Senate committee substitute to the 2nd edition makes the following changes. Deletes the content of the previous edition and replaces it with the following.

Part I.

Enacts GS 90-12.02 (establishing a physician and physician assistant military relocation license for military service members and spouses) authorizing the issuance of military relocation licenses to a physician or physician assistant who is not actively licensed by the NC Board of Medicine (Board) to practice as a physician or physician assistant if five listed requirements are met including that they are a servicemember or the spouse of a service member in the US Armed Forces, resides in the State pursuant to military orders for military service, and holds a license in another jurisdiction that has licensing requirements substantially similar to or exceeds the licensure requirements of the State. Specifies that the military relocation license will remain active for the duration of military orders for military service in the State and upon completion of annual registration. Specifies that the license becomes inactive when the any of the following occur: (1) the license holder relocates pursuant to military orders to reside in another state; (2) the military orders for service in this State expire; or (3) the servicemember separates from military service. Provides for notification to the Board upon events that render a license inactive. Allows for a military license to become a full license by completing an application for full licensure. Requires the Board to waive the application fee if the application is submitted within one year of the issuance of the military relocation license. Permits the Board to impose additional requirements by rule.

Makes conforming changes to GS 90-13.1 (license fees) to account for new GS 90-12.02 and GS 90-12.03 (discussed below).

Effective October 1, 2023.

Part II.

Enacts GS 90-12.03 (internationally-trained hospital physician employee license [International License]) authorizing the Board to issue an International License to a physician if eight listed requirements are met, including: (1) the applicant has been offered employment as a physician in a full-time capacity at (i) a hospital that is located in North Carolina, licensed by the State of North Carolina, and accredited by the Joint Commission or (ii) a medical practice located in a rural county with a population of 500 people per square mile, in North Carolina, and will be supervised by a physician licensed by the State of North Carolina; (2) the applicant is presently licensed to practice medicine in a foreign country or had such license expire no more than five years prior to submission of an application to the Board; (3) the applicant previously completed medical school and postgraduate training substantially similar to the State’s requirements for licensure; (4) the applicant is not subject to disciplinary order or other action by any medical licensing agency in any state or other jurisdiction.

Prevents a holder of the International License from practicing medicine or surgery outside the confines of the North Carolina hospital or its affiliates; establishes a Class 3 misdemeanor if the holder breaks that rule. Specifies upon conviction, the holder will be fined not more than $500 for each offense. The Board, at its discretion, may revoke the International License after due notice is given to the holder. Specifies that an International License becomes inactive at the time the holder does one of the following: (1) ceases to be employed in a full-time capacity by a North Carolina hospital or (2) obtains any other license to practice medicine issued by the Board. Specifies that the Board will retain jurisdiction over the holder of the inactive license.

Effective October 1, 2023.

Authorizes the Board to adopt rules necessary to issue an International License. Permits the Board to adopt a rule establishing a time limit for the term of an International License.

Part III.

Amends GS 93D-1 (definitions pertaining to the NC Hearing Aid Dealers and Fitters Board [HADF Board]) as follows. Expands the scope of fitting and selling hearing aids to include sales, rentals, prescriptions or orders for use of hearing aids. Defines over-the-counter hearing aid by cross reference to 21 CFR 800.30(b) (FDA regulations on medical devices). Makes technical changes. Expands the scope of practice of a hearing aid specialist to include prescribing or ordering the use of hearing aids, in addition to other acts related to hearing aids.  Specifies that the provisions of the article do not apply to over-the-counter hearing aids.

Part IV.

Amends the definition of certifying entity in GS 90-732(4) as it applies in Article 43 (Behavior Analyst Licensure) to include the Qualified Applied Behavior Analysis Credentialing Board, in addition to the already-existing Behavior Analyst Certification Board, Inc. Includes the successors for both of these certifying entities.

Part V.

Amends GS 90-118.10 by amending the State's policy related to renewal of optometry licenses, so that all licenses, primary and branch (was, licenses), issued by the NC State Board of Examiners in Optometry (Board) are subject to annual renewal and the exercise of any privilege granted by the license is subject to the issuance of a certificate of renewal of license. Changes the date of the issuance of the renewal to on or before December 31 (was first day of January of each year). Makes conforming changes. Requires applicants for renewal to include their practice's street address in their renewal application. Changes the date of the application deadline from January 31 to January 1; changes the date by which a person who fails to apply for renewal is considered to be guilty of unauthorized practice of optometry from March 31 to January 31. Adds that if the inactive license is not renewed by December 31 of that year, then the license expires and is not eligible for renewal.

Amends GS 90-123 as follows. Increases the following fees: application for general optometry license (was, exam), general optometry license renewal, and duplicate application for a branch office license or renewal (was, duplicate license or renewal) for each branch office. Adds fees for provisional license and renewal of a provisional license. Removes fees for certificate of license to a resident optometrist desiring to change to another state or territory, license to a practitioner of another state or territory to practice in North Carolina, and license to resume practice issued to an optometrist who has retired or who has left and returned to the state.

Amends GS 90-121.2 as follows. Amends the conditions under which the Board may take disciplinary action by: (1) removing instances when the licensee is mentally, emotionally, or physically unfit to practice optometry or is afflicted with such a physical or mental disability as to be deemed dangerous to the health and welfare of their patients and (2) adding instances when a licensee is unable to practice optometry with reasonable skill and safety by reason of abuse of alcohol, drugs, chemicals, or any other type of substance, or by reason of any physical or mental illness, abnormality, or other limiting condition. Adds that the Board may order an applicant or licensee to submit to a mental or physical examination while a licensing application is pending, or before or after charges may be presented against the applicant or licensee. Allows results of the exam to be admissible in evidence in a hearing before the Board. Makes conforming changes. Makes failure to comply unprofessional conduct.

Amends GS 90-121.6 by adding that reports licensed optometrists or those applying for licensure must make to the Board concerning medical malpractice must be made within 30 days of occurrence. Adds a provision setting out allowable methods for submitting these reports to the Board. Adds that failure to make these required reports is unprofessional conduct and grounds for discipline.

Enacts new GS 90-121.7 imposing on licensees a duty to report within 30 days any incidents the licensee reasonably believes to have occurred involving: (1) sexual misconduct of any person licensed by the Board with a patient and (2) fraudulent prescribing, drug diversion, or theft of any controlled substances by another person licensed by the Board. Failure to report is unprofessional conduct and grounds for discipline. Provides immunity from civil liability for those reporting in good faith and without fraud or malice. Reports made in bad faith, fraudulently, or maliciously are unprofessional conduct and grounds for discipline. Sets out the methods by which the reports can be submitted to the Board.

Amends GS 90-127.3 to require when giving patients that have received an eye exam a copy of their spectacle prescription that it be consistent with Federal Trade Commission rules and guidelines.

Enacts new GS 90-127.4 allowing an optometrist to register with the NC Board of Pharmacy to dispense drugs, limited to drugs for the diagnosis and treatment of abnormal conditions of the eye and its adnexa. Limits such dispensing to legend or prescription drugs to their own patients. Requires paying the dispensing fee and complying with the dispensing registration process. Requires registration with the NC Board of Pharmacy and the Board as well as compliance with all rules governing dispensing of drugs under this statute.

Enacts new GS 90-85.26B requiring dispensing optometrists dispensing prescription drugs to register annually with the Board and with the licensing board with jurisdiction over the dispensing optometrist. Requires dispensing to comply with laws and regulations applicable to pharmacists governing the distribution of drugs, including packaging, labeling, and record keeping. Discipline authority is vested in the licensing board having jurisdiction over the dispensing optometrist.

Amends GS 90-85.25 to allow the NC Board of Pharmacy to charge dispensing optometrists an annual registration fee and a reinstatement of registration fee, both set at $75.

Effective October 1, 2023.

Requires the Board and NC Board of Pharmacy to adopt rules to implement the changes set forth above.

Part VII.

Requires the Board of Nursing (Nursing Board) and the Department of Health and Human Services (DHHS), Division of Health Service Regulation (Division), to develop a plan to relocate the Nurse Aide I education and training program to the Nursing Board. Requires the relocation plan to ensure a seamless transition and ensure the program continues to meet federal requirements. Requires DHHS to continue to maintain the registries required by Article 15 of GS Chapter 131E. On or before February 1, 2024, requires DHHS and the Nursing Board to provide a report to the specified NCGA committee that must contain a relocation plan, a transition time line, and recommendations for statutory changes necessary to transition the Nurse Aide I education and training program from DHHS to the Nursing Board.

Part VIII.

Adds new Part 3A, Hospital Violence Prevention Act, in Article 5 of GS Chapter 131E, providing as follows. Defines law enforcement officer as a sworn law enforcement officer, a special police officer, or a campus police officer authorized to carry a firearm, or an armed security guard with a valid firearm registration permit. Requires licensed hospitals that have an emergency department to conduct a security risk assessment and to implement a security plan. Exempts hospitals that are not an academic medical center teaching hospital that are located in a county with less than 300,000 residents based on the 2020 census, upon the hospital’s good faith determination that a different level of security is necessary and appropriate for any of its emergency departments based on its security risk assessment from the requirement to have at least one law enforcement present at all times in the emergency department or on the same campus as the emergency department. Requires those hospitals to develop a security risk plan and allow DHHS access to the security risk assessment and plan along with the county emergency management director, county sheriff, and municipal police chief, if applicable. Provides for notice.

Requires all other hospital to use the results of the security assessment to develop a security plan with protocols to ensure at least one law enforcement officer is always present in the emergency department or on the same campus as the emergency department. Requires those hospitals to allow DHHS access to the security risk assessment and plan. Lists five requirements for the security plan, including: (1) training for law enforcement officers employed by the hospital that is appropriate for the populations served by the emergency department; (2) training for law enforcement officers employed by the hospital that is based on a trauma-informed approach to identifying and safely addressing situations involving patients, family members, or other persons who pose a risk of harm to themselves or others due to mental illness or substance use disorder or who are experiencing a mental health crisis; (3) safety protocols based on national standards and evaluated risks; (4) safety protocols that include the presence of at least one law enforcement officer in the emergency department or on the same campus as the emergency department at all times; and (5) training requirements for law enforcement officers employed by the hospital in the potential use of and response to weapons, defensive tactics, de-escalation techniques, appropriate physical restraint and seclusion techniques, crisis intervention, and trauma-informed approaches.

Requires DHHS to have access to all security plans for hospitals with an  emergency department and to maintain a list of those hospitals with a security plan. Requires every hospital with an emergency department to provide appropriate hospital workplace violence prevention program training, education, and resources to staff, practitioners, and non-law enforcement officer security personnel. Specifies that a hospital security risk assessment and security plan are not public records under State public records law.

Enacts GS 131E-88.2, as follows. Requires the Division to annually collect the following data from hospitals for the preceding calendar year: (1) the number of assaults occurring in the hospital or on hospital grounds that required the involvement of law enforcement, whether the assaults involved hospital personnel, and how those assaults were pursued by the hospital and processed by the judicial system, (2) the number and impact of incidences where patient behavioral health and substance use issues resulted in violence in the hospital and the number that occurred specifically in the emergency department, and (3) the number of workplace violence incidences occurring at the hospital that were reported as required by accrediting agencies, the Occupational Safety and Health Administration, and other entities, by September 1 of each year. Requires DHHS to examine data from those hospitals with emergency departments that developed the security plans discussed above. Specifies that the first reports on these matters are due on or before September 1, 2025. Requires DHHS to compile the report information required by GS 131E-88.2, including any recommendations to decrease the incidents of violence in hospitals and to decrease assaults on hospital personal, and to report this information to the specified NCGA committee by December 1 of each year. Specifies that the first of these reports is due on or before December 1, 2025.

Enacts GS 131E-88.3 which requires the Administrative Office of the Courts (AOC) to report annually by September 1, to the Division on the number of persons charged or convicted in the previous year under GS 14-34.6 (assault or affray on a firefighter, emergency medical technician, medical responder, and hospital personnel).  Effective October 1, 2024, with the first report due October 1, 2025. Sunsets October 30, 2030.

Effective October 1, 2024.

Requires DHHS, by October 1, 2023, to notify all licensed hospitals of these requirements, including reporting requirements.

Amends the definitions in GS 95-260 pertaining to workplace violence prevention to include hospital. Enacts new GS 95-269A (violation of order issued upon request of hospital) establishing that a person who knowingly violates a valid protective order issued upon the request of a hospital pursuant is guilty of a Class A1 misdemeanor for a first offense. Specifies that, unless covered under some other provision of law providing greater punishment, any person who knowingly violates a valid protective order, after having been previously convicted of two offenses under Article 23 of GS Chapter 95, is guilty of a Class H felony. Provides that unless covered under some other provision of law providing greater punishment, any person who, while in possession of a deadly weapon on or about his or her person or within close proximity to his or her person, knowingly violates a valid protective by failing to stay away from a place, or a person, as so directed under the terms of the order, is guilty of a Class H felony. Requires law enforcement to arrest and take a person into custody if they have probable cause to believe that the person knowingly has violated a valid protective order issued upon the request of a hospital.  

Unless covered under some other provision of law providing greater punishment, specifies that a person who commits a felony at a time when the person knows the behavior is prohibited by a valid protective order is guilty of a felony one class higher than the principal felony described in the charging document. Exempts convictions of a Class A or B1 felony or to repeat offender/deadly weapon convictions of the offenses set forth above. Sets forth pleading rules for indictments and required findings. Specifies that valid protective orders include emergency or ex parte orders. Provides that it is not a violation of a protective order issued upon the request of a hospital for any person subject to the protective order to enter that hospital seeking treatment for an emergency medical condition. Makes conforming changes. Effective December 1, 2023, and applies to offenses committed on or after that date.

Expands the type of hospital workers covered under GS 14-34.6 (assault or affray on a firefighter, an emergency medical technician, medical responder, and hospital personnel) to include hospital employees, licensed healthcare providers, or individuals under contract to provide services at a hospital (currently, hospital personnel and licensed healthcare providers providing or attempting to provide services to a patient). Upgrades the felony to a Class D felony if the person uses a firearm (currently, Class E felony) and to a Class F felony if they inflict bodily injury or use a deadly weapon other than a firearm (currently Class G felony). Amends GS 14-16.6 (assault on executive, legislative or court officer) to upgrade the felony to a Class E (was, Class F) felony if the person inflicts serious bodily injury. Amends the definition of court officer under GS 14-16.10 to include individuals contracted by a county department of county services and no longer requires the listed individuals to be performing service in proceedings under Subchapter I of GS Chapter 7B. Effective December 1, 2023, and applies to offenses committed on or after that date.

Amends GS 15A-1340.16 (aggravated and mitigating sentences) to expand list of aggravating factors to include if the offense was committed on the property of a hospital. Effective December 1, 2023, and applies to offenses committed on or after that date.

Makes organizational changes and conforming changes to act's long and short titles.