§ 90-1. North Carolina Medical Society incorporated.

The association of regularly graduated physicians, calling themselves the State Medical Society, is hereby declared to be a body politic and corporate, to be known and distinguished by the name of The Medical Society of the State of North Carolina. The name of the society is now the North Carolina Medical Society.

History. 1858-9, c. 258, s. 1; Code, s. 3121; Rev., s. 4491; C.S., s. 6605; 1981, c. 573, s. 1.

Cross References.

As to a civil action remedy for persons who are sexually exploited by their psychotherapists, see the Psychotherapy Patient/Client Sexual Exploitation Act, G.S. 90-21.41 et seq.

§ 90-1.1. Definitions.

The following definitions apply in this Article:

1. Board. — The North Carolina Medical Board.
2. Hearing officer. — Any current or past member of the Board who is a physician, physician assistant, or nurse practitioner and has an active license or approval to practice medical acts, tasks, or functions issued by the Board, or any current or retired judge of the Office of Administrative Hearings, a State district court, a State superior court, the North Carolina Court of Appeals, the North Carolina Supreme Court, or of the federal judiciary who has an active license to practice law in North Carolina and who is a member in good standing of the North Carolina State Bar.

   (2a) Inactive license. — A license that no longer grants the authorization to perform medical acts, tasks, or functions. A license can become inactive upon a licensee’s request, a licensee’s failure to register annually, a licensee’s voluntary surrender, or based on any disciplinary order issued by the Board.

3. Integrative medicine. — A diagnostic or therapeutic treatment that may not be considered a conventionally accepted medical treatment and that a licensed physician in the physician’s professional opinion believes may be of potential benefit to the patient, so long as the treatment poses no greater risk of harm to the patient than the comparable conventional treatments.
4. License. — An authorization issued by the Board to a physician, physician assistant, or anesthesiologist assistant to perform medical acts, tasks, or functions.

   (4a) Licensee. — Any person issued a license by the Board, whether the license is active or inactive, including an inactive license by means of surrender.

   (4b) Reserved.

   (4c) Modality. — A method of medical treatment.

5. The practice of medicine or surgery. — Except as otherwise provided by this subdivision, the practice of medicine or surgery, for purposes of this Article, includes any of the following acts:
   1. Advertising, holding out to the public, or representing in any manner that the individual is authorized to practice medicine in this State.
   2. Offering or undertaking to prescribe, order, give, or administer any drug or medicine for the use of any other individual.
   3. Offering or undertaking to prevent or diagnose, correct, prescribe for, administer to, or treat in any manner or by any means, methods, or devices any disease, illness, pain, wound, fracture, infirmity, defect, or abnormal physical or mental condition of any individual, including the management of pregnancy or parturition.
   4. Offering or undertaking to perform any surgical procedure on any individual.
   5. Using the designation “Doctor,” “Doctor of Medicine,” “Doctor of Osteopathy,” “Doctor of Osteopathic Medicine,” “Physician,” “Surgeon,” “Physician and Surgeon,” “Dr.,” “M.D.,” “D.O.,” or any combination thereof in the conduct of any occupation or profession pertaining to the prevention, diagnosis, or treatment of human disease or condition, unless the designation additionally contains the description of or reference to another branch of the healing arts for which the individual holds a valid license in this State or the use of the designation “Doctor” or “Physician” is otherwise specifically permitted by law.
   6. The performance of any act, within or without this State, described in this subdivision by use of any electronic or other means, including the Internet or telephone.

      The administration of required lethal substances or any assistance whatsoever rendered with an execution under Article 19 of Chapter 15 of the General Statutes does not constitute the practice of medicine or surgery.

History. 2007-346, s. 1; 2009-558, s. 1.1; 2013-154, s. 1(b); 2019-191, s. 1.

§ 90-2. Medical Board.

1. There is established the North Carolina Medical Board to regulate the practice of medicine and surgery for the benefit and protection of the people of North Carolina. The Board shall consist of 13 members:
   1. Six of the members shall be duly licensed physicians recommended by the Review Panel and appointed by the Governor as set forth in G.S. 90-3 .
   2. Five members shall all be appointed by the Governor as follows:
      1. One shall be a member of The Old North State Medical Society. This Board position shall be subject to recommendations of the Review Panel pursuant to G.S. 90-3 .
      2. One shall be a public member, and this Board position shall not be subject to recommendation of the Review Panel pursuant to G.S. 90-3.
      3. One shall be a physician assistant as defined in G.S. 90-18.1 as recommended by the Review Panel pursuant to G.S. 90-3.
      4. One shall be a nurse practitioner as defined in G.S. 90-18.2 as recommended by the Review Panel pursuant to G.S. 90-3.
      5. One shall be a duly licensed physician who is a doctor of osteopathic medicine or a full-time faculty member of one of the medical schools in North Carolina who utilizes integrative medicine in that person’s clinical practice, as recommended by the Review Panel pursuant to G.S. 90-3.
   3. Two public members appointed by the General Assembly in accordance with G.S. 120-121 , one upon recommendation of the Speaker of the House of Representatives and one upon the recommendation of the President Pro Tempore of the Senate. (a1) Each appointing and nominating authority shall endeavor to see, insofar as possible, that its appointees and nominees to the Board reflect the composition of the State with regard to gender, ethnic, racial, and age composition.
2. No member shall serve more than two complete three-year terms in a lifetime, except that each member shall serve until a successor is chosen and qualifies.

   (b1) A public member appointed pursuant to sub-subdivision (a)(2)b. and subdivision (a)(3) of this section shall not be a health care provider nor the spouse of a health care provider. For the purpose of Board membership, “health care provider” means any licensed health care professional, agent, or employee of a health care institution, health care insurer, health care professional school, or a member of any allied health profession. For purposes of this section, a person enrolled in a program as preparation to be a licensed health care professional or an allied health professional shall be deemed a health care provider. For purposes of this section, any person with significant financial interest in a health service or profession is not a public member.

3. Repealed by Session Laws 2003-366, s. 1, effective October 1, 2003.
4. Any member of the Board may be removed from office by the Governor for good cause shown. Any vacancy in the physician, physician assistant, or nurse practitioner membership of the Board shall be filled for the period of the unexpired term by the Governor from a list submitted by the Review Panel pursuant to G.S. 90-3 . Any vacancy in the public membership of the Board shall be filled by the appropriate appointing authority for the unexpired term.
5. The North Carolina Medical Board shall have the power to acquire, hold, rent, encumber, alienate, and otherwise deal with real property in the same manner as any private person or corporation, subject only to approval of the Governor and the Council of State as to the acquisition, rental, encumbering, leasing, and sale of real property. Collateral pledged by the Board for an encumbrance is limited to the assets, income, and revenues of the Board.

History. 1858-9, c. 258, ss. 3, 4; Code, s. 3123; Rev., s. 4492; C.S., s. 6606; Ex. Sess. 1921, c. 44, s. 1; 1981, c. 573, s. 2; 1991 (Reg. Sess., 1992), c. 787, s. 1; 1993, c. 241, s. 2; 1995, c. 94, s. 1; c. 405, s. 1; 1997-511, s. 1; 2003-366, s. 1; 2007-346, s. 2; 2015-213, s. 1; 2016-117, s. 2(a); 2017-206, s. 5(a); 2018-92, s. 2(a); 2019-191, ss. 2(a), 2(b).

§ 90-2.1. [Repealed]

Repealed by Session Laws 2007-346, s. 3, effective October 1, 2007.

§ 90-3. Review Panel recommends certain Board members; criteria for recommendations.

1. There is created a Review Panel to review all applicants for the physician positions, the physician assistant position, and the nurse practitioner position on the Board. The Review Panel shall consist of nine members, including four from the Medical Society, one from the Old North State Medical Society, one from the North Carolina Osteopathic Medical Association, one from the North Carolina Academy of Physician Assistants, one from the North Carolina Nurses Association Council of Nurse Practitioners, and one public member currently serving on the Board. All physicians, physician assistants, and nurse practitioners serving on the Review Panel shall be actively practicing in North Carolina.The Review Panel shall contract for the independent administrative services needed to complete its functions and duties. The Board shall provide funds to pay the reasonable cost for the administrative services of the Review Panel. The Board shall convene the initial meeting of the Review Panel. The Review Panel shall elect a chair, and all subsequent meetings shall be convened by the Review Panel.The Governor shall appoint Board members as provided in G.S. 90-2 . The Review Panel shall attempt to make its recommendations to the Governor reflect the composition of the State with regard to gender, ethnic, racial, and age composition.The Review Panel and its members and staff shall not be held liable in any civil or criminal proceeding for exercising, in good faith, the powers and duties authorized by law.
2. To be considered qualified for a physician position, the physician assistant position, or nurse practitioner position on the Board, an applicant shall meet each of the following criteria:
   1. Hold an active, nonlimited license to practice medicine in North Carolina, or in the case of a physician assistant and nurse practitioner, hold an active license or approval to perform medical acts, tasks, and functions in North Carolina.
   2. Have an active clinical or teaching practice. For purposes of this subdivision, the term “active” means patient care, or instruction of students in an accredited medical school or residency, or clinical research program, for 20 hours or more per week.
   3. Have actively practiced in this State for at least five consecutive years immediately preceding the appointment.
   4. Intend to remain in active practice in this State for the duration of the term on the Board.
   5. Submit at least three letters of recommendation, either from individuals or from professional or other societies or organizations.
   6. Have no public disciplinary history with the Board or any other licensing board in this State or another state over the past 10 years before applying for appointment to the Board.
   7. Have no history of felony convictions of any kind.
   8. Have no misdemeanor convictions related to the practice of medicine.
   9. Indicate, in a manner prescribed by the Review Panel, that the applicant: (i) understands that the primary purpose of the Board is to protect the public; (ii) is willing to take appropriate disciplinary action against his or her peers for misconduct or violations of the standards of medical care; and (iii) is aware of the time commitment needed to be a constructive member of the Board.
   10. Have not served more than 72 months as a member of the Board.
3. The Review Panel shall recommend at least two qualified nominees for each open position on the Board. If the Governor chooses not to appoint either of the recommended nominees, the Review Panel shall recommend at least two new qualified nominees.
4. Notice of open physician, physician assistant, or nurse practitioner positions on the Board shall be sent to all physicians currently licensed to practice medicine in North Carolina and all physician assistants and nurse practitioners currently licensed or approved to perform medical acts, tasks, and functions in this State.
5. Applicants for positions on the Board shall not be required to be members of any professional association or society, except as provided in G.S. 90-2(a)(2)a.
6. Notwithstanding any provision of G.S. 90-16 , the Board may provide confidential and nonpublic licensing and investigative information in its possession to the Review Panel regarding applicants.
7. All applications, records, papers, files, reports, and all investigative and licensing information received by the Review Panel from the Board and other documents received or gathered by the Review Panel, its members, employees, agents, and consultants as a result of soliciting, receiving, and reviewing applications and making recommendations as required in this section shall not be considered public records within the meaning of Chapter 132 of the General Statutes. All such information shall be privileged, confidential, and not subject to discovery, subpoena, or other means of legal compulsion for release to any person other than the Review Panel, the Board, and their employees, agents, or consultants, except as provided in this section. The Review Panel shall publish on its Internet Web site the names and practice addresses of all applicants within 10 days after the application deadline. The Review Panel shall publish on its Internet Web site the names and practice addresses of the nominees recommended to the Governor within 10 days after notifying the Governor of those recommendations and not less than 30 days prior to the expiration of the open position on the Board.
8. The Review Panel is a public body within the meaning of Article 33C of Chapter 143 of the General Statutes. In addition to the provisions contained in Article 33C of Chapter 143 of the General Statutes permitting a public body to conduct business in a closed session, the Review Panel shall meet in closed session to review applications; interview applicants; review and discuss information received from the Board; and discuss, debate, and vote on recommendations to the Governor.

History. 1858-9, c. 258, s. 9; Code, s. 3126; Rev., s. 4493; C.S., s. 6607; 1981, c. 573, s. 3; 2007-346, s. 4; 2015-213, s. 2; 2016-117, s. 2(b)-(d); 2019-191, s. 3.

Effect of Amendments.

Session Laws 2007-346, s. 4, effective January 1, 2008, rewrote the section which read: “The Governor shall appoint as physician members of the Board physicians elected and nominated by the North Carolina Medical Society.”

Session Laws 2015-213, s. 2, effective August 11, 2015, substituted “positions, the physician assistant position, and the” for “positions and the physician assistant or” in the first sentence of subsection (a); substituted “a physician position, the physician assistant position,” for “a physician position or the physician assistant” in subsection (b); substituted “and nurse practitioner” for “or nurse practitioner” in subdivision (b)(1); made a minor stylistic change in subsection (c); and substituted “physician, physician assistant, or nurse practitioner positions” for “physician positions or the physician assistant or nurse practitioner position,” near the beginning of subsection (d).

Session Laws 2016-117, s. 2(b), effective October 1, 2016, added subdivision (b)(10).

Session Laws 2016-117, s. 2(c), effective October 1, 2016, made a stylistic change in subsection (c).

Session Laws 2016-117, s. 2(d), effective October 1, 2016, added subsections (f) through (h).

Session Laws 2019-191, s. 3, effective October 1, 2019, substituted “Board” for “Board except as provided in G.S. 90-2(a)(2)a” in the first sentence of subsection (a); substituted “medical care” for “care or practice of medicine” in subdivision (b)(9); and added “regarding applicants” at the end of subsection (f).

§ 90-4. Board elects officers; quorum.

The North Carolina Medical Board is authorized to elect all officers and adopt all bylaws as may be necessary. A majority of the membership of the Board shall constitute a quorum for the transaction of business.

History. 1858-9, c. 258, s. 11; Code, s. 3128; Rev., s. 4494; C.S., s. 6608; 1981, c. 573, s. 4; 1995, c. 94, s. 7.

§ 90-5. Meetings of Board.

The North Carolina Medical Board shall meet at least once quarterly within the State of North Carolina and may hold any other meetings necessary to conduct the business of the Board.

History. Rev., s. 4495; 1915, c. 220, s. 1; C.S., s. 6609; 1935, c. 363; 1981, c. 573, s. 5; 1995, c. 94, s. 8; 2019-191, s. 4.

Effect of Amendments.

Session Laws 2019-191, s. 4, effective October 1, 2019, rewrote this section.

§ 90-5.1. Powers and duties of the Board.

1. The Board shall have the following powers and duties:
   1. Administer this Article.
   2. Issue interpretations of this Article.
   3. Adopt, amend, or repeal rules as may be necessary to carry out and enforce the provisions of this Article.
   4. Require an applicant or licensee to submit to the Board evidence of the applicant’s or licensee’s continuing competence in the practice of medicine.
   5. Regulate the retention and disposition of medical records, whether in the possession of a licensee or nonlicensee. In the case of the death of a licensee, the rules may provide for the disposition of the medical records by the estate of the licensee. This subsection shall not apply to records created or maintained by persons licensed under other Articles of this Chapter or to medical records maintained in the normal course of business by licensed health care institutions.
   6. Appoint a temporary or permanent custodian for medical records abandoned by a licensee.
   7. Develop educational programs to facilitate licensee awareness of provisions contained in this Article and public awareness of the role and function of the Board.
   8. Develop and implement methods to identify dyscompetent licensees and licensees who fail to meet acceptable standards of care.
   9. Develop and implement methods to assess and improve licensee practice.
   10. Develop and implement methods to ensure the ongoing competence of licensees.
2. Nothing in subsection (a) of this section shall restrict or otherwise limit powers and duties conferred on the Board in other sections of this Article.
3. Notwithstanding any other provision of law, the North Carolina Medical Board shall not set fees pursuant to rules. Any fees set pursuant to rules adopted by the Board and applicable on June 1, 2019, remain valid.

History. 2007-346, s. 5; 2019-191, ss. 5, 45.

Effect of Amendments.

Session Laws 2019-191, ss. 5, 45, effective October 1, 2019, substituted “shall have the following powers and duties” for “shall” in the introductory paragraph of subsection (a); substituted “licensees and licensees” for “physicans and pyhsicians” in subdivision (a)(8); substituted “licensee” for “physician” in subdivision (a)(9); and added subsection (c).

§ 90-5.2. Board to collect and publish certain data.

1. The Board shall require all licensees to report to the Board certain information, including, but not limited to, the following:
   1. The names of any schools of medicine or osteopathy attended and the year of graduation.
   2. Any graduate medical or osteopathic education.
   3. Any specialty board of certification as approved by the American Board of Medical Specialties, the Bureau of Osteopathic Specialists of American Osteopathic Association, or the Royal College of Physicians and Surgeons of Canada.
   4. Specialty area of practice.
   5. Hospital affiliations.
   6. Address and telephone number of the primary practice setting.
   7. A current, active e-mail address, which shall not be considered a public record within the meaning of Chapter 132 of the General Statutes. This information may be used or made available by the Board for the purpose of disseminating or soliciting information affecting public health or the practice of medicine.
   8. Any final disciplinary order or other action required to be reported to the Board pursuant to G.S. 90-14.13 that results in a suspension or revocation of privileges.
   9. Any final disciplinary order or action of any regulatory board or agency including other state medical boards, the United States Food and Drug Administration, the United States Drug Enforcement Administration, Medicare, or the North Carolina Medicaid program.
   10. Conviction of a felony.
   11. Conviction of certain misdemeanors, occurring within the last 10 years, in accordance with rules adopted by the Board.
   12. Any medical license, active or inactive, granted by another state or country.
   13. Certain malpractice information received pursuant to G.S. 90-5.3 , G.S. 90-14.13 , or from other sources in accordance with rules adopted by the Board. (a1) The Board shall make e-mail addresses reported pursuant to G.S. 90-5.2(a)(7) available to the Department of Health and Human Services for use in the North Carolina Controlled Substance Reporting System established by Article 5E of this Chapter.
2. Except as provided, the Board shall make information collected under G.S. 90-5.2(a) available to the public.
3. The Board may adopt rules to implement this section.
4. Failure to provide information as required by this section and in accordance with Board rules or knowingly providing false information may be considered unprofessional conduct as defined in G.S. 90-14(a)(6).

History. 2007-346, s. 6; 2009-217, s. 2; 2013-152, s. 5; 2016-117, s. 2(e), (f); 2019-191, s. 6.

§ 90-5.3. Reporting and publication of medical judgments, awards, payments, and settlements.

1. All applicants and licensees shall report the following to the Board:
   1. All medical malpractice judgments or awards affecting or involving the applicant or licensee.
   2. All settlements in the amount of seventy-five thousand dollars ($75,000) or more related to an incident of alleged medical malpractice affecting or involving the applicant or licensee where the settlement occurred on or after May 1, 2008.
   3. All settlements in the aggregate amount of seventy-five thousand dollars ($75,000) or more related to any one incident of alleged medical malpractice affecting or involving the applicant or licensee not already reported pursuant to subdivision (2) of this subsection where, instead of a single payment of seventy-five thousand dollars ($75,000) or more occurring on or after May 1, 2008, there is a series of payments made to the same claimant which, in the aggregate, equal or exceed seventy-five thousand dollars ($75,000).
2. The report required under subsection (a) of this section shall contain the following information:
   1. The date of the judgment, award, payment, or settlement.
   2. The specialty in which the applicant or licensee was practicing at the time the incident occurred that resulted in the judgment, award, payment, or settlement.
   3. The city, state, and country in which the incident occurred that resulted in the judgment, award, payment, or settlement.
   4. The date the incident occurred that resulted in the judgment, award, payment, or settlement.
3. The Board shall publish on the Board’s Web site or other publication information collected under this section. The Board shall publish this information for seven years from the date of the judgment, award, payment, or settlement. The Board shall not release or publish individually identifiable numeric values of the reported judgment, award, payment, or settlement. The Board shall not release or publish the identity of the patient associated with the judgment, award, payment, or settlement. The Board shall allow the applicant or licensee to publish a statement explaining the circumstances that led to the judgment, award, payment, or settlement, and whether the case is under appeal. The Board shall ensure these statements:
   1. Conform to the ethics of the medical profession.
   2. Not contain individually identifiable numeric values of the judgment, award, payment, or settlement.
   3. Not contain information that would disclose the patient’s identity.
4. The term “settlement” for the purpose of this section includes a payment made from personal funds, a payment by a third party on behalf of the applicant or licensee, or a payment from any other source of funds.
5. Nothing in this section shall limit the Board from collecting information needed to administer this Article.

History. 2009-217, s. 3; 2019-191, s. 7.

§ 90-5.4. Duty to report.

1. Every licensee has a duty to report in writing to the Board within 30 days any incidents that licensee reasonably believes to have occurred involving any of the following:
   1. Sexual misconduct of any person licensed by the Board under this Article with a patient. Patient consent or initiation of acts or contact by a patient shall not constitute affirmative defenses to sexual misconduct. For purposes of this section, the term “sexual misconduct” means vaginal intercourse, or any sexual act or sexual contact or touching as described in G.S. 14-27.20 . Sexual misconduct shall not include any act or contact that is for an accepted medical purpose.
   2. Fraudulent prescribing, drug diversion, or theft of any controlled substances by another person licensed by the Board under this Article. For purposes of this section, “drug diversion” means transferring controlled substances or prescriptions for controlled substances to (i) the licensee for personal use; (ii) a licensee’s immediate family member; (iii) any other person living in the same residence as the licensee; (iv) any person with whom the licensee is having a sexual relationship; or (v) any individual unless for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice. For the purposes of this section, the term “immediate family member” means a spouse, parent, child, sibling, and any step-family member or in-law coextensive with the preceding identified relatives.
2. For persons issued a license to practice by the Board under this Article, failure to report under this section shall constitute unprofessional conduct and shall be grounds for discipline under G.S. 90-14(a)(6). However, persons licensed by the Board who are employed by or serving as a director or agent of the North Carolina Physicians Health Program and who obtain information exclusively while functioning in their role as employee, director, or agent of the North Carolina Physicians Health Program that causes them reasonably to believe that incidents referred to in subdivisions (1) and (2) of subsection (a) of this section occurred shall not be required to report pursuant to this section but shall comply with the reporting provisions contained in G.S. 90-21.22 .
3. Any person who reports under this section in good faith and without fraud or malice shall be immune from civil liability. Reports made in bad faith, fraudulently, or maliciously shall constitute unprofessional conduct and shall be grounds for discipline under G.S. 90-14(a)(6).
4. The Board may adopt rules to implement this section.

History. 2019-191, s. 8.

§ 90-6.

Recodified as G.S. 90-8.1 and G.S. 90-8.2 , by Session Laws 2007-346, s. 7, effective October 1, 2007.

§ 90-7. [Repealed]

Repealed by Session Laws 2019-191, s. 9, effective October 1, 2019.

History. 1858-9, c. 258, s. 17; Code, s. 3134; Rev., s. 4497; C.S., s. 6611; 1995, c. 94, s. 10; repealed by 2019-191, s. 9, effective October 1, 2019.

§ 90-8. Officers may administer oaths, and subpoena witnesses, records and other materials.

The president and secretary of the Board may administer oaths to all persons appearing before it as the Board may deem necessary to perform its duties, and may summon and issue subpoenas for the appearance of any witnesses deemed necessary to testify concerning any matter to be heard before or inquired into by the Board. The Board may order that any patient records, documents or other material concerning any matter to be heard before or inquired into by the Board shall be produced before the Board or made available for inspection, notwithstanding any other provisions of law providing for the application of any physician-patient privilege with respect to such records, documents or other material. All records, documents, or other material compiled by the Board are subject to the provisions of G.S. 90-16 . Notwithstanding the provisions of G.S. 90-16 , in any proceeding before the Board, in any record of any hearing before the Board, and in the notice of charges against any licensee, the Board shall withhold from public disclosure the identity of a patient including information relating to dates and places of treatment, or any other information that would tend to identify the patient, unless the patient or the representative of the patient expressly consents to the disclosure. Upon written request, the Board shall revoke a subpoena if, upon a hearing, it finds that the evidence the production of which is required does not relate to a matter in issue, or if the subpoena does not describe with sufficient particularity the evidence the production of which is required, or if for any other reason in law the subpoena is invalid.

History. 1913, c. 20, s. 7; C.S., s. 6612; Ex. Sess. 1921, c. 44, s. 3; 1953, c. 1248, s. 1; 1975, c. 690, s. 1; 1979, c. 107, s. 8; 1987, c. 859, s. 5; 1991, c. 348, s. 1.

§ 90-8.1. Rules governing applicants for licensure.

1. The North Carolina Medical Board is empowered to adopt rules that prescribe additional qualifications for an applicant, including education and examination requirements and application procedures.
2. The Board shall not deny an application for licensure based solely on the applicant’s failure to become board certified.
3. By submitting an application for licensure, the applicant submits to the jurisdiction of the Board.

History. C.S., s. 6610; 1921, c. 47, s. 5; Ex. Sess. 1921, c. 44, s. 2; 1973, c. 92, s. 2; 1981, c. 665, s. 1; 1983, c. 53; 1995, c. 94, s. 9; c. 405, s. 2; 1999-290, s. 1; 2007-346, ss. 7, 8; 2016-117, s. 2(g); 2019-191, s. 10.

§ 90-8.2. Appointment of subcommittees.

1. The North Carolina Medical Board shall appoint and maintain a subcommittee to work jointly with a subcommittee of the Board of Nursing to develop rules to govern the performance of medical acts by registered nurses, including the determination of reasonable fees to accompany an application for approval not to exceed one hundred dollars ($100.00) and for renewal of approval not to exceed fifty dollars ($50.00). Rules developed by this subcommittee from time to time shall govern the performance of medical acts by registered nurses and shall become effective when adopted by both the North Carolina Medical Board and the Board of Nursing. The North Carolina Medical Board shall have responsibility for securing compliance with these rules.
2. The North Carolina Medical Board shall appoint and maintain a subcommittee of four licensed physicians to work jointly with a subcommittee of the North Carolina Board of Pharmacy to develop rules to govern the performance of medical acts by clinical pharmacist practitioners, including the determination of reasonable fees to accompany an application for approval not to exceed one hundred dollars ($100.00) and for renewal of approval not to exceed fifty dollars ($50.00). Rules recommended by the subcommittee shall be adopted in accordance with Chapter 150B of the General Statutes by both the North Carolina Medical Board and the North Carolina Board of Pharmacy and shall not become effective until adopted by both Boards. The North Carolina Medical Board shall have responsibility for ensuring compliance with these rules.

History. C.S., s. 6610; 1921, c. 47, s. 5; Ex. Sess. 1921, c. 44, s. 2; 1973, c. 92, s. 2; 1981, c. 665, s. 1; 1983, c. 53; 1995, c. 94, s. 9; c. 405, s. 2; 1999-290, s. 1; 2007-346, s. 7; 2007-418, s. 3.

§ 90-9. [Repealed]

Repealed by Session Laws 2007-418, s. 2, effective October 1, 2007.

§ 90-9.1. Requirements for licensure as a physician under this Article.

1. Except as provided in G.S. 90-9.2 , to be eligible for licensure as a physician under this Article, an applicant shall submit proof satisfactory to the Board that the applicant meets all of the following criteria:
   1. The applicant has passed each part of an examination described in G.S. 90-10.1 .
   2. The applicant has completed at least 130 weeks of medical education and satisfies any of the following:
      1. The applicant is a graduate of a medical college approved by the Liaison Commission on Medical Education, the Committee for the Accreditation of Canadian Medical Schools, or an osteopathic college approved by the American Osteopathic Association and has successfully completed one year of training in a medical education program approved by the Board after graduation from medical school; or
      2. The applicant is a graduate of a medical college approved or accredited by the Liaison Committee on Medical Education, the Committee on Accreditation of Canadian Medical Schools, or an osteopathic college approved by the American Osteopathic Association, is a dentist licensed to practice dentistry under Article 2 of Chapter 90 of the General Statutes, and has been certified by the American Board of Oral and Maxillofacial Surgery after having completed a residency in an Oral and Maxillofacial Surgery Residency program approved by the Board before completion of medical school.
      3. The applicant may satisfy the education and graduation requirements of subdivision (2) of this subsection by providing proof of current certification by a specialty board recognized by the American Board of Medical Specialties, Certificate of the College of Family Physicians, Fellowship of the Royal College of Physicians of Canada, Fellowship of the Royal College of Surgeons of Canada, American Osteopathic Association, the American Board of Oral and Maxillofacial Surgery, or any other specialty board the Board recognizes pursuant to rules.
   3. The applicant is of good moral character.
2. No license may be granted to any applicant who graduated from a medical or osteopathic college that has been disapproved by the Board pursuant to rules adopted by the Board.
3. The Board may, by rule, require an applicant to comply with other requirements or submit additional information the Board deems appropriate.

History. 2007-346, s. 9; 2019-191, s. 11.

Effect of Amendments.

Session Laws 2019-191, s. 11, effective October 1, 2019, rewrote subsection (a).

§ 90-9.2. Requirements for graduates of international medical schools.

1. To be eligible for licensure under this section, an applicant who is a graduate of a medical school not approved by the Liaison Commission on Medical Education, the Committee for the Accreditation of Canadian Medical Schools, or the American Osteopathic Association shall submit proof satisfactory to the Board that the applicant has met all of the following:
   1. The applicant has successfully completed two years of training in a medical education program approved by the Board after graduation from medical school, or provides proof of current certification by a specialty board recognized by the American Board of Medical Specialties, Certificate of the College of Family Physicians, Fellowship of the Royal College of Physicians of Canada, Fellowship of the Royal College of Surgeons of Canada, American Osteopathic Association, the American Board of Oral and Maxillofacial Surgery, or any specialty board the Board recognizes pursuant to rules.
   2. The applicant has good moral character.
   3. The applicant has a currently valid standard certificate of Educational Commission for Foreign Medical Graduates.
   4. The applicant has the ability to communicate in English.
   5. The applicant has successfully passed each part of an examination described in G.S. 90-10.1 .
2. The Board may waive ECFMG certification if the applicant:
   1. Has passed the ECFMG examination and successfully completed an approved Fifth Pathway Program. The applicant is required to provide the original ECFMG Certification Status Report from the ECFMG; or
   2. Has been licensed in another state on the basis of written examination before the establishment of ECFMG in 1958.
3. The Board may, by rule, require an applicant to comply with other requirements or submit additional information the Board deems appropriate.

History. 2007-346, s. 9; 2019-191, s. 12.

Effect of Amendments.

Session Laws 2019-191, s. 12, effective October 1, 2019, substituted “international” for “foreign” in the section heading; and rewrote subsection (a).

§ 90-9.3. Requirements for licensure as a physician assistant.

1. To be eligible for licensure as a physician assistant, an applicant shall submit proof satisfactory to the Board that the applicant has met all of the following:
   1. The applicant has successfully completed an educational program for physician assistants or surgeon assistants accredited by the Accreditation Review Commission on Education for the Physician Assistant or its predecessor or successor entities.
   2. The applicant has a current or previous certification issued by the National Commission on Certification of Physician Assistants or its successor.
   3. The applicant is of good moral character.
2. Before initiating practice of medical acts, tasks, or functions as a physician assistant, the physician assistant shall provide the Board the name, address, and telephone number of the physician who will supervise the physician assistant in the relevant medical setting.
3. The Board may, by rule, require an applicant to comply with other requirements or submit additional information the Board deems appropriate.

History. 2007-346, s. 9; 2019-191, s. 13.

§ 90-9.4. Requirements for licensure as an anesthesiologist assistant.

Every applicant for licensure as an anesthesiologist assistant in the State shall meet the following criteria:

1. Satisfy the North Carolina Medical Board that the applicant is of good moral character.
2. Submit to the Board proof of completion of a graduate level training program accredited by the Commission of Accreditation of Allied Health Education Programs or its successor organization.
3. Submit to the Board proof of current certification from the National Commission of Certification of Anesthesiologist Assistants (NCCAA) or its successor organization. The applicant shall take the certification exam within 12 months after completing training.
4. Meet any additional qualifications for licensure pursuant to rules adopted by the Board.

History. 2007-346, s. 9; 2019-191, s. 14.

Effect of Amendments.

Session Laws 2019-191, s. 14, effective October 1, 2019, substituted “organization” for “organization, including passage of a certification examination administered by the NCCAA” at the end of the first sentence in subdivision (3).

§ 90-9.5. Inactive licenses.

The Board retains jurisdiction over an inactive license, regardless of how it became inactive, including a request for inactivation, surrender of a license, or by operation of an order entered by the Board. The Board’s jurisdiction over the licensee extends for all matters, known and unknown to the Board, at the time of the inactivation or surrender of the license.

History. 2019-191, s. 15.

§ 90-10. [Repealed]

Repealed by Session Laws 2007-418, s. 2, effective October 1, 2007.

§ 90-10.1. Examinations accepted by the Board.

The Board may administer or accept the following examinations for licensure:

1. Repealed by Session Laws 2019-191, s. 16, effective October 1, 2019.
2. The National Board of Medical Examiners (NBME) examination or its successor.
3. The United States Medical Licensing Examination (USMLE) of this section or its successor.
4. The Federation Licensing Examination (FLEX) or its successor.
5. Other examinations the Board deems equivalent to the examinations described in subdivisions (1) through (3) of this section pursuant to rules adopted by the Board.

History. 2007-346, s. 10; 2019-191, s. 16.

Effect of Amendments.

Session Laws 2019-191, s. 16, effective October 1, 2019, deleted subdivision (1).

§ 90-11. Criminal background checks.

1. Repealed by Session Laws 2007-346, s. 11, effective October 1, 2007.

   (a1) Repealed by Session Laws 2007-346, s. 9.1, effective October 1, 2007.

2. The Department of Public Safety may provide a criminal record check to the Board for a person who has applied for a license through the Board. The Board shall provide to the Department of Public Safety, along with the request, the fingerprints of the applicant, any additional information required by the Department of Public Safety, and a form signed by the applicant consenting to the check of the criminal record and to the use of the fingerprints and other identifying information required by the State or national repositories. The applicant’s fingerprints shall be forwarded to the State Bureau of Investigation for a search of the State’s criminal history record file, and the State Bureau of Investigation shall forward a set of the fingerprints to the Federal Bureau of Investigation for a national criminal history check. The Board shall keep all information pursuant to this subsection privileged, in accordance with applicable State law and federal guidelines, and the information shall be confidential and shall not be a public record under Chapter 132 of the General Statutes.The Department of Public Safety may charge each applicant a fee for conducting the checks of criminal history records authorized by this subsection. The Board has the authority to collect this fee from each applicant and remit it to the Department of Public Safety.

History. C.S., s. 6615; 1921, c. 47, s. 3; Ex. Sess. 1921, c. 44, s. 5; 1971, c. 1150, s. 3; 1981, c. 573, s. 7; 1995, c. 94, s. 12; 1997-511, s. 2; 2002-147, s. 6; 2007-146, s. 1; 2007-346, ss. 9.1, 11; 2014-100, s. 17.1(o); 2019-191, s. 17.

§ 90-12. [Repealed]

Repealed by Session Laws 2007-346, s. 12, effective October 1, 2007.

Cross References.

For current provisions as to limited license to practice in a medical education and training program, see G.S. 90-12.01 .

§ 90-12.01. Limited license to practice in a medical education and training program.

1. As provided in rules adopted by the Board, the Board may issue a limited license known as a “resident’s training license” to a physician not otherwise licensed by the Board who is participating in a graduate medical education training program.
2. A resident’s training license shall become inactive at the time its holder ceases to be a resident in a training program or obtains any other license to practice medicine issued by the Board. The Board shall retain jurisdiction over the holder of the inactive license.
3. The program director of every graduate medical education program shall report to the Board the following actions involving a physician participating in a graduate medical education training program within 30 days of the date that the action takes effect:
   1. Any revocation or termination, including, but not limited to, any nonrenewal or dismissal of a physician from a graduate medical education training program.
   2. A resignation from, or completion of, a graduate medical education program or a transfer to another graduate medical education training program.

History. 2007-418, s. 4; 2019-191, s. 18.

§ 90-12.1. [Transferred]

Recodified as G.S. 90-12.4 , by Session Laws 2007-346, s. 7, effective October 1, 2007.

§ 90-12.1A. Limited volunteer license.

1. The Board may issue a “limited volunteer license” to an applicant who does all of the following:
   1. Has a license to practice medicine and surgery in another state.
   2. Produces a verification from the state of licensure indicating the applicant’s license is active and in good standing.
   3. Repealed by Session Laws 2011-355, s. 1, effective June 27, 2011.
2. , (c) Repealed by Session Laws 2011-355, s. 1, effective June 27, 2011.

   (d) The Board shall issue a limited license under this section within 30 days after an applicant provides the Board with information satisfying the requirements of this section.

   (e) The holder of a limited license under this section may practice medicine and surgery only in association with clinics that specialize in the treatment of indigent patients. The holder of the limited license may not receive compensation for services rendered at clinics specializing in the care of indigent patients.

   (e1) The holder of a limited volunteer license shall practice medicine and surgery within this State for no more than 30 days per calendar year.

   (f) The holder of a limited license issued pursuant to this section who practices medicine or surgery outside of an association with clinics that specialize in the treatment of indigent patients shall be guilty of a Class 3 misdemeanor and, upon conviction, shall be fined not more than five hundred dollars ($500.00) for each offense. The Board, in its discretion, may revoke the limited license after due notice is given to the holder of the limited license.

   (g) The Board may, by rule, require an applicant for a limited license under this section to comply with other requirements or submit additional information the Board deems appropriate.

History. 2007-418, s. 5; 2011-183, s. 54; 2011-355, ss. 1, 8; 2019-191, s. 19.

§ 90-12.1B. Retired limited volunteer license.

1. The Board may issue a “retired limited volunteer license” to an applicant who is a physician and who has allowed his or her license to practice medicine and surgery in this State or another state to become inactive.
2. A physician holding a limited license under this section shall comply with the continuing medical education requirements pursuant to rules adopted by the Board.
3. The holder of a limited license under this section may practice medicine and surgery only in association with clinics that specialize in the treatment of indigent patients. The holder of the limited license may not receive compensation for services rendered at clinics specializing in the care of indigent patients.
4. The Board shall issue a limited license under this section within 30 days after an applicant provides the Board with information satisfying the requirements of this section.
5. The holder of a limited license issued pursuant to this section who practices medicine or surgery outside of an association with clinics that specialize in the treatment of indigent patients shall be guilty of a Class 3 misdemeanor and, upon conviction, shall be fined not more than five hundred dollars ($500.00) for each offense. The Board, in its discretion, may revoke the limited license after due notice is given to the holder of the limited license.
6. The Board may, by rule, require an applicant for a limited license under this section to comply with other requirements or submit additional information the Board deems appropriate.

History. 2011-355, s. 2; 2019-191, s. 20.

Effect of Amendments.

Session Laws 2019-191, s. 20, effective October 1, 2019, substituted “in association with clinics” for “at clinics” in the first sentence of subsection (c); and substituted “outside of an association with” for “at places other than”, and “not more than five hundred dollars ($500.00)” for “not less than twenty-five dollars ($25.00) nor more than fifty dollars ($50.00)” in the first sentence of subsection (e).

§ 90-12.2. [Transferred]

Recodified as G.S. 90-12.5 , by Session Laws 2007-346, s. 7, effective October 1, 2007.

§ 90-12.2A. Special purpose license.

1. The Board may issue a special purpose license to practice medicine to an applicant who does all of the following:
   1. Holds a full and unrestricted license to practice in at least one other jurisdiction.
   2. Does not have any current or pending disciplinary or other action against him or her by any medical licensing agency in any state or other jurisdiction.
2. The holder of the special purpose license practicing medicine or surgery beyond the limitations of the license shall be guilty of a Class 3 misdemeanor and, upon conviction, shall be fined not more than five hundred dollars ($500.00) for each offense. The Board, at its discretion, may revoke the special license after due notice is given to the holder of the special purpose license.
3. The Board may adopt rules and set fees as appropriate to implement the provisions of this section.

History. 2007-418, s. 6; 2019-191, s. 21.

Effect of Amendments.

Session Laws 2019-191, s. 21, effective October 1, 2019, substituted “who does all of the following” for “who” in the introductory paragraph of subsection (a); substituted “jurisdiction” for “jurisdiction; and” in subdivision (a)(1); and substituted “not more than five hundred dollars ($500.00)” for “not less than twenty-five dollars ($25.00) nor more than fifty dollars ($50.00)” in subsection (b).

§ 90-12.3. Medical school faculty license.

1. The Board may issue a medical school faculty license to practice medicine and surgery to a physician who has met all of the following:
   1. The applicant holds a full-time faculty appointment as either an instructor, lecturer, assistant professor, associate professor, or full professor at a North Carolina medical school that is certified by the Liaison Committee on Medical Education or the Commission of Osteopathic College Accreditation of the American Osteopathic Association.
   2. The applicant is not subject to disciplinary order or other action by any medical licensing agency in any state or other jurisdiction.
2. The holder of the medical school faculty license issued under this section shall not practice medicine or surgery outside the confines of the medical school or its affiliates. The holder of the medical school faculty license practicing medicine or surgery beyond the limitations of the license shall be guilty of a Class 3 misdemeanor and, upon conviction, shall be fined not more than five hundred dollars ($500.00) for each offense. The Board, at its discretion, may revoke the special license after due notice is given to the holder of the medical school faculty license.

   (b1) A medical school faculty license shall become inactive at the time its holder does one or more of the following:

   1. Ceases to hold a full-time appointment as an instructor, lecturer, assistant professor, or full professor at a certified North Carolina medical school.
   2. Ceases to be employed in a full-time capacity by a certified North Carolina medical school.
   3. Obtains any other license to practice medicine issued by the Board.The Board shall retain jurisdiction over the holder of the inactive license.
3. The Board may adopt rules and set fees related to issuing medical school faculty licenses. The Board may, by rule, set a time limit for the term of a medical school faculty license.

History. 2007-418, s. 7; 2019-191, s. 22.

Effect of Amendments.

Session Laws 2019-191, s. 22, effective October 1, 2019, rewrote subsections (a) and (b); and added subsection (b1).

§ 90-12.4. Physician assistant limited volunteer license.

1. The Board shall issue a limited volunteer license to an applicant who:
   1. Holds a current license or registration in another state; and
   2. Produces a letter from the state of licensure indicating the applicant’s license or registration is active and in good standing.
2. The Board shall issue a limited license under this section within 30 days after the applicant provides the Board with information satisfying the requirements of this section.
3. The holder of a limited license may perform medical acts, tasks, or functions as a physician assistant only in association with clinics that specialize in the treatment of indigent patients. The holder of a limited license may not receive payment or other compensation for services rendered at clinics specializing in the care of indigent patients. The holder of a limited volunteer license shall practice as a physician assistant within this State for no more than 30 days per calendar year.
4. Before initiating the performance of medical acts, tasks, or functions as a physician assistant licensed under this section, the physician assistant shall provide the Board the name, address, and telephone number of the physician licensed under this Article who will supervise the physician assistant in the clinic specializing in the care of indigent patients.
5. The holder of a limited license issued pursuant to this section who practices as a physician assistant outside an association with clinics that specialize in the treatment of indigent patients shall be guilty of a Class 3 misdemeanor and, upon conviction, shall be fined not more than five hundred dollars ($500.00) for each offense. The Board, in its discretion, may revoke the limited license after due notice is given to the holder of the limited license.
6. The Board may, by rule, require an applicant for a limited license under this section to comply with other requirements or submit additional information the Board deems appropriate.

History. 1997-511, s. 3; 2007-346, s. 7; 2011-355, s. 3; 2019-191, s. 23.

§ 90-12.4A.

Reserved for future codification purposes.

§ 90-12.4B. Physician Assistant retired limited volunteer license.

1. The Board may issue a “retired limited volunteer license” to an applicant who is a physician assistant and who has allowed his or her license to become inactive.
2. A physician assistant holding a retired limited volunteer license under this section shall comply with the continuing medical education requirements pursuant to rules adopted by the Board.
3. The holder of a retired limited volunteer license under this section may perform medical acts, tasks, or functions as a physician assistant only in association with clinics that specialize in the treatment of indigent patients. The holder of a retired limited volunteer license may not receive compensation for services rendered at clinics specializing in the care of indigent patients.
4. The Board shall issue a retired limited volunteer license under this section within 30 days after an applicant provides the Board with information satisfying the requirements of this section.
5. The holder of a retired limited volunteer license issued pursuant to this section who practices as a physician assistant outside an association with clinics that specialize in the treatment of indigent patients shall be guilty of a Class 3 misdemeanor and, upon conviction, shall be fined not more than five hundred dollars ($500.00) for each offense. The Board, in its discretion, may revoke the limited license after due notice is given to the holder of the limited license.
6. The Board may, by rule, require an applicant for a retired limited volunteer license under this section to comply with other requirements or submit additional information the Board deems appropriate.

History. 2011-355, s. 4; 2019-191, s. 24.

Effect of Amendments.

Session Laws 2019-191, s. 24, effective October 1, 2019, substituted “in association with clinics” for “at clinics” in the first sentence of subsection (c); and, in the first sentence of subsection (e), substituted “outside of an association with” for “at places other than”, and “not more than five hundred dollars ($500.00)” for “not less than twenty-five dollars ($25.00) nor more than fifty dollars ($50.00).”

§ 90-12.5. Disasters and emergencies.

In the event of an occurrence which the Governor of the State of North Carolina has declared a state of emergency, or in the event of an occurrence for which a county or municipality has enacted an ordinance to deal with states of emergency under G.S. 166A-19.31 , or to protect the public health, safety, or welfare of its citizens under Article 22 of Chapter 130A of the General Statutes, G.S. 160A-174(a) or G.S. 153A-121(a) , as applicable, the Board may waive the requirements of this Article in order to permit the provision of emergency health services to the public.

History. 2002-179, s. 20(a); 2007-346, s. 7; 2012-12, s. 2(ff).

Cross References.

As to emergency management efforts, generally, see G.S. 166A-19 et seq.

§ 90-12.7. Treatment of overdose with opioid antagonist; immunity.

1. As used in this section, “opioid antagonist” means naloxone hydrochloride that is approved by the federal Food and Drug Administration for the treatment of a drug overdose.
2. The following individuals may prescribe an opioid antagonist in the manner prescribed by this subsection:
   1. A practitioner acting in good faith and exercising reasonable care may directly or by standing order prescribe an opioid antagonist to (i) a person at risk of experiencing an opiate-related overdose or (ii) a family member, friend, or other person in a position to assist a person at risk of experiencing an opiate-related overdose. As an indicator of good faith, the practitioner, prior to prescribing an opioid under this subsection, may require receipt of a written communication that provides a factual basis for a reasonable conclusion as to either of the following:
      1. The person seeking the opioid antagonist is at risk of experiencing an opiate-related overdose.
      2. The person other than the person who is at risk of experiencing an opiate-related overdose, and who is seeking the opioid antagonist, is in relation to the person at risk of experiencing an opiate-related overdose:
         1. A family member, friend, or other person.
         2. In the position to assist a person at risk of experiencing an opiate-related overdose.
   2. The State Health Director or a designee may prescribe an opioid antagonist pursuant to subdivision (1) of this subsection by means of a statewide standing order.
   3. A practitioner acting in good faith and exercising reasonable care may directly or by standing order prescribe an opioid antagonist to any governmental or nongovernmental organization, including a local health department, a law enforcement agency, or an organization that promotes scientifically proven ways of mitigating health risks associated with substance use disorders and other high-risk behaviors, for the purpose of distributing, through its agents, the opioid antagonist to (i) a person at risk of experiencing an opiate-related overdose or (ii) a family member, friend, or other person in a position to assist a person at risk of experiencing an opiate-related overdose.
3. A pharmacist may dispense an opioid antagonist to a person or organization pursuant to a prescription issued in accordance with subsection (b) of this section. For purposes of this section, the term “pharmacist” is as defined in G.S. 90-85.3 . (c1) A governmental or nongovernmental organization, including a local health department, a law enforcement agency, or an organization that promotes scientifically proven ways of mitigating health risks associated with substance use disorders and other high-risk behaviors may, through its agents, distribute an opioid antagonist obtained pursuant to a prescription issued in accordance with subdivision (3) of subsection (b) of this section to (i) a person at risk of experiencing an opiate-related overdose or (ii) a family member, friend, or other person in a position to assist a person at risk of experiencing an opiate-related overdose. An organization, through its agents, shall include with any distribution of an opioid antagonist pursuant to this subsection basic instruction and information on how to administer the opioid antagonist.
4. A person who receives an opioid antagonist that was prescribed pursuant to subsection (b) of this section or distributed pursuant to subsection (c1) of this section may administer an opioid antagonist to another person if (i) the person has a good faith belief that the other person is experiencing a drug-related overdose and (ii) the person exercises reasonable care in administering the drug to the other person. Evidence of the use of reasonable care in administering the drug shall include the receipt of basic instruction and information on how to administer the opioid antagonist.
5. All of the following individuals are immune from any civil or criminal liability for actions authorized by this section:
   1. Any practitioner who prescribes an opioid antagonist pursuant to subsection (b) of this section.
   2. Any pharmacist who dispenses an opioid antagonist pursuant to subsection (c) of this section.
   3. Any person who administers an opioid antagonist pursuant to subsection (d) of this section.
   4. The State Health Director acting pursuant to subsection (b) of this section.
   5. Any organization, or agent of the organization, that distributes an opioid antagonist pursuant to subsection (c1) of this section.

History. 2013-23, s. 2; 2015-94, s. 3; 2016-17, s. 2; 2017-74, s. 2; 2017-102, s. 37(a), (b).

Pilot Program to Treat Opiate Overdose.

Session Laws 2017-57, s. 16.3A(a), (b), provides: “(a) Pilot Project. — The Department of Public Safety, in conjunction with the City of Wilmington, shall develop and implement a pilot project to establish a Quick Response Team (QRT) to address the needs of opiate and heroin overdose victims who are not getting follow-up treatment. The QRT shall be staffed by firefighters, police officers, medics, behavioral health specialists, and other law enforcement as determined by the Department of Public Safety and the City of Wilmington. The Department of Public Safety and the City of Wilmington shall work together to develop the policy and procedures for the QRT. In doing so, all of the following shall be considered:

“(1) Increase engagement and treatment with family counseling and recovery groups.

“(2) Provide follow-up care to survivable overdose incidents with police or medics and licensed counselors.

“(3) Provide short-term and long-term support to overdose victims and families.

“(4) Provide follow-up within three to five days after an initial incident.

“(5) Create a fatality review panel to analyze and keep track of the deaths of those served by QRT.

“(b) Report. — The Department of Public Safety and the City of Wilmington shall report on the results of the pilot project to the chairs of the Joint Legislative Oversight Committee on Justice and Public Safety by February 1, 2019.”

§ 90-13. [Repealed]

Repealed by Session Laws 2007-418, s. 2, effective October 1, 2007.

§ 90-13.1. License fees.

1. Each applicant for a license to practice medicine and surgery in this State under either G.S. 90-9.1 or G.S. 90-9.2 shall pay to the North Carolina Medical Board an application fee of four hundred dollars ($400.00).
2. Each applicant for a limited license to practice in a medical education and training program under G.S. 90-12.01 shall pay to the Board a fee of one hundred dollars ($100.00).
3. An applicant for a limited volunteer license under G.S. 90-12.1 A or G.S. 90-12.1 B shall not pay a fee.
4. A fee of twenty-five dollars ($25.00) shall be paid for the issuance of a duplicate license.
5. All fees shall be paid in advance to the North Carolina Medical Board, to be held in a fund for the use of the Board.
6. For the initial and annual licensure of an anesthesiologist assistant, the Board may require the payment of a fee not to exceed one hundred fifty dollars ($150.00).

History. 1858-9, c. 258, s. 13; Code, s. 3130; Rev., s. 4501; 1913, c. 20, ss. 4, 5; C.S., s. 6619; 1921, c. 47, s. 5; Ex. Sess. 1921, c. 44, s. 7; 1953, c. 187; 1969, c. 929, s. 4; 1971, c. 817, s. 2; c. 1150, s. 5; 1977, c. 838, s. 4; 1979, c. 196, s. 1; 1981, c. 573, s. 15; 1983 (Reg. Sess., 1984), c. 1063, s. 1; 1985, c. 362, ss. 1-3; 1987, c. 859, ss. 13, 14; 1993 (Reg. Sess., 1994), c. 566, s. 2; 1995, c. 94, s. 15; c. 509, s. 37; 2000-5, s. 2; 2005-402, s. 5; 2007-146, s. 2; 2007-346, ss. 7, 13(a); 2007-418, s. 8; 2011-355, s. 5; 2016-117, s. 2(h).

§ 90-13.2. Registration every year with Board.

1. Every licensee shall register annually with the Board no later than 30 days after the person’s birthday.
2. A person who registers with the Board shall report to the Board the person’s name and office and residence address and any other information required by the Board, and shall pay an annual registration fee of two hundred fifty dollars ($250.00), except those who have a limited license to practice in a medical education and training program approved by the Board for the purpose of education or training shall pay a registration fee of one hundred twenty-five dollars ($125.00), and those who have a retired limited volunteer license pursuant to G.S. 90-12.1 B or a limited volunteer license pursuant to G.S. 90-12.1 A shall pay no annual registration fee. However, licensees who have a limited license to practice for the purpose of education and training under G.S. 90-12.01 shall not be required to pay more than one annual registration fee for each year of training.
3. Repealed by Session Laws 2016-117, s. 2(i), effective October 1, 2016.
4. A licensee who is not actively engaged in the performance of medical acts, tasks, or functions in North Carolina and who does not wish to register the license may direct the Board to place the license on inactive status.
5. A physician who fails to register as required by this section shall pay an additional fee of fifty dollars ($50.00) to the Board. The license of any physician who fails to register and who remains unregistered for a period of 30 days after certified notice of the failure is automatically inactive. The Board shall retain jurisdiction over the holder of the inactive license.
6. Except as provided in G.S. 90-12.1 B, a person whose license is inactive shall not practice medicine in North Carolina nor be required to pay the annual registration fee.
7. Upon payment of all accumulated fees and penalties, the license of the licensee may be reinstated, subject to the Board requiring the licensee to appear before the Board for an interview and to comply with other licensing requirements. The penalty may not exceed the applicable maximum fee for a license under G.S. 90-13.1 .
8. The Board shall not deny a licensee’s annual registration based solely on the licensee’s failure to become board certified.

History. 1957, c. 597; 1969, c. 929, s. 5; 1979, c. 196, s. 2; 1983 (Reg. Sess., 1984), c. 1063, s. 2; 1987, c. 859, s. 12; 1993 (Reg. Sess., 1994), c. 566, s. 1; 1995, c. 94, s. 16; 1995 (Reg. Sess., 1996), c. 634, s. 1(a); 1997-481, s. 3; 2000-5, s. 3; 2001-493, s. 3; 2005-402, s. 6; 2007-346, s. 7; 2007-418, s. 9; 2011-355, s. 6; 2016-117, s. 2(i); 2019-191, s. 25.

§ 90-13.3. Salaries, fees, expenses of the Board.

1. The compensation and expenses of the members and officers of the Board and all expenses proper and necessary in the opinion of the Board to the discharge of its duties under and to enforce the laws regulating the practice of medicine or surgery shall be paid out of the fund, upon the warrant of the Board.
2. The per diem compensation of Board members shall not exceed two hundred dollars ($200.00) per member for time spent in the performance and discharge of duties as a member. Any unexpended sum of money remaining in the treasury of the Board at the expiration of the terms of office of the members of the Board shall be paid over to their successors in office.

History. 2007-346, s. 13(b).

§ 90-14. Disciplinary Authority.

1. The Board shall have the power to place on probation with or without  conditions, impose limitations and conditions on, publicly reprimand, assess monetary redress, issue public letters of concern, mandate free medical services, require satisfactory completion of treatment programs or remedial or educational training, fine, deny, annul, suspend, or revoke a license, or other authority to practice medicine in this State, issued by the Board to any person who has been found by the Board to have committed any of the following acts or conduct, or for any of the following reasons:
   1. Immoral or dishonorable conduct.
   2. Producing or attempting to produce an abortion contrary to law.
   3. Made false statements or representations to the Board, or willfully concealed from the Board material information in connection with an application for a license, an application, request or petition for reinstatement or reactivation of a license, an annual registration of a license, or an investigation or inquiry by the Board.
   4. Repealed by Session Laws 1977, c. 838, s. 3.
   5. Being unable to practice medicine with reasonable skill and safety to patients by reason of illness, drunkenness, excessive use of alcohol, drugs, chemicals, or any other type of material or by reason of any physical or mental abnormality. The Board is empowered and authorized to require an applicant or licensee to submit to a mental or physical examination by physicians or physician assistants, or mental examinations by other licensed health care providers acting within the scope of their practice as allowed by law designated by the Board during the pendency of a license application and before or after charges may be presented against the applicant or licensee, and the results of the examination shall be admissible in evidence in a hearing before the Board. Failure to comply with an order pursuant to this subsection may be considered unprofessional conduct as defined in G.S. 90-14(a)(6).
   6. Unprofessional conduct, including, but not limited to, departure from, or the failure to conform to, the standards of acceptable and prevailing medical practice, or the ethics of the medical profession, irrespective of whether or not a patient is injured thereby, or the committing of any act contrary to honesty, justice, or good morals, whether the same is committed in the course of the licensee’s practice or otherwise, and whether committed within or without North Carolina. The Board shall not revoke the license of or deny a license to a person, or discipline a licensee in any manner, solely because of that person’s practice of a therapy that is experimental, nontraditional, or that departs from acceptable and prevailing medical practices unless, by competent evidence, the Board can establish that the treatment has a safety risk greater than the prevailing treatment or that the treatment is generally not effective.
   7. Conviction in any court of a crime involving moral turpitude, or the violation of a law involving the practice of medicine, or a conviction of a felony; provided that a felony conviction shall be treated as provided in subsection (c) of this section.
   8. By false representations has obtained or attempted to obtain practice, money or anything of value.
   9. Has advertised or publicly professed to treat human ailments under a system or school of treatment or practice other than that for which the physician has been educated.
   10. Adjudication of mental incompetency, which shall automatically suspend a license unless the Board orders otherwise.
   11. Lack of professional competence to practice medicine with a reasonable degree of skill and safety for patients or failing to maintain acceptable standards of care. In this connection the Board may consider repeated acts of an applicant or licensee’s failure to treat a patient properly. The Board may, upon reasonable grounds, require an applicant or licensee to submit to inquiries or examinations, written or oral, as the Board deems necessary to determine the professional qualifications of that applicant or licensee. Failure to comply with an order pursuant to this subsection may be considered unprofessional conduct as defined in G.S. 90-14(a)(6). In order to annul, suspend, deny, or revoke a license of an accused person, the Board shall find by the greater weight of the evidence that the care provided was not in accordance with the standards of practice for the procedures or treatments administered.

       (11a) Not actively practiced as a licensee, or having not maintained continued competency, as determined by the Board, for the two-year period immediately preceding the filing of an application for an initial license from the Board or the filing of a request, petition, motion, or application to reactivate or reinstate an inactive, suspended, or revoked license previously issued by the Board. The Board is authorized to adopt any rules or regulations it deems necessary to carry out the provisions of this subdivision.

   12. Promotion of the sale of drugs, devices, appliances or goods for a patient, or providing services to a patient, in such a manner as to exploit the patient, and upon a finding of the exploitation, the Board may order the licensee pay restitution to the payer of the bill, whether the patient or the insurer, provided that a determination of the amount of restitution shall be based on credible testimony in the record.
   13. Having a license revoked, suspended, restricted, or acted against or having a license to practice denied by the licensing authority of any jurisdiction, including Canada, the United Kingdom, and Australia. For purposes of this subdivision, the licensing authority’s acceptance of a license to practice voluntarily relinquished by a licensee or relinquished by stipulation, consent order, or other settlement in response to or in anticipation of the filing of administrative charges against the licensee’s license, or an inactivation or voluntary surrender of a license while under investigation is an action against a license to practice.
   14. The failure to comply with an order issued under this Article or the failure to respond, within a reasonable period of time and in a reasonable manner as determined by the Board, to inquiries from the Board concerning any matter affecting the license to practice medicine.
   15. The failure to complete an amount not to exceed 150 hours of continuing medical education during any three consecutive calendar years pursuant to rules adopted by the Board.
   16. A violation of any provision of this Article.
   17. Failure to make reports as required by this Article.
2. The Board shall refer to the North Carolina Physicians Health Program all licensees whose health and effectiveness have been significantly impaired by alcohol, drug addiction or mental illness. Sexual misconduct shall not constitute mental illness for purposes of this subsection.
3. Except as provided in subsection (c1) of this section, a felony conviction shall result in the automatic revocation of a license issued by the Board, unless the Board orders otherwise or receives a request for a hearing from the person within 60 days of receiving notice from the Board, after the conviction, of the provisions of this subsection. If the Board receives a timely request for a hearing in such a case, the provisions of G.S. 90-14.2 shall be followed. (c1) A felony conviction under Article 7B of Chapter 14 of the General Statutes shall result in the automatic denial or revocation of a license issued by the Board, and that denial or revocation shall be permanent, and the applicant or licensee shall be ineligible for reapplication, relicensure, reinstatement, or restoration under subsection (c2) of this section.

   (c2) Except as provided in subsection (c1) of this section, where the Board has exercised its authority pursuant to this section to revoke a license, the holder of the revoked license will not be eligible to make an application for reinstatement before two years from the effective date of the revocation.

4. Repealed by Session Laws 2006-144, s. 4, effective October 1, 2006, and applicable to acts or omissions that occur on or after that date.
5. The Board and its members and staff shall not be held liable in any civil or criminal proceeding for exercising, in good faith, the powers and duties authorized by law.
6. A person, partnership, firm, corporation, association, authority, or other entity acting in good faith without fraud or malice shall be immune from civil liability for (i) reporting, investigating, assessing, monitoring, or providing an expert medical opinion to the Board regarding the acts or omissions of a licensee or applicant that violate the provisions of subsection (a) of this section or any other provision of law relating to the fitness of a licensee or applicant to practice medicine and (ii) initiating or conducting proceedings against a licensee or applicant if a complaint is made or action is taken in good faith without fraud or malice. A person shall not be held liable in any civil proceeding for testifying before the Board in good faith and without fraud or malice in any proceeding involving a violation of subsection (a) of this section or any other law relating to the fitness of an applicant or licensee to practice medicine, or for making a recommendation to the Board in the nature of peer review, in good faith and without fraud and malice.
7. Prior to taking action against any licensee for providing care not in accordance with the standards of care for the procedures or treatments administered, the Board shall whenever practical consult with a licensee who routinely utilizes or is familiar with the same modalities and who has an understanding of the standards of practice for the modality administered. Information obtained as result of the consultation shall be available to the licensee at the informal nonpublic precharge conference.
8. No investigation of a licensee shall be initiated upon the direction of a single member of the Board without another Board member concurring. A Board member shall not serve as an expert in determining the basis for the initiation of an investigation.
9. At the time of first communication from the Board or agent of the Board to a licensee regarding a complaint or investigation, the Board shall provide notice in writing to the licensee that informs the licensee: (i) of the existence of any complaint or other information forming the basis for the initiation of an investigation; (ii) that the licensee may retain counsel; (iii) how the Board will communicate with the licensee regarding the investigation or disciplinary proceeding in accordance with subsections (m) and (n) of this section; (iv) that the licensee has a duty to respond to inquiries from the Board concerning any matter affecting the license, and all information supplied to the Board and its staff will be considered by the Board in making a determination with regard to the matter under investigation; (v) that the Board will complete its investigation within six months or provide an explanation as to why it must be extended; and (vi) that if the Board makes a decision to initiate public disciplinary proceedings, the licensee may request in writing an informal nonpublic precharge conference.
10. After the Board has made a nonpublic determination to initiate disciplinary proceedings, but before public charges have been issued, the licensee requesting so in writing, shall be entitled to an informal nonpublic precharge conference. At least five days prior to the informal nonpublic precharge conference, the Board will provide to the licensee the following: (i) all relevant information obtained during an investigation, including exculpatory evidence except for information that would identify an anonymous complainant; (ii) the substance of any written expert opinion that the Board relied upon, not including information that would identify an anonymous complainant or expert reviewer; (iii) notice that the licensee may retain counsel, and if the licensee retains counsel all communications from the Board or agent of the Board regarding the disciplinary proceeding will be made through the licensee’s counsel; (iv) notice that if a Board member initiated the investigation then that Board member will not participate in the adjudication of the matter before the Board or hearing committee; (v) notice that the Board may use an administrative law judge or designate hearing officers to conduct hearings as a hearing committee to take evidence; (vi) notice that the hearing shall proceed in the manner prescribed in Article 3A of Chapter 150B of the General Statutes and as otherwise provided in this Article; and (vii) any Board member who serves as a hearing officer in this capacity shall not serve as part of the quorum that determines the final agency decision. The provisions of this section do not apply where the Board has exercised its authority under G.S. 150B-3(c) and issued an order of summary suspension.
11. When the Board has made a determination that the public health, safety, or welfare requires emergency action, the Board may seek to require of a licensee the taking of any action adversely impacting the licensee’s medical practice or license without first giving notice of the proposed action, the basis for the proposed action, and information required under subsection (i) of this section.
12. The Board shall complete any investigation initiated pursuant to this section no later than six months from the date of first communication required under subsection (i) of this section, unless the Board provides to the licensee a written explanation of the circumstances and reasons for extending the investigation.
13. If a licensee retains counsel to represent the licensee in any matter related to a complaint, investigation, or proceeding, the Board shall communicate to the licensee through the licensee’s counsel.
14. Notwithstanding subsection (m) of this section, if the licensee has retained counsel, the Board may serve to both the licensee and the licensee’s counsel orders to produce, appear, submit to assessment, examination, or orders following a hearing, or provide notice that the Board will not be taking any further action against a licensee.

History. C.S., s. 6618; 1921, c. 47, s. 4; Ex. Sess. 1921, c. 44, s. 6; 1933, c. 32; 1953, c. 1248, s. 2; 1969, c. 612, s. 4; c. 929, s. 6; 1975, c. 690, s. 4; 1977, c. 838, s. 3; 1981, c. 573, ss. 9, 10; 1987, c. 859, ss. 6-10; 1993, c. 241, s. 1; 1995, c. 405, s. 4; 1997-443, s. 11A.118(a); 1997-481, s. 1; 2000-184, s. 5; 2003-366, ss. 3, 4; 2006-144, s. 4; 2007-346, s. 14; 2009-363, ss. 2, 3; 2009-558, ss. 1.2, 1.3, 1.4; 2016-117, s. 2(j); 2019-191, s. 26.

Effect of Amendments.

Session Laws 2006-144, s. 4, effective October 1, 2006, and applicable to acts or omissions that occur on or after that date, inserted “place on probation with or without conditions, impose limitations and conditions on, publicly reprimand, assess monetary redress, issue public letters of concern, mandate free medical services, require satisfactory completion of treatment programs or remedial or educational training, fine” in the introductory language of subsection (a); deleted “by members of the Board or by other physicians licensed to practice medicine in this State,” following “written or oral” in the middle of subdivision (a)(11); added subdivision (a)(11a); in the concluding paragraph of subsection (a), deleted the former first sentence, and substituted “otherwise acted upon” for “rescinded”; in subsection (b), substituted “North Carolina Physicians Health Program” for “State Medical Society Physician Health and Effectiveness Committee” near the beginning, inserted “and physician assistants” following “all physicians” near the middle, and added the last sentence; repealed subsection (d) relating to confidential information; and substituted “reporting, investigating, or providing an expert medical opinion to the Board regarding” for “reporting or” near the beginning of subsection (f).

Session Laws 2007-346, s. 14, effective October 1, 2007, rewrote the section heading; in subdivision (a)(3), deleted “who has” preceding “willfully concealed” and inserted “an application, request or petition for reinstatement or reactivation of a license, an annual registration of a license, or an investigation or inquiry by the Board”; inserted “or failing to maintain acceptable standards of one or more areas of professional physician practice” in subdivision (a)(11).

Session Laws 2009-363, ss. 2 and 3, effective July 27, 2009, substituted “licensees” for “physicians and physician assistants” in the first sentence of subsection (b), and inserted “assessing, monitoring” in the first sentence of subsection (f).

Session Laws 2016-117, s. 2(j), effective October 1, 2016, rewrote subsection (n).

Session Laws 2019-191, s. 26, effective October 1, 2019, rewrote subsection (a); added the exception at the beginning of subsection (c); added subsections (c1) and (c2); substituted “standards of care” for “standards of practice” in the first sentence of subsection (g); added the last sentence of subsection (j); substituted “When the Board has made a determination that the public health, safety, or welfare requires emergency action, the Board may” for “Unless the conditions specified in G.S. 150B-3(c) exist, the Board shall not” at the beginning of subsection (k); and made a minor stylistic change.

Legal Periodicals.

For 1997 legislative survey, see 20 Campbell L. Rev. 469 (1998).

For article, “Physicians’ Elusive Public Health Duties,” see 99 N.C.L. Rev. 923 (2021).

§ 90-14.1. Judicial review of Board’s decision denying issuance of a license.

Whenever an applicant fails to satisfy the Board of the applicant’s qualifications to be issued a license, the Board shall immediately notify such person of its decision, and indicate in what respect the applicant has so failed to satisfy the Board. Such applicant shall be given a formal hearing before the Board upon request of such applicant filed with or mailed by registered mail to the secretary of the Board within 10 days after receipt of the Board’s decision, stating the reasons for such request. The Board shall within 20 days of receipt of such request notify such applicant of the time and place of a public hearing, which shall be held within a reasonable time. The burden of satisfying the Board of the applicant’s qualifications for licensure shall be upon the applicant. Following such hearing, the Board shall determine whether the applicant is entitled to be licensed. Any decision of the Board shall be subject to judicial review upon appeal to the superior court of the county where the Board is located upon the filing with the Board of a written notice of appeal with exceptions taken to the decision of the Board within 20 days after service of notice of the Board’s final decision. Within 30 days after receipt of notice of appeal, the secretary of the Board shall certify to the clerk of the superior court of the county where the Board is located the record of the case which shall include a copy of the notice of hearing, a transcript of the testimony and evidence received at the hearing, a copy of the decision of the Board, and a copy of the notice of appeal and exceptions. Upon appeal the case shall be heard by the judge without a jury, upon the record, except that in cases of alleged omissions or errors in the record, testimony may be taken by the court. The decision of the Board shall be upheld unless the substantial rights of the applicant have been prejudiced because the decision of the Board is in violation of law or is not supported by any evidence admissible under this Article, or is arbitrary or capricious.

History. 1953, c. 1248, s. 3; 1995, c. 94, s. 14; 2019-191, s. 27.

Effect of Amendments.

Session Laws 2019-191, s. 27, effective October 1, 2019, in the first sentence, substituted “an applicant fails to satisfy the Board of the applicant’s qualifications” for “the North Carolina Medical Board has determined that a person who has duly made application to take an examination to be given by the Board showing his education, training and other qualifications required by said Board, or that a person who has taken and passed an examination given by the Board, has failed to satisfy the Board of his qualifications to be examined or” near the beginning, deleted “for any cause other than failure to pass an examination” preceding “the Board shall” near the middle, and deleted “at Raleigh, North Carolina” following “of the Board” near the end; substituted “the applicant’s qualifications” for “his qualifications” in the third sentence; substituted “is entitled to be licensed” for “is qualified to be examined or is entitled to be licensed as the case may be” in the fourth sentence; in the fifth sentence, deleted “such” following “Any” at the beginning and substituted “superior court of the county where the Board is located” for “Superior Court of Wake County” near the middle; substituted “superior court of the county where the Board is located” for “Superior Court of Wake County” near the middle of the sixth sentence; and deleted the former last sentence, which read: “Each party to the review proceeding may appeal to the Supreme Court as hereinafter provided in G.S. 90-14.11 .”

Legal Periodicals.

For article on administrative evidence rules, see 49 N.C.L. Rev. 635 (1971).

§ 90-14.2. Hearing before disciplinary action.

1. Before the Board shall take disciplinary action against any license granted by it, the licensee shall be given a written notice indicating the charges made against the licensee and stating that the licensee will be given an opportunity to be heard concerning the charges at a time and place stated in the notice, or at a time and place to be thereafter designated by the Board, and the Board shall hold a public hearing not less than 30 days from the date of the service of notice upon the licensee, at which the licensee may appear personally and through counsel, may cross examine witnesses and present evidence in the licensee’s own behalf. A licensee who is mentally incompetent shall be represented at such hearing and shall be served with notice as herein provided by and through a guardian ad litem appointed by the clerk of the court of the county in which the licensee resides. The licensee may file written answers to the charges within 30 days after the service of the notice, which answer shall become a part of the record but shall not constitute evidence in the case.
2. Once charges have been issued, neither counsel for the Board nor counsel for the respondent shall communicate ex parte, directly or indirectly, pertaining to a matter that is an issue of fact or a question of law with a hearing officer or Board member who is permitted to participate in a final decision in a disciplinary proceeding. In conducting hearings, the Board shall retain independent counsel to provide advice to the Board or any hearing committee constituted under G.S. 90-14.5(a) concerning contested matters of procedure and evidence.
3. Once charges have been issued, the parties may engage in discovery as provided in G.S. 1A-1 , the North Carolina Rules of Civil Procedure. Additionally, pursuant to any written request by the respondent or respondent’s counsel, the Board shall provide information obtained during an investigation, except for the following:
   1. Information that is subject to attorney-client privilege or is attorney work product.
   2. Information that would identify an anonymous complainant.
   3. Information generated during an investigation that will not be offered into evidence by the Board and is related to:
      1. Advice, opinions, or recommendations of the Board staff, consultants, or agents.
      2. Deliberations by the Board and its committees during an investigation.

History. 1953, c. 1248, s. 3; 1975, c. 690, s. 5; 2007-346, s. 15; 2009-558, s. 2; 2016-117, s. 2(k); 2019-191, s. 28.

Effect of Amendments.

Session Laws 2007-346, s. 15, effective October 1, 2007, substituted “disciplinary action” for “revocation or suspension of a license” in the section heading; substituted “take disciplinary action against” for “revoke, restrict or suspend” near the beginning of the paragraph.

Session Laws 2016-117, s. 2(k), effective October 1, 2016, added subsection (c).

Session Laws 2019-191, s. 28, effective October 1, 2019, substituted “licensee” for “licensee, which notice may be prepared by a committee or one or more members of the Board designated by the Board” in the first sentence of subsection (a).

§ 90-14.3. Service of notices.

Any notice required by this Chapter may be served either personally by an employee of the Board or by an officer authorized by law to serve process, or by registered or certified mail, return receipt requested, directed to the licensee or applicant at his last known address as shown by the records of the Board. If notice is served personally, it shall be deemed to have been served at the time when the officer or employee of the Board delivers the notice to the person addressed or delivers the notice at the licensee’s or applicant’s last known address as shown by records of the Board with a person of suitable age and discretion then residing therein. Where notice is served by registered or certified mail, it shall be deemed to have been served on the date borne by the return receipt showing delivery of the notice to the licensee’s or applicant’s last known address as shown by the records of the Board, regardless of whether the notice was actually received or whether the notice was unclaimed or undeliverable for any reason.

History. 1953, c. 1248, s. 3; 1995, c. 405, s. 5; 2007-346, s. 16.

Effect of Amendments.

Session Laws 2007-346, s. 16, effective October 1, 2007, inserted “by an employee of the Board” in the first sentence, inserted “or employee of the board” and “or delivers the notice at the licensee’s or applicant’s last known address as shown by records of the Board with a person of suitable age and discretion then residing therein” in the second sentence, substituted “licensee’s or applicant’s last known address as shown by the records of the Board, regardless of whether the notice was actually received or whether the notice was unclaimed or undeliverable for any reason” for “addressee, showing refusal of the addressee to accept the notice, or showing failure to locate the addressee at the last known address as shown by the records of the Board” at the end.

§ 90-14.4. [Repealed]

Repealed by Session Laws 2007-346, s. 17, effective October 1, 2007.

§ 90-14.5. Use of recommended decisions; appointment of hearing officers.

1. Except as provided in subsection (a1) of this section, the Board, in its discretion, may designate in writing three or more hearing officers to conduct hearings as a hearing committee to take evidence. A majority of hearing officers participating in a hearing committee shall be licensees of the Board. The Board shall make a reasonable effort to include on the panel at least one physician licensed in the same or similar specialty as the licensee against whom the complaint has been filed. If a current or retired judge as described in G.S. 90-1.1(2) who is not a current or past Board member participates as a hearing officer, the Board may elect not to retain independent counsel for the hearing committee. (a1) The Board may use an administrative law judge consistent with Article 3A of Chapter 150B of the General Statutes in lieu of a hearing committee so long as the Board has not solely alleged that the licensee failed to meet an applicable standard of care. Notwithstanding this subsection, the Board may use an administrative law judge consistent with Article 3A of Chapter 150B of the General Statutes if the licensee is a current or former Board member.
2. Repealed by Session Laws 2019-191, s. 29, effective October 1, 2019.
3. The hearing committee shall submit a recommended decision that contains findings of fact and conclusions of law to the Board. Before the Board makes a final decision, it shall give each party an opportunity to file written exceptions to the recommended decision made by the hearing committee and to present oral arguments to the Board. A quorum of the Board will issue a final decision. No member of the Board who served as a member of the hearing committee described in subsection (a) of this section may participate as a member of the quorum of the Board that issues a final agency decision.
4. Hearing officers are entitled to receive per diem compensation and reimbursement for expenses as authorized by the Board. The per diem compensation shall not exceed the amount allowed by G.S. 90-13.3 .

History. 1953, c. 1248, s. 3; 2006-144, s. 5; 2007-346, s. 18; 2009-558, s. 3; 2019-191, s. 29.

Effect of Amendments.

Session Laws 2006-144, s. 5, effective October 1, 2006, and applicable to hearings held on or after that date, substituted “hearing committee and” for “trial examiner” in the section heading; and rewrote the section.

Session Laws 2007-346, s. 18, effective October 1, 2007, added “appointment of hearing officers” in the section heading; substituted “hearing officers” for “of its members” in subsection (a); added subsection (d).

Session Laws 2019-191, s. 29, effective October 1, 2019, in subsection (a1), substituted “recommended decisions” for “hearing committee and depositions” in the section heading; in subsection (a1), in the first sentence, inserted “solely” and deleted “medical” preceding “care”, and added the second sentence; and deleted subsection (b).

§ 90-14.6. Evidence admissible.

1. Except as otherwise provided in proceedings held pursuant to this Article the Board shall admit and hear evidence in the same manner and form as prescribed by law for civil actions. A complete record of such evidence shall be made, together with the other proceedings incident to the hearing.
2. Subject to the North Carolina Rules of Civil Procedure and Rules of Evidence, in proceedings held pursuant to this Article, the individual under investigation may call witnesses, including medical practitioners licensed in the United States with training and experience in the same field of practice as the individual under investigation and familiar with the standard of care among members of the same health care profession in North Carolina. Witnesses shall not be restricted to experts certified by the American Board of Medical Specialties. A Board member shall not testify as an expert witness.
3. Subject to the North Carolina Rules of Civil Procedure and Rules of Evidence, statements contained in medical or scientific literature shall be competent evidence in proceedings held pursuant to this Article. Documentary evidence may be received in the form of a copy or excerpt or may be incorporated by reference, if the materials so incorporated are available for examination by the parties. Upon timely request, a party shall be given an opportunity to compare the copy with the original if available.

   (c1) Evidence and testimony may be presented at hearings before the Board or a hearing committee in the form of depositions before any person authorized to administer oaths in accordance with the procedure for the taking of depositions in civil actions in the superior court.

4. When evidence is not reasonably available under the Rules of Civil Procedure and Rules of Evidence to show relevant facts, then the most reliable and substantial evidence available shall be admitted. At the discretion of the presiding officer of the hearing, the Board may receive witness testimony at a hearing by means of telephone or videoconferencing.
5. Any final agency decision of the Board shall be based upon a preponderance of the evidence admitted in the hearing.

History. 1953, c. 1248, s. 3; 2003-366, s. 5; 2007-346, s. 19; 2009-558, s. 4; 2019-191, s. 30.

Effect of Amendments.

Session Laws 2007-346, s. 19, effective October 1, 2007, inserted “Except as otherwise provided” at the beginning of subsection (a); in subsection (b), substituted “individual” for “licensee” following “to this Article” and substituted “with training and experience in the same field of practice as the individual under investigation and familiar with the standard of care among members of the same health care profession in North Carolina” for “with expertise in the same field of practice as the licensee under investigation, and the Board shall consider this testimony”; added the second and third sentences in subsection (c); added subsection (d).

Session Laws 2019-191, s. 30, effective October 1, 2019, added subsection (c1); and added the last sentence in subsection (d).

Legal Periodicals.

For article on administrative evidence rules, see 49 N.C.L. Rev. 635 (1971).

§ 90-14.7. Procedure where person fails to request or appear for hearing.

If a person who has requested a hearing does not appear, and no continuance has been granted, the Board or its trial examiner or committee may hear the evidence of such witnesses as may have appeared, and the Board may proceed to consider the matter and dispose of it on the basis of the evidence before it. For good cause, the Board may reopen any case for further hearing.

History. 1953, c. 1248, s. 3.

§ 90-14.8. Appeal from Board’s decision taking disciplinary action on a license.

1. A licensee against whom the Board imposes any public disciplinary sanction, as authorized under G.S. 90-14(a), may appeal such action.
2. A licensee against whom any public disciplinary sanction is imposed by the Board may obtain a review of the decision of the Board in the superior court of the county where the Board is located or the county in which the licensee resides, upon filing with the secretary of the Board a written notice of appeal within 30 days after the date of the service of the decision of the Board, stating all exceptions taken to the decision of the Board and indicating the court in which the appeal is to be heard. The court shall schedule and hear the case within six months of the filing of the appeal.
3. Within 30 days after the receipt of a notice of appeal as herein provided, the Board shall prepare, certify and file with the clerk of the Superior Court in the county where the notice of appeal has been filed the record of the case comprising a copy of the charges, notice of hearing, transcript of testimony, and copies of documents or other written evidence produced at the hearing, decision of the Board, and notice of appeal containing exceptions to the decision of the Board.

History. 1953, c. 1248, s. 3; 1981, c. 573, s. 12; 2007-346, s. 20; 2009-558, s. 5; 2019-191, s. 31.

Effect of Amendments.

Session Laws 2007-346, s. 20, effective October 1, 2007, substituted “taking disciplinary action on a license” for “revoking or suspending a license” in the section heading; deleted “or in the superior court in the county in which the hearing was held or upon agreement of the parties to the appeal in any other superior court of the State” following “Wake County” in the first paragraph, and substituted “the Superior Court of Wake County” for “the superior court in the county to which the appeal is directed” in the second paragraph.

Session Laws 2019-191, s. 31, effective October 1, 2019, substituted “superior court of the county where the Board is located” for “Superior Court of Wake County” in the first sentence of subsection (b).

§ 90-14.9. Appeal bond; stay of Board order.

1. The person seeking the review shall file with the clerk of the reviewing court a copy of the notice of appeal and an appeal bond of two hundred dollars ($200.00) at the same time the notice of appeal is filed with the Board. Subject to subsection (b) of this section, at any time before or during the review proceeding the aggrieved person may apply to the reviewing court for an order staying the operation of the Board decision pending the outcome of the review, which the court may grant or deny in its discretion.
2. No stay shall be granted under this section unless the Board is given prior notice and an opportunity to be heard in response to the application for an order staying the operation of the Board decision.

History. 1953, c. 1248, s. 3; 1995, c. 405, s. 6.

§ 90-14.10. Scope of review.

Upon the review of the Board’s decision taking disciplinary action on a license, the case shall be heard by the judge without a jury, upon the record, except that in cases of alleged omissions or errors in the record, testimony thereon may be taken by the court. The court may affirm the decision of the Board or remand the case for further proceedings; or it may reverse or modify the decision if the substantial rights of the accused physician have been prejudiced because the findings or decisions of the Board are in violation of substantive or procedural law, or are not supported by competent, material, and substantial evidence admissible under this Article, or are arbitrary or capricious. At any time after the notice of appeal has been filed, the court may remand the case to the Board for the hearing of any additional evidence which is material and is not cumulative and which could not reasonably have been presented at the hearing before the Board.

History. 1953, c. 1248, s. 3; 2007-346, s. 21.

Effect of Amendments.

Session Laws 2007-346, s. 21, effective October 1, 2007, substituted “taking disciplinary action” for “revoking or suspending” near the beginning of the section.

Legal Periodicals.

For article on administrative evidence rules, see 49 N.C.L. Rev. 635 (1971).

§ 90-14.11. Appeal; appeal bond.

1. Any party to the review proceeding, including the Board, may appeal from the decision of the superior court under rules of procedure applicable in other civil cases. No appeal bond shall be required of the Board. Subject to subsection (b) of this section, the appealing party may apply to the superior court for a stay of that court’s decision or a stay of the Board’s decision, whichever shall be appropriate, pending the outcome of the appeal.
2. No stay shall be granted unless all parties are given prior notice and an opportunity to be heard in response to the application for an order staying the operation of the Board decision.

History. 1953, c. 1248, s. 3; 1989, c. 770, s. 75.1; 1995, c. 405, s. 7.

§ 90-14.12. Injunctions.

The Board may appear in its own name in the superior courts in an action for injunctive relief to prevent violation of this Article and the superior courts shall have power to grant such injunctions regardless of whether criminal prosecution has been or may be instituted as a result of such violations. Actions under this section shall be commenced in the superior court district or set of districts as defined in G.S. 7A-41.1 in which the respondent resides or has his principal place of business or in which the alleged acts occurred, or in the case of an action against a nonresident, in the district where the Board resides.

History. 1953, c. 1248, s. 3; 1981, c. 573, s. 13; 1987 (Reg. Sess., 1988), c. 1037, s. 100; 2001-27, s. 1.

§ 90-14.13. Reports of disciplinary action by health care institutions; reports of professional liability insurance awards or settlements; immunity from liability.

1. The chief administrative officer of every licensed hospital or other health care institution, including Health Maintenance Organizations, as defined in G.S. 58-67-5 , preferred providers, as defined in G.S. 58-50-56 , and all other provider organizations that issue credentials to persons licensed under this Article shall, after consultation with the chief of staff of that institution, report to the Board the following actions involving a physician’s privileges to practice in that institution within 30 days of the date that the action takes effect:
   1. A summary revocation, summary suspension, or summary limitation of privileges, regardless of whether the action has been finally determined.
   2. A revocation, suspension, or limitation of privileges that has been finally determined by the governing body of the institution.
   3. A resignation from practice or voluntary reduction of privileges while under investigation or threat of investigation.
   4. Any action reportable pursuant to Title IV of P.L. 99-660, the Health Care Quality Improvement Act of 1986, as amended, not otherwise reportable under subdivisions (1), (2), or (3) of this subsection. (a1) A hospital is not required to report any of the following:

      (1) The suspension or limitation of a licensee’s privileges for failure to complete medical records in a timely manner.

      (2) A resignation from practice due solely to the licensee’s completion of a medical residency, internship, or fellowship.

      The Board is authorized to adopt rules limiting the reporting requirements of subsection (a) of this section.

      (a2) The Board shall report all violations of subsection (a) of this section known to it to the licensing agency for the institution involved. The licensing agency for the institution involved is authorized to order the payment of a civil penalty of two hundred fifty dollars ($250.00) for a first violation and five hundred dollars ($500.00) for each subsequent violation if the institution fails to report as required under subsection (a) of this section.

2. Any licensee who does not possess professional liability insurance, or possess professional liability insurance from entities not owned and operated within this State, shall report to the Board any award of damages or any settlement of any malpractice complaint affecting his or her practice within 30 days of the award or settlement.
3. The chief administrative officer of each insurance company providing professional liability insurance for persons licensed under this Article, the administrative officer of the Liability Insurance Trust Fund Council created by G.S. 116-220 , and the administrative officer of any trust fund or other fund operated or administered by a hospital authority, group, or provider shall report to the Board within 30 days any of the following:
   1. Any award of damages or settlement of any claim or lawsuit affecting or involving a licensee that it insures.
   2. Any cancellation or nonrenewal of its professional liability coverage of a licensee, if the cancellation or nonrenewal was for cause.
   3. A malpractice payment that is reportable pursuant to Title IV of P.L. 99-660, the Health Care Quality Improvement Act of 1986, as amended, not otherwise reportable under subdivision (1) or (2) of this subsection.For the purposes of this subsection, a “claim” means an oral or written request for compensation made by a patient or a patient’s representative, or an offer of compensation to a patient or a patient’s representative, based on a belief that the patient was injured due to care affecting or involving a licensee. The Board shall determine whether the patient’s care affected or involved a licensee under this Article.
4. The Board shall report all violations of this section to the Commissioner of Insurance. The Commissioner of Insurance is authorized to order the payment of a civil penalty of two hundred fifty dollars ($250.00) for a first violation and five hundred dollars ($500.00) for each subsequent violation against an insurer for failure to report as required under this section.
5. The Board may request details about any action covered by this section, and the licensees or officers shall promptly furnish the requested information. The reports required by this section are privileged, not open to the public, confidential and are not subject to discovery, subpoena, or other means of legal compulsion for release to anyone other than the Board or its employees or agents involved in application for license or discipline, except as provided in G.S. 90-16 . Any officer making a report required by this section, providing additional information required by the Board, or testifying in any proceeding as a result of the report or required information shall be immune from any criminal prosecution or civil liability resulting therefrom unless such person knew the report was false or acted in reckless disregard of whether the report was false.

History. 1981, c. 573, s. 14; 1987, c. 859, s. 11; 1995, c. 405, s. 8; 1997-481, s. 2; 1997-519, s. 3.14; 2006-144, s. 6; 2016-117, s. 2 (l); 2019-191, s. 32.

§ 90-15.

Recodified as G.S. 90-13.1 , by Session Laws 2007-346, s. 7, effective October 1, 2007.

§ 90-15.1. [Transferred]

Recodified as G.S. 90-13.2 , by Session Laws 2007-346, s. 7, effective October 1, 2007.

§ 90-16. Self-reporting requirements; confidentiality of Board investigative information; cooperation with law enforcement; patient protection; Board to keep public records.

1. The North Carolina Medical Board shall keep a regular record of its proceedings with the names of the members of the Board present and other information as to its actions. The North Carolina Medical Board shall publish the names of those licensed within 30 days after granting the license.
2. The Board may in a closed session receive evidence involving or concerning the treatment of a patient who has not expressly or impliedly consented to the public disclosure of such treatment as may be necessary for the protection of the rights of such patient or of the accused physician and the full presentation of relevant evidence.
3. All records, papers, investigative files, investigative reports, other investigative information and other documents containing information in the possession of or received or gathered by the Board, or its members or employees or consultants as a result of investigations, inquiries, assessments, or interviews conducted in connection with a licensing, complaint, assessment, potential impairment matter, disciplinary matter, or report of professional liability insurance awards or settlements pursuant to G.S. 90-14.13 , shall not be considered public records within the meaning of Chapter 132 of the General Statutes and are privileged, confidential, and not subject to discovery, subpoena, or other means of legal compulsion for release to any person other than the Board, its employees or consultants involved in the application for license, impairment assessment, or discipline of a license holder, except as provided in subsection (e1) of this section. For purposes of this subsection, investigative information includes information relating to the identity of, and a report made by, a physician or other person performing an expert review for the Board and transcripts of any deposition taken by Board counsel in preparation for or anticipation of a hearing held pursuant to this Article but not admitted into evidence at the hearing.
4. Repealed by Session Laws 2016-117, s. 2(o), effective October 1, 2016.
5. Information furnished to a licensee or applicant, or counsel for a licensee or applicant, under G.S. 90-14.2(c) shall be subject to discovery or subpoena between and among the parties in a civil case in which the licensee is a party.

   (e1) When the Board receives a complaint regarding the care of a patient, the Board shall provide the licensee with a copy of the complaint as soon as practical and inform the complainant of the disposition of the Board’s inquiry into the complaint and the Board’s basis for that disposition. If providing a copy of the complaint identifies an anonymous complainant or compromises the integrity of an investigation, the Board shall provide the licensee with a summary of all substantial elements of the complaint. Upon written request of a patient, the Board may provide the patient a licensee’s written response to a complaint filed by the patient with the Board regarding the patient’s care. Upon written request of a complainant, who is not the patient but is authorized by State and federal law to receive protected health information about the patient, the Board may provide the complainant a licensee’s written response to a complaint filed with the Board regarding the patient’s care. Any information furnished to the patient or complainant pursuant to this subsection shall be inadmissible in evidence in any civil proceeding. However, information, documents, or records otherwise available are not immune from discovery or use in a civil action merely because they were included in the Board’s review or were the subject of information furnished to the patient or complainant pursuant to this subsection.

6. Any notice or statement of charges against any licensee, or any notice to any licensee of a hearing in any proceeding shall be a public record within the meaning of Chapter 132 of the General Statutes, notwithstanding that it may contain information collected and compiled as a result of any such investigation, inquiry or interview; and provided, further, that if any such record, paper or other document containing information theretofore collected and compiled by the Board, as hereinbefore provided, is received and admitted in evidence in any hearing before the Board, it shall thereupon be a public record within the meaning of Chapter 132 of the General Statutes.
7. In any proceeding before the Board, in any record of any hearing before the Board, and in the notice of the charges against any licensee (notwithstanding any provision herein to the contrary) the Board may withhold from public disclosure the identity of a patient who has not expressly or impliedly consented to the public disclosure of treatment by the accused physician.
8. If investigative information in the possession of the Board, its employees, or agents indicates that a crime may have been committed, the Board may report the information to the appropriate law enforcement agency, the North Carolina Department of Justice, the United States Department of Justice, the United States Attorney, or the district attorney of the district in which the offense was committed.
9. The Board shall cooperate with and assist a law enforcement agency, the North Carolina Department of Justice, the United States Department of Justice, the United States Attorney, or the district attorney conducting a criminal investigation or prosecution of a licensee by providing information that is relevant to the criminal investigation or prosecution to the agency or attorney as required by this subsection. Information disclosed by the Board to an investigative agency or attorney pursuant to this subsection or subsection (h) of this section remains confidential and may not be disclosed by the investigating agency except as necessary to further the investigation or prosecution.
10. All persons licensed under this Article shall self-report to the Board within 30 days of arrest or indictment any of the following:
    1. Any felony arrest or indictment.
    2. Any arrest for driving while impaired or driving under the influence.
    3. Any arrest or indictment for the possession, use, or sale of any controlled substance.
11. The Board, its members and staff, may release confidential or nonpublic information to any health care licensure board in this State or another state or authorized Department of Health and Human Services personnel with enforcement or investigative responsibilities about the issuance, denial, annulment, suspension, or revocation of a license, or the voluntary surrender of a license by a licensee of the Board, including the reasons for the action, or an investigative report made by the Board. The Board shall notify the licensee within 60 days after the information is transmitted. A summary of the information that is being transmitted shall be furnished to the licensee. If the licensee requests in writing within 30 days after being notified that the information has been transmitted, the licensee shall be furnished a copy of all information so transmitted. The notice or copies of the information shall not be provided if the information relates to an ongoing criminal investigation by any law enforcement agency or authorized Department of Health and Human Services personnel with enforcement or investigative responsibilities.

History. 1858-9, c. 258, s. 12; Code, s. 3129; Rev., s. 4500; C.S., s. 6620; 1921, c. 47, s. 6; 1977, c. 838, s. 5; 1993 (Reg. Sess., 1994), c. 570, s. 6; 1995, c. 94, s. 17; 1997-481, s. 4; 2006-144, s. 7; 2007-346, s. 22; 2009-363, s. 4; 2009-558, s. 6; 2016-117, s. 2(o); 2019-191, s. 33.

Effect of Amendments.

Session Laws 2006-144, s. 7, effective October 1, 2006, rewrote the section heading; and rewrote the section.

Session Laws 2007-346, s. 22, effective October 1, 2007, rewrote the section.

Session Laws 2009-363, s. 4, effective July 27, 2009, in subsection (c), in the first sentence, inserted “or consultants” and “assessments,” and substituted “complaint, assessment, potential impairment matter” for “complaint or,” and “consultants” for “agents,” and inserted “impairment assessment.”

Session Laws 2016-117, s. 2(o), effective October 1, 2016, deleted former subsection (d), which pertained to the Board providing a licensee or applicant with access to all information in its possession that the Board intends to offer into evidence in presenting its case in chief at a contested hearing.

Session Laws 2019-191, s. 33, effective October 1, 2019, rewrote this section.

Legal Periodicals.

For comment, “You Can’t Always Get What You Want: A Look at North Carolina’s Public Records Law,” see 72 N.C.L. Rev. 1527 (1994).

§ 90-17. [Repealed]

Repealed by Session Laws 1967, c. 691, s. 59.

§ 90-18. Practicing without license; penalties.

1. No person shall perform any act constituting the practice of medicine or surgery, as defined in this Article, or any of the branches thereof, unless the person shall have been first licensed and registered so to do in the manner provided in this Article. Any person who practices medicine or surgery without being duly licensed and registered, as provided in this Article, shall not be allowed to maintain any action to collect any fee for such services. Any person so practicing without being duly licensed and registered in this State shall be guilty of a Class 1 misdemeanor. Any person so practicing without being duly licensed and registered in this State and who is falsely representing himself or herself in a manner as being licensed or registered under this Article or any Article of this Chapter shall be guilty of a Class I felony. Any person so practicing without being duly licensed and registered in this State and who is an out-of-state practitioner shall be guilty of a Class I felony. Any person who has a license or approval under this Article that is inactive due solely to the failure to complete annual registration in a timely fashion as required by this Article or any person who is licensed, registered, and practicing under any other Article of this Chapter shall be guilty of a Class 1 misdemeanor.
2. Repealed by Session Laws 2007-346, s. 23, effective October 1, 2007.
3. The following shall not constitute practicing medicine or surgery as defined in this Article:
   1. The administration of domestic or family remedies.
   2. The practice of dentistry by any legally licensed dentist engaged in the practice of dentistry and dental surgery.
   3. The practice of pharmacy by any legally licensed pharmacist engaged in the practice of pharmacy. (3a) The provision of drug therapy management by a licensed pharmacist engaged in the practice of pharmacy pursuant to an agreement that is physician, pharmacist, patient, and disease specific when performed in accordance with rules and rules developed by a joint subcommittee of the North Carolina Medical Board and the North Carolina Board of Pharmacy and approved by both Boards. Drug therapy management shall be defined as: (i) the implementation of predetermined drug therapy which includes diagnosis and product selection by the patient’s physician; (ii) modification of prescribed drug dosages, dosage forms, and dosage schedules; and (iii) ordering tests; (i), (ii), and (iii) shall be pursuant to an agreement that is physician, pharmacist, patient, and disease specific.
   4. The practice of medicine and surgery by any surgeon or physician of the United States Army, Navy, or Public Health Service in the discharge of his official duties.
   5. The treatment of the sick or suffering by mental or spiritual means without the use of any drugs or other material means.
   6. The practice of optometry by any legally licensed optometrist engaged in the practice of optometry.
   7. The practice of midwifery as defined in G.S. 90-178.2 .
   8. The practice of podiatric medicine and surgery by any legally licensed podiatric physician when engaged in the practice of podiatry as defined in Article 12A of this Chapter.
   9. Repealed by Session Laws 2019-191, s. 34, effective October 1, 2019.
   10. The practice of chiropractic by any legally licensed chiropractor when engaged in the practice of chiropractic as defined by law, and without the use of any drug or surgery.
   11. The practice of medicine or surgery by any nonregistered reputable physician or surgeon who comes into this State, either in person or by use of any electronic or other mediums, on an irregular basis, to consult with a resident registered physician or to consult with personnel at a medical school about educational or medical training. This proviso shall not apply to physicians resident in a neighboring state and regularly practicing in this State.

       (11a) The practice of medicine or surgery by any physician who comes into this State to practice medicine or surgery so long as:

       1. The physician or surgeon has an oral or written agreement with a sports team to provide general or emergency medical care to the team members, coaching staff, or families traveling with the team for a specific sporting event taking place in this State; and
       2. The physician or surgeon does not provide care or consultation to any person residing in this State other than an individual described in sub-subdivision a. of this subdivision.The exemption shall remain in force while the physician or surgeon is traveling with the team. The exemption shall not exceed 10 days per individual sporting event. However, the executive director of the Board may grant a physician or surgeon additional time for exemption of up to 20 additional days per individual sporting event.
   12. Any person practicing radiology as hereinafter defined shall be deemed to be engaged in the practice of medicine within the meaning of this Article. “Radiology” is a specialty branch of the practice of medicine in which illness or disease is diagnosed or treated using various techniques or modalities, including radiant energy or ionizing radiation, and ultrasound and magnetic resonance. The education and training for the practice of radiology includes extensive study in the physics of radiant energy and medical imaging, radiation protection, and the application of ionizing radiation in the diagnosis and treatment of disease.
   13. The performance of any medical acts, tasks, and functions by a licensed physician assistant at the direction or under the supervision of a physician in accordance with rules adopted by the Board. This subdivision shall not limit or prevent any physician from delegating to a qualified person any acts, tasks, and functions that are otherwise permitted by law or established by custom. The Board shall authorize physician assistants licensed in this State or another state to perform specific medical acts, tasks, and functions during a disaster.
   14. The practice of nursing by a registered nurse engaged in the practice of nursing and the performance of acts otherwise constituting medical practice by a registered nurse when performed in accordance with rules and regulations developed by a joint subcommittee of the North Carolina Medical Board and the Board of Nursing and adopted by both boards.
   15. The practice of dietetics/nutrition by a licensed dietitian/nutritionist under the provisions of Article 25 of this Chapter.
   16. The practice of acupuncture by a licensed acupuncturist in accordance with the provisions of Article 30 of this Chapter.
   17. The use of an automated external defibrillator as provided in G.S. 90-21.15 .
   18. The practice of medicine by any nonregistered physician residing in another state or foreign country who is contacted by one of the physician’s regular patients for treatment by use of any method of communication while the physician’s patient is temporarily in this State.
   19. The practice of medicine or surgery by any physician who comes into this State to practice medicine or surgery at a camp that specializes in providing therapeutic recreation for individuals with chronic illnesses, as long as all the following conditions are satisfied:
       1. The physician provides documentation to the medical director of the camp that the physician is licensed and in good standing to practice medicine in another state.
       2. The physician provides services only at the camp or in connection with camp events or camp activities that occur off the grounds of the camp.
       3. The physician receives no compensation for the services.
       4. The physician provides those services within this State for no more than 30 days per calendar year.
       5. The camp has a medical director who holds an unrestricted license to practice medicine and surgery issued under this Article.
   20. The provision of anesthesia services by a licensed anesthesiologist assistant under the supervision of an anesthesiologist licensed under Article 1 of this Chapter in accordance with rules adopted by the Board.

History. 1858-9, c. 258, s. 2; Code, s. 3122; 1885, c. 117, s. 2; c. 261; 1889, c. 181, ss. 1, 2; Rev., ss. 3645, 4502; C.S., s. 6622; 1921, c. 47, s. 7; Ex. Sess. 1921, c. 44, s. 8; 1941, c. 163; 1967, c. 263, s. 1; 1969, c. 612, s. 5; c. 929, s. 3; 1971, c. 817, s. 1; c. 1150, s. 6; 1973, c. 92, s. 1; 1983, c. 897, s. 2; 1993, c. 303, s. 2; c. 539, s. 615; 1994, Ex. Sess., c. 24, s. 14(c); 1995, c. 94, ss. 18, 19; 1997-511, s. 4; 1997-514, s. 1; 1999-290, s. 2; 2000-113, s. 2; 2001-27, s. 2; 2003-109, s. 1; 2005-415, s. 2; 2007-146, s. 3; 2007-346, s. 23; 2011-183, s. 127(b); 2011-194, s. 1; 2019-191, s. 34.

Cross References.

As to unauthorized practice; penalty for violation of Article, see G.S. 90-118.11 .

§ 90-18.1. Limitations on physician assistants.

1. Any person who is licensed under the provisions of G.S. 90-9.3 to perform medical acts, tasks, and functions as a physician assistant may use the title “physician assistant” or “PA.” Any other person who uses the title in any form or holds out to be a physician assistant or to be so licensed, shall be deemed to be in violation of this Article.
2. Physician assistants are authorized to write prescriptions for drugs under the following conditions:
   1. The North Carolina Medical Board has adopted regulations governing the approval of individual physician assistants to write prescriptions with such limitations as the Board may determine to be in the best interest of patient health and safety.
   2. The physician assistant holds a current license issued by the Board.
   3. Repealed by Session Laws 2019-191, s. 35, effective October 1, 2019.
   4. The supervising physician has provided to the physician assistant written instructions about indications and contraindications for prescribing drugs and a written policy for periodic review by the physician of the drugs prescribed.
   5. A physician assistant shall personally consult with the supervising physician prior to prescribing a targeted controlled substance as defined in Article 5 of this Chapter when all of the following conditions apply:
      1. The patient is being treated by a facility that primarily engages in the treatment of pain by prescribing narcotic medications.
      2. The therapeutic use of the targeted controlled substance will or is expected to exceed a period of 30 days.

         When a targeted controlled substance prescribed in accordance with this subdivision is continuously prescribed to the same patient, the physician assistant shall consult with the supervising physician at least once every 90 days to verify that the prescription remains medically appropriate for the patient.

3. Physician assistants are authorized to compound and dispense drugs under the following conditions:
   1. The function is performed under the supervision of a licensed pharmacist.
   2. Rules and regulations of the North Carolina Board of Pharmacy governing this function are complied with.
   3. The physician assistant holds a current license issued by the Board.
4. Physician assistants are authorized to order medications, tests and treatments in hospitals, clinics, nursing homes, and other health facilities under the following conditions:
   1. The North Carolina Medical Board has adopted regulations governing the approval of individual physician assistants to order medications, tests, and treatments with such limitations as the Board may determine to be in the best interest of patient health and safety.
   2. The physician assistant holds a current license issued by the Board.
   3. The supervising physician has provided to the physician assistant written instructions about ordering medications, tests, and treatments, and when appropriate, specific oral or written instructions for an individual patient, with provision for review by the physician of the order within a reasonable time, as determined by the Board, after the medication, test, or treatment is ordered.
   4. The hospital or other health facility has adopted a written policy about ordering medications, tests, and treatments, including procedures for verification of the physician assistants’ orders by nurses and other facility employees and such other procedures as are in the interest of patient health and safety.
5. Any prescription written by a physician assistant or order given by a physician assistant for medications, tests, or treatments shall be deemed to have been authorized by the physician approved by the Board as the supervisor of the physician assistant and the supervising physician shall be responsible for authorizing the prescription or order.

   (e1) Any medical certification completed by a physician assistant for a death certificate shall be deemed to have been authorized by the physician approved by the Board as the supervisor of the physician assistant, and the supervising physician shall be responsible for authorizing the completion of the medical certification.

6. Any registered nurse or licensed practical nurse who receives an order from a physician assistant for medications, tests, or treatments is authorized to perform that order in the same manner as if it were received from a licensed physician.
7. Any person who is licensed under G.S. 90-9.3 to perform medical acts, tasks, and functions as a physician assistant shall comply with each of the following:
   1. Maintain a current and active license to practice in this State.
   2. Maintain an active registration with the Board.
   3. Have a current Intent to Practice form filed with the Board.
8. A physician assistant serving active duty in the Armed Forces of the United States is exempt from the requirements of subdivision (g)(3) of this section.
9. A physician assistant’s license shall become inactive any time the holder fails to comply with the requirements of subsection (g) of this section. A physician assistant with an inactive license shall not practice medical acts, tasks, or functions. The Board shall retain jurisdiction over the holder of the inactive license.

History. 1975, c. 627; 1977, c. 904, s. 1; 1977, 2nd Sess., c. 1194, s. 1; 1995, c. 94, s. 20; 1997-511, s. 5; 2007-346, ss. 24, 25; 2011-183, s. 56; 2011-197, s. 1; 2017-74, s. 4; 2019-191, s. 35; 2021-70, s. 1(a).

§ 90-18.2. Limitations on nurse practitioners.

1. Any nurse approved under the provisions of G.S. 90-18(c)(14) to perform medical acts, tasks or functions may use the title “nurse practitioner.” Any other person who uses the title in any form or holds out to be a nurse practitioner or to be so approved, shall be deemed to be in violation of this Article.
2. Nurse practitioners are authorized to write prescriptions for drugs under all of the following conditions:
   1. The North Carolina Medical Board and Board of Nursing have adopted regulations developed by a joint subcommittee governing the approval of individual nurse practitioners to write prescriptions with such limitations as the boards may determine to be in the best interest of patient health and safety.
   2. The nurse practitioner has current approval from the boards.
   3. Repealed by Session Laws 2019-191, s. 36, effective October 1, 2019.
   4. The supervising physician has provided to the nurse practitioner written instructions about indications and contraindications for prescribing drugs and a written policy for periodic review by the physician of the drugs prescribed.
   5. A nurse practitioner shall personally consult with the supervising physician prior to prescribing a targeted controlled substance as defined in Article 5 of this Chapter when all of the following conditions apply:
      1. The patient is being treated by a facility that primarily engages in the treatment of pain by prescribing narcotic medications.
      2. The therapeutic use of the targeted controlled substance will or is expected to exceed a period of 30 days.

         When a targeted controlled substance prescribed in accordance with this subdivision is continuously prescribed to the same patient, the nurse practitioner shall consult with the supervising physician at least once every 90 days to verify that the prescription remains medically appropriate for the patient.

3. Nurse practitioners are authorized to compound and dispense drugs under the following conditions:
   1. The function is performed under the supervision of a licensed pharmacist; and
   2. Rules and regulations of the North Carolina Board of Pharmacy governing this function are complied with.
4. Nurse practitioners are authorized to order medications, tests and treatments in hospitals, clinics, nursing homes and other health facilities under all of the following conditions:
   1. The North Carolina Medical Board and Board of Nursing have adopted regulations developed by a joint subcommittee governing the approval of individual nurse practitioners to order medications, tests and treatments with such limitations as the boards may determine to be in the best interest of patient health and safety.
   2. The nurse practitioner has current approval from the boards.
   3. The supervising physician has provided to the nurse practitioner written instructions about ordering medications, tests and treatments, and when appropriate, specific oral or written instructions for an individual patient, with provision for review by the physician of the order within a reasonable time, as determined by the Board, after the medication, test or treatment is ordered.
   4. The hospital or other health facility has adopted a written policy, approved by the medical staff after consultation with the nursing administration, about ordering medications, tests and treatments, including procedures for verification of the nurse practitioners’ orders by nurses and other facility employees and such other procedures as are in the interest of patient health and safety.
5. Any prescription written by a nurse practitioner or order given by a nurse practitioner for medications, tests or treatments shall be deemed to have been authorized by the physician approved by the boards as the supervisor of the nurse practitioner and such supervising physician shall be responsible for authorizing such prescription or order.

   (e1) Any medical certification completed by a nurse practitioner for a death certificate shall be deemed to have been authorized by the physician approved by the boards as the supervisor of the nurse practitioner, and the supervising physician shall be responsible for authorizing the completion of the medical certification.

6. Any registered nurse or licensed practical nurse who receives an order from a nurse practitioner for medications, tests or treatments is authorized to perform that order in the same manner as if it were received from a licensed physician.

History. 1977, 2nd Sess., c. 1194, s. 2; 1995, c. 94, s. 21; 2011-197, s. 2; 2017-74, s. 5; 2019-191, s. 36; 2021-70, s. 1(b).

§ 90-18.2A. Physician assistants receiving, prescribing, or dispensing prescription drugs without charge or fee.

The North Carolina Medical Board shall have sole jurisdiction to regulate and license physician assistants receiving, prescribing, or dispensing prescription drugs under the supervision of a licensed physician without charge or fee to the patient. The provisions of G.S. 90-18.1(c)(1), (c)(2), and G.S. 90-85.21(b), shall not apply to the receiving, prescribing, or dispensing of prescription drugs without charge or fee to the patient.

History. 2004-124, s. 10.2E(a).

§ 90-18.3. Medical or physical examination by nurse practitioners and physician assistants.

1. Whenever a statute or State agency rule requires that a medical or physical examination shall be conducted by a physician, the examination may be conducted and the form signed by a nurse practitioner or a physician assistant, and a physician need not be present. Nothing in this section shall otherwise change the scope of practice of a nurse practitioner or a physician assistant, as defined by G.S. 90-18.1 and G.S. 90-18.2 , respectively.
2. This section shall not apply to physical examinations conducted pursuant to G.S. 1A-1 , Rule 35; G.S. 15B-12 ; G.S. 90-14 unless those statutes or rules are amended to make the provisions of this section applicable.

History. 1999-226, s. 1; 2004-124, s. 18.2(f); 2019-191, s. 37.

Effect of Amendments.

Session Laws 2004-124, s. 18.2(f), effective July 1, 2004, deleted “or any rules adopted by the North Carolina Boxing Commission requiring physical examinations” following “G.S. 90-14” in subsection (b).

Session Laws 2019-191, s. 37, effective October 1, 2019, substituted “Medical or physician” for “Physical” in the section heading; and, in subsection (a), inserted “medical or” and substituted “physician” for “physician’s” twice.

§ 90-18.4. Limitations on clinical pharmacist practitioners.

1. Any pharmacist who is approved under the provisions of G.S. 90-18(c)(3a) to perform medical acts, tasks, and functions may use the title “clinical pharmacist practitioner”. Any other person who uses the title in any form or holds himself or herself out to be a clinical pharmacist practitioner or to be so licensed shall be deemed to be in violation of this Article.
2. Clinical pharmacist practitioners are authorized to implement predetermined drug therapy, which includes diagnosis and product selection by the patient’s physician, modify prescribed drug dosages, dosage forms, and dosage schedules, and to order laboratory tests pursuant to a drug therapy management agreement that is physician, pharmacist, patient, and disease specific under the following conditions:
   1. The North Carolina Medical Board and the North Carolina Board of Pharmacy have adopted rules developed by a joint subcommittee governing the approval of individual clinical pharmacist practitioners to practice drug therapy management with such limitations that the Boards determine to be in the best interest of patient health and safety.
   2. The clinical pharmacist practitioner has current approval from both Boards.
   3. The North Carolina Medical Board has assigned an identification number to the clinical pharmacist practitioner which is shown on written prescriptions written by the clinical pharmacist practitioner.
   4. The drug therapy management agreement prohibits the substitution of a chemically dissimilar drug product by the pharmacist for the product prescribed by the physician without the explicit consent of the physician and includes a policy for periodic review by the physician of the drugs modified pursuant to the agreement or changed with the consent of the physician.
3. Clinical pharmacist practitioners in hospitals and other health facilities that have an established pharmacy and therapeutics committee or similar group that determines the prescription drug formulary or other list of drugs to be utilized in the facility and determines procedures to be followed when considering a drug for inclusion on the formulary and procedures to acquire a nonformulary drug for a patient may order medications and tests under the following conditions:
   1. The North Carolina Medical Board and the North Carolina Board of Pharmacy have adopted rules governing the approval of individual clinical pharmacist practitioners to order medications and tests with such limitations as the Boards determine to be in the best interest of patient health and safety.
   2. The clinical pharmacist practitioner has current approval from both Boards.
   3. The supervising physician has provided to the clinical pharmacist practitioner written instructions for ordering, changing, or substituting drugs, or ordering tests with provision for review of the order by the physician within a reasonable time, as determined by the Boards, after the medication or tests are ordered.
   4. The hospital or health facility has adopted a written policy, approved by the medical staff after consultation with nursing administrators, concerning the ordering of medications and tests, including procedures for verification of the clinical pharmacist practitioner’s orders by nurses and other facility employees and such other procedures that are in the best interest of patient health and safety.
   5. Any drug therapy order written by a clinical pharmacist practitioner or order for medications or tests shall be deemed to have been authorized by the physician approved by the Boards as the supervisor of the clinical pharmacist practitioner and the supervising physician shall be responsible for authorizing the prescription order.
4. Any registered nurse or licensed practical nurse who receives a drug therapy order from a clinical pharmacist practitioner for medications or tests is authorized to perform that order in the same manner as if the order was received from a licensed physician.

History. 1999-290, s. 3.

§ 90-18.5. Limitations on anesthesiologist assistants.

1. Any person who is licensed to provide anesthesia services as an assistant to an anesthesiologist licensed under Article 1 of this Chapter may use the title “anesthesiologist assistant.” Any other person who uses the title in any form or holds himself or herself out to be an anesthesiologist assistant or to be so licensed without first obtaining a license shall be deemed in violation of this Article. A student in any anesthesiologist assistant training program shall be identified as a “student anesthesiologist assistant” or an “anesthesiologist assistant student,” but under no circumstances shall the student use or permit to be used on the student’s behalf the terms “intern,” “resident,” or “fellow.”
2. Anesthesiologist assistants are authorized to provide anesthesia services under the supervision of an anesthesiologist licensed under Article 1 of this Chapter under the following conditions:
   1. The North Carolina Medical Board has adopted rules governing the provision of anesthesia services by an anesthesiologist assistant consistent with the requirements of subsection (c) of this section.
   2. The anesthesiologist assistant holds a current license issued by the Board or is a student anesthesiologist assistant participating in a training program leading to certification by the National Commission for Certification of Anesthesiologist Assistants and licensure as an anesthesiologist assistant under G.S. 90-9.4 .
3. The North Carolina Medical Board shall adopt rules to implement this section that include requirements and limitations on the provision of anesthesia services by an anesthesiologist assistant as determined by the Board to be in the best interests of patient health and safety. Rules adopted by the Board pursuant to this section shall include the following requirements:
   1. That an anesthesiologist assistant be supervised by an anesthesiologist licensed under this Article who is actively engaged in clinical practice and immediately available on-site to provide assistance to the anesthesiologist assistant.
   2. That an anesthesiologist may supervise no more than two anesthesiologist assistants or student anesthesiologist assistants at one time. The limitation on the number of anesthesiologist assistants and student anesthesiologist assistants that an anesthesiologist may supervise in no way restricts the number of other qualified anesthesia providers an anesthesiologist may concurrently supervise. After January 1, 2010, the Board may allow an anesthesiologist to supervise up to four licensed anesthesiologist assistants concurrently and may revise the supervision limitations of student anesthesiologist assistants such that the supervision requirements for student anesthesiologist assistants are similar to the supervision requirements for student nurse anesthetists.
   3. That anesthesiologist assistants comply with all continuing education requirements and recertification requirements of the National Commission for Certification of Anesthesiologist Assistants or its successor organization.
4. Nothing in this section shall limit or expand the scope of practice of physician assistants under existing law.

History. 2007-146, s. 4; 2008-187, s. 14.

Effect of Amendments.

Session Laws 2008-187, s. 14, effective August 7, 2008, substituted “G.S. 90-9.4” for “G.S. 90-11(a1)” in subdivision (b)(2).

§ 90-18.6. Requirements for certain nicotine replacement therapy programs.

The Health and Wellness Trust Fund (“Trust Fund”) or the Department of Health and Human Services (“Department”) may contract for the operation of a tobacco-use cessation program through which the Trust Fund or the Department, as applicable, may engage agents or contractors for the purpose of (i) recommending to individuals over-the-counter nicotine replacement therapy products and supplying the products free of charge to the individual and (ii) discussing with the individual contraindications and all other aspects of over-the-counter nicotine replacement therapy. All medical aspects of the nicotine replacement therapy programs shall be supervised by a physician who is licensed under this Article to practice medicine and who is under contract to or employed by the Trust Fund or the Department, as applicable, for the purpose of supervising nicotine replacement therapy programs. The physician under contract with or employed by the Trust Fund or the Department, as applicable, shall be responsible for supervision of all agents or contractors of nicotine replacement therapy programs that provide nicotine replacement therapy services to members of the public. The Trust Fund or the Department, as contracting entity, shall report the name of the supervising physician to the North Carolina Medical Board.

History. 2008-107, s. 10.4B.

§ 90-18.7. [Repealed]

Repealed by Session Laws 2019-191, s. 38, effective October 1, 2019.

History. 2013-43, s. 2; repealed by 2019-191, s. 38, effective October 1, 2019.

§§ 90-19, 90-20. [Repealed]

Repealed by Session Laws 1967, c. 691, s. 59.

§ 90-21. [Repealed]

Repealed by Session Laws 2007-346, s. 26, effective October 1, 2007.

§ 90-21.1. When physician may treat minor without consent of parent, guardian or person in loco parentis.

It shall be lawful for any physician licensed to practice medicine in North Carolina to render treatment to any minor without first obtaining the consent and approval of either the father or mother of said child, or any person acting as guardian, or any person standing in loco parentis to said child where:

1. The parent or parents, the guardian, or a person standing in loco parentis to said child cannot be located or contacted with reasonable diligence during the time within which said minor needs to receive the treatment herein authorized, or
2. Where the identity of the child is unknown, or where the necessity for immediate treatment is so apparent that any effort to secure approval would delay the treatment so long as to endanger the life of said minor, or
3. Where an effort to contact a parent, guardian, or person standing in loco parentis would result in a delay that would seriously worsen the physical condition of said minor, or
4. Where the parents refuse to consent to a procedure, and the necessity for immediate treatment is so apparent that the delay required to obtain a court order would endanger the life or seriously worsen the physical condition of the child. No treatment shall be administered to a child over the parent’s objection as herein authorized unless the physician shall first obtain the opinion of another physician licensed to practice medicine in the State of North Carolina that such procedure is necessary to prevent immediate harm to the child.

   Provided, however, that the refusal of a physician to use, perform or render treatment to a minor without the consent of the minor’s parent, guardian, or person standing in the position of loco parentis, in accordance with this Article, shall not constitute grounds for a civil action or criminal proceedings against such physician.

History. 1965, c. 810, s. 1; 1977, c. 625, s. 1.

Cross References.

As to application of this section to surgical operations on inmates of State penal institutions, see G.S. 148-22.2 .

OPINIONS OF ATTORNEY GENERAL

See opinion of Attorney General to Lena S. Davis, 41 N.C. Op. Att'y Gen. 489 (1971).

See opinion of Attorney General to Mr. Ed McClearsen, Staff Attorney, Mental Health Study Commission, 47 N.C. Op. Att'y Gen. 83 (1977).

A physician associated with a publicly supported family planning clinic can delegate responsibility for medically related contraceptive services to a nurse practitioner or physician’s assistant whom he supervises and who functions under his standing orders, if these functions are specifically approved for the individual nurse practitioner or physician’s assistant by the Board of Medical Examiners. Opinion of Attorney General to Margie Rose, M.P.H. Branch Head, Family Planning Branch, Division of Health Services, 47 N.C. Op. Att'y Gen. 80 (1977).

Counseling minors for sickle cell disease and related genetic disorders does not constitute “treatment” as defined under G.S. 90-21.2 . See opinion of Attorney General to Sarah T. Morrow, M.D., M.P.H., Secretary, Dep’t of Human Resources, 49 N.C. Op. Att'y Gen. 181 (1980).

Parental consent is required for counseling minors for sickle cell disease and related genetic disorders and such consent remains valid for later counseling if obtained at the time of testing. See opinion of Attorney General of Sarah T. Morrow, M.D., M.P.H., Secretary, Dep’t of Human Resources, 49 N.C. Op. Att'y Gen. 181 (1980).

To provide genetic counseling to minors without consent would appear to be a violation of the common-law principles governing the parent-child relationship and thus would leave the individual providing these services potentially vulnerable to litigation. See opinion of Attorney General to Sarah T. Morrow, M.D., M.P.H., Secretary, Dep’t of Human Resources, 49 N.C. Op. Att'y Gen. 181 (1980).

§ 90-21.2. “Treatment” defined.

The word “treatment” as used in G.S. 90-21.1 is hereby defined to mean any medical procedure or treatment, including X rays, the administration of drugs, blood transfusions, use of anesthetics, and laboratory or other diagnostic procedures employed by or ordered by a physician licensed to practice medicine in the State of North Carolina that is used, employed, or ordered to be used or employed commensurate with the exercise of reasonable care and equal to the standards of medical practice normally employed in the community where said physician administers treatment to said minor.

History. 1965, c. 810, s. 2.

Legal Periodicals.

For article, “Operationalizing the Standard of Medical Care: Uses and Limitations of Epidemiology to Guide Expert Testimony in Medical Negligence Allegations,” see 37 Wake Forest L. Rev. 675 (2002).

For article, “Jurors as Beneficiaries of Proposals to Objectify Proof of the Standard of Care in Medical Malpractice Cases,” see 37 Wake Forest L. Rev. 943 (2002).

For article, “Observations on the Search for Objective Proof of the Standard of Care in Medical Malpractice Cases,” see 37 Wake Forest L. Rev. 953 (2002).

For article, “Ascertaining Customary Care in Malpractice Cases: Asking Those Who Know,” see 37 Wake Forest L. Rev. 699 (2002).

For article, “Empirical Evidence and Malpractice Litigation,” see 37 Wake Forest L. Rev. 757 (2002).

For article, “Measuring Medical Practice Patterns: Sources of Evidence from Health Services Research,” see 37 Wake Forest L. Rev. 779 (2002).

For article, “Using Statistical Evidence to Prove the Malpractice Standard of Care: Bridging Legal, Clinical, and Statistical Thinking,” see 37 Wake Forest L. Rev. 821 (2002).

For article, “Determining the Standard of Care in Medical Malpractice: The Physician’s Perspective,” see 37 Wake Forest L. Rev. 861 (2002).

For article, “The Process of Managing Medical Malpractice Cases: The Role of Standard of Care,” see 37 Wake Forest L. Rev. 877 (2002).

For article, “Following the Man on the Clapham Omnibus: Social Science Evidence in Malpractice Litigation,” see 37 Wake Forest L. Rev. 903 (2002).

For article, “Unwarranted Variations in the Quality of Health Care: Can the Law Help Medicine Provide a Remedy/Remedies,” see 37 Wake Forest L. Rev. 925 (2002).

For comment, “Setting the ‘Bar’ in North Carolina Medical Malpractice Litigation: Working with the Standard of Care that Everyone Loves to Hate,” see 89 N.C.L. Rev. 234 (2010).

§ 90-21.3. Performance of surgery on minor; obtaining second opinion as to necessity.

The word “treatment” as defined in G.S. 90-21.2 shall also include any surgical procedure which in the opinion of the attending physician is necessary under the terms and conditions set out in G.S. 90-21.1 ; provided, however, no surgery shall be conducted upon a minor as herein authorized unless the surgeon shall first obtain the opinion of another physician licensed to practice medicine in the State of North Carolina that said surgery is necessary under the conditions set forth in G.S. 90-21.1 ; provided further, that in any emergency situation that shall arise in a rural community, or in a community where it is impossible for the surgeon to contact any other physician for the purpose of obtaining his opinion as to the necessity for immediate surgery, it shall not be necessary for the surgeon to obtain approval from another physician before performing such surgery as is necessary under the terms and conditions set forth in G.S. 90-21.1.

History. 1965, c. 810, s. 3.

§ 90-21.4. Responsibility, liability and immunity of physicians.

1. Any physician licensed to practice medicine in North Carolina providing health services to a minor under the terms, conditions and circumstances of this Article shall not be held liable in any civil or criminal action for providing such services without having obtained permission from the minor’s parent, legal guardian, person standing in loco parentis, or a legal custodian other than a parent when granted specific authority in a custody order to consent to medical or psychiatric treatment. The physician shall not be relieved on the basis of this Article from liability for negligence in the diagnosis and treatment of a minor.
2. The physician shall not notify a parent, legal guardian, person standing in loco parentis, or a legal custodian other than a parent when granted specific authority in a custody order to consent to medical or psychiatric treatment, without the permission of the minor, concerning the medical health services set out in G.S. 90-21.5(a) , unless the situation in the opinion of the attending physician indicates that notification is essential to the life or health of the minor. If a parent, legal guardian[,] person standing in loco parentis, or a legal custodian other than a parent when granted specific authority in a custody order to consent to medical or psychiatric treatment contacts the physician concerning the treatment or medical services being provided to the minor, the physician may give information.

History. 1965, c. 810, s. 4; 1977, c. 582, s. 1; 1985, c. 589, s. 30.

OPINIONS OF ATTORNEY GENERAL

This section provides immunity from civil or criminal liability to a nurse practitioner or physician’s assistant for non-negligent acts performed under the physician’s supervision and while functioning under the physician’s standing orders if the delegation of responsibility is proper. Opinion of Attorney General to Margie Rose, M.P.H. Branch Head, Family Planning Branch, Division of Health Services, 47 N.C. Op. Att'y Gen. 80 (1977).

§ 90-21.5. Minor’s consent sufficient for certain medical health services.

1. Subject to subsection (a1) of this section, any minor may give effective consent to a physician licensed to practice medicine in North Carolina for medical health services for the prevention, diagnosis and treatment of (i) venereal disease and other diseases reportable under G.S. 130A-135 , (ii) pregnancy, (iii) abuse of controlled substances or alcohol, and (iv) emotional disturbance. This section does not authorize the inducing of an abortion, performance of a sterilization operation, or admission to a 24-hour facility licensed under Article 2 of Chapter 122C of the General Statutes except as provided in G.S. 122C-223 . This section does not prohibit the admission of a minor to a treatment facility upon his own written application in an emergency situation as authorized by G.S. 122C-223 . (a1) Notwithstanding any other provision of law to the contrary, a health care provider shall obtain written consent from a parent or legal guardian prior to administering any vaccine that has been granted emergency use authorization and is not yet fully approved by the United States Food and Drug Administration to an individual under 18 years of age.
2. Any minor who is emancipated may consent to any medical treatment, dental and health services for himself or for his child.

History. 1971, c. 35; 1977, c. 582, s. 2; 1983, c. 302, s. 2; 1985, c. 589, s. 31; 1985 (Reg. Sess., 1986), c. 863, s. 4; 2009-570, s. 10; 2021-110, s. 9.

§ 90-21.6. Definitions.

For the purposes of Part 2 only of this Article, unless the context clearly requires otherwise:

1. “Unemancipated minor” or “minor” means any person under the age of 18 who has not been married or has not been emancipated pursuant to Article 35 of Chapter 7B of the General Statutes.
2. “Abortion” means the use or prescription of any instrument, medicine, drug, or any other substance or device with intent to terminate the pregnancy of a woman known to be pregnant, for reasons other than to save the life or preserve the health of an unborn child, to remove a dead unborn child, or to deliver an unborn child prematurely, by accepted medical procedures in order to preserve the health of both the mother and the unborn child.

History. 1995, c. 462, s. 1; 1998-202, s. 13(t).

§ 90-21.7. Parental consent required.

1. No physician licensed to practice medicine in North Carolina shall perform an abortion upon an unemancipated minor unless the physician or agent thereof or another physician or agent thereof first obtains the written consent of the minor and of:
   1. A parent with custody of the minor; or
   2. The legal guardian or legal custodian of the minor; or
   3. A parent with whom the minor is living; or
   4. A grandparent with whom the minor has been living for at least six months immediately preceding the date of the minor’s written consent.
2. The pregnant minor may petition, on her own behalf or by guardian ad litem, the district court judge assigned to the juvenile proceedings in the district court where the minor resides or where she is physically present for a waiver of the parental consent requirement if:
   1. None of the persons from whom consent must be obtained pursuant to this section is available to the physician performing the abortion or the physician’s agent or the referring physician or the agent thereof within a reasonable time or manner; or
   2. All of the persons from whom consent must be obtained pursuant to this section refuse to consent to the performance of an abortion; or
   3. The minor elects not to seek consent of the person from whom consent is required.

History. 1995, c. 462, s. 1.

Legal Periodicals.

For comment, “The Burial of an Impartial Judicial System: The Lifting of Restrictions on Judicial Candidate Speech in North Carolina,” see 33 Wake Forest L. Rev. 413 (1998).

For a note on minors’ rights vis-a-vis abortion, see 1999 Duke L.J. 297 (1999).

§ 90-21.8. Procedure for waiver of parental consent.

1. The requirements and procedures under Part 2 of this Article are available and apply to unemancipated minors seeking treatment in this State.
2. The court shall ensure that the minor or her guardian ad litem is given assistance in preparing and filing the petition and shall ensure that the minor’s identity is kept confidential.
3. The minor may participate in proceedings in the court on her own behalf or through a guardian ad litem. The court shall advise her that she has a right to appointed counsel, and counsel shall be provided upon her request in accordance with rules adopted by the Office of Indigent Defense Services.
4. Court proceedings under this section shall be confidential and shall be given precedence over other pending matters necessary to ensure that the court may reach a decision promptly. In no case shall the court fail to rule within seven days of the time of filing the application. This time limitation may be extended at the request of the minor. At the hearing, the court shall hear evidence relating to the emotional development, maturity, intellect, and understanding of the minor; the nature, possible consequences, and alternatives to the abortion; and any other evidence that the court may find useful in determining whether the parental consent requirement shall be waived.
5. The parental consent requirement shall be waived if the court finds:
   1. That the minor is mature and well-informed enough to make the abortion decision on her own; or
   2. That it would be in the minor’s best interests that parental consent not be required; or
   3. That the minor is a victim of rape or of felonious incest under G.S. 14-178 .
6. The court shall make written findings of fact and conclusions of law supporting its decision and shall order that a confidential record of the evidence be maintained. If the court finds that the minor has been a victim of incest, whether felonious or misdemeanor, it shall advise the Director of the Department of Social Services of its findings for further action pursuant to Article 3 of Chapter 7B of the General Statutes.
7. If the female petitioner so requests in her petition, no summons or other notice may be served upon the parents, guardian, or custodian of the minor female.
8. The minor may appeal an order issued in accordance with this section. The appeal shall be a de novo hearing in superior court. The notice of appeal shall be filed within 24 hours from the date of issuance of the district court order. The de novo hearing may be held out of district and out of session and shall be held as soon as possible within seven days of the filing of the notice of appeal. The record of the de novo hearing is a confidential record and shall not be open for general public inspection. The Chief Justice of the North Carolina Supreme Court shall adopt rules necessary to implement this subsection.
9. No court costs shall be required of any minor who avails herself of the procedures provided by this section.

History. 1995, c. 462, s. 1; 1998-202, s. 13(u); 2000-144, s. 35.

Cross References.

For the Indigent Defense Services Act, see Chapter 7A, Subchapter IX, Article 39B.

§ 90-21.9. Medical emergency exception.

The requirements of parental consent prescribed by G.S. 90- 21.7(a) shall not apply when, in the best medical judgment of the physician based on the facts of the case before the physician, a medical emergency exists that so complicates the pregnancy as to require an immediate abortion, or when the conditions prescribed by G.S. 90-21.1(4) are met.

History. 1995, c. 462, s. 1.

§ 90-21.10. Penalty.

Any person who intentionally performs an abortion with knowledge that, or with reckless disregard as to whether, the person upon whom the abortion is to be performed is an unemancipated minor, and who intentionally or knowingly fails to conform to any requirement of Part 2 of this Article shall be guilty of a Class 1 misdemeanor.

History. 1995, c. 462, s. 1.

§ 90-21.11. Definitions.

The following definitions apply in this Article:

1. Health care provider. —  Without limitation, any of the following:
   1. A person who pursuant to the provisions of Chapter 90 of the General Statutes is licensed, or is otherwise registered or certified to engage in the practice of or otherwise performs duties associated with any of the following: medicine, surgery, dentistry, pharmacy, optometry, midwifery, osteopathy, podiatry, chiropractic, radiology, nursing, physiotherapy, pathology, anesthesiology, anesthesia, laboratory analysis, rendering assistance to a physician, dental hygiene, psychiatry, or psychology.
   2. A hospital, a nursing home licensed under Chapter 131E of the General Statutes, or an adult care home licensed under Chapter 131D of the General Statutes.
   3. Any other person who is legally responsible for the negligence of a person described by sub-subdivision a. of this subdivision, a hospital, a nursing home licensed under Chapter 131E of the General Statutes, or an adult care home licensed under Chapter 131D of the General Statutes.
   4. Any other person acting at the direction or under the supervision of a person described by sub-subdivision a. of this subdivision, a hospital, a nursing home licensed under Chapter 131E of the General Statutes, or an adult care home licensed under Chapter 131D of the General Statutes.
   5. Any paramedic, as defined in G.S. 131E-155(15a).
2. Medical malpractice action. — Either of the following:
   1. A civil action for damages for personal injury or death arising out of the furnishing or failure to furnish professional services in the performance of medical, dental, or other health care by a health care provider.
   2. A civil action against a hospital, a nursing home licensed under Chapter 131E of the General Statutes, or an adult care home licensed under Chapter 131D of the General Statutes for damages for personal injury or death, when the civil action (i) alleges a breach of administrative or corporate duties to the patient, including, but not limited to, allegations of negligent credentialing or negligent monitoring and supervision and (ii) arises from the same facts or circumstances as a claim under sub-subdivision a. of this subdivision.

History. 1975, 2nd Sess., c. 977, s. 4; 1987, c. 859, s. 1; 1995, c. 509, s. 135.2(o); 2011-400, s. 5; 2017-131, s. 1.

Cross References.

As to limitation of actions for malpractice, see G.S. 1-15 and G.S. 1-17 .

As to liability insurance or self-insurance covering health-care practitioners employed by The University of North Carolina, see G.S. 116-219 through 116-222.

§ 90-21.12. Standard of health care.

1. Except as provided in subsection (b) of this section, in any medical malpractice action as defined in G.S. 90-21.11(2)(a), the defendant health care provider shall not be liable for the payment of damages unless the trier of fact finds by the greater weight of the evidence that the care of such health care provider was not in accordance with the standards of practice among members of the same health care profession with similar training and experience situated in the same or similar communities under the same or similar circumstances at the time of the alleged act giving rise to the cause of action; or in the case of a medical malpractice action as defined in G.S. 90-21.11(2)(b), the defendant health care provider shall not be liable for the payment of damages unless the trier of fact finds by the greater weight of the evidence that the action or inaction of such health care provider was not in accordance with the standards of practice among similar health care providers situated in the same or similar communities under the same or similar circumstances at the time of the alleged act giving rise to the cause of action.
2. In any medical malpractice action arising out of the furnishing or the failure to furnish professional services in the treatment of an emergency medical condition, as the term “emergency medical condition” is defined in 42 U.S.C. § 1395dd(e)(1)(A), the claimant must prove a violation of the standards of practice set forth in subsection (a) of this section by clear and convincing evidence.

History. 1975, 2nd Sess., c. 977, s. 4; 2011-283, s. 4.1(a); 2011-400, s. 6.

Effect of Amendments.

Session Laws 2011-283, s. 4.1(a), effective June 24, 2011, updated the federal reference in subsection (b).

Session Laws 2011-400, s. 6, effective October 1, 2011, and applicable to causes of actions arising on or after that date, rewrote the section.

Legal Periodicals.

For comment on the statutory standard of care for North Carolina health care providers, see 1 Campbell L. Rev. 111 (1979).

For article discussing the North Carolina medical malpractice statute, see 62 N.C.L. Rev. 711 (1984).

For note suggesting the need for a new tort of breach of confidence, in light of Watts v. Cumberland County Hospital System, 75 N.C. App. 1, 330 S.E.2d 242 (1985), see 8 Campbell L. Rev. 145 (1985).

For note, “Psychiatrists’ Liability to Third Parties for Harmful Acts Committed by Dangerous Patients,” see 64 N.C.L. Rev. 1534 (1986).

For article, “The American Medical Association vs. The American Tort System,” see 8 Campbell L. Rev. 241 (1986).

For note on expansion of the application of res ipsa loquitur in medical malpractice, in light of Parks v. Perry, 68 N.C. App. 202, 314 S.E.2d 287, cert. denied, 311 N.C. 761 , 321 S.E.2d 142 (1984), see 21 Wake Forest L. Rev. 537 (1986).

For note, “Nurse Malpractice in North Carolina: The Standard of Care,” see 65 N.C.L. Rev. 579 (1987).

For note, “Liability in the Absence of a Traditional Physician-Patient Relationship: What Every ‘On Call’ Doctor Should Know: Mozingo v. Pitt County Memorial Hospital,” see 28 Wake Forest L. Rev. 747 (1993).

For note, “The Evolution and Status of the Contributory Negligence Defense to Medical Malpractice Actions in North Carolina — McGill v. French,” see 16 Campbell L. Rev. 103 (1994).

For comment, “North Carolina’s Limited Liability Company Act: A Legislative Mandate for Professional Limited Liability,” see 29 Wake Forest L. Rev. 857 (1994).

For article, “Senate Bill 33 Grants Protection to Emergency Room Providers ... and Just About Everyone Else, Too,” see 91 N.C.L. Rev. 720 (2013).

For article, “Medical Malpractice and Wrongful Death: Some Lives are Worth More Than Others,” see 8 Elon L. Rev. 461 (2016).

For comment, “Two Tiers of Plaintiffs: How North Carolina’s Tort Reform Efforts Discriminate Against Low-Income Plaintiffs,” see 96 N.C.L. Rev. 512 (2018).

For article, “Aid in Dying in North Carolina,” see 97 N.C. L. Rev. Addendum 1 (2019).

§ 90-21.12A. Nonresident physicians.

A patient may bring a medical malpractice claim in the courts of this State against a nonresident physician who practices medicine or surgery by use of any electronic or other media in this State.

History. 1997-514, s. 2.

Legal Periodicals.

For 1997 legislative survey, see 20 Campbell L. Rev. 469 (1998).

§ 90-21.13. Informed consent to health care treatment or procedure.

1. No recovery shall be allowed against any health care provider upon the grounds that the health care treatment was rendered without the informed consent of the patient or other person authorized to give consent for the patient where:
   1. The action of the health care provider in obtaining the consent of the patient or other person authorized to give consent for the patient was in accordance with the standards of practice among members of the same health care profession with similar training and experience situated in the same or similar communities; and
   2. A reasonable person, from the information provided by the health care provider under the circumstances, would have a general understanding of the procedures or treatments and of the usual and most frequent risks and hazards inherent in the proposed procedures or treatments which are recognized and followed by other health care providers engaged in the same field of practice in the same or similar communities; or
   3. A reasonable person, under all the surrounding circumstances, would have undergone such treatment or procedure had he been advised by the health care provider in accordance with the provisions of subdivisions (1) and (2) of this subsection.
2. A consent which is evidenced in writing and which meets the foregoing standards, and which is signed by the patient or other authorized person, shall be presumed to be a valid consent. This presumption, however, may be subject to rebuttal only upon proof that such consent was obtained by fraud, deception or misrepresentation of a material fact. A consent that meets the foregoing standards, that is given by a patient, or other authorized person, who under all the surrounding circumstances has capacity to make and communicate health care decisions, is a valid consent.
3. The following persons, in the order indicated, are authorized to consent to medical treatment on behalf of a patient who is comatose or otherwise lacks capacity to make or communicate health care decisions:
   1. A guardian of the patient’s person, or a general guardian with powers over the patient’s person, appointed by a court of competent jurisdiction pursuant to Article 5 of Chapter 35A of the General Statutes; provided that, if the patient has a health care agent appointed pursuant to a valid health care power of attorney, the health care agent shall have the right to exercise the authority to the extent granted in the health care power of attorney and to the extent provided in G.S. 32A-19(a) unless the Clerk has suspended the authority of that health care agent in accordance with G.S. 35A-1208(a) .
   2. A health care agent appointed pursuant to a valid health care power of attorney, to the extent of the authority granted.
   3. An agent, with powers to make health care decisions for the patient, appointed by the patient, to the extent of the authority granted.
   4. The patient’s spouse.
   5. A majority of the patient’s reasonably available parents and children who are at least 18 years of age.
   6. A majority of the patient’s reasonably available siblings who are at least 18 years of age.
   7. An individual who has an established relationship with the patient, who is acting in good faith on behalf of the patient, and who can reliably convey the patient’s wishes. (c1) If none of the persons listed under subsection (c) of this section is reasonably available, then the patient’s attending physician, in the attending physician’s discretion, may provide health care treatment without the consent of the patient or other person authorized to consent for the patient if there is confirmation by a physician other than the patient’s attending physician of the patient’s condition and the necessity for treatment; provided, however, that confirmation of the patient’s condition and the necessity for treatment are not required if the delay in obtaining the confirmation would endanger the life or seriously worsen the condition of the patient.
4. No action may be maintained against any health care provider upon any guarantee, warranty or assurance as to the result of any medical, surgical or diagnostic procedure or treatment unless the guarantee, warranty or assurance, or some note or memorandum thereof, shall be in writing and signed by the provider or by some other person authorized to act for or on behalf of such provider.
5. In the event of any conflict between the provisions of this section and those of G.S. 35A-1245 , 90-21.17, and 90-322, Articles 1A and 19 of Chapter 90, and Article 3 of Chapter 122C of the General Statutes, the provisions of those sections and Articles shall control and continue in full force and effect.

History. 1975, 2nd Sess., c. 977, s. 4; 2003-13, s. 5; 2007-502, s. 13; 2008-187, s. 37(b); 2017-153, s. 2.5; 2018-142, s. 35(a).

Cross References.

As to application of this section to surgical operations on inmates of State penal institutions, see G.S. 148-22.2 .

As to application of this section to treatment of prisoners’ self-inflicted injuries, see G.S. 148-46.2 .

§ 90-21.14. First aid or emergency treatment; liability limitation.

1. Any person, including a volunteer medical or health care provider at a facility of a local health department as defined in G.S. 130A-2 or at a nonprofit community health center or a volunteer member of a rescue squad, who voluntarily and without expectation of compensation renders first aid or emergency health care treatment to a person who is unconscious, ill or injured,
   1. When the reasonably apparent circumstances require prompt decisions and actions in medical or other health care, and
   2. When the necessity of immediate health care treatment is so reasonably apparent that any delay in the rendering of the treatment would seriously worsen the physical condition or endanger the life of the person, shall not be liable for damages for injuries alleged to have been sustained by the person or for damages for the death of the person alleged to have occurred by reason of an act or omission in the rendering of the treatment unless it is established that the injuries were or the death was caused by gross negligence, wanton conduct or intentional wrongdoing on the part of the person rendering the treatment. The immunity conferred in this section also applies to any person who uses an automated external defibrillator (AED) and otherwise meets the requirements of this section.

      (a1) Recodified as G.S. 90-21.16 by Session Laws 2001-230, s. 1(a), effective October 1, 2001.

2. Nothing in this section shall be deemed or construed to relieve any person from liability for damages for injury or death caused by an act or omission on the part of such person while rendering health care services in the normal and ordinary course of his business or profession. Services provided by a volunteer health care provider who receives no compensation for his services and who renders first aid or emergency treatment to members of athletic teams are deemed not to be in the normal and ordinary course of the volunteer health care provider’s business or profession.
3. In the event of any conflict between the provisions of this section and those of G.S. 20-166(d), the provisions of G.S. 20-166(d) shall control and continue in full force and effect.

History. 1975, 2nd Sess., c. 977, s. 4; 1985, c. 611, s. 2; 1989, cc. 498, 655; 1991, c. 655, s. 1; 1993, c. 439, s. 1; 1995, c. 85, s. 1; 2000-5, s. 4; 2001-230, ss. 1(a), 2; 2009-424, s. 1; 2014-120, s. 18.

Cross References.

As to immunity from liability of persons rendering first aid or emergency assistance at the scene of a motor vehicle accident, see G.S. 20-166(d).

As to application of this section to surgical operations on inmates of State penal institutions, see G.S. 148-22.2 .

As to application of this section to treatment of prisoners’ self-inflicted injuries, see G.S. 148-46.2 .

§ 90-21.15. Emergency treatment using automated external defibrillator; immunity.

1. It is the intent of the General Assembly that, when used in accordance with this section, an automated external defibrillator may be used during an emergency for the purpose of attempting to save the life of another person who is in or who appears to be in cardiac arrest.
2. For purposes of this section:
   1. “Automated external defibrillator” means a device, heart monitor, and defibrillator that meets all of the following requirements:
      1. The device has received approval from the United States Food and Drug Administration of its premarket notification filed pursuant to 21 U.S.C. § 360(k), as amended.
      2. The device is capable of recognizing the presence or absence of ventricular fibrillation or rapid ventricular tachycardia and is capable of determining, without intervention by an operator, whether defibrillation should be performed.
      3. Upon determining that defibrillation should be performed, the device automatically charges and requests delivery of, or delivers, an electrical impulse to an individual’s heart.
   2. “Person” means an individual, corporation, limited liability company, partnership, association, unit of government, or other legal entity.
   3. “Training” means a nationally recognized course or training program in cardiopulmonary resuscitation (CPR) and automated external defibrillator use including the programs approved and provided by the:
      1. American Heart Association.
      2. American Red Cross.
3. The use of an automated external defibrillator when used to attempt to save or to save a life shall constitute “first-aid or emergency health care treatment” under G.S. 90-21.14(a).
4. The person who provides the cardiopulmonary resuscitation and automated external defibrillator training to a person using an automated external defibrillator, the person responsible for the site where the automated external defibrillator is located when the person has provided for a program of training, and a North Carolina licensed physician writing a prescription without compensation for an automated external defibrillator whether or not required by any federal or state law, shall be immune from civil liability arising from the use of an automated external defibrillator used in accordance with subsection (c) of this section.
5. The immunity from civil liability otherwise existing under law shall not be diminished by the provisions of this section.
6. Nothing in this section requires the purchase, placement, or use of automated external defibrillators by any person, entity, or agency of State, county, or local government. Nothing in this section applies to a product’s liability claim against a manufacturer or seller as defined in G.S. 99B-1 .
7. In order to enhance public health and safety, a seller of an automated external defibrillator shall notify the North Carolina Department of Health and Human Services, Division of Health Service Regulation, Office of Emergency Medical Services of the existence, location, and type of automated external defibrillator.

History. 2000-113, s. 1; 2007-182, s. 1.1.

§ 90-21.15A. Emergency treatment using epinephrine auto-injector; immunity.

1. Definitions. —  The following definitions apply in this section:
   1. Administer. — The direct application of an epinephrine auto-injector to the body of an individual.
   2. Authorized entity. — Any entity or organization, other than a school described in G.S. 115C-375.2 A, at which allergens capable of causing anaphylaxis may be present, including, but not limited to, recreation camps, colleges, universities, day care facilities, youth sports leagues, amusement parks, restaurants, places of employment, and sports arenas. An authorized entity shall also include any person, corporation, or other entity that owns or operates any entity or organization listed.
   3. Epinephrine auto-injector. — A single-use device used for the automatic injection of a premeasured dose of epinephrine into the human body.
   4. Health care provider. — A health care provider licensed to prescribe drugs under the laws of this State.
   5. Provide. — To supply one or more epinephrine auto-injectors to an individual.
2. Prescribing to Authorized Entities Permitted. —  A health care provider may prescribe epinephrine auto-injectors in the name of an authorized entity for use in accordance with this section, and pharmacists and health care providers may dispense epinephrine auto-injectors pursuant to a prescription issued in the name of an authorized entity. A prescription issued pursuant to this section shall be valid for no more than two years.
3. Authorized Entities Permitted to Maintain Supply. —  An authorized entity may acquire and stock a supply of epinephrine auto-injectors pursuant to a prescription issued in accordance with this section. An authorized entity that acquires and stocks epinephrine auto-injectors shall make a good-faith effort to store the supply of epinephrine auto-injectors in accordance with the epinephrine auto-injector manufacturer’s instructions for use and any additional requirements that may be established by the Department of Health and Human Services. An authorized entity that acquires and stocks a supply of epinephrine auto-injectors pursuant to a prescription issued in accordance with this section shall designate employees or agents to be responsible for the storage, maintenance, control, and general oversight of epinephrine auto-injectors acquired by the authorized entity.
4. Use of Epinephrine Auto-Injectors by Authorized Entities. —  An employee or agent of an authorized entity or other individual who has completed the training required by subsection (e) of this section may use epinephrine auto-injectors prescribed pursuant to G.S. 90-726.1 to do any of the following:
   1. Provide an epinephrine auto-injector to any individual who the employee, agent, or other individual believes in good faith is experiencing anaphylaxis, or a person believed in good faith to be the parent, guardian, or caregiver of such individual, for immediate administration, regardless of whether the individual has a prescription for an epinephrine auto-injector or has previously been diagnosed with an allergy.
   2. Administer an epinephrine auto-injector to any individual who the employee, agent, or other individual believes in good faith is experiencing anaphylaxis, regardless of whether the individual has a prescription for an epinephrine auto-injector or has previously been diagnosed with an allergy.
5. Mandatory Training Program. —  An authorized entity that elects to acquire and stock a supply of epinephrine auto-injectors as described in subsection (c) of this section shall designate employees or agents to complete an anaphylaxis training program. The training may be conducted online or in person and shall, at a minimum, include all of the following components:
   1. How to recognize signs and symptoms of severe allergic reactions, including anaphylaxis.
   2. Standards and procedures for the storage and administration of an epinephrine auto-injector.
   3. Emergency follow-up procedures.In-person training shall cover the three components listed in this subsection and be conducted by (i) a physician, physician assistant, or registered nurse licensed to practice in this State; (ii) a nationally recognized organization experienced in training laypersons in emergency health treatment; or (iii) an entity or individual approved by the Department of Health and Human Services.Online training shall cover the three components listed in this subsection and be offered (i) by a nationally recognized organization experienced in training laypersons in emergency health treatment; (ii) by an entity or individual approved by the Department of Health and Human Services; or (iii) by means of an online training course that has been approved by another state.
6. Immunity. —
   1. The following persons are immune from criminal liability and from suit in any civil action brought by any person for injuries or related damages that result from any act or omission taken pursuant to this section:
      1. Any authorized entity that voluntarily and without expectation of payment possesses and makes available epinephrine auto-injectors.
      2. Any employee or agent of an authorized entity, or any other individual, who provides or administers an epinephrine auto-injector to an individual whom the employee, agent, or other individual believes in good faith is experiencing symptoms of anaphylaxis and has completed the required training set forth in subsection (e) of this section.
      3. A health care provider that prescribes epinephrine auto-injectors to an authorized entity.
      4. A pharmacist or health care provider that dispenses epinephrine auto-injectors to an authorized entity.
      5. Any individual or entity that conducts the training mandated by subsection (e) of this section.
   2. The immunity conferred by this section does not apply to acts or omissions constituting willful or wanton conduct as defined in G.S. 1D-5(7) or intentional wrongdoing.
   3. Nothing in this section creates or imposes any duty, obligation, or basis for liability on any authorized entity, any employee or agent of an authorized entity, or any other individual to acquire, possess, store, make available, or administer an epinephrine auto-injector.
   4. This section does not eliminate, limit, or reduce any other immunity or defense that may be available under State law, including the protections set forth in G.S. 90-21.14 .
7. Liability for Acts Outside of This State. —  An authorized entity located in this State shall not be liable under the laws of this State for any injuries or related damages resulting from the provision or administration of an epinephrine auto-injector outside of this State under either of the following circumstances:
   1. If the authorized entity would not have been liable for such injuries or related damages if the epinephrine auto-injector had been provided or administered within this State.
   2. If the authorized entity is not liable for such injuries or related damages under the laws of the state in which the epinephrine auto-injector was provided or administered.
8. Does Not Constitute Practice of Medicine. —  The administration of an epinephrine auto-injector in accordance with this section is not the practice of medicine or any other profession that otherwise requires licensure.

History. 2015-274, s. 1.

§ 90-21.16. Volunteer health care professionals; liability limitation.

1. This section applies as follows:
   1. Any volunteer medical or health care provider at a facility of a local health department or at a nonprofit community health center,
   2. Any volunteer medical or health care provider rendering services to a patient referred by a local health department as defined in G.S. 130A-2(5), nonprofit community health center, or nonprofit community health referral service at the provider’s place of employment,
   3. Any volunteer medical or health care provider serving as medical director of an emergency medical services (EMS) agency, or
   4. Repealed by Session Laws 2011-355, s. 7, effective June 27, 2011.
   5. Any volunteer medical or health care provider licensed or certified in this State who provides services within the scope of the provider’s license or certification at a free clinic facility, who receives no compensation for medical services or other related services rendered at the facility, center, agency, or clinic, or who neither charges nor receives a fee for medical services rendered to the patient referred by a local health department, nonprofit community health center, or nonprofit community health referral service at the provider’s place of employment shall not be liable for damages for injuries or death alleged to have occurred by reason of an act or omission in the rendering of the services unless it is established that the injuries or death were caused by gross negligence, wanton conduct, or intentional wrongdoing on the part of the person rendering the services. The free clinic, local health department facility, nonprofit community health center, nonprofit community health referral service, or agency shall use due care in the selection of volunteer medical or health care providers, and this subsection shall not excuse the free clinic, health department facility, community health center, or agency for the failure of the volunteer medical or health care provider to use ordinary care in the provision of medical services to its patients.
2. Nothing in this section shall be deemed or construed to relieve any person from liability for damages for injury or death caused by an act or omission on the part of such person while rendering health care services in the normal and ordinary course of his or her business or profession. Services provided by a medical or health care provider who receives no compensation for his or her services and who voluntarily renders such services at the provider’s place of employment, facilities of free clinics, local health departments as defined in G.S. 130A-2 , nonprofit community health centers, or as a volunteer medical director of an emergency medical services (EMS) agency, are deemed not to be in the normal and ordinary course of the volunteer medical or health care provider’s business or profession.
3. As used in this section, a “free clinic” is a nonprofit, 501(c)(3) tax-exempt organization organized for the purpose of providing health care services without charge or for a minimum fee to cover administrative costs.

   (c1) For a volunteer medical or health care provider who provides services at a free clinic to receive the protection from liability provided in this section, the free clinic shall provide the following notice to the patient, or person authorized to give consent for treatment, for the patient’s retention prior to the delivery of health care services:

   “NOTICE Under North Carolina law, a volunteer medical or health care provider shall not be liable for damages for injuries or death alleged to have occurred by reason of an act or omission in the medical or health care provider’s voluntary provision of health care services unless it is established that the injuries or death were caused by gross negligence, wanton conduct, or intentional wrongdoing on the part of the volunteer medical or health care provider.”

4. A nonprofit community health referral service that refers low-income patients to medical or health care providers for free services is not liable for the acts or omissions of the medical or health care providers in rendering service to that patient if the nonprofit community health referral service maintains liability insurance covering the acts and omissions of the nonprofit health referral service and any liability pursuant to subsection (a) of this section.
5. As used in this section, a “nonprofit community health referral service” is a nonprofit, 501(c)(3) tax-exempt organization organized to provide for no charge the referral of low-income, uninsured patients to volunteer health care providers who provide health care services without charge to patients.

History. 1991, c. 655, s. 1,; 1993, c. 439, s. 1; 1995, c. 85, s. 1; 2000-5, s. 4; 2001-230, ss. 1(a), 1(b); 2009-435, s. 1; 2011-355, s. 7; 2013-49, s. 1.

Cross References.

As to Voluntary Health Care Services Act, generally, see Chapter 90, Article 1J.

As to immunity from civil liability for acts or omissions, see G.S. 90-21.108 .

§ 90-21.17. Portable do not resuscitate order and Medical Order for Scope of Treatment.

1. It is the intent of this section to recognize a patient’s desire and right to withhold cardiopulmonary resuscitation and other life-prolonging measures to avoid loss of dignity and unnecessary pain and suffering through the use of a portable do not resuscitate (“DNR”) order or a Medical Order for Scope of Treatment (MOST).This section establishes an optional and nonexclusive procedure by which a patient or the patient’s representative may exercise this right.
2. A physician may issue a portable DNR order or MOST for a patient:
   1. With the consent of the patient;
   2. If the patient is a minor, with the consent of the patient’s parent or guardian; or
   3. If the patient is not a minor but is incapable of making an informed decision regarding consent for the order, with the consent of the patient’s representative.The physician shall document the basis for the DNR order or MOST in the patient’s medical record. When the order is a MOST, the patient or the patient’s representative must sign the form, provided, however, that if it is not practicable for the patient’s representative to sign the original MOST form, the patient’s representative shall sign a copy of the completed form and return it to the health care professional completing the form. The copy of the form with the signature of the patient’s representative, whether in paper or electronic form, shall be placed in the patient’s medical record. When the signature of the patient’s representative is on a separate copy of the MOST form, the original MOST form must indicate in the appropriate signature field that the signature is “on file”.
3. The Department of Health and Human Services shall develop a portable DNR order form and a MOST form. The official DNR form shall include fields for the name of the patient; the name, address, and telephone number of the physician; the signature of the physician; and other relevant information. At a minimum, the official MOST form shall include fields for: the name of the patient; an advisory that a patient is not required to have a MOST; the name, telephone number, and signature of the physician, physician assistant, or nurse practitioner authorizing the order; the name and contact information of the health care professional who prepared the form with the patient or the patient’s representative; information on who agreed (i.e., the patient or the patient’s representative) to the options selected on the MOST form; a range of options for cardiopulmonary resuscitation, medical interventions, antibiotics, medically administered fluids and nutrition; patient or patient representative’s name, contact information, and signature; effective date of the form and review dates; a prominent advisory that directions in a MOST form may suspend, while those MOST directions are in effect, any conflicting directions in a patient’s previously executed declaration of an advance directive for a natural death (“living will”), health care power of attorney, or other legally authorized instrument; and an advisory that the MOST may be revoked by the patient or the patient’s representative. The official MOST form shall also include the following statement written in boldface type directly above the signature line: “You are not required to sign this form to receive treatment.” The form may be approved by reference to a standard form that meets the requirements of this subsection. For purposes of this section, the “patient’s representative” means an individual from the list of persons authorized to consent to the withholding of life-prolonging measures pursuant to G.S. 90-322 .
4. No physician, emergency medical professional, hospice provider, or other health care provider shall be subject to criminal prosecution, civil liability, or disciplinary action by any professional licensing or certification agency for withholding cardiopulmonary resuscitation or other life-prolonging measures from a patient in good faith reliance on an original DNR order or MOST form adopted pursuant to subsection (c) of this section, provided that (i) there are no reasonable grounds for doubting the validity of the order or the identity of the patient, and (ii) the provider does not have actual knowledge of the revocation of the portable DNR order or MOST. No physician, emergency medical professional, hospice provider, or other health care provider shall be subject to criminal prosecution, civil liability, or disciplinary action by any professional licensing or certification agency for failure to follow a DNR order or MOST form adopted pursuant to subsection (c) of this section if the provider had no actual knowledge of the existence of the DNR order or MOST.
5. A health care facility may develop policies and procedures that authorize the facility’s provider to accept a portable DNR order or MOST as if it were an order of the medical staff of that facility. This section does not prohibit a physician in a health care facility from issuing a written order, other than a portable DNR order or MOST not to resuscitate a patient in the event of cardiac or respiratory arrest, or to use, withhold, or withdraw additional medical interventions as provided in the MOST, in accordance with acceptable medical practice and the facility’s policies.
6. Nothing in this section shall affect the validity of portable DNR order or MOST forms in existence prior to the effective date of this section.

History. 2001-445, s. 1; 2007-502, s. 14.

§ 90-21.18. Medical directors; liability limitation.

A medical director of a licensed nursing home shall not be named a defendant in an action pursuant to this Article except under any of the following circumstances:

1. Where allegations involve a patient under the direct care of the medical director.
2. Where allegations involve willful or intentional misconduct, recklessness, or gross negligence in connection with the failure to supervise, or other acts performed or failed to be performed, by the medical director in a supervisory or consulting role.

History. 2004-149, s. 2.9.

§ 90-21.19. Liability limit for noneconomic damages.

1. Except as otherwise provided in subsection (b) of this section, in any medical malpractice action in which the plaintiff is entitled to an award of noneconomic damages, the total amount of noneconomic damages for which judgment is entered against all defendants shall not exceed five hundred thousand dollars ($500,000). Judgment shall not be entered against any defendant for noneconomic damages in excess of five hundred thousand dollars ($500,000) for all claims brought by all parties arising out of the same professional services. On January 1 of every third year, beginning with January 1, 2014, the Office of State Budget and Management shall reset the limitation on damages for noneconomic loss set forth in this subsection to be equal to five hundred thousand dollars ($500,000) times the ratio of the Consumer Price Index for November of the prior year to the Consumer Price Index for November 2011. The Office of State Budget and Management shall inform the Revisor of Statutes of the reset limitation. The Revisor of Statutes shall publish this reset limitation as an editor’s note to this section. In the event that any verdict or award of noneconomic damages stated pursuant to G.S. 90-21.19 B exceeds these limits, the court shall modify the judgment as necessary to conform to the requirements of this subsection.
2. Notwithstanding subsection (a) of this section, there shall be no limit on the amount of noneconomic damages for which judgment may be entered against a defendant if the trier of fact finds both of the following:
   1. The plaintiff suffered disfigurement, loss of use of part of the body, permanent injury or death.
   2. The defendant’s acts or failures, which are the proximate cause of the plaintiff’s injuries, were committed in reckless disregard of the rights of others, grossly negligent, fraudulent, intentional or with malice.
3. The following definitions apply in this section:
   1. Consumer Price Index. — The Consumer Price Index — All Urban Consumers, for the South urban area, as published by the Bureau of Labor Statistics of the United States Department of Labor.
   2. Noneconomic damages. — Damages to compensate for pain, suffering, emotional distress, loss of consortium, inconvenience, and any other nonpecuniary compensatory damage. “Noneconomic damages” does not include punitive damages as defined in G.S. 1D-5 .
   3. Same professional services. — The transactions, occurrences, or series of transactions or occurrences alleged to have caused injury to the health care provider’s patient.
4. Any award of damages in a medical malpractice action shall be stated in accordance with G.S. 90-21.19 B. If a jury is determining the facts, the court shall not instruct the jury with respect to the limit of noneconomic damages under subsection (a) of this section, and neither the attorney for any party nor a witness shall inform the jury or potential members of the jury panel of that limit.

History. 2011-400, s. 7; 2015-40, s. 9.

Reset of Liability Limit on Noneconomic Damages for Medical Malpractice.

On April 15, 2014, the North Carolina Administrative Office of the Courts provided notice, pursuant to G.S. 90-21.14 , that it had calculated the reset limitation on damages for noneconomic loss set forth in subsection (a) of G.S. 90-21.14 to be equal to $515,000, effective January 1, 2014.

By letter dated December 20, 2016, the Office of State Budget and Management (OSBM) notified the Office of the Revisor of Statutes that, in accordance with G.S. 90-21.19(a) , the OSBM was resetting the limitation on damages for noneconomic losses related to medical malpractice to be equal to $533,409, effective January 1, 2017.

By letter dated December 17, 2019, the Office of State Budget and Management (OSBM) notified the Office of the Revisor of Statutes that, in accordance with G.S. 90-21.19(a) , the OSBM was resetting the limitation on damages for noneconomic losses related to medical malpractice to be equal to $562,338, effective January 1, 2020.

§ 90-21.19A.

Reserved for future codification purposes.

§ 90-21.19B. Verdicts and awards of damages in medical malpractice actions; form.

In any malpractice action, any verdict or award of damages, if supported by the evidence, shall indicate specifically what amount, if any, is awarded for noneconomic damages. If applicable, the court shall instruct the jury on the definition of noneconomic damages under G.S. 90-21.19(b) .

History. 2011-400, s. 8.

§ 90-21.20. Reporting by physicians and hospitals of wounds, injuries and illnesses.

1. Such cases of wounds, injuries or illnesses as are enumerated in subsection (b) shall be reported as soon as it becomes practicable before, during or after completion of treatment of a person suffering such wounds, injuries, or illnesses. If such case is treated in a hospital, sanitarium or other medical institution or facility, such report shall be made by the Director, Administrator, or other person designated by the Director or Administrator, or if such case is treated elsewhere, such report shall be made by the physician or surgeon treating the case, to the chief of police or the police authorities of the city or town of this State in which the hospital or other institution, or place of treatment is located. If such hospital or other institution or place of treatment is located outside the corporate limits of a city or town, then the report shall be made by the proper person in the manner set forth above to the sheriff of the respective county or to one of his deputies.
2. Cases of wounds, injuries or illnesses which shall be reported by physicians, and hospitals include every case of a bullet wound, gunshot wound, powder burn or any other injury arising from or caused by, or appearing to arise from or be caused by, the discharge of a gun or firearm, every case of illness apparently caused by poisoning, every case of a wound or injury caused, or apparently caused, by a knife or sharp or pointed instrument if it appears to the physician or surgeon treating the case that a criminal act was involved, and every case of a wound, injury or illness in which there is grave bodily harm or grave illness if it appears to the physician or surgeon treating the case that the wound, injury or illness resulted from a criminal act of violence.
3. Each report made pursuant to subsections (a) and (b) above shall state the name of the wounded, ill or injured person, if known, and the age, sex, race, residence or present location, if known, and the character and extent of his injuries. (c1) In addition to the reporting requirements of subsection (b) of this section, cases involving recurrent illness or serious physical injury to any child under the age of 18 years where the illness or injury appears, in the physician’s professional judgment, to be the result of non-accidental trauma shall be reported by the physician as soon as it becomes practicable before, during, or after completion of treatment. If the case is treated in a hospital, sanitarium, or other medical institution or facility, the report shall be made by the Director, Administrator, or other person designated by the Director or Administrator of the medical institution or facility, or if the case is treated elsewhere, the report shall be made by the physician or surgeon treating the case to the chief of police or the police authorities of the city or town in this State in which the hospital or other institution or place of treatment is located. If the hospital or other institution or place of treatment is located outside the corporate limits of a city or town, then the report shall be made by the proper person in the manner set forth above to the sheriff of the respective county or to one of the sheriff’s deputies. This reporting requirement is in addition to the duty set forth in G.S. 7B-301 to report child abuse, neglect, dependence, or the death of any juvenile as the result of maltreatment to the director of the department of social services in the county where the juvenile resides or is found.
4. Any hospital, sanitarium, or other like institution or Director, Administrator, or other designated person, or physician or surgeon participating in good faith in the making of a report pursuant to this section shall have immunity from any liability, civil or criminal, that might otherwise be incurred or imposed as the result of the making of such report.

History. 1971, c. 4; 1977, c. 31; c. 843, s. 2; 2008-179, s. 1.

§ 90-21.20A. Reporting by physicians of pilots’ mental or physical disabilities or infirmities.

1. A physician who reports to a government agency responsible for pilots’ licenses or certificates or a government agency responsible for air safety that a pilot or an applicant for a pilot’s license or certificate suffers from or probably suffers from a physical disability or infirmity that the physician believes will or reasonably could affect the person’s ability to safely operate an aircraft shall have immunity, civil or criminal, that might otherwise be incurred or imposed as the result of making such a report.
2. A physician who gives testimony about a pilot’s or an applicant’s mental or physical disability or infirmity in any administrative hearing or other proceeding held to consider the issuance, renewal, revocation, or suspension of a pilot’s license or certificate shall have immunity from any liability, civil or criminal, that might otherwise be incurred or imposed as the result of such testimony.

History. 1997-464, s. 2.

§ 90-21.20B. Access to and disclosure of medical information for certain purposes.

1. Notwithstanding G.S. 8-53 or any other provision of law, a health care provider may disclose to a law enforcement officer protected health information only to the extent that the information may be disclosed under the federal Standards for Privacy of Individually Identifiable Health Information, 45 C.F.R. § 164.512(f) and is not specifically prohibited from disclosure by other state or federal law. (a1) Notwithstanding any other provision of law, if a person is involved in a vehicle crash:
   1. Any health care provider who is providing medical treatment to the person shall, upon request, disclose to any law enforcement officer investigating the crash the following information about the person: name, current location, and whether the person appears to be impaired by alcohol, drugs, or another substance.
   2. Law enforcement officers shall be provided access to visit and interview the person upon request, except when the health care provider requests temporary privacy for medical reasons.
   3. A health care provider shall disclose a certified copy of all identifiable health information related to that person as specified in a search warrant or an order issued by a judicial official.
2. A prosecutor or law enforcement officer receiving identifiable health information under this section shall not disclose this information to others except as necessary to the investigation or otherwise allowed by law.
3. A certified copy of identifiable health information, if relevant, shall be admissible in any hearing or trial without further authentication.
4. As used in this section, “health care provider” has the same meaning as in G.S. 90-21.11 .
5. Notwithstanding G.S. 8-53 or any other provision of law, a health care provider may disclose protected health information for purposes of treatment, payment, or health care operations to the extent that disclosure is permitted under 45 C.F.R. § 164.506 and is not specifically prohibited by other state or federal law. As used in this subsection, “treatment, payment, or health care operations” are as defined in the Standards for Privacy of Individually Identifiable Health Information.

History. 2006-253, s. 17; 2007-115, s. 3.

Effect of Amendments.

Session Laws 2007-115, s. 3, effective June 27, 2007, substituted “certain” for “law enforcement” in the section heading; added subsection (a); redesignated former subsection (a) as present subsection (a1); and added subsection (e).

§ 90-21.21. [Repealed]

Repealed by Session Laws 1979, c. 529, s. 1.

§ 90-21.22. Health program for medical professionals.

1. The North Carolina Medical Board (Board) may enter into agreements with the North Carolina Medical Society (Society), the North Carolina Academy of Physician Assistants (Academy), and the North Carolina Physicians Health Program (Program) for the purposes of identifying, reviewing, and evaluating the ability of licensees of the Board who have been referred to the Program to function in their professional capacity and to coordinate regimens for treatment and rehabilitation. The agreement shall include guidelines for all items outlined below:
   1. The assessment, referral, monitoring, support, and education of licensees of the Board by reason of a physical or mental illness, a substance use disorder, or professional sexual misconduct.
   2. Procedures for the Board to refer licensees to the Program.
   3. Criteria for the Program to report licensees to the Board.
   4. A procedure by which licensees may obtain review of recommendations by the Program regarding assessment or treatment.
   5. Periodic reporting of statistical information by the Program to the Board, the Society, and the Academy.
   6. Maintaining the confidentiality of nonpublic information.
2. Repealed by Session Laws 2016-117, s. 2(n), effective October 1, 2016.
3. The North Carolina Physicians Health Program (Program) is an independent organization for medical professionals that provides screening, referral, monitoring, educational, and support services. The Board, Society, and the Academy may provide funds for the administration of the Program.
4. The Program shall report immediately to the Board detailed information about any licensee of the Board who meets any of the following criteria:
   1. The licensee constitutes an imminent danger to patient care by reason of mental illness, physical illness, substance use disorder, professional sexual misconduct, or any other reason.
   2. The licensee refuses to submit to an assessment as ordered by the Board, has entered into a monitoring contract and fails to comply with the terms of the Program’s monitoring contract, or is still unsafe to practice medicine after treatment.
   3. Repealed by Session Laws 2016-117, s. 2(n), effective October 1, 2016.
5. Any information acquired, created, or used in good faith by the Program pursuant to this section is privileged, confidential, and not subject to discovery, subpoena, or other means of legal compulsion for release to any person other than to the Board, the Program, or their employees or consultants. No person participating in good faith in the Program shall be required in a civil case to disclose the fact of participation in the Program or any information acquired or opinions, recommendations, or evaluations acquired or developed solely in the course of participating in the Program pursuant to this section.
6. Activities conducted in good faith pursuant to the agreement authorized by subsection (a) of this section shall not be grounds for civil action under the laws of this State.
7. Upon the written request of a licensee, the Program shall provide the licensee and the licensee’s legal counsel with a copy of a written assessment of the licensee prepared as part of the licensee’s participation in the Program. In addition, the licensee shall be entitled to a copy of any written assessment created by a treatment provider or facility at the recommendation of the Program, to the extent permitted by State and federal laws and regulations. Any information furnished to a licensee pursuant to this subsection shall be inadmissible in evidence and shall not be subject to discovery in any civil proceeding. However, this subsection shall not be construed to make information, documents, or records otherwise available for discovery or use in a civil action immune from discovery or use in a civil action merely because the information, documents, or records were included as part of the Program’s assessment of the licensee or were the subject of information furnished to the licensee pursuant to this subsection. For purposes of this subsection, a civil action or proceeding shall not include administrative actions or proceedings conducted in accordance with Article 1 of Chapter 90 and Chapter 150B of the General Statutes.
8. The Board has authority to adopt, amend, or repeal rules as may be necessary to carry out and enforce the provisions of this section.

History. 1987, c. 859, s. 15; 1993, c. 176, s. 1; 1995, c. 94, s. 23; 2006-144, s. 8; 2016-117, s. 2(n).

Effect of Amendments.

Session Laws 2006-144, s. 8, effective October 1, 2006, added “by reason of impairment, mental illness, physical illness, the commission of professional sexual boundary violations, or any other reason” at the end of subdivision (d)(1).

Session Laws 2016-117, s. 2(n), effective October 1, 2016, rewrote the section.

Legal Periodicals.

For article, “‘What Is and What Should Never Be’ Privileged in North Carolina: The Peer Review Privilege After Armstrong v. Barnes,” see 85 N.C.L. Rev. 1741 (2007).

§ 90-21.22A. Medical review and quality assurance committees.

1. As used in this section, the following terms mean:
   1. “Medical review committee.” —  A committee composed of health care providers licensed under this Chapter that is formed for the purpose of evaluating the quality of, cost of, or necessity for health care services, including provider credentialing. “Medical review committee” does not mean a medical review committee established under G.S. 131E-95 .
   2. “Quality assurance committee.” —  Risk management employees of an insurer licensed to write medical professional liability insurance in this State, who work in collaboration with health care providers licensed under this Chapter, and insured by that insurer, to evaluate and improve the quality of health care services.
2. A member of a duly appointed medical review or quality assurance committee who acts without malice or fraud shall not be subject to liability for damages in any civil action on account of any act, statement, or proceeding undertaken, made, or performed within the scope of the functions of the committee.
3. The proceedings of a medical review or quality assurance committee, the records and materials it produces, and the materials it considers shall be confidential and not considered public records within the meaning of G.S. 132-1 , 131E-309, or 58-2-100; and shall not be subject to discovery or introduction into evidence in any civil action against a provider of health care services who directly provides services and is licensed under this Chapter, a PSO licensed under Article 17 of Chapter 131E of the General Statutes, an ambulatory surgical facility licensed under Chapter 131E of the General Statutes, or a hospital licensed under Chapter 122C or Chapter 131E of the General Statutes or that is owned or operated by the State, which civil action results from matters that are the subject of evaluation and review by the committee. No person who was in attendance at a meeting of the committee shall be required to testify in any civil action as to any evidence or other matters produced or presented during the proceedings of the committee or as to any findings, recommendations, evaluations, opinions, or other actions of the committee or its members. However, information, documents, or records otherwise available are not immune from discovery or use in a civil action merely because they were presented during proceedings of the committee. Documents otherwise available as public records within the meaning of G.S. 132-1 do not lose their status as public records merely because they were presented or considered during proceedings of the committee. A member of the committee may testify in a civil action but cannot be asked about the person’s testimony before the committee or any opinions formed as a result of the committee hearings.
4. This section applies to a medical review committee, including a medical review committee appointed by one of the entities licensed under Articles 1 through 67 of Chapter 58 of the General Statutes.
5. Subsection (c) of this section does not apply to proceedings initiated under G.S. 58-50-61 or G.S. 58-50-62 .

History. 1997-519, s. 4.3; 1998-227, s. 3; 2002-179, s. 18; 2004-149, s. 2.6.

§ 90-21.23. Election by State.

For the purpose of making applicable in the State the early opt-in provisions of Title 4 of the “Health Care Quality Improvement Act of 1986,” P.L. 99-660, the State elects to exercise on October 1, 1987, the provisions of Title 4, Section 411(c)(2)(A) of that act to promote good faith professional review activities.

History. 1987, c. 859, s. 19.

§§ 90-21.24 through 90-21.36. [Repealed]

Repealed by Session Laws 2015-288, s. 4, as amended by Session Laws 2016-94, s. 12G.4(a), effective September 30, 2016.

Article Has a Delayed Repeal Date.

Session Laws 2016-94, s. 12G.4(b), as amended by Session Laws 2016-123, s. 5.7, provides: “Notwithstanding subsection (a) of this section or any other provision of law to the contrary, each party to a cooperative agreement for which a certificate of public advantage was issued prior to September 30, 2016, shall submit a report to the Department of Health and Human Services and the Attorney General on its activities pursuant to the cooperative agreement through September 30, 2017. The report shall include at least all of the following:

“(1) A description of the activities conducted pursuant to the agreement.

“(2) Price and cost information.

“(3) The nature and scope of its activities pursuant to the agreement through September 30, 2017, and the likely effect of those activities.

“(4) Any additional information requested by the Department or the Attorney General.”

Session Laws 2016-94, s. 1.2, provides: “This act shall be known as the ‘Current Operations and Capital Improvements Appropriations Act of 2016.’ ”

Session Laws 2016-94, s. 39.4, provides: “Except for statutory changes or other provisions that clearly indicate an intention to have effects beyond the 2016-2017 fiscal year, the textual provisions of this act apply only to funds appropriated for, and activities occurring during, the 2016-2017 fiscal year.”

Session Laws 2016-94, s. 39.7, is a severability clause.

§§ 90-21.37 through 90-21.40.

Reserved for future codification purposes.

§ 90-21.41. Definitions.

The following definitions apply in this Article:

1. Client. — A person who may also be called patient or counselee who seeks or obtains psychotherapy, whether or not the person is charged for the service. The term “client” includes a former client.
2. Psychotherapist. — A psychiatrist licensed in accordance with Article 1 of Chapter 90 of the General Statutes, a psychologist as defined in G.S. 90-270.2(9), a licensed clinical mental health counselor as defined in G.S. 90-330(a), a substance abuse professional as defined in G.S. 90-113.31(8), a social worker engaged in a clinical social work practice as defined in G.S. 90B-3(6) , a fee-based pastoral counselor as defined in G.S. 90-382(4) , a licensed marriage and family therapist as defined in G.S. 90-270.47(3), or a mental health service provider, who performs or purports to perform psychotherapy.
3. Psychotherapy. — The professional treatment or professional counseling of a mental or emotional condition that includes revelation by the client of intimate details of thoughts and emotions of a very personal nature to assist the client in modifying behavior, thoughts and emotions that are maladjustive or contribute to difficulties in living.
4. Sexual exploitation. — Either of the following, whether or not it occurred with the consent of a client or during any treatment, consultation, evaluation, interview, or examination:
   1. Sexual contact which includes any of the following actions:
      1. Sexual intercourse, cunnilingus, fellatio, anal intercourse, or any intrusion, however slight, into the oral, genital, or anal openings of the client’s body by any part of the psychotherapist’s body or by any object used by the psychotherapist for the purpose of sexual stimulation or gratification of either the psychotherapist or the client; or any intrusion, however slight, into the oral, genital, or anal openings of the psychotherapist’s body by any part of the client’s body or by any object used by the client for the purpose of sexual stimulation or gratification of either the psychotherapist or the client, if agreed to, or not resisted by the psychotherapist.
      2. Kissing of, or the intentional touching by the psychotherapist of, the client’s lips, genital area, groin, inner thigh, buttocks, or breast, or of the clothing covering any of these body parts, for the purpose of sexual stimulation or gratification of either the psychotherapist or the client, or kissing of, or the intentional touching by the client of, the psychotherapist’s lips, genital area, groin, inner thigh, buttocks, or breast, or of the clothing covering any of these body parts, if agreed to or not resisted by the psychotherapist, for the purpose of sexual stimulation or gratification to either the psychotherapist or the client.
   2. Any act done or statement made by the psychotherapist for the purpose of sexual stimulation or gratification of the client or psychotherapist which includes any of the following actions:
      1. The psychotherapist’s relating to the client the psychotherapist’s own sexual fantasies or the details of the psychotherapist’s own sexual life.
      2. The uncovering or display of breasts or genitals of the psychotherapist to the client.
      3. The showing of sexually graphic pictures to the client for purposes other than diagnosis or treatment.
      4. Statements containing sexual innuendo, sexual threats, or sexual suggestions regarding the relationship between the psychotherapist and the client.
5. Sexual history. — Sexual activity of the client other than that conduct alleged by the client to constitute sexual exploitation in an action pursuant to this Article.
6. Therapeutic deception. — A representation by a psychotherapist that sexual contact with the psychotherapist is consistent with or part of the client’s treatment.

History. 1998-213, s. 1; 2019-240, s. 3(g).

§ 90-21.42. Action for sexual exploitation.

Any client who is sexually exploited by the client’s psychotherapist shall have remedy by civil action for sexual exploitation if the sexual exploitation occurred:

1. At any time between and including the first date and last date the client was receiving psychotherapy from the psychotherapist;
2. Within three years after the termination of the psychotherapy; or
3. By means of therapeutic deception.

History. 1998-213, s. 1.

§ 90-21.43. Remedies.

A person found to have been sexually exploited as provided under this Article may recover from the psychotherapist actual or nominal damages, and reasonable attorneys’ fees as the court may allow. The trier of fact may award punitive damages in accordance with the provisions of Chapter 1D of the General Statutes.

History. 1998-213, s. 1.

§ 90-21.44. Scope of discovery.

1. In an action under this Article, evidence of the client’s sexual history is not subject to discovery, except under the following conditions:
   1. The client claims impairment of sexual functioning.
   2. The psychotherapist requests a hearing prior to conducting discovery and makes an offer of proof of the relevancy of the evidence, and the court finds that the information is relevant and that the probative value of the history outweighs its prejudicial effect.
2. The court shall allow the discovery only of specific information or examples of the client’s conduct that are determined by the court to be relevant. The court order shall detail the information or conduct that is subject to discovery.

History. 1998-213, s. 1.

§ 90-21.45. Admissibility of evidence of sexual history.

1. At the trial of an action under this Article, evidence of the client’s sexual history is not admissible unless:
   1. The psychotherapist requests a hearing prior to trial and makes an offer of proof of the relevancy of the sexual history; and
   2. The court finds that, in the interest of justice, the evidence is relevant and that the probative value of the evidence substantially outweighs its prejudicial effect.
2. The court shall allow the admission only of specific information or examples of instances of the client’s conduct that are determined by the court to be relevant. The court’s order shall detail the conduct that is admissible, and no other such evidence may be introduced.
3. Sexual history otherwise admissible pursuant to this section may not be proved by reputation or opinion.

History. 1998-213, s. 1.

§ 90-21.46. Prohibited defense.

It shall not be a defense in any action brought pursuant to this Article that the client consented to the sexual exploitation or that the sexual contact with a client occurred outside a therapy or treatment session or that it occurred off the premises regularly used by the psychotherapist for therapy or treatment sessions.

History. 1998-213, s. 1.

§ 90-21.47. Statute of limitations.

An action for sexual exploitation must be commenced within three years after the cause of action accrues. A cause of action for sexual exploitation accrues at the later of either:

1. The last act of the psychotherapist giving rise to the cause of action.
2. At the time the client discovers or reasonably should discover that the sexual exploitation occurred; however, no cause of action shall be commenced more than 10 years from the last act of the psychotherapist giving rise to the cause of action.

History. 1998-213, s. 1.

§ 90-21.48. Agreements to not pursue complaint before licensing entity void.

Any provision of a settlement agreement of a claim based in whole or part on an allegation of sexual exploitation as defined in this Article, which prohibits a party from initiating or pursuing a complaint before the regulatory entity responsible for overseeing the conduct or licensing of the psychotherapist, is void.

History. 1998-213, s. 1.

§ 90-21.49.

Reserved for future codification purposes.

§ 90-21.50. Definitions.

As used in this Article, unless the context clearly indicates otherwise, the term:

1. “Health benefit plan” means an accident and health insurance policy or certificate; a nonprofit hospital or medical service corporation contract; a health maintenance organization subscriber contract; a self-insured indemnity program or prepaid hospital and medical benefits plan offered under the State Health Plan for Teachers and State Employees and subject to the requirements of Article 3 of Chapter 135 of the General Statutes, a plan provided by a multiple employer welfare arrangement; or a plan provided by another benefit arrangement, to the extent permitted by the Employee Retirement Income Security Act of 1974, as amended, or by any waiver of or other exception to that act provided under federal law or regulation. “Health benefit plan” does not mean any plan implemented or administered by the North Carolina or United States Department of Health and Human Services, or any successor agency, or its representatives. “Health benefit plan” does not mean any of the following kinds of insurance:
   1. Accident.
   2. Credit.
   3. Disability income.
   4. Long-term or nursing home care.
   5. Medicare supplement.
   6. Specified disease.
   7. Dental or vision.
   8. Coverage issued as a supplement to liability insurance.
   9. Workers’ compensation.
   10. Medical payments under automobile or homeowners.
   11. Hospital income or indemnity.
   12. Insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability policy or equivalent self-insurance.
   13. Short-term limited duration health insurance policies as defined in Part 144 of Title 45 of the Code of Federal Regulations.
2. “Health care decision” means a determination that is made by a managed care entity and is subject to external review under Part 4 of Article 50 of Chapter 58 of the General Statutes and is also a determination that:
   1. Is a noncertification, as defined in G.S. 58-50-61 , of a prospective or concurrent request for health care services, and
   2. Affects the quality of the diagnosis, care, or treatment provided to an enrollee or insured of the health benefit plan.
3. “Health care provider” means:
   1. An individual who is licensed, certified, or otherwise authorized under this Chapter to provide health care services in the ordinary course of business or practice of a profession or in an approved education or training program; or
   2. A health care facility, licensed under Chapters 131E or 122C of the General Statutes, where health care services are provided to patients;

      “Health care provider” includes: (i) an agent or employee of a health care facility that is licensed, certified, or otherwise authorized to provide health care services; (ii) the officers and directors of a health care facility; and (iii) an agent or employee of a health care provider who is licensed, certified, or otherwise authorized to provide health care services.

4. “Health care service” means a health or medical procedure or service rendered by a health care provider that:
   1. Provides testing, diagnosis, or treatment of a health condition, illness, injury, or disease; or
   2. Dispenses drugs, medical devices, medical appliances, or medical goods for the treatment of a health condition, illness, injury, or disease.
5. “Insured or enrollee” means a person that is insured by or enrolled in a health benefit plan under a policy, plan, certificate, or contract issued or delivered in this State by an insurer.
6. “Insurer” means an entity that writes a health benefit plan and that is an insurance company subject to Chapter 58 of the General Statutes, a service corporation organized under Article 65 of Chapter 58 of the General Statutes, a health maintenance organization organized under Article 67 of Chapter 58 of the General Statutes, a self-insured health maintenance organization or managed care entity operated or administered by or under contract with the Executive Administrator and Board of Trustees of the State Health Plan for Teachers and State Employees pursuant to Article 3 of Chapter 135 of the General Statutes, a multiple employer welfare arrangement subject to Article 50A of Chapter 58 of the General Statutes, or the State Health Plan for Teachers and State Employees.
7. “Managed care entity” means an insurer that:
   1. Delivers, administers, or undertakes to provide for, arrange for, or reimburse for health care services or assumes the risk for the delivery of health care services; and
   2. Has a system or technique to control or influence the quality, accessibility, utilization, or costs and prices of health care services delivered or to be delivered to a defined enrollee population.

      Except for the State Health Plan for Teachers and State Employees, “managed care entity” does not include: (i) an employer purchasing coverage or acting on behalf of its employees or the employees of one or more subsidiaries or affiliated corporations of the employer, or (ii) a health care provider.

8. “Ordinary care” means that degree of care that, under the same or similar circumstances, a managed care entity of ordinary prudence would have used at the time the managed care entity made the health care decision.
9. “Physician” means:
   1. An individual licensed to practice medicine in this State;
   2. A professional association or corporation organized under Chapter 55B of the General Statutes; or
   3. A person or entity wholly owned by physicians.
10. “Successor external review process” means an external review process equivalent in all respects to G.S. 58-50-75 through G.S. 58-50-95 that is approved by the Department and implemented by a health benefit plan in the event that G.S. 58-50-75 through G.S. 58-50-95 are found by a court of competent jurisdiction to be void, unenforceable, or preempted by federal law, in whole or in part.

History. 2001-446, s. 4.7; 2007-323, s. 28.22A(o); 2007-345, s. 12; 2019-202 s. 8; 2021-62, ss. 4.2(a), 4.2(b).

§ 90-21.51. Duty to exercise ordinary care; liability for damages for harm.

1. Each managed care entity for a health benefit plan has the duty to exercise ordinary care when making health care decisions and is liable for damages for harm to an insured or enrollee proximately caused by its failure to exercise ordinary care.
2. In addition to the duty imposed under subsection (a) of this section, each managed care entity for a health benefit plan is liable for damages for harm to an insured or enrollee proximately caused by decisions regarding whether or when the insured or enrollee would receive a health care service made by:
   1. Its agents or employees; or
   2. Representatives that are acting on its behalf and over whom it has exercised sufficient influence or control to reasonably affect the actual care and treatment of the insured or enrollee which results in the failure to exercise ordinary care.
3. It shall be a defense to any action brought under this section against a managed care entity for a health benefit plan that:
   1. The managed care entity and its agents or employees, or representatives for whom the managed care entity is liable under subsection (b) of this section, did not control or influence or advocate for the decision regarding whether or when the insured or enrollee would receive a health care service; or
   2. The managed care entity did not deny or delay payment for any health care service or treatment prescribed or recommended by a physician or health care provider to the insured or enrollee.
4. In an action brought under this Article against a managed care entity, a finding that a physician or health care provider is an agent or employee of the managed care entity may not be based solely on proof that the physician or health care provider appears in a listing of approved physicians or health care providers made available to insureds or enrollees under the managed care entity’s health benefit plan.
5. An action brought under this Article is not a medical malpractice action as defined in Article 1B of this Chapter. A managed care entity may not use as a defense in an action brought under this Article any law that prohibits the corporate practice of medicine.
6. A managed care entity shall not be liable for the independent actions of a health care provider, who is not an agent or employee of the managed care entity, when that health care provider fails to exercise the standard of care required by G.S. 90-21.12 . A health care provider shall not be liable for the independent actions of a managed care entity when the managed care entity fails to exercise the standard of care required by this Article.
7. Nothing in this Article shall be construed to create an obligation on the part of a managed care entity to provide to an insured or enrollee a health care service or treatment that is not covered under its health benefit plan.
8. A managed care entity shall not enter into a contract with a health care provider, or with an employer or employer group organization, that includes an indemnification or hold harmless clause for the acts or conduct of the managed care entity. Any such indemnification or hold harmless clause is void and unenforceable to the extent of the restriction.

History. 2001-446, s. 4.7.

Legal Periodicals.

For comment, “Patients’ Bill of Rights; Legislative Cure-All or Prescription for Disaster?,” see 81 N.C.L. Rev. 653 (2003).

§ 90-21.52. No liability under this Article on the part of an employer or employer group organization that purchases coverage or assumes risk on behalf of its employees or a physician or health care provider; liability of State Health Plan under State Tort Claims Act.

1. Except as otherwise provided in subsection (b) of this section, this Article does not create any liability on the part of an employer or employer group purchasing organization that purchases health care coverage or assumes risk on behalf of its employees.
2. Liability in tort of the State Health Plan for Teachers and State Employees for its health care decisions shall be under Article 31 of Chapter 143 of the General Statutes.
3. This Article does not create any liability on the part of a physician or health care provider in addition to that otherwise imposed under existing law. No managed care entity held liable under this Article shall be entitled to contribution under Chapter 1B of the General Statutes. No managed care entity held liable under this Article shall have a right to indemnity against physicians, health care providers, or entities wholly owned by physicians or health care providers or any combination thereof, except when:
   1. The liability of the managed care entity is based on an administrative decision to approve or disapprove payment or reimbursement for, or denial, reduction, or termination of coverage, for a health care service and the physician organizations, health care providers, or entities wholly owned by physicians or health care providers or any combination thereof, which have made the decision at issue, have agreed explicitly, in a written addendum or agreement separate from the managed care organization’s standard professional service agreement, to assume responsibility for making noncertification decisions under G.S. 58-50-61(13) with respect to certain insureds or enrollees; and
   2. The managed care entity has not controlled or influenced or advocated for the decision regarding whether or when payment or reimbursement should be made or whether or when the insured or enrollee should receive a health care service.The right to indemnity set forth herein shall not apply to professional medical or health care services provided by a physician or health care provider, and shall only apply where the agreement to assume responsibility for making noncertification decisions for the managed care entity is shown to have been undertaken voluntarily and the managed care organization has not adversely affected the terms and conditions of the relationship with the health care provider based upon the willingness to execute or refusal to execute an agreement under G.S. 58-50-61(13).

History. 2001-446, s. 4.7; 2001-508, s. 2; 2007-323, s. 28.22A(o); 2007-345, s. 12.

Effect of Amendments.

Session Laws 2007-323, s. 28.22A(o), as amended by Session Laws 2007-345, s. 12, effective July 1, 2008, substituted “State Health Plan for Teachers and State Employees” for “Teachers’ and State Employees’ Comprehensive Major Medical Plan” in subsection (b).

§ 90-21.53. Separate trial required.

Upon motion of any party in an action that includes a claim brought pursuant to this Article involving a managed care entity, the court shall order separate discovery and a separate trial of any claim, cross-claim, counterclaim, or third-party claim against any physician or other health care provider.

History. 2001-446, s. 4.7.

Legal Periodicals.

For comment, “Patients’ Bill of Rights: Legislative Cure-All or Prescription for Disaster?,” see 81 N.C.L. Rev. 653 (2003).

§ 90-21.54. Exhaustion of administrative remedies and appeals.

No action may be commenced under this Article until the plaintiff has exhausted all administrative remedies and appeals, including those internal remedies and appeals established under G.S. 58-50-61 through G.S. 58-50-62 , and G.S. 58-50-75 through G.S. 58-50-95 , and including those established under any successor external review process.

History. 2001-446, s. 4.7.

§ 90-21.55. External review decision.

1. Either the insured or enrollee or the personal representative of the insured or enrollee or the managed care entity may use an external review decision made in accordance with G.S. 58-50-75 through G.S. 58-50-95 , or made in accordance with any successor external review process, as evidence in any cause of action which includes an action brought under this Part, provided that an adequate foundation is laid for the introduction of the external review decision into evidence and the testimony is subject to cross-examination.
2. Any information, documents, or other records or materials considered by the Independent Review Organization licensed under Part 4 of Article 50 of Chapter 58 of the General Statutes, or the successor review process, in conducting its review shall be admissible in any action commenced under this Article in accordance with Chapter 8 of the General Statutes and the North Carolina Rules of Evidence.

History. 2001-446, s. 4.7.

Legal Periodicals.

For comment, “Patients’ Bill of Rights: Legislative Cure-All or Prescription for Disaster?,” see 81 N.C.L. Rev. 653 (2003).

§ 90-21.56. Remedies.

1. Except as provided in G.S. 90-21.52(b), an insured or enrollee who has been found to have been harmed by the managed care entity pursuant to an action brought under this Article may recover actual or nominal damages and, subject to the provisions and limitations of Chapter 1D of the General Statutes, punitive damages.
2. This Article does not limit a plaintiff from pursuing any other remedy existing under the law or seeking any other relief that may be available outside of the cause of action and relief provided under this Article.
3. The rights conferred under this Article as well as any rights conferred by the Constitution of North Carolina or the Constitution of the United States may not be waived, deferred, or lost pursuant to any contract between the insured or enrollee and the managed care entity that relates to a dispute involving a health care decision. Arbitration or mediation may be used to settle the controversy if, after the controversy arises, the insured or enrollee, or the estate of the insured or enrollee, voluntarily and knowingly consents in writing to use arbitration or mediation to settle the controversy.

History. 2001-446, s. 4.7.

§ 90-21.60. Voluntary arbitration; prior agreements to arbitration void.

1. Application of Article. —  This Article applies to all claims for damages for personal injury or wrongful death based on alleged negligence in the provision of health care by a health care provider as defined in G.S. 90-21.11 where all parties have agreed to submit the dispute to arbitration under this Article in accordance with the requirements of G.S. 90-21.61 .
2. When Agreement Is Void. —  Except as provided in G.S. 90-21.61(a), any contract provision or other agreement entered into prior to the commencement of an action that purports to require a party to elect arbitration under this Article is void and unenforceable. This Article does not impair the enforceability of any arbitration provision that does not specifically require arbitration under this Article.

History. 2007-541, s. 1.

Legal Periodicals.

For article, “Clause Construction: A Glimpse Into Judicial and Arbitral Decision-Making,” see 68 Duke L.J. 1324 (2019).

§ 90-21.61. Requirements for submitting to arbitration.

1. Before Action Is Filed. —  Before an action is filed, a person who claims damages for personal injury or wrongful death based on alleged negligence in the provision of health care by a health care provider as defined in G.S. 90-21.11 and the allegedly negligent health care provider may jointly submit their dispute to arbitration under this Article by, acting through their attorneys, filing a stipulation to arbitrate with the clerk of superior court in the county where the negligence allegedly occurred. The filing of such a stipulation provides jurisdiction to the superior court to enforce the provisions of this Article and tolls the statute of limitations.
2. Once Action Is Filed. —  The parties to an action for damages for personal injury or wrongful death based on alleged negligence in the provision of health care by a health care provider as defined in G.S. 90-21.11 may elect at any time during the pendency of the action to file a stipulation with the court in which all parties to the action agree to submit the dispute to arbitration under this Article.
3. Declaration Not to Arbitrate. —  In the event that the parties do not unanimously agree to submit a dispute to arbitration under subsection (b) of this section, the parties shall file a declaration with the court prior to the discovery scheduling conference required by G.S. 1A-1 , Rule 26(f1).The declaration shall state that the attorney representing the party has presented the party with a copy of the provisions of this Article, that the attorneys representing the parties have discussed the provisions of this Article with the parties and with each other, and that the parties do not unanimously agree to submit the dispute to arbitration under this Article. The declaration is without prejudice to the parties’ subsequent agreement to submit the dispute to arbitration.

History. 2007-541, s. 1.

§ 90-21.62. Selection of arbitrator.

1. Selection by Agreement. —  An arbitrator shall be selected by agreement of all the parties no later than 45 days after the date of the filing of the stipulation where the parties agreed to submit the dispute to arbitration under this Article. The parties may agree to select more than one arbitrator to conduct the arbitration. The parties may agree in writing to the selection of a particular arbitrator or particular arbitrators as a precondition for a stipulation to arbitrate.
2. Selection From List. —  If all the parties are unable to agree to an arbitrator by the time specified in subsection (a) of this section, the arbitrator shall be selected from emergency superior court judges who agree to be on a list maintained by the Administrative Office of the Courts. Each party shall alternately strike one name on the list, and the last remaining name on the list shall be the arbitrator. The emergency superior court judge serving as an arbitrator would be compensated at the same rate as an emergency judge serving in superior court.

History. 2007-541, s. 1.

§ 90-21.63. Witnesses; discovery; depositions; subpoenas.

1. General Conduct of Arbitration; Experts. —  The arbitrator may conduct the arbitration in such manner as the arbitrator considers appropriate so as to aid in the fair and expeditious disposition of the proceeding subject to the requirements of this section and G.S. 90-21.64 . Except as provided in subsection (b) of this section, each side shall be entitled to two experts on the issue of liability, two experts on the issue of damages, and one rebuttal expert.
2. Experts in Case of Multiple Parties. —  Where there are multiple parties on one side, the arbitrator shall determine the number of experts that are allowed based on the minimum number of experts necessary to ensure a fair and economic resolution of the action.
3. Discovery. —  Notwithstanding G.S. 90-21.64(a)(1), unless the arbitrator determines that exceptional circumstances require additional discovery, each party shall be entitled to all of the following discovery from any other party:
   1. Twenty-five interrogatories, including subparts.
   2. Ten requests for admission.
   3. Whatever is allowed under applicable court rules for:
      1. Requests for production of documents and things and for entry upon land for inspection and other purposes; and
      2. Requests for physical and mental examinations of persons.
4. Depositions. —  Each party shall be entitled to all of the following depositions:
   1. Depositions of any party and any expert that a party expects to call as a witness. —  Except by order of the arbitrator for good cause shown, the length of the deposition of a party or an expert witness under this subdivision shall be limited to four hours.
   2. Depositions of other witnesses. —  Unless the arbitrator determines that exceptional circumstances require additional depositions, the total number of depositions of persons under this subdivision shall be limited to five depositions per side, each of which shall last no longer than two hours and for which each side shall be entitled to examine for one hour.
5. Subpoenas. —  An arbitrator may issue a subpoena for the attendance of a witness and for the production of records and other evidence at any hearing and may administer oaths. A subpoena shall be served in the manner for service of subpoenas in a civil action and, upon the motion to the court by a party to the arbitration proceeding or by the arbitrator, enforced in the manner for enforcement of subpoenas in a civil action.

History. 2007-541, s. 1.

§ 90-21.64. Time limitations for arbitration.

1. Time Frames. —  The time frames provided in this section shall run from the date of the filing of the stipulation where the parties agreed to submit the dispute to arbitration under the Article. Any arbitration under this Article shall be conducted according to the time frames as follows:
   1. Within 45 days, the claimant shall provide a copy to the defendants of all relevant medical records. Alternatively, the claimant may provide to the defendants a release, in compliance with the federal Health Insurance Portability and Accountability Act, for all relevant medical records, along with the names and addresses of all health care providers who may have possession, custody, or control of the relevant medical records. The provisions of this subdivision shall not limit discovery conducted pursuant to G.S. 90-21.63(c).
   2. Within 120 days, the claimant shall disclose to each defendant the name and curriculum vitae or other documentation of qualifications of any expert the claimant expects to call as a witness.
   3. Within 140 days, each defendant shall disclose to the claimant the name and curriculum vitae or other documentation of qualifications of any expert the defendant expects to call as a witness.
   4. Within 160 days, each party shall disclose to each other party the name and curriculum vitae or other documentation of qualifications of any rebuttal expert the party expects to call as a witness.
   5. Within 240 days, all discovery shall be completed.
   6. Within 270 days, the arbitration hearing shall commence.
2. Scheduling Order. —  The arbitrator shall issue a case scheduling order in every proceeding specifying the dates by which the requirements of subdivisions (2) through (6) of subsection (a) of this section shall be completed. The scheduling order also shall specify a deadline for the service of dispositive motions and briefs.
3. Public Policy as to When Hearings Begin. —  It is the express public policy of the General Assembly that arbitration hearings under this Article be commenced no later than 10 months after the parties file the stipulation where the parties agreed to submit the dispute to arbitration under this Article. The arbitrator may grant a continuance of the commencement of the arbitration hearing only where a party shows that exceptional circumstances create an undue and unavoidable hardship on the party or where all parties consent to the continuance.

History. 2007-541, s. 1.

§ 90-21.65. Written decision by arbitration.

1. Issuing the Decision. —  The arbitrator shall issue a decision in writing and signed by the arbitrator within 14 days after the completion of the arbitration hearing and shall promptly deliver a copy of the decision to each party or the party’s attorneys.
2. Limit on Damages. —  The arbitrator shall not make an award of damages that exceeds a total of one million dollars ($1,000,000) for any dispute submitted to arbitration under this Article, regardless of the number of claimants or defendants that are parties to the dispute.
3. Finding if Damages Awarded. —  If the arbitrator makes an award of damages to the claimant, the arbitrator shall make a finding as to whether the injury or death was caused by the negligence of the defendant.
4. Paying the Arbitrator. —  The fees and expenses of the arbitrator shall be paid equally by the parties.
5. Attorneys’ Fees and Costs. —  Each party shall bear its own attorneys’ fees and costs.

History. 2007-541, s. 1.

§ 90-21.66. Judgment by court.

After a party to the arbitration proceeding receives notice of a decision, the party may file a motion with the court for a judgment in accordance with the decision at which time the court shall issue such a judgment unless the decision is modified, corrected, or vacated as provided in G.S. 90-21.68 .

History. 2007-541, s. 1.

§ 90-21.67. Retention of jurisdiction by court.

The court shall retain jurisdiction over the action during the pendency of the arbitration proceeding. The court may, at the request of the arbitrator, enter orders necessary to enforce the provisions of this Article.

History. 2007-541, s. 1.

§ 90-21.68. Appeal of arbitrator’s decision.

There is no right to a trial de novo on an appeal of the arbitrator’s decision under this Article. An appeal of the arbitrator’s decision is limited to the bases for appeal provided under G.S. 1-569.23 or G.S. 1-569.24 .

History. 2007-541, s. 1.

§ 90-21.69. Revised Uniform Arbitration Act not applicable.

The provisions of Article 45C of Chapter 1 of the General Statutes do not apply to arbitrations conducted under this Article except to the extent specifically provided in this Article.

History. 2007-541, s. 1.

§§ 90-21.70 through 90-21.79.

Reserved for future codification purposes.

§ 90-21.80. Short title.

This act may be cited as the “Woman’s Right to Know Act.”

History. 2011-405, s. 1.

Legal Periodicals.

For article, “Casey, Camnitz, and Compelled Speech: Why the Fourth Circuit’s Interpretation of Casey Sets the Right Standard for Speech-and-Display Provisions,” see 94 N.C.L. Rev. 1036 (2016).

For note, “A Violent Birth: Reframing Coerced Procedures During Childbirth as Obstetric Violence,” see 67 Duke L.J. 827 (2018).

§ 90-21.81. Definitions.

The following definitions apply in this Article:

1. Abortion. — The use or prescription of any instrument, medicine, drug, or other substance or device intentionally to terminate the pregnancy of a woman known to be pregnant with an intention other than to do any of the following:
   1. Increase the probability of a live birth.
   2. Preserve the life or health of the child.
   3. Remove a dead, unborn child who died as the result of (i) natural causes in utero, (ii) accidental trauma, or (iii) a criminal assault on the pregnant woman or her unborn child which causes the premature termination of the pregnancy.
2. Attempt to perform an abortion. — An act, or an omission of a statutorily required act, that, under the circumstances as the actor believes them to be, constitutes a substantial step in a course of conduct planned to culminate in the performance of an abortion in violation of this Article or Article 1K of this Chapter.
3. Department. — The Department of Health and Human Services.
4. Display a real-time view of the unborn child. — An ultrasound or any more scientifically advanced means of viewing the unborn child in real time.
5. Medical emergency. — A condition which, in reasonable medical judgment, so complicates the medical condition of the pregnant woman as to necessitate the immediate abortion of her pregnancy to avert her death or for which a delay will create serious risk of substantial and irreversible physical impairment of a major bodily function, not including any psychological or emotional conditions. For purposes of this definition, no condition shall be deemed a medical emergency if based on a claim or diagnosis that the woman will engage in conduct which would result in her death or in substantial and irreversible physical impairment of a major bodily function.
6. Physician. — An individual licensed to practice medicine in accordance with this Chapter.
7. Probable gestational age. — What, in the judgment of the physician, will, with reasonable probability, be the gestational age of the unborn child at the time the abortion is planned to be performed.
8. Qualified professional. — An individual who is a registered nurse, nurse practitioner, or physician assistant licensed in accordance with Article 1 of this Chapter, or a qualified technician acting within the scope of the qualified technician’s authority as provided by North Carolina law and under the supervision of a physician.
9. Qualified technician. — A registered diagnostic medical sonographer who is certified in obstetrics and gynecology by the American Registry for Diagnostic Medical Sonography (ARDMS) or a nurse midwife or advanced practice nurse practitioner in obstetrics with certification in obstetrical ultrasonography.
10. Stable Internet Web site. — A Web site that, to the extent reasonably practicable, is safeguarded from having its content altered other than by the Department.
11. Woman. — A female human, whether or not she is an adult.

History. 2011-405, s. 1; 2013-366, s. 3(b).

Effect of Amendments.

Session Laws 2013-366, s. 3(b), effective October 1, 2013, inserted “or Article 1K of this Chapter” in subdivision (2). For applicability, see Editor’s note.

Legal Periodicals.

For note, “Conscience Clauses and the Right of Refusal: The War Between Legal and Ethical Responsibility,” see 55 Wake Forest L. Rev. 717 (2020).

§ 90-21.82. Informed consent to abortion.

No abortion shall be performed upon a woman in this State without her voluntary and informed consent. Except in the case of a medical emergency, consent to an abortion is voluntary and informed only if all of the following conditions are satisfied:

1. At least 72 hours prior to the abortion, a physician or qualified professional has orally informed the woman, by telephone or in person, of all of the following:
   1. The name of the physician who will perform the abortion to ensure the safety of the procedure and prompt medical attention to any complications that may arise. The physician performing a surgical abortion shall be physically present during the performance of the entire abortion procedure. The physician prescribing, dispensing, or otherwise providing any drug or chemical for the purpose of inducing an abortion shall be physically present in the same room as the patient when the first drug or chemical is administered to the patient.
   2. The particular medical risks associated with the particular abortion procedure to be employed, including, when medically accurate, the risks of infection, hemorrhage, cervical tear or uterine perforation, danger to subsequent pregnancies, including the ability to carry a child to full term, and any adverse psychological effects associated with the abortion.
   3. The probable gestational age of the unborn child at the time the abortion is to be performed.
   4. The medical risks associated with carrying the child to term.
   5. The display of a real-time view of the unborn child and heart tone monitoring that enable the pregnant woman to view her unborn child or listen to the heartbeat of the unborn child are available to the woman. The physician performing the abortion, qualified technician, or referring physician shall inform the woman that the printed materials and Web site described in G.S. 90-21.83 and G.S. 90-21.84 contain phone numbers and addresses for facilities that offer the services free of charge. If requested by the woman, the physician or qualified professional shall provide to the woman the list as compiled by the Department.
   6. If the physician who is to perform the abortion has no liability insurance for malpractice in the performance or attempted performance of an abortion, that information shall be communicated.
   7. The location of the hospital that offers obstetrical or gynecological care located within 30 miles of the location where the abortion is performed or induced and at which the physician performing or inducing the abortion has clinical privileges. If the physician who will perform the abortion has no local hospital admitting privileges, that information shall be communicated. If the physician or qualified professional does not know the information required in sub-subdivisions a., f., or g. of this subdivision, the woman shall be advised that this information will be directly available from the physician who is to perform the abortion. However, the fact that the physician or qualified professional does not know the information required in sub-subdivisions a., f., or g. shall not restart the 72-hour period. The information required by this subdivision shall be provided in English and in each language that is the primary language of at least two percent (2%) of the State’s population. The information may be provided orally either by telephone or in person, in which case the required information may be based on facts supplied by the woman to the physician and whatever other relevant information is reasonably available. The information required by this subdivision may not be provided by a tape recording but shall be provided during a consultation in which the physician is able to ask questions of the patient and the patient is able to ask questions of the physician. If, in the medical judgment of the physician, a physical examination, tests, or the availability of other information to the physician subsequently indicates a revision of the information previously supplied to the patient, then that revised information may be communicated to the patient at any time before the performance of the abortion. Nothing in this section may be construed to preclude provision of required information in a language understood by the patient through a translator.
2. The physician or qualified professional has informed the woman, either by telephone or in person, of each of the following at least 72 hours before the abortion:
   1. That medical assistance benefits may be available for prenatal care, childbirth, and neonatal care.
   2. That public assistance programs under Chapter 108A of the General Statutes may or may not be available as benefits under federal and State assistance programs.
   3. That the father is liable to assist in the support of the child, even if the father has offered to pay for the abortion.
   4. That the woman has other alternatives to abortion, including keeping the baby or placing the baby for adoption.
   5. That the woman has the right to review the printed materials described in G.S. 90-21.83 , that these materials are available on a State-sponsored Web site, and the address of the State-sponsored Web site. The physician or a qualified professional shall orally inform the woman that the materials have been provided by the Department and that they describe the unborn child and list agencies that offer alternatives to abortion. If the woman chooses to view the materials other than on the Web site, the materials shall either be given to her at least 72 hours before the abortion or be mailed to her at least 72 hours before the abortion by certified mail, restricted delivery to addressee.
   6. That the woman is free to withhold or withdraw her consent to the abortion at any time before or during the abortion without affecting her right to future care or treatment and without the loss of any State or federally funded benefits to which she might otherwise be entitled. The information required by this subdivision shall be provided in English and in each language that is the primary language of at least two percent (2%) of the State’s population. The information required by this subdivision may be provided by a tape recording if provision is made to record or otherwise register specifically whether the woman does or does not choose to have the printed materials given or mailed to her. Nothing in this subdivision shall be construed to prohibit the physician or qualified professional from e-mailing a Web site link to the materials described in this subdivision or G.S. 90-21.83 .
3. The woman certifies in writing, before the abortion, that the information described in subdivisions (1) and (2) of this section has been furnished her and that she has been informed of her opportunity to review the information referred to in sub-subdivision (2)e. of this section. The original of this certification shall be maintained in the woman’s medical records, and a copy shall be given to her.
4. Before the performance of the abortion, the physician who will perform the abortion or the qualified technician must receive a copy of the written certification required by subdivision (3) of this section.

History. 2011-405, s. 1; 2013-366, s. 4(a); 2015-62, s. 7(b).

Effect of Amendments.

Session Laws 2013-366, s. 4(a), effective October 1, 2013, rewrote sub-subdivision (1)a., which formerly read “The name of the physician who will perform the abortion.”

Session Laws 2015-62, s. 7(b), effective October 1, 2015, substituted “72 hours” for “24 hours” in the introductory sentence of subdivisions (1) and (2); substituted “72 hours” for “24 hours” the first time it appears in subdivision (2)e.; and substituted “72-hour” for “24-hour” in the second paragraph of subdivision (1). For applicability, see editor’s note.

Legal Periodicals.

For article, “Casey, Camnitz, and Compelled Speech: Why the Fourth Circuit’s Interpretation of Casey Sets the Right Standard for Speech-and-Display Provisions,” see 94 N.C.L. Rev. 1036 (2016).

For article, “Regulating Physician Speech,” see 97 N.C.L. Rev. 843 (2019).

For note, “Conscience Clauses and the Right of Refusal: The War Between Legal and Ethical Responsibility,” see 55 Wake Forest L. Rev. 717 (2020).

§ 90-21.83. Printed information required.

1. Within 90 days after this Article becomes effective, the Department shall publish in English and in each language that is the primary language of at least two percent (2%) of the State’s population and shall cause to be available on the State Web site established under G.S. 90-21.84 , the following printed materials in a manner that ensures that the information is comprehensible to a person of ordinary intelligence:
   1. Geographically indexed materials designed to inform a woman of public and private agencies and services available to assist her through pregnancy, upon childbirth, and while the child is dependent, including adoption agencies. The information shall include a comprehensive list of the agencies available, a description of the services they offer, including which agencies offer, at no cost to the woman, imaging that enables the woman to view the unborn child or heart tone monitoring that enables the woman to listen to the heartbeat of the unborn child, and a description of the manner, including telephone numbers, in which they might be contacted. In the alternative, in the discretion of the Department, the printed materials may contain a toll-free, 24-hour-a-day telephone number that may be called to obtain, orally or by tape recorded message tailored to the zip code entered by the caller, a list of these agencies in the locality of the caller and of the services they offer.
   2. Materials designed to inform the woman of the probable anatomical and physiological characteristics of the unborn child at two-week gestational increments from the time a woman can be known to be pregnant until full term, including pictures or drawings representing the development of the unborn child at two-week gestational increments. The pictures shall contain the dimensions of the unborn child, information about brain and heart functions, the presence of external members and internal organs, and be realistic and appropriate for the stage of pregnancy depicted. The materials shall be objective, nonjudgmental, and designed to convey only accurate scientific information about the unborn child at the various gestational ages. The material shall contain objective information describing the methods of abortion procedures employed, the medical risks associated with each procedure, the possible adverse psychological effects of abortion, as well as the medical risks associated with carrying an unborn child to term.
2. The materials referred to in subsection (a) of this section shall be printed in a typeface large enough to be clearly legible. The Web site provided for in G.S. 90-21.84 shall be maintained at a minimum resolution of 70 DPI (dots per inch). All pictures appearing on the Web site shall be a minimum of 200x300 pixels. All letters on the Web site shall be a minimum of 12-point font. All information and pictures shall be accessible with an industry-standard browser requiring no additional plug-ins.
3. The materials required under this section shall be available at no cost from the Department upon request and in appropriate numbers to any physician, person, health facility, hospital, or qualified professional.
4. The Department shall cause to be available on the State Web site a list of resources the woman may contact for assistance upon receiving information from the physician performing the ultrasound that the unborn child may have a disability or serious abnormality and shall do so in a manner prescribed by subsection (b) of this section.

History. 2011-405, s. 1; 2013-366, s. 4(b).

Effect of Amendments.

Session Laws 2013-366, s. 4(b), effective October 1, 2013, added subsection (d).

Legal Periodicals.

For article, “Regulating Physician Speech,” see 97 N.C.L. Rev. 843 (2019).

§ 90-21.84. Internet Web site.

The Department shall develop and maintain a stable Internet Web site to provide the information described under G.S. 90-21.83 . No information regarding who accesses the Web site shall be collected or maintained. The Department shall monitor the Web site on a regular basis to prevent and correct tampering.

History. 2011-405, s. 1.

§ 90-21.85. Display of real-time view requirement.

1. Notwithstanding G.S. 14-45.1 , except in the case of a medical emergency, in order for the woman to make an informed decision, at least four hours before a woman having any part of an abortion performed or induced, and before the administration of any anesthesia or medication in preparation for the abortion on the woman, the physician who is to perform the abortion, or qualified technician working in conjunction with the physician, shall do each of the following:
   1. Perform an obstetric real-time view of the unborn child on the pregnant woman.
   2. Provide a simultaneous explanation of what the display is depicting, which shall include the presence, location, and dimensions of the unborn child within the uterus and the number of unborn children depicted. The individual performing the display shall offer the pregnant woman the opportunity to hear the fetal heart tone. The image and auscultation of fetal heart tone shall be of a quality consistent with the standard medical practice in the community. If the image indicates that fetal demise has occurred, a woman shall be informed of that fact.
   3. Display the images so that the pregnant woman may view them.
   4. Provide a medical description of the images, which shall include the dimensions of the embryo or fetus and the presence of external members and internal organs, if present and viewable.
   5. Obtain a written certification from the woman, before the abortion, that the requirements of this section have been complied with, which shall indicate whether or not she availed herself of the opportunity to view the image.
   6. Retain a copy of the written certification prescribed by subdivision (a)(5) of this section. The certification shall be placed in the medical file of the woman and shall be kept by the abortion provider for a period of not less than seven years. If the woman is a minor, then the certification shall be placed in the medical file of the minor and kept for at least seven years or for five years after the minor reaches the age of majority, whichever is greater. If the woman has had an obstetric display of a real-time image of the unborn child within 72 hours before the abortion is to be performed, the certification of the physician or qualified technician who performed the procedure in compliance with this subsection shall be included in the patient’s records and the requirements under this subsection shall be deemed to have been met.
2. Nothing in this section shall be construed to prevent a pregnant woman from averting her eyes from the displayed images or from refusing to hear the simultaneous explanation and medical description.
3. In the event the person upon whom the abortion is to be performed is an unemancipated minor, as defined in G.S. 90-21.6(1) , the information described in subdivisions (a)(2) and (a)(4) of this section shall be furnished and offered respectively to a person required to give parental consent under G.S. 90-21.7(a) and the unemancipated minor. The person required to give consent in accordance with G.S. 90-21.7(a) , as appropriate, shall make the certification required by subdivision (a)(5) of this section. In the event the person upon whom the abortion is to be performed has been adjudicated mentally incompetent by a court of competent jurisdiction, the information shall be furnished and offered respectively to her spouse or a legal guardian if she is married or, if she is not married, to one parent or a legal guardian and the woman. The spouse, legal guardian, or parent, as appropriate, shall make the certification required by subdivision (a)(5) of this section. In the case of an abortion performed pursuant to a court order under G.S. 90-21.8(e) and (f), the information described in subdivisions (a)(2) and (a)(4) of this section shall be provided to the minor, and the certification required by subdivision (a)(5) of this section shall be made by the minor.

History. 2011-405, s. 1.

Legal Periodicals.

For article, “Health Care Decisions in the New Era of Health Care Reform: An Overview,” see 92 N.C. L. Rev. 1445 (2014).

For note, “Removing the ‘Silencer’ Coverage and Protection of Physician Speech under the First Amendment,” see 65 Duke L.J. 801 (2016).

For article, “Casey, Camnitz, and Compelled Speech: Why the Fourth Circuit’s Interpretation of Casey Sets the Right Standard for Speech-and-Display Provisions,” see 94 N.C.L. Rev. 1036 (2016).

§ 90-21.86. Procedure in case of medical emergency.

When a medical emergency compels the performance of an abortion, the physician shall inform the woman, before the abortion if possible, of the medical indications supporting the physician’s judgment that an abortion is necessary to avert her death or that a 72-hour delay will create a serious risk of substantial and irreversible impairment of a major bodily function, not including psychological or emotional conditions. As soon as feasible, the physician shall document in writing the medical indications upon which the physician relied and shall cause the original of the writing to be maintained in the woman’s medical records and a copy given to her.

History. 2011-405, s. 1; 2015-62, s. 7(c).

Effect of Amendments.

Session Laws 2015-62, s. 7(c), effective October 1, 2015, substituted “72-hour” for “24-hour” in the first sentence. For applicability, see Editor’s note.

§ 90-21.87. Informed consent for a minor.

If the woman upon whom an abortion is to be performed is an unemancipated minor, the voluntary and informed written consent required under G.S. 90-21.82 shall be obtained from the minor and from the adult individual who gives consent pursuant to G.S. 90-21.7(a) .

History. 2011-405, s. 1.

§ 90-21.88. Civil remedies.

1. Any person upon whom an abortion has been performed and any father of an unborn child that was the subject of an abortion may maintain an action for damages against the person who performed the abortion in knowing or reckless violation of this Article. Any person upon whom an abortion has been attempted may maintain an action for damages against the person who performed the abortion in willful violation of this Article.
2. Injunctive relief against any person who has willfully violated this Article may be sought by and granted to (i) the woman upon whom an abortion was performed or attempted to be performed in violation of this Article, (ii) any person who is the spouse, parent, sibling, or guardian of, or a current or former licensed health care provider of, the woman upon whom an abortion has been performed or attempted to be performed in violation of this Article, or (iii) the Attorney General. The injunction shall prevent the abortion provider from performing or inducing further abortions in this State in violation of this Article.
3. If judgment is rendered in favor of the plaintiff in any action authorized under this section, the court shall also tax as part of the costs reasonable attorneys’ fees in favor of the plaintiff against the defendant. If judgment is rendered in favor of the defendant and the court finds that the plaintiff’s suit was frivolous or brought in bad faith, then the court shall tax as part of the costs reasonable attorneys’ fees in favor of the defendant against the plaintiff.

History. 2011-405, s. 1.

§ 90-21.89. Protection of privacy in court proceedings.

In every proceeding or action brought under this Article, the court shall rule whether the anonymity of any woman upon whom an abortion has been performed or attempted shall be preserved from public disclosure if she does not give her consent to the disclosure. The court, upon motion or sua sponte, shall make the ruling and, upon determining that her anonymity should be preserved, shall issue orders to the parties, witnesses, and counsel and shall direct the sealing of the record and exclusion of individuals from courtrooms or hearing rooms to the extent necessary to safeguard her identity from public disclosure. Each order issued pursuant to this section shall be accompanied by specific written findings explaining (i) why the anonymity of the woman should be preserved from public disclosure, (ii) why the order is essential to that end, (iii) how the order is narrowly tailored to serve that interest, and (iv) why no reasonable less restrictive alternative exists. In the absence of written consent of the woman upon whom an abortion has been performed or attempted, anyone who brings an action under G.S. 90-21.88 (a) or (b) shall do so under a pseudonym. This section may not be construed to conceal the identity of the plaintiff or of witnesses from the defendant.

History. 2011-405, s. 1.

§ 90-21.90. Assurance of informed consent.

1. All information required to be provided under G.S. 90-21.82 to a woman considering abortion shall be presented to the woman individually and, except for information that may be provided by telephone, in the physical presence of the woman and in a language the woman understands to ensure that the woman has adequate opportunity to ask questions and to ensure the woman is not the victim of a coerced abortion.
2. Should a woman be unable to read the materials provided to the woman pursuant to this section, a physician or qualified professional shall read the materials to the woman in a language the woman understands before the abortion.

History. 2011-405, s. 1.

§ 90-21.91. Assurance that consent is freely given.

If a physician acting pursuant to this Article has reason to believe that a woman is being coerced into having an abortion, the physician or qualified professional shall inform the woman that services are available for the woman and shall provide the woman with private access to a telephone and information about, but not limited to, each of the following services:

1. Rape crisis centers.
2. Shelters for victims of domestic violence.
3. Restraining orders.
4. Pregnancy care centers.

History. 2011-405, s. 1.

§ 90-21.92. Severability.

If any one or more provision, section, subsection, sentence, clause, phrase, or word of this Article or the application thereof to any person or circumstance is found to be unconstitutional, the same is hereby declared to be severable, and the balance of this Article shall remain effective, notwithstanding such unconstitutionality. The General Assembly hereby declares that it would have passed this Article, and each provision, section, subsection, sentence, clause, phrase, or word thereof, irrespective of the fact that any one or more provision, section, subsection, sentence, clause, phrase, or word be declared unconstitutional.

History. 2011-405, s. 1.

§§ 90-21.93 through 90-21.99.

Reserved for future codification purposes.

§ 90-21.100. Short title.

This Article shall be known and may be cited as the Volunteer Health Care Services Act.

History. 2012-155, s. 1.

§ 90-21.101. Findings.

1. The General Assembly makes the following findings:
   1. Access to high-quality health care services is a concern of all persons.
   2. Access to high-quality health care services may be limited for some residents of this State, particularly those who reside in remote, rural areas or in the inner city.
   3. Physicians and other health care providers have traditionally worked to ensure broad access to health care services.
   4. Many health care providers from North Carolina and elsewhere are willing to volunteer their services to address the health care needs of North Carolinians who may otherwise not be able to obtain high-quality health care services.
2. The General Assembly further finds that it is the public policy of this State to encourage and facilitate the voluntary provision of health care services.

History. 2012-155, s. 1.

§ 90-21.102. Definitions.

The following definitions apply in this Article:

1. Department. — The North Carolina Department of Health and Human Services.
2. Free clinic. — A nonprofit, 501(c)(3) tax-exempt organization organized for the purpose of providing health care services without charge or for a minimum fee to cover administrative costs.
3. Health care provider. — Any person who:
   1. Is licensed to practice as a physician or a physician assistant under Article 1 of this Chapter.
   2. Holds a limited volunteer license under G.S. 90-12.1 A.
   3. Holds a retired limited volunteer license under G.S. 90-12.1 B.
   4. Holds a physician assistant limited volunteer license under G.S. 90-12.4 .
   5. Holds a physician assistant retired limited volunteer license under 90-12.4B.
   6. Is a volunteer health care professional to whom G.S. 90-21.16 applies.
   7. Is licensed to practice dentistry under Article 2 of this Chapter.
   8. Is licensed to practice pharmacy under Article 4A of this Chapter.
   9. Is licensed to practice optometry under Article 6 of this Chapter.
   10. Is licensed to practice as a registered nurse or licensed practical nurse under Article 9A of this Chapter.
   11. Is licensed to practice as a dental hygienist under Article 16 of this Chapter.
   12. Holds a license as a registered licensed optician under Article 17 of this Chapter.
   13. Is licensed to practice as a physician, physician assistant, dentist, pharmacist, optometrist, registered nurse, licensed practical nurse, dental hygienist, or optician under provisions of law of another state of the United States comparable to the provisions referenced in sub-subdivisions a. through l. of this subdivision.
4. Sponsoring organization. — Any nonprofit organization that organizes or arranges for the voluntary provision of health care services pursuant to this Article.
5. Voluntary provision of health care services. — The provision of health care services by a health care provider in association with a sponsoring organization in which both of the following circumstances exist:
   1. The health care services are provided without charge to the recipient of the services or to a third party on behalf of the recipient.
   2. The health care provider receives no compensation or other consideration in exchange for the health care services provided.

      For the purposes of this Article, the provision of health care services in nonprofit community health centers, local health department facilities, free clinic facilities, or at a provider’s place of employment when the patient is referred by a nonprofit community health referral service shall not be considered the voluntary provision of health care.

History. 2012-155, s. 1; 2012-194, s. 47(a); 2013-49, s. 2.

Effect of Amendments.

Session Laws 2012-194, s. 47(a), effective January 1, 2013, in subdivision (3)m, substituted “through l. ” for “through n.”; and in paragraph following subdivision (5)b, substituted “nonprofit” for “non-profit” twice and substituted “provider’s” for “providers.”

Session Laws 2013-49, s. 2, effective October 1, 2013, deleted “and that maintains liability insurance covering the acts and omissions of the free clinic and any liability pursuant to G.S. 90-21.16(a)” at the end of subdivision (2). For applicability, see Editor’s note.

§ 90-21.103. Limitation on duration of voluntary health care services.

A sponsoring organization duly registered in accordance with G.S. 90-21.104 may organize or arrange for the voluntary provision of health care services at a location in this State for a period not to exceed seven calendar days in any calendar year.

History. 2012-155, s. 1.

§ 90-21.104. Registration, reporting, and record-keeping requirements.

1. A sponsoring organization shall not organize or arrange for the voluntary provision of health care services in this State without first registering with the Department on a form prescribed by the Department. The registration form shall contain all of the following information:
   1. The name of the sponsoring organization.
   2. The name of the principal individuals who are the officers or organizational officials responsible for the operation of the sponsoring organization.
   3. The street address, city, zip code, and county of the sponsoring organization’s principal office and each of the principal individuals described in subdivision (2) of this subsection.
   4. Telephone numbers for the principal office of the sponsoring organization and for each of the principal individuals described in subdivision (2) of this subsection.
   5. Any additional information requested by the Department.
2. Each sponsoring organization that applies for registration under this Article shall pay a one-time registration fee in the amount of fifty dollars ($50.00), which it shall submit to the Department along with the completed registration form required by subsection (a) of this section. Upon approval by the Department, a sponsoring organization’s registration remains valid unless revoked by the Department pursuant to subsection (f) of this section.
3. Upon any change in the information required under subsection (a) of this section, the sponsoring organization shall notify the Department of the change, in writing, within 30 days after the effective date of the change.
4. Each registered sponsoring organization has the duty and responsibility to do all of the following:
   1. Except as provided in this subdivision, by no later than 14 days before a sponsoring organization initiates voluntary health care services in this State, the sponsoring organization shall submit to the Department a list containing the following information regarding each health care provider who is to provide voluntary health care services on behalf of the sponsoring organization during any part of the time period in which the sponsoring organization is authorized to provide voluntary health care services in the State:
      1. Name.
      2. Date of birth.
      3. State of licensure.
      4. License number.
      5. Area of practice.
      6. Practice address.

         By no later than 3 days prior to voluntary health care services being rendered, a sponsoring organization may amend the list to add health care providers defined in G.S. 90-21.102(3)a. through G.S. 90-21.102(3) l .

   2. Beginning April 1, 2013, submit quarterly reports to the Department identifying all health care providers who engaged in the provision of voluntary health care services in association with the sponsoring organization in this State during the preceding calendar quarter. The quarterly report must include the date, place, and type of voluntary health care services provided by each health care provider.
   3. Maintain a list of health care providers associated with its provision of voluntary health care services in this State. For each health care provider listed, the sponsoring organization shall maintain a copy of a current license or statement of exemption from licensure or certification. For health care providers currently licensed or certified under this Chapter, the sponsoring organization may maintain a copy of the health care provider’s license or certification verification obtained from a State-sponsored Internet Web site.
   4. Maintain records of the quarterly reports and records required under this subsection for a period of five years from the date of voluntary service and make these records available upon request to any State licensing board established under this Chapter.
5. Compliance with subsections (a) through (d) of this section is prima facie evidence that the sponsoring organization has exercised due care in its selection of health care providers.
6. The Department may revoke the registration of any sponsoring organization that fails to comply with the requirements of this Article. A sponsoring organization may challenge the Department’s decision to revoke its registration by filing a contested case under Article 3 of Chapter 150B of the General Statutes.
7. The Department may waive any of the requirements of this section during a natural disaster or other emergency circumstance.

History. 2012-155, s. 1; 2012-194, s. 47(b).

Effect of Amendments.

Session Laws 2012-194, s. 47(b), effective January 1, 2013, substituted “G.S. 90-21.102(3) l .” for “G.S. 90-21.102(3)m.” in the paragraph following subdivision “(d)(1)f.”

§ 90-21.105. Department and licensure boards to review licensure status of volunteers.

The Department shall forward the information received from a sponsoring organization under G.S. 90-21.104(d)(1) to the appropriate licensure board within seven days after receipt. Upon receipt of any information or notice from a licensure board that a health care provider on the list submitted by the sponsoring organization pursuant to G.S. 90-21.104(d)(1) is not licensed, authorized, or in good standing, or is the subject of an investigation or pending disciplinary action, the Department shall immediately notify the sponsoring organization that the health care provider is not permitted to engage in the voluntary provision of health care services on behalf of the sponsoring organization.

History. 2012-155, s. 1.

§ 90-21.106. On-site requirements.

A sponsoring organization that organizes or arranges for the provision of voluntary health care services at a location in this State shall ensure that at least one health care provider licensed to practice in this State, with access to the controlled substances reporting system established under G.S. 90-113.73 , is located on the premises where the provision of voluntary health care services is occurring. In addition, every sponsoring organization shall post in a clear and conspicuous manner the following notice in the premises where the provision of voluntary health care services is occurring:

“NOTICE

Under North Carolina law, there is no liability for damages for injuries or death alleged to have occurred by reason of an act or omission in the health care provider’s voluntary provision of health care services, unless it is established that the injuries or death were caused by gross negligence, wanton conduct, or intentional wrongdoing on the part of the health care provider.”

History. 2012-155, s. 1.

§ 90-21.107. Additional licensure not required for certain volunteers.

1. A health care provider who engages in the voluntary provision of health care services in association with a sponsoring organization for no more than seven days during any calendar year shall not be required to obtain additional licensure or authorization in connection therewith if the health care provider meets any of the following criteria:
   1. The health care provider is duly licensed or authorized under the laws of this State to practice in the area in which the health care provider is providing voluntary health care services and is in good standing with the applicable licensing board.
   2. The health care provider lawfully practices in another state or district in the area in which the health care provider is providing voluntary health care services and is in good standing with the applicable licensing board.
2. This exemption from additional licensure or authorization requirements does not apply if any of the following circumstances exist:
   1. The health care provider has been subjected to public disciplinary action or is the subject of a pending disciplinary proceeding in any state in which the health care provider is or ever has been licensed.
   2. The health care provider’s license has been suspended or revoked pursuant to disciplinary proceedings in any state in which the health care provider is or ever has been licensed.
   3. The health care provider renders services outside the scope of practice authorized by the health care provider’s license or authorization.

History. 2012-155, s. 1.

§ 90-21.108. Immunity from civil liability for acts or omissions.

1. Subject to subsection (b) of this section, a health care provider who engages in the voluntary provision of health care services at any location in this State in association with a sponsoring organization shall not be liable for damages for injuries or death alleged to have occurred by reason of an act or omission in the health care provider’s voluntary provision of health care services, unless it is established that the injuries or death were caused by gross negligence, wanton conduct, or intentional wrongdoing on the part of the health care provider.
2. The immunity from civil liability provided by subsection (a) of this section does not apply if any of the following circumstances exist:
   1. The health care provider receives, directly or indirectly, any type of compensation, benefits, or other consideration of any nature from any person for the health care services provided.
   2. The health care services provided are not part of the health care provider’s training or assignment.
   3. The health care services provided are not within the scope of the health care provider’s license or authority.
   4. The health care services provided are not authorized by the appropriate authorities to be performed at the location.

History. 2012-155, s. 1.

§§ 90-21.109 through 90-21.119.

Reserved for future codification purposes.

§ 90-21.120. Definitions.

The following definitions apply in this Article:

1. Abortion. — As defined in G.S. 90-21.81(1).
2. Attempt to perform an abortion. — As defined in G.S. 90-21.81(2).
3. Woman. — As defined in G.S. 90-21.81(11).

History. 2013-366, s. 3(a).

§ 90-21.121. Sex-selective abortion prohibited.

1. Notwithstanding any of the provisions of G.S. 14-45.1 , no person shall perform or attempt to perform an abortion upon a woman in this State with knowledge, or an objective reason to know, that a significant factor in the woman seeking the abortion is related to the sex of the unborn child.
2. Nothing in this section shall be construed as placing an affirmative duty on a physician to inquire as to whether the sex of the unborn child is a significant factor in the pregnant woman seeking the abortion.

History. 2013-366, s. 3(a).

§ 90-21.122. Civil remedies.

1. Any person who violates any provision of this Article shall be liable for damages, including punitive damages pursuant to Chapter 1D of the General Statutes, and may be enjoined from future acts.
2. A claim for damages against any person who has violated a provision of this Article may be sought by (i) the woman upon whom an abortion was performed or attempted in violation of this Article, (ii) any person who is the spouse or guardian of the woman upon whom an abortion was performed or attempted in violation of this Article, or (iii) a parent of the woman upon whom an abortion was performed or attempted in violation of this Article if the woman was a minor at the time the abortion was performed or attempted.
3. A claim for injunctive relief against any person who has violated a provision of this Article may be sought by (i) the woman upon whom an abortion was performed or attempted in violation of this Article, (ii) any person who is the spouse, guardian, or current or former licensed health care provider of the woman upon whom an abortion was performed or attempted in violation of this Article, or (iii) a parent of the woman upon whom an abortion was performed or attempted in violation of this Article if the woman was a minor at the time the abortion was performed or attempted.
4. Any person who violates the terms of an injunction issued in accordance with this section shall be subject to civil contempt and shall be fined ten thousand dollars ($10,000) for the first violation, fifty thousand dollars ($50,000) for the second violation, and one hundred thousand dollars ($100,000) for the third violation and each subsequent violation. Each performance or attempted performance of an abortion in violation of the terms of an injunction is a separate violation. The fine shall be the exclusive penalty for civil contempt under this subsection. The fine under this subsection shall be cumulative. No fine shall be assessed against the woman upon whom an abortion is performed or attempted.
5. The clear proceeds of any civil penalty assessed under this section shall be remitted to the Civil Penalty and Forfeiture Fund in accordance with G.S. 115C-457.2 .

History. 2013-366, s. 3(a).

§ 90-21.123. Protection of privacy in court proceedings.

In every proceeding or action brought under this Article, the court shall rule whether the anonymity of any woman upon whom an abortion has been performed or attempted shall be preserved from public disclosure if the woman does not give her consent to the disclosure. The court, upon motion or sua sponte, shall make the ruling and, upon determining that the woman’s anonymity should be preserved, shall issue orders to the parties, witnesses, and counsel and shall direct the sealing of the record and exclusion of individuals from courtrooms or hearing rooms to the extent necessary to safeguard the woman’s identity from public disclosure. Each order issued pursuant to this section shall be accompanied by specific written findings explaining (i) why the anonymity of the woman should be preserved from public disclosure, (ii) why the order is essential to that end, (iii) how the order is narrowly tailored to serve that interest, and (iv) why no reasonable, less restrictive alternative exists. In the absence of written consent of the woman upon whom an abortion has been performed or attempted, anyone who brings an action under G.S. 90-21.122 shall do so under a pseudonym. This section may not be construed to conceal the identity of the plaintiff or of witnesses from the defendant.

History. 2013-366, s. 3(a).

§§ 90-21.124 through 90-21.129.

Reserved for future codification purposes.

§ 90-21.130. Short title.

This Article shall be known and may be cited as the Emergency or Disaster Treatment Protection Act.

History. 2020-3, s. 3D.7(a); 2021-3, s. 2.13(a).

§ 90-21.131. Purpose.

It is the purpose of this Article to promote the public health, safety, and welfare of all citizens by broadly protecting the health care facilities and health care providers in this State from liability that may result from treatment of individuals during the COVID-19 public health emergency under conditions resulting from circumstances associated with the COVID-19 public health emergency. A public health emergency that occurs on a statewide basis requires an enormous response from State, federal, and local governments working in concert with private and public health care providers in the community. The rendering of treatment to patients during such a public health emergency is a matter of vital State concern affecting the public health, safety, and welfare of all citizens.

History. 2020-3, s. 3D.7(a); 2021-3, s. 2.13(a).

§ 90-21.132. Definitions.

The following definitions apply in this Article:

1. COVID-19. — Coronavirus disease 2019.
2. COVID-19 emergency declaration. — Executive Order No. 116 issued March 10, 2020, by Governor Roy A. Cooper, including any amendments issued by executive order, subject to extensions under Chapter 166A of the General Statutes.
3. COVID-19 emergency rule. — Any executive order, declaration, directive, request, or other State or federal authorization, policy statement, rule making, or regulation that waives, suspends, or modifies applicable State or federal law regarding scope of practice, including modifications authorizing health care providers licensed in another state to practice in this State, or the delivery of care, including those regarding the facility space in which care is delivered and which equipment is used during the COVID-19 emergency declaration.
4. Damages. — Economic or noneconomic losses for harm to an individual.
5. Harm. — Physical and nonphysical contact that results in injury to or death of an individual.
6. Health care facility. — Any entity licensed pursuant to Chapter 122C, 131D, or 131E of the General Statutes or Article 64 of Chapter 58 of the General Statutes, and any clinical laboratory certified under the federal Clinical Laboratory Improvement Amendments in section 353 of the Public Health Service Act (42 U.S.C. § 263a).
7. Health care provider. —
   1. An individual who is licensed, certified, or otherwise authorized under Chapter 90 or 90B of the General Statutes to provide health care services in the ordinary course of business or practice of a profession or in an approved education or training program.
   2. A health care facility where health care services are provided to patients, residents, or others to whom such services are provided as allowed by law.
   3. Individuals licensed under Chapter 90 of the General Statutes or practicing under a waiver in accordance with G.S. 90-12.5 .
   4. Any emergency medical services personnel as defined in G.S. 131E-155(7).
   5. Any individual providing health care services within the scope of authority permitted by a COVID-19 emergency rule.
   6. Any individual who is employed as a health care facility administrator, executive, supervisor, board member, trustee, or other person in a managerial position or comparable role at a health care facility.
   7. An agent or employee of a health care facility that is licensed, certified, or otherwise authorized to provide health care services.
   8. An officer or director of a health care facility.
   9. An agent or employee of a health care provider who is licensed, certified, or otherwise authorized to provide health care services.
   10. An individual who volunteers to assist a State agency, department, or approved organization in the administration of COVID-19 vaccinations, including clinical, clinical support, and nonclinical support activities.
8. Health care service. — Treatment, clinical direction, supervision, management, or administrative or corporate service, provided by a health care facility or a health care provider during the period of the COVID-19 emergency declaration, regardless of the location in this State where the service is rendered:
   1. To provide testing, diagnosis, or treatment of a health condition, illness, injury, or disease related to a confirmed or suspected case of COVID-19.
   2. To dispense drugs, medical devices, medical appliances, or medical goods for the treatment of a health condition, illness, injury, or disease related to a confirmed or suspected case of COVID-19.
   3. To provide care to any other individual who presents or otherwise seeks care at or from a health care facility or to a health care provider during the period of the COVID-19 emergency declaration.
9. Volunteer organization. — Any medical organization, company, or institution that has made its facility or facilities available to support the State’s response and activities under the COVID-19 emergency declaration and in accordance with any applicable COVID-19 emergency rule.

History. 2020-3, s. 3D.7(a); 2021-3, ss. 2.13(a), 2.14(a).

§ 90-21.133. Immunity.

1. Notwithstanding any law to the contrary, except as provided in subsection (b) of this section, any health care facility, health care provider, or entity that has legal responsibility for the acts or omissions of a health care provider shall have immunity from any civil liability for any harm or damages alleged to have been sustained as a result of an act or omission in the course of arranging for or providing health care services only if all of the following apply:
   1. The health care facility, health care provider, or entity is arranging for or providing health care services during the period of the COVID-19 emergency declaration, including, but not limited to, the arrangement or provision of those services pursuant to a COVID-19 emergency rule.
   2. The arrangement or provision of health care services is impacted, directly or indirectly:
      1. By a health care facility, health care provider, or entity’s decisions or activities in response to or as a result of the COVID-19 pandemic; or
      2. By the decisions or activities, in response to or as a result of the COVID-19 pandemic, of a health care facility or entity where a health care provider provides health care services.
   3. The health care facility, health care provider, or entity is arranging for or providing health care services in good faith.
2. The immunity from any civil liability provided in subsection (a) of this section shall not apply if the harm or damages were caused by an act or omission constituting gross negligence, reckless misconduct, or intentional infliction of harm by the health care facility or health care provider providing health care services; provided that the acts, omissions, or decisions resulting from a resource or staffing shortage shall not be considered to be gross negligence, reckless misconduct, or intentional infliction of harm.
3. Notwithstanding any law to the contrary, a volunteer organization shall have immunity from any civil liability for any harm or damages occurring in or at its facility or facilities arising from the State’s response and activities under the COVID-19 emergency declaration and in accordance with any applicable COVID-19 emergency rule, unless it is established that such harm or damages were caused by the gross negligence, reckless misconduct, or intentional infliction of harm by the volunteer organization.

History. 2020-3, s. 3D.7(a); 2021-3, s. 2.13(a).

§ 90-21.134. Severability.

This Article shall be liberally construed to effectuate its public health emergency purpose as outlined in G.S. 90-121.131. The provisions of this Article are severable. If any part of this Article is declared to be invalid by a court, the invalidity does not affect other parts of this Article that can be given effect without the invalid provision.

History. 2020-3, s. 3D.7(a); 2021-3, s. 2.13(a).

§ 90-22. Practice of dentistry regulated in public interest; Article liberally construed; Board of Dental Examiners; composition; qualifications and terms of members; vacancies; nominations and elections; compensation; expenditures by Board.

1. The practice of dentistry in the State of North Carolina is hereby declared to affect the public health, safety and welfare and to be subject to regulation and control in the public interest. It is further declared to be a matter of public interest and concern that the dental profession merit and receive the confidence of the public and that only qualified persons be permitted to practice dentistry in the State of North Carolina. This Article shall be liberally construed to carry out these objects and purposes.
2. The North Carolina State Board of Dental Examiners heretofore created by Chapter 139, Public Laws 1879 and by Chapter 178, Public Laws 1915, is hereby continued as the agency of the State for the regulation of the practice of dentistry in this State. Said Board of Dental Examiners shall consist of six dentists who are licensed to practice dentistry in North Carolina, one dental hygienist who is licensed to practice dental hygiene in North Carolina and one person who shall be a citizen and resident of North Carolina and who shall be licensed to practice neither dentistry nor dental hygiene. The dental hygienist or the consumer member cannot participate or vote in any matters of the Board which involves the issuance, renewal or revocation of the license to practice dentistry in the State of North Carolina. The consumer member cannot participate or vote in any matters of the Board which involve the issuance, renewal or revocation of the license to practice dental hygiene in the State of North Carolina. Members of the Board licensed to practice dentistry in North Carolina shall have been elected in an election held as hereinafter provided in which every person licensed to practice dentistry in North Carolina and residing or practicing in North Carolina shall be entitled to vote. Each member of said Board shall be elected for a term of three years and until his successor shall be elected and shall qualify. Each year there shall be elected two dentists for such terms of three years each. Every three years there shall be elected one dental hygienist for a term of three years. Dental hygienists shall be elected to the Board in an election held in accordance with the procedures hereinafter provided in which those persons licensed to practice dental hygiene in North Carolina and residing or practicing in North Carolina shall be entitled to vote. Every three years a person who is a citizen and resident of North Carolina and licensed to practice neither dentistry nor dental hygiene shall be appointed to the Board for a term of three years by the Governor of North Carolina. Any vacancy occurring on said Board shall be filled by a majority vote of the remaining members of the Board to serve until the next regular election conducted by the Board, at which time the vacancy will be filled by the election process provided for in this Article, except that when the seat on the Board held by a person licensed to practice neither dentistry nor dental hygiene in North Carolina shall become vacant, the vacancy shall be filled by appointment by the Governor for the period of the unexpired term. No dentist shall be nominated for or elected to membership on said Board, unless, at the time of such nomination and election such person is licensed to practice dentistry in North Carolina and actually engaged in the practice of dentistry. No dental hygienist shall be nominated for or elected to membership on said Board unless, at the time of such nomination and election, such person is licensed to practice dental hygiene in North Carolina and is currently employed in dental hygiene in North Carolina. No person shall be nominated, elected, or appointed to serve more than two consecutive terms on said Board.
3. Nominations and elections of members of the North Carolina State Board of Dental Examiners shall be as follows:
   1. An election shall be held each year to elect successors to those members whose terms are expiring in the year of the election, each successor to take office on the first day of August following the election and to hold office for a term of three years and until his successor has been elected and shall qualify; provided that if in any year the election of the members of such Board for that year shall not have been completed by August 1 of that year, then the said members elected that year shall take office immediately after the completion of the election and shall hold office until the first of August of the third year thereafter and until their successors are elected and qualified. Persons appointed to the Board by the Governor shall take office on the first day of August following their appointment and shall hold office for a term of three years and until such person’s successor has been appointed and shall qualify; provided that if in any year the Governor shall not have appointed a person by August first of that year, then the said member appointed that year shall take office immediately after his appointment and shall hold office until the first of August of the third year thereafter and until such member’s successor is appointed and qualified.
   2. Every dentist with a current North Carolina license residing or practicing in North Carolina shall be eligible to vote in elections of dentists to the Board. Every dental hygienist with a current North Carolina license residing or practicing in North Carolina shall be eligible to vote in elections of dental hygienists to the Board. The holding of such a license to practice dentistry or dental hygiene in North Carolina shall constitute registration to vote in such elections. The list of licensed dentists and dental hygienists shall constitute the registration list for elections to the appropriate seats on the Board.
   3. All elections shall be conducted by the Board of Dental Examiners which is hereby constituted a Board of Dental Elections. If a member of the Board of Dental Examiners whose position is to be filled at any election is nominated to succeed himself, and does not withdraw his name, he shall be disqualified to serve as a member of the Board of Dental Elections for that election and the remaining members of the Board of Dental Elections shall proceed and function without his participation.
   4. Nomination of dentists for election shall be made to the Board of Dental Elections by a written petition signed by not less than 10 dentists licensed to practice in North Carolina and residing or practicing in North Carolina. Nomination of dental hygienists for election shall be made to the Board of Dental Elections by a written petition signed by not less than 10 dental hygienists licensed to practice in North Carolina and residing or practicing in North Carolina. Such petitions shall be filed with said Board of Dental Elections subsequent to January 1 of the year in which the election is to be held and not later than midnight of the twentieth day of May of such year, or not later than such earlier date (not before April 1) as may be set by the Board of Dental Elections: provided, that not less than 10 days’ notice of such earlier date shall be given to all dentists or dental hygienists qualified to sign a petition of nomination. The Board of Dental Elections shall, before preparing ballots, notify all persons who have been duly nominated of their nomination.
   5. Any person who is nominated as provided in subdivision (4) above may withdraw his name by written notice delivered to the Board of Dental Elections or its designated secretary at any time prior to the closing of the polls in any election.
   6. Following the close of nominations, there shall be prepared, under and in accordance with such rules and regulations as the Board of Dental Elections shall prescribe, ballots containing, in alphabetical order, the names of all nominees; and each ballot shall have such method of identification, and such instructions and requirements printed thereon, as shall be prescribed by the Board of Dental Elections. At such time as may be fixed by the Board of Dental Elections a ballot and a return official envelope addressed to said Board shall be mailed to each person entitled to vote in the election being conducted, together with a notice by said Board designating the latest day and hour for return mailing and containing such other items as such Board may see fit to include. The said envelope shall bear a serial number and shall have printed on the left portion of its face the following:

      Click to viewThe Board of Dental Elections may cause to be printed or stamped or written on said envelope such additional notice as it may see fit to give. No ballot shall be valid or shall be counted in an election unless, within the time hereinafter provided, it has been delivered to said Board by hand or by mail and shall be sealed. The said Board by rule may make provision for replacement of lost or destroyed envelopes or ballots upon making proper provisions to safeguard against abuse.

   7. The date and hour fixed by the Board of Dental Elections as the latest time for delivery by hand or mailing of said return ballots shall be not earlier than the tenth day following the mailing of the envelopes and ballots to the voters.
   8. The said ballots shall be canvassed by the Board of Dental Elections beginning at noon on a day and at a place set by said Board and announced by it in the notice accompanying the sending out of the ballots and envelopes, said date to be not later than four days after the date fixed by the Board for the closing of the balloting. The canvassing shall be made publicly and any licensed dentists may be present. The counting of ballots shall be conducted as follows: The envelopes shall be displayed to the persons present and an opportunity shall be given to any person present to challenge the qualification of the voter whose signature appears on the envelope or to challenge the validity of the envelope. Any envelope (with enclosed ballot) challenged shall be set aside, and the challenge shall be heard later or at that time by said Board. After the envelopes have been so exhibited, those not challenged shall be opened and the ballots extracted therefrom, insofar as practicable without showing the marking on the ballots, and there shall be a final and complete separation of each envelope and its enclosed ballot. Thereafter each ballot shall be presented for counting, shall be displayed and, if not challenged, shall be counted. No ballot shall be valid if it is marked for more nominees than there are positions to be filled in that election: provided, that no ballot shall be rejected for any technical error unless it is impossible to determine the voter’s choices or choice from the ballot. The counting of the ballots shall be continued until completed. During the counting, challenge may be made to any ballot on the grounds only of defects appearing on the face of the ballot. The said Board may decide the challenge immediately when it is made or it may put aside the ballot and determine the challenge upon the conclusion of the counting of the ballots.
   9. 1. Where there is more than one nominee eligible for election to a single seat:
         1. The nominee receiving a majority of the votes cast shall be declared elected.
         2. In the event that no nominee receives a majority, a second election shall be conducted between the two nominees who receive the highest number of votes.
      2. Where there are more than two nominees eligible for election to either of two seats at issue in the same election:
         1. A majority shall be any excess of the sum ascertained by dividing the total number of votes cast for all nominees by four.
         2. In the event that more than two nominees receive a majority of the votes cast, the two receiving the highest number of votes shall be declared elected.
         3. In the event that only one of the nominees receives a majority, he shall be declared elected and the Board of Dental Examiners shall thereupon order a second election to be conducted between the two nominees receiving the next to highest number of votes.
         4. In the event that no nominee receives a majority, a second election shall be conducted between the four candidates receiving the highest number of votes. At such second election, the two nominees receiving the highest number of votes shall be declared elected.
      3. In any election, if there is a tie between candidates, the tie shall be resolved by the vote of the Board of Dental Examiners, provided that if a member of that Board is one of the candidates in the tie, he may not participate in such vote.
   10. In the event there shall be required a second election, there shall be followed the same procedure as outlined in the paragraphs above subject to the same limitations and requirements: provided, that if the second election is between four candidates, then the two receiving the highest number of votes shall be declared elected.
   11. In the case of the death or withdrawal of a candidate prior to the closing of the polls in any election, he shall be eliminated from the contest and any votes cast for him shall be disregarded. If, at any time after the closing of the period for nominations because of lack of plural or proper nominations or death, or withdrawal, or disqualification or any other reason, there shall be (i) only two candidates for two positions, they shall be declared elected by the Board of Dental Elections, or (ii) only one candidate for one position, he shall be declared elected by the Board of Dental Elections, or (iii) no candidate for two positions, the two positions shall be filled by the Board of Dental Examiners, or (iv) no candidate for one position, the position shall be filled by the Board of Dental Examiners, or (v) one candidate for two positions, the one candidate shall be declared elected by the Board of Dental Elections and one qualified dentist shall be elected to the other position by the Board of Dental Examiners. In the event of the death or withdrawal of a candidate after election but before taking office, the position to which he was elected shall be filled by the Board of Dental Examiners. In the event of the death or resignation of a member of the Board of Dental Examiners, after taking office, his position shall be filled for the unexpired term by the Board of Dental Examiners.
   12. An official list of licensed dentists shall be kept at an office of the Board of Dental Elections and shall be open to the inspection of any person at all times. Copies may be made by any licensed dentist. As soon as the voting in any election begins a list of the licensed dentists shall be posted in such office of said Board and indication by mark or otherwise shall be made on that list to show whether a ballot-enclosing envelope has been returned.
   13. All envelopes enclosing ballots and all ballots shall be preserved and held separately by the Board of Dental Elections for a period of six months following the close of an election.
   14. From any decision of the Board of Dental Elections relative to the conduct of such elections, appeal may be taken to the courts in the manner otherwise provided by Chapter 150B of the General Statutes of North Carolina.
   15. The Board of Dental Elections is authorized to make rules and regulations relative to the conduct of these elections, provided same are not in conflict with the provisions of this section and provided that notice shall be given to all licensed dentists residing in North Carolina.
4. For service on the Board of Dental Elections, the members of such Board shall receive the per diem compensation and expenses allowed by this Article for service as members of the Board of Dental Examiners. The Board of Dental Elections is authorized and empowered to expend from funds collected under the provisions of this Article such sum or sums as it may determine necessary in the performance of its duties as a Board of Dental Elections, said expenditures to be in addition to the authorization contained in G.S. 90-43 and to be disbursed as provided therein.
5. The Board of Dental Elections is authorized to appoint such secretary or secretaries and/or assistant secretary or assistant secretaries to perform such functions in connection with such nominations and elections as said Board shall determine, provided that any protestant or contestant shall have the right to a hearing by said Board in connection with any challenge of a voter, or an envelope, or a ballot or the counting of an election. Said Board is authorized to designate an office or offices for the keeping of lists of registered dentists, for the issuance and the receipt of envelopes and ballots.

“Serial No. of Envelope Signature of Voter Address of Voter (Note: The enclosed ballot is not valid unless the signature of the voter is on this envelope).”

History. 1935, c. 66, s. 1; 1957, c. 592, s. 1; 1961, c. 213, s. 1; 1971, c. 755, s. 1; 1973, c. 1331, s. 3; 1979, 2nd Sess., c. 1195, ss. 1-5; 1981, c. 751, ss. 1, 2; 1987, c. 827, s. 1.

Disapproval of Certain Dental Board Rules

Session Laws 2016-31, ss. 1-4, provides clarification of certain rules and regulations governing the North Carolina Board of Dental Examiners. For full provisions, see notes under the same catchline in G.S. 90-28 .

Legal Periodicals.

For article, “In Defense of Occupational Licensing: A Legal Practitioner’s Perspective,” see 43 Campbell L. Rev. 423 (2021).

§ 90-23. Officers; common seal.

The North Carolina State Board of Dental Examiners shall, at each annual meeting thereof, elect one of its members president and one secretary-treasurer. The common seal which has already been adopted by said Board, pursuant to law, shall be continued as the seal of said Board.

History. 1935, c. 66, s. 2.

§ 90-24. Quorum; adjourned meetings.

A majority of the members of said Board shall constitute a quorum for the transaction of business and at any meeting of the Board, if a majority of the members are not present at the time and the place appointed for the meeting, those members of the Board present may adjourn from day to day until a quorum is present, and the action of the Board taken at any adjourned meeting thus had shall have the same force and effect as if had upon the day and at the hour of the meeting called and adjourned from day to day.

History. 1935, c. 66, s. 2; 1981, c. 751, s. 3.

§ 90-25. Records and transcripts.

The said Board shall keep a record of its transactions at all annual or special meetings and shall provide a record book in which shall be entered the names and proficiency of all persons to whom licenses may be granted under the provisions of law. The said book shall show, also, the license number and the date upon which such license was issued and shall show such other matters as in the opinion of the Board may be necessary or proper. Said book shall be deemed a book of record of said Board and a transcript of any entry therein or a certification that there is not entered therein the name, proficiency and license number or date of granting such license, certified under the hand of the secretary-treasurer, attested by the seal of the North Carolina State Board of Dental Examiners, shall be admitted as evidence in any court of this State when the same shall otherwise be competent.

History. 1935, c. 66, s. 2.

§ 90-26. Annual and special meetings.

The North Carolina State Board of Dental Examiners shall meet annually on the date and at the time and place as may be determined by the Board, and at such other dates, times, and places as may be determined by action of the Board or by any majority of the members thereof. Notice of the date, time, and place of the annual meeting and of the date, time, and place of any special or called meeting shall be given in writing, by registered or certified mail or personally, to each member of the Board at least 10 days prior to said meeting; provided the requirements of notice may be waived by any member of the Board. At the annual meeting or at any special or called meeting, the said Board shall have the power to conduct examination of applicants and to transact such other business as may come before it, provided that in case of a special meeting, the purpose for which said meeting is called shall be stated in the notice.

History. 1935, c. 66, s. 3; 1961, c. 446, s. 1; 1981, c. 751, s. 4; 1995 (Reg. Sess., 1996), c. 584, s. 5.

§ 90-27. Judicial powers; additional data for records.

The president of the North Carolina State Board of Dental Examiners, and/or the secretary-treasurer of said Board, shall have the power to administer oaths, issue subpoenas requiring the attendance of persons and the production of papers and records before said Board in any hearing, investigation or proceeding conducted by it. The sheriff or other proper official of any county of the State shall serve the process issued by said president or secretary-treasurer of said Board pursuant to its requirements and in the same manner as process issued by any court of record. The said Board shall pay for the service of all process, such fees as are provided by law for the service of like process in other cases.

Any person who shall neglect or refuse to obey any subpoena requiring him to attend and testify before said Board or to produce books, records or documents shall be guilty of a Class 1 misdemeanor.

The Board shall have the power, upon the production of any papers, records or data, to authorize certified copies thereof to be substituted in the permanent record of the matter in which such books, records or data shall have been introduced in evidence.

History. 1935, c. 66, s. 4; 1993, c. 539, s. 616; 1994, Ex. Sess., c. 24, s. 14(c).

§ 90-28. Bylaws and regulations; acquisition of property.

1. The North Carolina State Board of Dental Examiners shall have the power to make necessary bylaws and regulations, not inconsistent with the provisions of this Article, regarding any matter referred to in this Article and for the purpose of facilitating the transaction of business by the Board.
2. The Board shall have the power to acquire, hold, rent, encumber, alienate, and otherwise deal with real property in the same manner as a private person or corporation, subject only to approval of the Governor and the Council of State. Collateral pledged by the Board for an encumbrance is limited to the assets, income, and revenues of the Board.

History. 1935, c. 66, s. 5; 2005-366, s. 3.

Disapproval of Certain Dental Board Rules

Session Laws 2016-31, s. 1, provides: “Pursuant to G.S. 150B-21.3(b1), 21 NCAC 16Q .0101 (General Anesthesia and Sedation Definitions), as adopted by the North Carolina Board of Dental Examiners on December 12, 2015, and approved by the Rules Review Commission on March 17, 2016, is disapproved.”

At its March 17, 2016, meeting, the Rules Review Commission adopted several changes to the Dental Board’s rules in 21 NCAC 16O and 16Q, governing nitrous oxide, sedation, and anesthesia. More than 10 objections were filed to the proposed amendments to 21 NCAC 16Q .0101, and that rule is presently subject to legislative review. In light of the pending legislative review, pursuant to G.S. 150B-21.3(b1), the Dental Board sought to delay the effective date of certain rules until the conclusion of the review. Specifically the Board requested to delay the effective dates of the following rules:

21 NCAC 16Q .0201 (amendment); 21 NCAC 16Q .0202 (amendment); 21 NCAC 16Q .0204 (amendment); 21 NCAC 16Q .0205 (repeal); 21 NCAC 16Q .0206 (adoption); 21 NCAC 16Q .0207 (adoption); 21 NCAC 16Q .0301 (amendment); 21 NCAC 16Q .0302 (amendment); 21 NCAC 16Q .0304 (amendment); 21 NCAC 16Q .0305 (adoption); 21 NCAC 16Q .0306 (adoption); 21 NCAC 16Q .0401 (repeal); 21 NCAC 16Q .0402 (repeal); 21 NCAC 16Q .0404 (adoption); 21 NCAC 16Q .0405 (adoption); 21 NCAC 16Q .0406 (adoption); 21 NCAC 16Q .0407 (adoption); 21 NCAC 16Q .0408 (adoption); 21 NCAC 16Q .0501 (repeal); 21 NCAC 16Q .0601 - .0602 (repeal); and 21 NCAC 16Q .0703 (adoption).

Session Laws 2016-31, s. 2, disapproved all of the rules listed in the letter except those listed in Session Laws 2016-31, s. 3, which were 21 NCAC 16Q .0204 (Procedure for General Anesthesia Evaluation or Inspection and Re-inspection), 21 NCAC 16Q .0205 (Results of Site Evaluation and Reevaluation), 21 NCAC 16Q .0306 (Procedure for Moderate Conscious Sedation Evaluation or Inspection and Re-Inspection), 21 NCAC 16Q .0408 (Procedure for Moderate Pediatric Conscious Sedation Evaluation or Inspection and Re-Inspection), 21 NCAC 16Q .0703 (Reports of Adverse Occurrences), 21 NCAC 16Q .0601 (Reports of Adverse Occurrences), and 21 NCAC 16Q .0602 (Failure to Report).

Session Laws 2016-31, s. 4, provides: “Notwithstanding G.S. 150B-21.3(b), the North Carolina Board of Dental Examiners shall not enforce the following rules which became effective April 1, 2016: 21 NCAC 16O .0301 (Nitrous Oxide Sedation); 21 NCAC 16O .0302 (Nitrous Oxide Monitoring); 21 NCAC 16O .0401 (Non-Delegable Functions). The Board shall continue to enforce these rules as they existed prior to the amendments which became effective on April 1, 2016.”

Effect of Amendments.

Session Laws 2005-366, s. 3, effective September 8, 2005, added “acquisition of property” to the section heading; designated the existing provisions of the section as “(a)”; deleted “said” preceding “Board” at the end of subsection (a); added subsection (b); and made a minor punctuation change.

§§ 90-28.1 through 90-28.4.

Reserved for future codification purposes.

§ 90-28.5. Disasters and emergencies.

If the Governor declares a state of emergency or a county or municipality enacts ordinances under G.S. 153A-121 , 160A-174, 166A-19.31, or Article 22 of Chapter 130A of the General Statutes, the North Carolina Board of Dental Examiners may waive the requirements of this Article and Article 16 of this Chapter to permit the provision of dental and dental hygiene services to the public during the state of emergency.

History. 2020-3, s. 3D.1(a).

§ 90-29. Necessity for license; dentistry defined; exemptions.

1. No person shall engage in the practice of dentistry in this State, or offer or attempt to do so, unless such person is the holder of a valid license or certificate of renewal of license duly issued by the North Carolina State Board of Dental Examiners.
2. A person shall be deemed to be practicing dentistry in this State who does, undertakes or attempts to do, or claims the ability to do any one or more of the following acts or things which, for the purposes of this Article, constitute the practice of dentistry:
   1. Diagnoses, treats, operates, or prescribes for any disease, disorder, pain, deformity, injury, deficiency, defect, or other physical condition of the human teeth, gums, alveolar process, jaws, maxilla, mandible, or adjacent tissues or structures of the oral cavity;
   2. Removes stains, accretions or deposits from the human teeth;
   3. Extracts a human tooth or teeth;
   4. Performs any phase of any operation relative or incident to the replacement or restoration of all or a part of a human tooth or teeth with any artificial substance, material or device;
   5. Corrects the malposition or malformation of the human teeth;
   6. Administers an anesthetic of any kind in the treatment of dental or oral diseases or physical conditions, or in preparation for or incident to any operation within the oral cavity; provided, however, that this subsection shall not apply to a lawfully qualified nurse anesthetist who administers such anesthetic under the supervision and direction of a licensed dentist or physician, or to a registered dental hygienist qualified to administer local anesthetics. (6a) Expired pursuant to Session Laws 1991, c. 678, s. 2.
   7. Takes or makes an impression of the human teeth, gums or jaws;
   8. Makes, builds, constructs, furnishes, processes, reproduces, repairs, adjusts, supplies or professionally places in the human mouth any prosthetic denture, bridge, appliance, corrective device, or other structure designed or constructed as a substitute for a natural human tooth or teeth or as an aid in the treatment of the malposition or malformation of a tooth or teeth, except to the extent the same may lawfully be performed in accordance with the provisions of G.S. 90-29.1 and 90-29.2;
   9. Uses a Roentgen or X-ray machine or device for dental treatment or diagnostic purposes, or gives interpretations or readings of dental Roentgenograms or X rays;
   10. Performs or engages in any of the clinical practices included in the curricula of recognized dental schools or colleges;
   11. Owns, manages, supervises, controls or conducts, either himself, by and through another person or other persons, or by use of any electronic or other digital means, any enterprise wherein any one or more of the acts or practices set forth in subdivisions (1) through (10) above are done, attempted to be done, or represented to be done.
   12. Uses, in connection with his name, any title or designation, such as “dentist,” “dental surgeon,” “doctor of dental surgery,” “D.D.S.,” “D.M.D.,” or any other letters, words or descriptive matter which, in any manner, represents him as being a dentist able or qualified to do or perform any one or more of the acts or practices set forth in subdivisions (1) through (10) above;
   13. Represents to the public, by any advertisement or announcement, by or through any media, the ability or qualification to do or perform any of the acts or practices set forth in subdivisions (1) through (10) above.
   14. The administration by dentists of diagnostic tests and antibody tests for coronavirus disease 2019 to patients only if such tests have been approved or authorized for emergency use by the United States Food and Drug Administration.
3. The following acts, practices, or operations, however, shall not constitute the unlawful practice of dentistry:
   1. Any act by a duly licensed physician or surgeon performed in the practice of his profession;
   2. The practice of dentistry, in the discharge of their official duties, by dentists in any branch of the Armed Forces of the United States or in the full-time employ of any agency of the United States;
   3. The teaching or practice of dentistry, in dental schools or colleges operated and conducted in this State and approved by the North Carolina State Board of Dental Examiners, by any person or persons licensed to practice dentistry anywhere in the United States or in any country, territory or other recognized jurisdiction until December 31, 2002. On or after January 1, 2003, all dentists previously practicing under G.S. 90-29(c)(3) shall be granted an instructor’s license upon application to the Board and payment of the required fee.
   4. The practice of dentistry in dental schools or colleges in this State approved by the North Carolina State Board of Dental Examiners by students enrolled in such schools or colleges as candidates for a doctoral degree in dentistry when such practice is performed as a part of their course of instruction and is under direct supervision of a dentist who is either duly licensed in North Carolina or qualified under subdivision (3) above as a teacher; additionally, the practice of dentistry by such students at State or county institutions with resident populations, hospitals, State or county health departments, area health education centers, nonprofit health care facilities serving low-income populations and approved by the State Health Director or his designee and approved by the Board of Dental Examiners, and State or county-owned nursing homes; subject to review and approval or disapproval by the said Board of Dental Examiners when in the opinion of the dean of such dental school or college or his designee, the students’ dental education and experience are adequate therefor, and such practice is a part of the course of instruction of such students, is performed under the direct supervision of a duly licensed dentist acting as a teacher or instructor, and is without remuneration except for expenses and subsistence all as defined and permitted by the rules and regulations of said Board of Dental Examiners. Should the Board disapprove a specific program, the Board shall within 90 days inform the dean of its actions. Nothing herein shall be construed to permit the teaching of, delegation to or performance by any dental hygienist, dental assistant, or other auxiliary relative to any program of extramural rotation, of any function not heretofore permitted by the Dental Practice Act, the Dental Hygiene Act or by the rules and regulations of the Board;
   5. The temporary practice of dentistry by licensed dentists of another state or of any territory or country when the same is performed, as clinicians, at meetings of organized dental societies, associations, colleges or similar dental organizations, or when such dentists appear in emergency cases upon the specific call of a dentist duly licensed to practice in this State;
   6. The practice of dentistry by a person who is a graduate of a dental school or college approved by the North Carolina State Board of Dental Examiners and who is not licensed to practice dentistry in this State, when such person is the holder of a valid intern permit, or provisional license, issued to him by the North Carolina State Board of Dental Examiners pursuant to the terms and provisions of this Article, and when such practice of dentistry complies with the conditions of said intern permit, or provisional license;
   7. Any act or acts performed by a dental hygienist when such act or acts are lawfully performed pursuant to the authority of Article 16 of this Chapter 90 or the rules and regulations of the Board promulgated thereunder;
   8. Activity which would otherwise be considered the practice of dental hygiene performed by students enrolled in a school or college approved by the Board in a board-approved dental hygiene program under the direct supervision of a dental hygienist or a dentist duly licensed in North Carolina or qualified for the teaching of dentistry pursuant to the provisions of subdivision (3) above;
   9. Any act or acts performed by an assistant to a dentist licensed to practice in this State when said act or acts are authorized and permitted by and performed in accordance with rules and regulations promulgated by the Board;
   10. Dental assisting and related functions as a part of their instructions by students enrolled in a course in dental assisting conducted in this State and approved by the Board, when such functions are performed under the supervision of a dentist acting as a teacher or instructor who is either duly licensed in North Carolina or qualified for the teaching of dentistry pursuant to the provisions of subdivision (3) above;
   11. The extraoral construction, manufacture, fabrication or repair of prosthetic dentures, bridges, appliances, corrective devices, or other structures designed or constructed as a substitute for a natural human tooth or teeth or as an aid in the treatment of the malposition or malformation of a tooth or teeth, by a person or entity not licensed to practice dentistry in this State, when the same is done or performed solely upon a written work order in strict compliance with the terms, provisions, conditions and requirements of G.S. 90-29.1 and 90-29.2.
   12. The use of a dental x-ray machine in the taking of dental radiographs by a dental hygienist, certified dental assistant, or a dental assistant who can show evidence of satisfactory performance on an equivalency examination, recognized by the Board of Dental Examiners, based on seven hours of instruction in the production and use of dental x rays and an educational program of not less than seven hours in clinical dental radiology.
   13. A dental assistant, or dental hygienist who shows evidence of education and training in Nitrous Oxide — Oxygen Inhalant Conscious Sedation within a formal educational program may aid and assist a licensed dentist in the administration of Nitrous Oxide — Oxygen Inhalant Conscious Sedation. Any dental assistant who can show evidence of having completed an educational program recognized by the Board of not less than seven clock hours on Nitrous Oxide — Oxygen Inhalant Conscious Sedation may also aid and assist a licensed dentist in the administration of Nitrous Oxide — Oxygen Inhalant Conscious Sedation. Any dental hygienist or dental assistant who has been employed in a dental office where Nitrous Oxide — Oxygen Inhalant Conscious Sedation was utilized, and who can show evidence of performance and instruction of not less than one year prior to July 1, 1980, qualifies to aid and assist a licensed dentist in the administration of Nitrous Oxide — Oxygen Inhalant Conscious Sedation.
   14. The operation of a nonprofit health care facility serving low-income populations and approved by the State Health Director or his designee and approved by the North Carolina State Board of Dental Examiners.

History. 1935, c. 66, s. 6; 1953, c. 564, s. 3; 1957, c. 592, s. 2; 1961, c. 446, s. 2; 1965, c. 163, ss. 1, 2; 1971, c. 755, s. 2; 1977, c. 368; 1979, 2nd Sess., c. 1195, ss. 10, 15; 1991, c. 658, s. 1; c. 678, ss. 1, 2; 1997-481, ss. 5, 6; 2002-37, s. 8; 2011-183, s. 57; 2020-3, s. 3D.2(a); 2021-95, s. 1(a).

Disapproval of Certain Dental Board Rules

Session Laws 2016-31, s. 1, provides: “Pursuant to G.S. 150B-21.3(b1), 21 NCAC 16Q .0101 (General Anesthesia and Sedation Definitions), as adopted by the North Carolina Board of Dental Examiners on December 12, 2015, and approved by the Rules Review Commission on March 17, 2016, is disapproved.”

At its March 17, 2016, meeting, the Rules Review Commission adopted several changes to the Dental Board’s rules in 21 NCAC 16O and 16Q, governing nitrous oxide, sedation, and anesthesia. More than 10 objections were filed to the proposed amendments to 21 NCAC 16Q .0101, and that rule is presently subject to legislative review. In light of the pending legislative review, pursuant to G.S. 150B-21.3(b1), the Dental Board sought to delay the effective date of certain rules until the conclusion of the review. Specifically the Board requested to delay the effective dates of the following rules:

21 NCAC 16Q .0201 (amendment); 21 NCAC 16Q .0202 (amendment); 21 NCAC 16Q .0204 (amendment); 21 NCAC 16Q .0205 (repeal); 21 NCAC 16Q .0206 (adoption); 21 NCAC 16Q .0207 (adoption); 21 NCAC 16Q .0301 (amendment); 21 NCAC 16Q .0302 (amendment); 21 NCAC 16Q .0304 (amendment); 21 NCAC 16Q .0305 (adoption); 21 NCAC 16Q .0306 (adoption); 21 NCAC 16Q .0401 (repeal); 21 NCAC 16Q .0402 (repeal); 21 NCAC 16Q .0404 (adoption); 21 NCAC 16Q .0405 (adoption); 21 NCAC 16Q .0406 (adoption); 21 NCAC 16Q .0407 (adoption); 21 NCAC 16Q .0408 (adoption); 21 NCAC 16Q .0501 (repeal); 21 NCAC 16Q .0601 - .0602 (repeal); and 21 NCAC 16Q .0703 (adoption).

Session Laws 2016-31, s. 2, disapproved all of the rules listed in the letter except those listed in Session Laws 2016-31, s. 3, which were 21 NCAC 16Q .0204 (Procedure for General Anesthesia Evaluation or Inspection and Re-inspection), 21 NCAC 16Q .0205 (Results of Site Evaluation and Reevaluation), 21 NCAC 16Q .0306 (Procedure for Moderate Conscious Sedation Evaluation or Inspection and Re-Inspection), 21 NCAC 16Q .0408 (Procedure for Moderate Pediatric Conscious Sedation Evaluation or Inspection and Re-Inspection), 21 NCAC 16Q .0703 (Reports of Adverse Occurrences), 21 NCAC 16Q .0601 (Reports of Adverse Occurrences), and 21 NCAC 16Q .0602 (Failure to Report).

Session Laws 2016-31, s. 4, provides: “Notwithstanding G.S. 150B-21.3(b), the North Carolina Board of Dental Examiners shall not enforce the following rules which became effective April 1, 2016: 21 NCAC 16O .0301 (Nitrous Oxide Sedation); 21 NCAC 16O .0302 (Nitrous Oxide Monitoring); 21 NCAC 16O .0401 (Non-Delegable Functions). The Board shall continue to enforce these rules as they existed prior to the amendments which became effective on April 1, 2016.”

§ 90-29.1. Extraoral services performed for dentists.

Licensed dentists may employ or engage the services of any person, firm or corporation to construct or repair, extraorally, prosthetic dentures, bridges, or other replacements for a part of a tooth, a tooth, or teeth. A person, firm, or corporation so employed or engaged, when constructing or repairing such dentures, bridges, or replacements, exclusively, directly, and solely on the written work order of a licensed member of the dental profession as hereafter provided, and not for the public or any part thereof, shall not be deemed or considered to be practicing dentistry as defined in this Article.

History. 1957, c. 592, s. 3; 1961, c. 446, ss. 3, 4; 1979, 2nd Sess., c. 1195, s. 6.

§ 90-29.2. Requirements in respect to written work orders; penalty.

1. Any licensed dentist who employs or engages the services of any person, firm or corporation to construct or repair, extraorally, prosthetic dentures, bridges, orthodontic appliance, or other replacements, for a part of a tooth, a tooth or teeth, shall furnish such person, firm or corporation with a written work order on forms prescribed by the North Carolina State Board of Dental Examiners which shall contain:
   1. The name and address of the person, firm, or corporation to which the work order is directed.
   2. The patient’s name or identification number. If a number is used, the patient’s name shall be written upon the duplicate copy of the work order retained by the dentist.
   3. The date on which the work order was written.
   4. A description of the work to be done, including diagrams if necessary.
   5. A specification of the type and quality of materials to be used.
   6. The signature of the dentist and the number of his license to practice dentistry.
2. The person, firm or corporation receiving a work order from a licensed dentist shall retain the original work order and the dentist shall retain a duplicate copy thereof for inspection at any reasonable time by the North Carolina State Board of Dental Examiners or its duly authorized agents, for a period of two years in both cases.
3. If the person, firm or corporation receiving a written work order from a licensed dentist engages another person, firm or corporation (hereinafter referred to as “subcontractor”) to perform some of the services relative to such work order, he or it shall furnish a written subwork order with respect thereto on forms prescribed by the North Carolina State Board of Dental Examiners which shall contain:
   1. The name and address of the subcontractor.
   2. A number identifying the subwork order with the original work order, which number shall be endorsed on the work order received from the licensed dentist.
   3. The date on which the subwork order was written.
   4. A description of the work to be done by the subcontractor, including diagrams if necessary.
   5. A specification of the type and quality of materials to be used.
   6. The signature of the person, firm or corporation issuing the subwork order.The subcontractor shall retain the subwork order and the issuer thereof shall retain a duplicate copy, attached to the work order received from the licensed dentist, for inspection by the North Carolina State Board of Dental Examiners or its duly authorized agents, for a period of two years in both cases.
4. Any licensed dentist who:
   1. Employs or engages the services of any person, firm or corporation to construct or repair extraorally, prosthetic dentures, bridges, or other dental appliances without first providing such person, firm, or corporation with a written work order; or
   2. Fails to retain a duplicate copy of the work order for two years; or
   3. Refuses to allow the North Carolina State Board of Dental Examiners to inspect his files of work orders

      is guilty of a Class 1 misdemeanor and the North Carolina State Board of Dental Examiners may revoke or suspend his license therefor.

5. Any such person, firm, or corporation, who:
   1. Furnishes such services to any licensed dentist without first obtaining a written work order therefor from such dentist; or
   2. Acting as a subcontractor as described in (c) above, furnishes such services to any person, firm or corporation, without first obtaining a written subwork order from such person, firm or corporation; or
   3. Fails to retain the original work order or subwork order, as the case may be, for two years; or
   4. Refuses to allow the North Carolina State Board of Dental Examiners or its duly authorized agents, to inspect his or its files of work orders or subwork orders shall be guilty of a Class 1 misdemeanor.

History. 1961, c. 446, s. 5; 1993, c. 539, ss. 617, 618; 1994, Ex. Sess., c. 24, s. 14(c).

§ 90-29.3. Provisional license.

1. The North Carolina State Board of Dental Examiners shall, subject to its rules and regulations, issue a provisional license to practice dentistry to any person who is licensed to practice dentistry anywhere in the United States or in any country, territory or other recognized jurisdiction, if the Board shall determine that said licensing jurisdiction imposed upon said person requirements for licensure no less exacting than those imposed by this State. A provisional licensee may engage in the practice of dentistry only in strict accordance with the terms, conditions and limitations of his license and with the rules and regulations of the Board pertaining to provisional license.
2. A provisional license shall be valid until the date of the announcement of the results of the next succeeding Board examination of candidates for licensure to practice dentistry in this State, unless the same shall be earlier revoked or suspended by the Board.
3. No person who has failed an examination conducted by the North Carolina State Board of Dental Examiners shall be eligible to receive a provisional license.
4. Any person desiring to secure a provisional license shall make application therefor in the manner and form prescribed by the rules and regulations of the Board and shall pay the fee prescribed in G.S. 90-39 of this Article.
5. A provisional licensee shall be subject to those various disciplinary measures and penalties set forth in G.S. 90-41 upon a determination of the Board that said provisional licensee has violated any of the terms or provisions of this Article.

History. 1969, c. 804, s. 1.

§ 90-29.4. Intern permit.

The North Carolina State Board of Dental Examiners may, in the exercise of the discretion of said Board, issue to a person who is not licensed to practice dentistry in this State and who is a graduate of a dental school, college, or institution approved by said Board, an intern permit authorizing such person to practice dentistry under the supervision or direction of a dentist duly licensed to practice in this State, subject to the following particular conditions:

1. An intern permit shall be valid for no more than one year from the date the permit was issued. The Board may, in its discretion, renew the permit for not more than five additional one-year periods. However, no person who has attempted and failed a Board-approved written or clinical examination shall be granted an intern permit or intern permits embracing or covering an aggregate time span of more than 72 calendar months. An intern permit holder who has held an unrestricted dental license in a Board-approved state or jurisdiction for the five years immediately preceding the issuance of an intern permit in this State may, in the Board’s discretion, have the intern permit renewed for additional one-year periods beyond 72 months if the intern permit holder’s approved employing institution comes before the Board on the permit holder’s behalf for each subsequent annual renewal;
2. The holder of a valid intern permit may practice dentistry only under the supervision or direction of one or more dentists duly licensed to practice in this State;
3. The holder of a valid intern permit may practice dentistry only (i) as an employee in a hospital, sanatorium, or a like institution which is licensed or approved by the State of North Carolina and approved by the North Carolina State Board of Dental Examiners; (ii) as an employee of a nonprofit health care facility serving low-income populations and approved by the State Health Director or his designee and approved by the North Carolina State Board of Dental Examiners; or (iii) as an employee of the State of North Carolina or an agency or political subdivision thereof, or any other governmental entity within the State of North Carolina, when said employment is approved by the North Carolina State Board of Dental Examiners;
4. The holder of a valid intern permit shall receive no fee or fees or compensation of any kind or nature for dental services rendered by him other than such salary or compensation as might be paid to him by the entity specified in subdivision (3) above wherein or for which said services are rendered;
5. The holder of a valid intern permit shall not, during the term of said permit or any renewal thereof, change the place of his internship without first securing the written approval of the North Carolina State Board of Dental Examiners;
6. The practice of dentistry by the holder of a valid intern permit shall be strictly limited to the confines of and to the registered patients of the hospital, sanatorium or institution to which he is attached or to the persons officially served by the governmental entity by whom he is employed;
7. Any person seeking an intern permit shall first file with the North Carolina State Board of Dental Examiners such papers and documents as are required by said Board, together with the application fee authorized by G.S. 90-39 . A fee authorized by G.S. 90-39 shall be paid for any renewal of said intern permit. Such person shall further supply to the Board such other documents, materials or information as the Board may request;
8. Any person seeking an intern permit or who is the holder of a valid intern permit shall comply with such limitations as the North Carolina State Board of Dental Examiners may place or cause to be placed, in writing, upon such permit, and shall comply with such rules and regulations as the Board might promulgate relative to the issuance and maintenance of said permit in the practice of dentistry relative to the same;
9. The holder of an intern permit shall be subject to the provisions of G.S. 90-41 .

History. 1971, c. 755, s. 3; 1997-481, s. 7; 2002-37, s. 10; 2006-41, s. 1.

Effect of Amendments.

Session Laws 2006-41, s. 1, effective June 29, 2006, rewrote subdivision (1).

§ 90-29.5. Instructor’s license.

1. The Board may issue an instructor’s license to a person who is not otherwise licensed to practice dentistry in this State if the person meets both of the following conditions:
   1. Is licensed to practice dentistry anywhere in the United States or in any country, territory, or other recognized jurisdiction.
   2. Has met or been approved under the credentialing standards of a dental school or an academic medical center with which the person is to be affiliated; such dental school or academic medical center shall be accredited by the American Dental Association’s Commission on Accreditation or the Joint Commission on Accreditation of Health Care Organizations.
2. The holder of an instructor’s license may teach and practice dentistry:
   1. In or on behalf of a dental school or college offering a doctoral degree in dentistry operated and conducted in this State and approved by the North Carolina State Board of Dental Examiners;