Identical to H 228, filed 2/27/19.

Part I.

Amends GS 90-1.1 which sets out the definitions used in GS Chapter 90, Article 1, Practice of Medicine, as follows. Expands the definition of license to also include authorization to an anesthesiologist assistant (in addition to physicians and physician assistants) to perform medical acts, tasks, or functions. Adds the terms inactive license and licensee (which is defined to include persons issued a license whether it is active or inactive).

Amends GS 90-2 by amending the membership of the North Carolina Medical Board (Board) who are appointed by the Governor to require that one be a doctor of osteopathic medicine (was, be a doctor of osteopathy). Effective October 31, 2019.

Amends GS 90-2(d) concerning the filling of specified Board vacancies by removing limitations set in GS 90-2(a)(2)a.

Amends GS 90-3 concerning the Review Panel’s review of specified types of applicants for Board membership by removing limitations set in GS 90-2(a)(2)a. Also amends the qualifications that must be met by physicians, physician assistants, or nurse practitioners on the Board to require that the applicant indicate they are willing to take appropriate disciplinary action against peers for violations of the standards of medical care (was, standard of care or practice of medicine). Makes additional clarifying changes.

Amends GS 90-5 by deleting the current Board meeting requirements and instead requires the Board to meet at least once quarterly within the State and allows holding any other necessary meetings.

Amends GS 90-5.1 by giving the board the power to identify dyscomptent licensees and licensees (was, physicians only) who fail to meet acceptable standards of care. Also allows the Board to assess and improve licensee practice (was, physician practice only).

Amends GS 90-5.2 to require that that licensees report to the Board any graduate medical or osteopathic education (previously limited that education to institutions approved by specified entities).

Amends GS 90-5.3, concerning specified reporting and publication requirements, by making changes to conform to the new definition of license.

Enacts new GS 90-5.4 requiring every licensee to report in writing to the Board within 30 day any incidents that the licensee reasonably believes to have occurred that involve sexual misconduct of any licensed person, or fraudulent prescribing, drug diversion, misuse, or theft of any controlled substances by a licensed person. Failure to report constitutes unprofessional conduct and is grounds for discipline. Provides immunity from civil liability for reports made in good faith and without fraud or malice. Those made in bad faith, fraudulently, or maliciously are unprofessional conduct and are grounds for discipline.

Repeals GS 90-7, which required a bond by the secretary of the Board.

Amends GS 90-8.1 by adding that by submitting a license application, the applicant submits to the Board’s jurisdiction.

Amends GS 90-9.1 by amending criteria to be met for licensure as a physician by adding that the application must have completed at least 130 weeks of medical education that satisfies the already listed education requirements, and adds that the applicant provide proof of a current certification by a specialty board recognized by the specified specialty boards. Makes additional clarifying and technical changes.

Amends GS 90-9.2, concerning the requirements for graduates of international medical schools to require that applicants for licensure who graduate from a medical school not approved by the specified entities have successfully completed two years (was, three years) of training in a medical education program approved by the Board after graduation from medical school, or allows providing proof of current certification by a listed specialty board; also adds the requirement that the applicant has passed each part of the exam in GS 90-10.1. Makes additional clarifying changes.

Amends GS 90-9.3, which sets out the requirements for licensure as a physician assistant by changing the organization that accredits the education program that physician assistants or surgeon assistants must have completed.

Amends GS 90-9.4, which sets out the criteria for licensure as an anesthesiologist assistant by removing the requirement to pass a certification exam administered by the NCCAA.

Enacts new GS 90-9.5 giving the Board jurisdiction over inactive licenses, regardless of how the license became inactive.

Repeals GS 90-10.1(1), which allowed the Board to administer or accept for licensure a State Board licensing examination.

Amends GS 90-11 to allow the Board to collect a fee from each applicant for purposes of criminal record checks and requires that the payment be given to the Department of Public Safety.

Amends GS 90-12.01 by adding that the program director of every graduate medical program must report to the Board on adverse actions or resignations by a physician participating in a graduate medical education training program.

Amends GS 90-12.1A concerning the issuance of a limited volunteer license to require that applicants produce a verification (was, a letter) from the state of licensure indicating applicant’s license is active and in good standing. Increases the fine for limited license holders who practice outside of an association with clinics that specialize in the treatment of indigent patients from a range of $25-$50 to no more than $500. Makes additional clarifying changes.

Amends GS 90-12.1 (applicable to retired limited volunteer license) and GS 90-12.2A (applicable to special purpose license) to increase the fine for improper practice from a range of $25-$50 to no more than $500. Makes additional clarifying changes.

Amends GS 90-12.3 by amending the qualifications to be met in order to receive a medical school faculty license to require that the applicant hold a full-time faculty appointment as either an instructor, lecturer, assistant professor, associate professor, or full professor at an NC medical school that is certified by the specified entities. Increases the fine for improper practice from a range of $25-$50 to no more than $500. Adds conditions under which a medical school faculty license will become inactive. Makes additional clarifying changes.

Amends GS 90-12.4, applicable to a physician limited volunteer license and GS 90-12.4B, applicable to a physician assistant retired limited volunteer license, by increasing the fine for improper practice from a range of $25-$50 to no more than $500. Makes other clarifying changes.

Amends GS 90-13.1 by increasing the fees for duplicate licenses and for the licensure of an anesthesiologist assistant. Adds a $230 fee for initial licensure of a physician assistant. Makes a conforming deletion in GS 90-9.3.

Amends GS 90-13.2 to add registration fees and related fines for physician assistants and anesthesiologist assistants. Increases the fine for physicians who fail to register. Makes additional changes that expand provisions to all licensees, not just physicians.

Enacts new GS 90-13.2A allowing for corporate certificates and establishing fees that are to be paid by professional corporations practicing medicine.

Amends GS 90-13.3 by increasing the per diem to Board members.

Amends GS 90-14 by amending the Board’s disciplinary authority as follows. Allows the Board to require an applicant or licensee (was, a physician only) to submit to a mental or physical exam and expands upon who may conduct that exam; failure to comply may be considered unprofessional conduct. Deletes the provision prohibiting license revocation or denial or discipline solely because a person’s practice of a therapy departs from acceptable and prevailing medical practice. Amends allowing action due to lack of professional competence to practice to include consideration of repeated acts of an applicant’s or licensee’s (was, physician’s only) failure to properly treat a patient; makes conforming changes and adds that failure to comply with a related order may be considered unprofessional conduct. Extends other disciplinary authority to conduct by all licensees, not just physicians. Adds that the board may take action for a violation of any provision of the Article and for failure to make required reports. Adds that a felony conviction under GS Chapter 14, Article 7B (rape and other sexual assaults), results in the automatic permanent denial or revocation of a license. Adds that the provisions allowing for an informal nonpublic precharge conference do not apply where the Board has issued an order of summary suspension. Provides that when it is determined that emergency action is required, 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.

Amends GS 90-14.1 to require that when an applicant fails to satisfy the qualifications for licensure, the Board must immediately notify the person of its decision and indicate how the applicant has failed to meet the requirements. Allows for appeal to superior court of the county where the Board is located (was, Superior Court of Wake County) and removes other references to the Board being located in Raleigh. Removes provision allowing each party to the review proceeding to appeal to the Supreme Court.

Amends GS 90-14.2 by no longer specifying that a notice of charges made against a licensee may be prepared by a committee of one or more designated Board members.

Amends GS 90-14.5 to allow the Board to use an administrative law judge if the licensee is a current or former Board member. Moves the provision allowing evidence and testimony to be presented at a hearing before the Board or committee in the form of deposition before any person authorized to administer oaths into GS 90-14.6. Allows the Board to receive witness testimony at a hearing via telephone or videoconferencing.

Amends GS 90-14.8 by amending the court that may hear review of a Board decision.

Amends GS 90-14.13 to extend reporting requirements for health care institutions and provider organizations to include specified actions taken concerning licensees, not just physicians. Allows the Board to adopt rules limiting these reporting requirements. Requires the specified report from licensees who do not possess professional liability insurance or professional liability insurance from entities not owned and operated within the state. Defines claim for purpose of provisions related to reporting by insurance companies providing professional liability insurance.

Amends GS 90-16 to no longer require the Board to keep a regular record of its proceedings with the names of the applicants for license. Amends the entities to which the Board, its members, and staff may release confidential or nonpublic information.

Amends GS 90-18(c) to no longer exclude the practice of osteopathy by any legally licensed osteopath from the practice of medicine or surgery. Amends the definition of radiology. Makes other clarifying changes.

Amends GS 90-18.1 by amending the conditions under which physician assistants are authorized to write prescriptions for drugs by removing the condition that the Board has assigned an identification number to the assistant which is shown on the written prescription. Amends the conditions under which physician assistants are authorized to order medications, tests, and treatments to no longer require that the facility’s written policy on such actions have been approved by the medical staff after consultation with the nursing administrator. Makes additional clarifying changes.

Amends GS 90-18.2 by amending the conditions under which nurse practitioners are authorized to write prescription drugs by removing the condition that the Board has assigned an identification number to the assistant which is shown on the written prescription. Makes other clarifying changes.

Amends GS 90-18.3 to allow nurse practitioners and physician assistants to conduct medical exams when a statute or state agency rule requires that such an exam be conducted by a physician.

Repeals GS 90-18.7, which concerned the coordination of rules on pathological materials.

Part II.

Amends GS 115B-14 to allow a professional corporation to be formed by and between or among any combination of a physician assistant, an anesthesiology assistant, or a certified nurse anesthetist to render anesthesia and related services that the respective stockholders are approved to provide.

Part III.

Amends GS 143-519 by amending the membership of the Emergency Medical Services Disciplinary Committee to allow a member to be a current or former (was, current) physician member of the Board.

Part IV.

Amends GS 8-53, concerning communications between health care providers and patients, to extend the applicability of the statute to a person authorized to practice under Article 1 of GS Chapter 90.

Part V.

Amends GS 90-411, concerning record copy fees, by deleting the provision stating that the statute only applies with respect to liability claims for personal injury and claims for Social Security disability.

Part VII.

Enacts new GS 14-27.33A making it a Class C felony if a person who undertakes meical treatment of a patient either: (1) represents to the patient that sexual contact between the person and the patient is necessary or will be beneficial to the patient's health and induces the patient to engage in sexual contact with the person by means of the representation, (2) represents to the patient that sexual penetration between the person and the patient is necessary or will be beneficial to the patient's health and who induces the patient to engage in sexual penetration with the person by means of the representation, (3) engages in sexual contact with the patient while the patient is incapacitated, or (4) engages in sexual penetration with the patient while the patient is incapacitated. Applies to offenses committed on or after December 1, 2019.

Part VII.

Amends GS 130A-115 by adding that in the absence of a treating physician, physician assistant, or nurse practitioner in charge of the patient's care at the time of death, chief medical officer of the hospital or facility in which the death occurred, or a physician performing an autopsy, the death certificate may be completed by any other physician, physician assistant, or nurse practitioner who undertakes reasonable efforts to ascertain the events surrounding the patient's death. Gives a person doing so immunity from civil liability or professional discipline.

Part VIII.

Act is effective October 1, 2019.

Appropriates $15,000,000 in additional recurring funds for 2019-20 from the General Fund to the Board of Governors of The University of North Carolina, to be allocated to East Carolina University to support the operation of the Brody School of Medicine at ECU. Effective July 1, 2019.

Appropriates $316,646 in recurring funds for 2019-20 from the General Fund to the Department of Public Instruction, to be allocated to Pitt County Schools for the Innovation Early College High School for each fiscal year in which the cooperative innovative high school is in operation. Effective July 1, 2019.