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Striking the right balance: A former public Board Member’s view on self-regulation

One of the greatest honors a citizen of North Carolina can receive is appointment to the North Carolina Medical Board. That honor was mine between November 2007 and October 2013, when it was my great privilege to serve as one of the Board’s three public members. I served one year of an unfilled term and then was appointed to serve the maximum of two three-year terms. I can honestly say that my time on the Medical Board was one of the most enriching and illuminating professional experiences of my life.

The Board’s outgoing president, Paul Camnitz, MD, suggested that I share some reflections about my service to the NCMB.

A public member’s job is to act as proxy for patients and their loved ones. It is our job to advocate for their best interests, to ensure that licensed physicians and physician assistants are held accountable for their actions. The Medical Practice Act, the state law that gives the Board its authority, states that the Board is to regulate medicine and surgery “for the benefit and
protection of the people of North Carolina.” That is the highest duty of the entire Board.

As a public member, fulfilling this mandate requires both principle and courage, as it may involve challenging and questioning those members of the Board who are trained clinicians and, invariably, high performing members of the medical profession. I have been proud to speak up for North Carolinians over the past seven years, and I am even more proud to say that the physicians and other medical professionals on the Board have heard and considered my words and the words of other public members.

It is generally assumed in medical regulation that public members are less inclined to coddle licensees who come before the Board and more inclined to vote for more serious discipline. In some jurisdictions, including the United Kingdom, a system of medical regulation I have become familiar with due to my involvement with the NCMB and my Anglophilic tendencies, medical boards have sought to shore up their public images by giving greater control to public members. The General Medical Council that regulates medicine in England, Scotland, Wales and
Northern Ireland, reserves half its Board seats for public members, for example. In North Carolina, three of the 12—a quarter —of Board seats are held by public members.

Medical Boards are perennially under scrutiny—from the news media, from the public, from elected officials— and the NCMB has always been sensible of the fact that its current practice of physician-led regulation is a privilege. This was acknowledged frequently during my years on the Board and the message was clear: the NCMB must be effective, fair and just in regulating medical professionals or that privilege may be taken away.

Having spent countless hours reading disciplinary case files and participating in complex discussions about missed diagnoses and standards of care in urban settings versus the agrarian areas of North Carolina, I believe this would be a grave error. I did my level best to keep up with the medical discussions, but I am not medically trained. As a lay person, one misses an enormous amount of the intricacies and factors that go into why the licensee might miss a diagnosis. Even with the benefit of independent expert medical opinions to guide the Board—as a retired judge I am well aware that competing opinions are easily found—I do not think lay people are in a position to make the best decisions about cases involving quality of care.

My conclusion after seven years on the Board is that the NCMB strikes the optimal balance between accountability to the public and fairness to the medical professional. Medicine is constantly evolving and in many ways the pressures have never been greater. The advent of the Affordable Care Act is bringing more people into the health care system and that may bring even more “business” to the NCMB. The current structure of the Board is best equipped to handle this, and I hope it is preserved.

I could not end this article without some acknowledgement of what the Board has meant to me personally. It is no exaggeration to say that serving on the Medical Board saved my life not once but twice. The first time the Board saved my life it was metaphoric. When I got the call from the Governor’s Office in fall 2007, an offer of a public member seat on the other end of the line, I was deeply grieving the loss of my wife of 40 years, who died in July 2006. Serving on the Medical Board gave me a new sense of purpose and direction at a time when it was sorely needed. The second time the Board saved my life was quite literal. The morning of a regularly scheduled Board Meeting in March 2009, I woke up feeling poorly but managed to make it in to the Board’s offices. My physician colleagues on the Board listened to my complaints of headache and dizziness and two in particular, Dr. Camnitz and then- Board President Dr. George Saunders, insisted that I receive emergency medical attention.

Hours later I was undergoing surgery for a bilateral subdural hematoma, from which I am happy to say I fully recovered. I shudder to imagine the outcome, however, had I been at a Bar Association meeting instead of the Medical Board that day.

John B. Lewis, Jr. is a retired attorney and former NC Court of Appeals judge. Judge Lewis served as a Court of Appeals recall judge, a temporary administrative law judge and an emergency Special Superior Court judge. His term on the NCMB ended October 31, 2013. He married Margaret “Peg” O’Connell in February 2014.