The Meeting Summary provides brief descriptions of selected actions taken by the NC Medical Board during its most recent meeting or hearing. Actions are listed by committee, where applicable.
For a full account of the Board’s proceedings please check the meeting minutes, which are posted approximately two months after the meeting date. You can subscribe to our Meeting Minutes RSS feed to be notified when the minutes are posted.
Summary of the Board Meeting held Mar. 20-22, 2019
Advanced Practice Practitioner and Allied Health Committee
Supervision of NPs and PAs providing MAT – The Committee received a report from staff on opportunities under federal law for NCMB to expand those clinicians who can lawfully supervise NPs or PAs who provide medication-assisted treatment (MAT) for opioid-use disorder.
There are two options under federal law. The Board may choose to create its own eligibility criteria for supervising physicians pursuant to 21 U.SC. § 823(g)(2)(G)(ii)(VI)(“the physician has such other training or experience as the State medical licensing board. . . considers to demonstrate the ability of the physician to treat and manage opiate-dependent patients.”). Or, the Board may choose to amend its rules. Specifically, the Board could amend 21 NCAC 32B .1001, 21 NCAC 32S .0212, and 21 NCAC 32M .0109 by adding the following clause: “For purposes of Medication Assisted Treatment pursuant to 21 U.SC. § 823(g), the physician assistant or nurse practitioner shall be supervised by a physician who possesses a DATA waiver or is otherwise qualified pursuant to 21 U.SC. § 823(g)(2)(G)(ii).”
The full Board discussed these options and declined, at this time, to pursue any changes to current MAT supervision rules.
PHYSICIAN ASSISTANT ADVISORY MEETING - Emily Adams, Executive Director NC Academy of Physician Assistants (NCAPA), reported to the Committee that the NCAPA supports the Board’s proposed legislative changes to the Medical Practice Act (H228)
Ms. Adams reported to the Committee that the NCAPA has received information from pharmacists that some pharmacists are being denied reimbursement for filling prescriptions written by physician assistants and nurse practitioners where the supervising physician’s name and telephone number do not appear on the prescriptions in contravention of Board rules requiring the same. The question was posed whether these rule requirements, 21 NCAC 32S .0212(5)(c) and 21 NCAC 32M .0109(b)(5)(a), are still necessary.
The Board accepted the Year-End Financial Statement Audit Report for the fiscal year ending on October 31, 2018.
The Committee agreed to serve as a sounding and advisory board for the current NCMB President’s Initiative, which will focus on developing engaging content for the medical student and/or medical resident audience. NCMB hopes to partner with Campbell University School of Osteopathic Medicine and test programming with Campbell DO students.
Clinician Obligation to Complete a Certificate of Death – The Board approved the Committee’s recommendation to adopt a new position statement entitled, Clinician Obligation to Complete a Certificate of Death. The position statement states that clinicians who certify deaths are not expected to pinpoint the exact cause of death, only to provide certification of a reasonable cause of death based on the available evidence. The Board directed staff to explain the Board’s rationale for adopting the position statement, along with the full text of the position statement, in the next issue of the Forum newsletter. The full text of the position statement, as adopted, appears below:
Clinician Obligation to Complete a Certificate of Death
North Carolina law requires that when a death does not meet criteria for jurisdiction by the Medical Examiner (N.C. Gen. Stat. § 130A-383) the death certificate shall be completed and signed by the physician, physician assistant, or nurse practitioner (“clinician”) in charge of the patient’s care for the illness or condition which resulted in death. Delaying the completion of a death certificate or refusing to sign a death certificate makes an already difficult time for surviving family members and other loved ones even more so and may result in unnecessary complications with funeral arrangements, estate proceedings, and other legal and personal matters.
The Board recognizes that clinicians may not be comfortable with uncertainty, however, a clinician should not decline to sign a death certificate simply because the exact anatomic or physiologic cause of death is uncertain. Less than 10% of deaths result in an autopsy. Clinicians are not expected or required to establish beyond a doubt the specific cause of death but should exercise their best judgment under the circumstances using available information.
Review of the patient’s medical history should provide adequate information to state a reasonable or likely cause of death. Examples of acceptable causes of death may include arteriosclerotic cardiovascular disease, hypertension, Alzheimer’s disease, or complications of diabetes mellitus. Furthermore, it is acceptable to use “probable” or “possible” to identify a suspected cause of death. In the end, a clinician’s determination of the cause of death is a medical opinion and is based on the best available medical evidence, which may include the cumulative effects of multiple risk factors or a previously known disease process. Use of standard nomenclature without abbreviations and legible writing is encouraged.
The Board will not pursue disciplinary action against clinicians who complete death certificates in good faith and to the best of their ability in accord with the information available — even if that information is limited. The clinician 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 is not possible in many instances). The Board also recognizes that clinicians may believe, for a variety of reasons, they were not “in charge of the patient’s care for the illness or condition which resulted in death.” This is often because death has occurred weeks or months after the last contact with the patient. The Board encourages clinicians to undertake completion of death certificates for patient’s (current, recent, or remote) under these circumstances as a professional, ethical, civic, and public health responsibility. Failure or refusal to complete a death certificate, when the licensee clearly has a responsibility to do so, could lead the Board to consider disciplinary action.
Licensees should perform this final aspect of patient care promptly and with consideration for the decedent and his or her loved ones. Questions or concerns by clinicians regarding medical examiner responsibilities in a particular case or for advice on the completion of a death certificate may be discussed in a collegial and professional manner with the county medical examiner or Chief Medical Examiner’s office. Legal requirements regarding completion of a death certificate may be found at N.C. Gen. Stat. § 130A 115. Additional guidance on the proper completion of death certificates is available at https://www.cdc.gov/nchs/data/misc/hb_cod.pdf (Physicians’ Handbook on Medical Certification of Death).
Revised position statements – The Board approved the Committee’s recommendation to accept revised versions of the position statements entitled Telemedicine and Guidelines for Avoiding Misunderstandings During Physical Examinations. The revised versions are now posted on the NCMB website here: http://www.ncmedboard.org/positionstatements
Proposed revisions to position statement: The Board approved the Committee’s decision to tentatively approve a revised version of the position statement entitled Collaborative Care Within the Healthcare Team. Among other changes, the Board approved updating the title of the position statement to “Unprofessional Behavior Within the Healthcare Team.” The Board will accept feedback on the revised position statement through close of business on Friday, April 26. Interested parties may view the revised position statement at http://www.ncmedboard.org/about-the-board/latest-board-activity/policy-discussions