Books, New York; 1996

WORK ADDICTION
Work addiction inventory
Co-Dependency-Care Addiction | Referenced in Chained to the Desk: A Guidebook for Workaholics, Their Partners, and Children, and the Clinicians Who Treat Them; by Bryan E. Robinson (New York University Press, 1998)

BURNOUT
Burnout inventory
Compassion Fatigue
Professional Quality of Life
Maslow Self Actualization

SELF CARE-IMPROVEMENT
AMA Physician Resources
Life stress inventory
Heart Math
Exercise is Medicine
Weight Management
Zung Depression scale
British Medical Association

Jul
312012

Easy money—Work from home

Newsletter: 2012, No. 3
Categories: Board News,

Image for Easy money—Work from home The Medical Board occasionally receives inquiries for information and advice from physicians who have been contacted by recruiters or who have seen advertisements for various telemedicine positions and providers. The Board recognizes that telemedicine is a useful tool with evolving technology that, if employed appropriately, may provide important benefits to patients. However, physicians should protect themselves by thoroughly evaluating a telemedicine provider and proposed means of delivering care before agreeing to treat patients via telemedicine.

Here are several important considerations:
How are you being contacted?
Your point of contact may not be the actual owner of the telemedicine service. A recruiting company, email contact or advertisement may provide vague or incorrect answers to your questions. Affirmatively determine who actually owns the telemedicine service. The owner of the telemedicine practice may be an out-of-state non-physician, which could raise concerns about illegal or unethical business arrangements.

Have an attorney experienced in North Carolina health care law review all contracts and documents.
Confirm that the means you will be using to provide patient care remotely is acceptable and in accord with North Carolina law and Medical Board policies.

If you will be providing telemedicine patient care in more than one state be aware of the multiple state license domino effect.
Many practitioners who primarily practice telemedicine hold medical licenses in multiple states. If an individual is disciplined by a medical board in one state, it often rapidly triggers a series of medical board investigations in all states where a physician is licensed. It’s possible to be disciplined by other state medical boards for conduct in a different state, even if you have not provided any patient care—via telemedicine or face-to-face—in those other states.

Physicians practicing via telemedicine will be held to the same standard of care as licensees employing more traditional inperson medical care.
You will be held to the standard of care applicable to the type of care you are providing. There is no watered down or special standard of care for telemedicine practice. If you are providing primary or family medicine type care you will be held to the standard of care expected of a family medicine physician seeing the patient in person. A failure to conform to the appropriate standard of care may subject the physician to discipline by the Board.

Physicians using telemedicine to provide care to patients located in North Carolina must provide an appropriate examination prior to diagnosing or treating the patient.
Obviously, the examination will not be exactly the same as an exam conducted in person. However, the examination must be substantially equivalent to one that would be conducted in person and allow the practitioner to gather all needed information to make a diagnosis.

Physicians using telemedicine should have some means of verifying that the person seeking treatment is in fact who they claim to be.
For example, it is not appropriate to prescribe antibiotics to a wife who does a telemedicine consultation on behalf of her husband. In some cases the Board is familiar with telemedicine practitioners have prescribed in the name of the patient they are speaking to knowing that the medication is intended for another party. This is clearly substandard practice.

Licensees using telemedicine must ensure the availability of appropriate follow-up care and maintain a complete medical record.
Records must be available to the patient and to other treating health care providers.

Prescribing controlled substances by means of telemedicine is an invitation to disaster.
Don’t do it.

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View the North Carolina Medical Board’s official position statement on Telemedicine.
View the Board's entire collection of position statements.

Jul
312012

Highlights from the 100th meeting of the FSMB

Newsletter: 2012, No. 3
Categories: Bulletin Board,

Every year the NC Medical Board sends a delegation of Board Members and staff to the annual meeting of the Federation of State Medical Boards (FSMB). The FSMB is a national membership organization that represents and supports state medical and osteopathic regulatory boards in the United States and territories.

This April, the FSMB held its 100th annual meeting in Ft. Worth, TX. The summary below highlights significant actions taken by the House of Delegates, the governing body of the FSMB. More information

Impact of medical board regulatory actions
The NC Medical Board has received feedback from licensees, professional groups and others that medical board actions frequently result in unintended and undesirable consequences to the licensee, such as the loss of specialty board certification. The NCMB does not believe these consequent actions are always necessary or appropriate. As a result the Board introduced a resolution (Resolution 12-1) in the Federation’s House of Delegates that would address this issue.

Resolution 12-1 was ADOPTED: Resolved, the FSMB shall convene a meeting with the ABMS and AOA BOS to collaborate on strategies to achieve the common goal of avoiding unintended limitations of specialty board certification and recertification based on state board disciplinary action, while protecting the public and maintaining high standards of specialty practice, and shall report back to the House of Delegates on its progress at the 2013 Annual Meeting.

Limited exemption from CME requirements
Medical Boards recognize that participation in American Board of Medical Specialties (ABMS) Maintenance of Certification programs or American Osteopathic Association Bureau of Osteopathic Specialists/Osteopathic Continuous Certification programs represent a significant commitment to continuing education on the part of a licensee. The Minnesota Board of Medical Practice introduced Resolution 12-3 to allow participants in ABMS MOC and AOA BOS/OCC programs to use this participation to meet CME requirements for the purpose of license renewal.

Resolution 12-3 was ADOPTED: Resolved, that the FSMB supports the use of, and encourages state boards to recognize, a licensee’s participation in an ABMS MOC and/or AOA BOS OCC program as an acceptable means of meeting CME requirements for license renewal.

The NCMB has adopted rule changes consistent with this resolution; the rules won final approval in July and are set to take effect August 1, 2012 (see CME Rule article, pg. 16)

Social media, reentry to clinical practice policies
The FSMB establishes workgroups to study relevant issues in medical regulation and form policy recommendations that may be adopted by the Federation and, in some instances, serve as guidelines for state medical boards.

The FSMB House of Delegates took the following actions related to reports offered by two workgroups:

1. The Model Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice contained in BRD RPT 12-1; Report of the Special Committee on Ethics and Professionalism were ADOPTED as policy and the remainder of the report filed.

Some points covered in the guidelines include:

  • Physicians should only have online interaction with patients when discussing the patient’s medical treatment within the physician-patient relationship—and these interactions should never occur on personal social networking or social media websites.

  • Patient privacy and confidentiality must be protected at all times, especially on social media and social networking websites. Although physicians may discuss their experiences in non-clinical settings, they should never provide any information that could be used to identify patients.

  • Physicians should be aware that any information they post on a social networking site may be disseminated to a larger audience, and that what they say may be taken out of context or remain publicly available online in perpetuity.


2. The recommendations contained in BRD RPT 12-2; Report on the Special Committee on Reentry to Practice were ADOPTED as policy and the remainder of the report filed.

The Reentry report encourages state medical boards to develop a standardized process for physicians and physician assistants to demonstrate their competence prior to reentering practice after an extended absence from clinical practice. It includes 12 Reentry Guidelines designed to provide medical boards with a framework of common standards and conceptual processes for physician and physician assistant reentry. The guidelines include:
  • Education and Communications Issues

  • Determining Fitness to Reenter Practice

  • Mentoring Practitioners Who Want to Reenter the Workforce

  • Improving Regulation of Licensed Practitioners Who Are Clinically Inactive

  • The Relationship between Licensure and Specialty Certification


The NCMB has a well-defined Reentry Program and has been a leader among medical boards in establishing reentry as a regulatory priority. More information on reentry in North Carolina

Jul
312012

Electronic health records: A benefit when only used wisely

Newsletter: 2012, No. 3
Categories: President's Message,

Image for Electronic health records: A benefit when only used wisely This issue’s President’s Message is a cautionary tale for those of you using electronic health records. Now before you scoff and call me a technophobe, let me explain.

I’ve been using EHR in my own practice since 2003 and, overall, it has been a positive experience. I firmly believe that a good system, well used, forces a physician or physician assistant to think in an organized manner. The process of completing the EHR entry can help ensure that the patient record thoroughly and accurately documents what went on during a patient encounter.

As a member of the Board I’ve seen enough examples of illegible, chickenscratch, handwritten records to understand how valuable that is. From the Board’s perspective, it’s relatively easy, upon review of a well done EHR, to reconstruct what happened during a given episode of care and make some determination about the appropriateness of a licensee’s actions. Clinicians who use their EHR systems effectively may be confident that, if needed, they will be able to defend their records and their care.

Here’s the problem: Everyone who is using an EHR system isn’t necessarily using it well. The Board has noticed an increased instance of disciplinary cases in which improper use of EHR is a factor. The problems fall in two main categories:

  1. The licensee is overusing template content provided through the EHR, which results in incomplete and/or inaccurate records.

  2. The licensee lacks the time to become proficient in the use of his or her EHR, which results in incomplete and/or inaccurate patient records.

EHR template content: NOT a substitute for a good exam
Sometimes the errors or omissions in poorly executed EHRs are glaring and ridiculous. For example, in the course of reviewing a case, the Board may look at a record that purports to accurately document a physical examination of a female patient. Yet, upon review, it is determined that the record indicates that male genitalia were examined, with no abnormalities present (a great relief to the patient, no doubt).

Here’s a brief sampling of other EHR-related documentation errors observed by the Board and its staff:
  • A morbidly obese woman with a history of four C-sections and two laparoscopic ab-dominal procedures described in the record as having a “flat abdomen” with “no scars.”

  • The records of a patient with chronic cellulitis, chronic epididymitis and chronic low back pain contain exams that do not match the history, with numerous “normal” skin, musculoskeletal and neuro exams.

  • A patient is prescribed increasing doses of opioids for low back pain, although records show the history of present illness is identical for many visits, raising questions about the need to continue/increase opioid therapy.

Why are these sorts of errors problematic? First, it diminishes the value of the record to other treating clinicians, who will glean little meaningful information about the patient. And from the Board’s perspective, a template-driven record raises doubts about the overall quality of the licensee’s care. To be blunt, how careful can the Board assume an examination was if the licensee describes a female patient as having male anatomy? What else might the licensee have gotten wrong? Did the licensee even examine the patient? Obviously, this is not the direction a licensee would want the discussion to move in when his or her case is before the Board.

To be sure, template content in EHRs can be helpful. It can improve billing by ensuring that insurance company requirements are met. It can save time by reducing the need for the practitioner to manually enter each component of care. However, templates cannot take the place of a good, detailed, accurate physical exam and history. All of us are under incredible time pressures and it may be tempting to rely on templates to get through your documentation more quickly. Don’t do it. Bottom line, if you didn’t do something, don’t put it in the record. When you do use templates to document an exam, take the time to customize the record to ensure you document it accurately.

Don’t know how to use your EHR? Get help
That brings me to my second assertion, that many problems the Board sees with EHRs has to do with the fact that licensees are too swamped to make the time to learn to properly use their EHR system. I suspect this is the case for most of the licensees we see with evident problems using EHR well.

Learning to properly use your EHR is absolutely critical. Truly, how can anyone afford not to? I know taking days or weeks out of already packed work schedules to learn a new system is difficult. But when one considers the extremely high cost to purchase and run most EHRs (typically at least a few thousand dollars a month, plus a sizeable upfront investment), investing the additional time and expense to train on the system is negligible.

Many established EHR vendors have intensive training available, for an additional fee. However, to address the specific concerns raised in this article NC AHEC, which received a federal grant to help medical practices become meaningful users of EHR, may be an even better choice. A primary goal of the NC AHEC program is to help practices use EHR to help improve care and satisfaction for practitioners, their patients and staff.

NC AHEC had a tremendous response to its grant program, which provided free or subsidized training to primary care practices. It is now in the process of transitioning to a fee-based EHR training service that will be available to clinicians in all practice areas. Learn more about the service or sign your practice up as a potential client, email the program administrators for more information.

Until next time,
Ralph

Jun
042012

NCMB and physician supervision of certified nurse midwives: the facts


A great deal of misinformation is circulating regarding the NC Medical Board's interest in home birth and, more specifically, its role in physician supervision of certified nurse midwives (CNMs).

Here are the facts:

  • The Medical Board does not have a position on home birth. It is neither for it nor against it.

  • The Board does not license CNMs and has no direct authority to affect the ability of these practitioners to provide care to patients.

  • To practice lawfully, CNMs must be supervised by a licensed physician in accordance with criteria set out in Article 10A of the NC General Statutes. Proper supervision includes having detailed written guidelines that describe the clinical roles of the CNM and the supervising physician, written guidelines that describe how and under what circumstances the CNM and the supervising physician will communicate, and a formal process for periodically reviewing care, among other things.

  • The Board has no policy that would prohibit physicians from supervising CNMs and has no plans to adopt such a policy. Any physician who meets the requirements of state law and related administrative rules may supervise CNMs.

May
152012

Notice of corporate suspensions

Newsletter: 2012, No. 1
Categories: Announcements,

In April, the North Carolina Medical Board notified the NC Secretary of State’s office that it had suspended 304 Professional Corporations and PLLCs due to failure to renew business registration by Dec. 31, 2011, as required by NC law.

Suspended professional business entities no longer qualify to provide professional services, specifically the practice of medicine, in North Carolina. Reinstatement is required to restore a medical corporation’s professional business status.

To reinstate a business and have the suspension lifted .(JavaScript must be enabled to view this email address)the NCMB’s Corporations Coordinator. Our coordinator will guide you through the process and the fees involved.

  • Businesses that have been suspended for less than one year will be allowed to reinstate by completing the online registration after their file is reopened. Fees will include the past due registration fee plus a $10 late fee.

  • Businesses that have been suspended for more than one year must submit certain notarized statements to recertify and register with NCMB. These businesses are subject to a recertification fee, plus the $10 late fee and a $25 registration fee for each year they failed to register.

You may verify whether a business is in good standing by looking it up on the Secretary of State’s website’s Corporate Search by Name.

Please direct questions concerning the status of a professional business or requests to have a professional business reinstated via email to the NCMB’s Corporations Coordinator.

May
152012

Quarterly adverse actions report | November 2011-January 2012

Newsletter: 2012, No. 1

The Board actions listed below are published in an abbreviated format. The report does not include non-prejudicial actions such as reentry agreements and non-disciplinary consent orders. Recent Board actions are also available at www.ncmedboard.org. Go to “Professional Resources” to view current disciplinary data or to sign up to receive notification when new actions are posted via the RSS Feed subscription service.

Quarterly_Adverse_Action_Report_Nov_Janu_2012.pdf

May
152012

Year in Review: A look back at data from 2011

Newsletter: 2012, No. 1

The annual Year in Review feature highlights a selection of Board data in a two-page graphic spread that, we hope, illustrates some interesting points about the NCMB’s work and licensee population.

This year’s feature demonstrates two points about the physician population that, while hardly surprising, clearly illustrate some of the challenges ahead for North Carolina. First, North Carolina’s medical practitioners are mostly concentrated in a few urban areas while many rural parts of the state have few or none. And second, the physician population in NC is graying rapidly. More than 46 percent are age 50 or older. By comparison, only about 25 percent of physician assistants in the state are in the 50+ age bracket.

The lower third of the page presents data about the Board’s disciplinary caseload in 2011. Interesting fact: On average, it takes less than 100 days for the NCMB to close a case, from complaint received to case resolution.

Visit the NCMB’s Data Center online for additional graphics and information.

Forum_Spring_2012_Year_in_Review.pdf

May
152012

Board introduces reentry center on website

Newsletter: 2012, No. 1
Categories: Bulletin Board,

The NC Medical Board has established a new online resource to provide licensees and others with additional information and tools related to the Board’s physician and physician assistant reentry requirements.

Since 2005, the NC Medical Board has been a leader in reentry, which is a structured system that takes steps to ensure that physicians and physician assistants who return to medical practice after a significant period of inactivity can practice safely. Licensees who have been out of clinical practice for two or more years are required to complete an approved program of reentry before returning to unrestricted practice in North Carolina. The Board views its reentry program as a cost-effective alternative to other ways
of demonstrating clinical competence before reentering active clinical practice, such as completing a mini-residency program or a formal personalized education program.

The NCMB established formal standards for reentry in 2011 with the implementation of administrative rules (21 NCAC 32B.1370) that list specific factors that affect the terms of an individual’s reentry program. These factors include the length of time out of practice, the prior intensity of practice, the skills needed for the intended area of practice, the reason for the interruption in practice, and the licensee’s activities during the interruption in practice, including the amount of practice-relevant CME completed.

A reentry program is defined as consisting of a multiphase period of mentoring under a physician approved by the Board. Phases of the program include an observation phase, during which the reentry candidate observes his or her mentor in practice; a phase during which the reentry candidate practices under their mentor’s direct supervision; and a final phase during which the reentry candidate practices under the mentor’s indirect supervision.

To date, more than 150 physicians and physician assistants have successfully completed reentry programs. The facing page provides key data about the Board’s reentry program to date.

Find the reentry center on the NCMB’s website. Go to “Professional Resources” and select “Special Topics.”
Reentry statistics: Forum_Spring_2012_Reentry_Statistics.pdf


.......................................................
The online reentry center includes:
The Board’s reentry rules

  • The Board’s reentry position statement

  • Sample letter notifying licensee of reentry requirement

  • Reentry plan content guidelines

  • Sample reentry plan (document submitted by the licensee seeking reentry/licensure that describes his/her proposed reentry program)

  • Sample reentry program (binding legal document executed by the Board that describes requirements and terms of licensee’s reentry program)

FAQs about reentry
What is “reentry”? The Board’s reentry program is a system for ensuring that licensees who are clinically inactive for two or more years or have otherwise not maintained competency are safe to practice upon relicensure and/or resuming active clinical duties.

What authorizes the Board to require licensees to complete a reentry program? The Board is authorized by state law to ensure that its licensees meet minimum standards for competency. Administrative rule 21 NCAC 32B.1730 describes the Board’s requirements in detail.

Who is subject to the Board’s reentry requirements?Any physician or physician assistant who, upon application for licensure or relicensure in NC, reports that he or she has been out of clinical practice for two or more years. By rule, the NCMB has the authority to determine that a physician or PA has failed to maintain competency by some means other than length of time out of practice.

What does a reentry program typically involve? The reentry candidate must find an approved physician mentor, who agrees to monitor the candidate in practice in accordance with a structured agreement and provide detailed observations to the Board of the candidate’s level of competence.

How long does it take to complete reentry? It depends on the unique circumstances of each reentry candidate (determining factors are covered in the reentry rules). The average duration of a reentry program is 10.9 months.

May
152012

PA site visits in 2011 find more in compliance, fewer serious problems

Newsletter: 2012, No. 1
Categories: Bulletin Board,

Physician assistant site review results for 2011 show a nearly 10-point increase in the percentage of site visits that found PAs in full compliance for NCMB rules regarding supervision of mid-level practitioners. In addition, the percentage of site visits that resulted in Board action dropped by three points.

The NCMB has conducted annual PA site reviews since 2005 to ensure compliance with administrative rules regarding the supervision of midlevel practitioners. The Board reviews a certain number of PAs, who are selected at random, each year. Starting in 2010, the NCMB began publishing the results of its PA site visits. Results from 2011 are below.

2011 PA site visit results
Sixty-nine percent of physician assistants/sites reviewed in 2011 were found to be in full compliance with Board rules. In 24 percent of sites reviewed, the Board noted one or more instances of noncompliance. However, in all such cases the PAs corrected the noted discrepancies and the Board took no formal action against their licenses. In 2010, 30 percent of PAs/sites reviewed fell in this category. In the remaining 7 percent of sites reviewed in 2011, the Board issued confidential Private Letters of Concern (PLOC) to the PAs. In each of these cases, PAs could not produce the required documentation of quality improvement meetings with their supervising physicians.

Areas of noncompliance
PAs continued to struggle in 2011 with the same few aspects of the NCMB’s supervisory rules that have come up in previous years. Issues noted include:

  • The PAs prescription blank did not contain his/her approval/prescribing number, DEA number, name and/or supervising physician’s name as required by Rule 21 NCAC 32S.0212 (5) (a) and (b).

  • The PA did not have a dated and signed back up supervising physician list as required by Rule 21 NCAC 32S .0215 (b). This rule requires the PA to keep a current list that includes approved back-up supervising physicians, signed and dated by each back-up supervising physician, the primary supervising physician and the PA. This list must be retained as part of the Supervisory Arrangement.

  • Statement of Supervisory Arrangement lacked a clear explanation of the physician’s supervision of the PA as required by Rule 21 NCAC 32S .0213 (b). The rules states, “Each team of physician(s) and physician assistant(s) shall ensure that the physician assistant's scope of practice is identified; that delegation of medical tasks is appropriate to the skills of the supervising physician(s) as well as the physician assistant's level of competence; that the relationship of, and access to, each supervising physician is
    defined; and that a process for evaluation of the physician assistant's performance is established.”

  • Quality Improvement meeting documentation was not signed and/or dated by the PA and/or supervising physician as required by Rule 21 NCAC 32S .0213 (d), which states, “a written record of these meetings shall be signed and dated by both the supervising physician and the physician assistant.”

Are you in compliance?
Don’t wait to be selected for a site review to make sure you are in full compliance with supervisory rules. Review the PA rules and regulations. A complete description of the information PAs should expect to provide during a compliance review is available on the PA Site Visit Checklist.

PA site visits: How they work >PAs selected for review are notified in advance by a Board investigator, who schedules a face-to-face meeting. The PA is asked to produce certain documents that must be kept on file at the PA’s practice location. The Board investigator also asks the PA a series of questions regarding his or her practice arrangement, such as how frequently he or she has one-on-one direct contact with the supervising physician.


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