A BILL TO BE ENTITLED
AN ACT to strengthen the authority of the north carolina medical board to discipline physicians and certain others authorized to practice medicine in order to improve patient safety, as recommended by the House Select Committee on Health Care.
The General Assembly of North Carolina enacts:
SECTION 1.  G.S. 90‑14 reads as rewritten:
"§ 90‑14.  Revocation, suspension, annulment or denial of license.
(a)	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 who has willfully concealed from the Board material information in connection with an application for a license.
(4)	Repealed by Session Laws 1977, c. 838, s. 3.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 a physician licensed by it to submit to a mental or physical examination by physicians designated by the Board before or after charges may be presented against the physician, and the results of the examination shall be admissible in evidence in a hearing before the Board.
(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 physician'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 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. In this connection the Board may consider repeated acts of a physician indicating the physician's failure to properly treat a patient. The Board may, upon reasonable grounds, require a physician to submit to inquiries or examinations, written or oral, as the Board deems necessary to determine the professional qualifications of such licensee. 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 medicine or practiced as a physician assistant, 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 a request, petition, motion, or application to reactivate 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 restitution be made to the payer of the bill, whether the patient or the insurer, by the physician; provided that a determination of the amount of restitution shall be based on credible testimony in the record.
(13)	Having a license to practice medicine or the authority to practice medicine revoked, suspended, restricted, or acted against or having a license to practice medicine denied by the licensing authority of any jurisdiction. For purposes of this subdivision, the licensing authority's acceptance of a license to practice medicine voluntarily relinquished by a physician or relinquished by stipulation, consent order, or other settlement in response to or in anticipation of the filing of administrative charges against the physician's license, is an action against a license to practice medicine.
(14)	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.
The Board may, in its discretion and upon such terms and conditions and for such period of time as it may prescribe, restore a license so revoked or otherwise acted upon, except that no license that has been revoked shall be restored for a period of two years following the date of revocation.
(b)	The Board shall refer to the North Carolina Physicians Health Program all physicians and physician assistants 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. A physician or physician assistant shall be limited to two referrals to the North Carolina Physicians Health Program except upon the suspension or revocation of the physician's or physician assistant's license.
(c)	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.
(d)	The Board and its members and staff may release confidential or nonpublic information to any health care licensure board in this State or another state about the issuance, denial, annulment, suspension, or revocation of a license, or the voluntary surrender of a license by a Board‑licensed physician, including the reasons for the action, or an investigative report made by the Board. The Board shall notify the physician within 60 days after the information is transmitted. A summary of the information that is being transmitted shall be furnished to the physician. If the physician requests, in writing, within 30 days after being notified that such information has been transmitted, he 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.
(e)	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.
(f)	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, 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.
(g)	Prior to taking action against any licensee who practices integrative medicine for providing care not in accordance with the standards of practice for the procedures or treatments administered, the Board shall consult with a licensee who practices integrative medicine."
SECTION 2.  G.S. 90‑14.5 reads as rewritten:
"§ 90‑14.5.  Use of hearing committee and depositions.

(a)	The Board, in its discretion, may designate in writing three or more of its members to conduct hearings as a hearing committee to take evidence.
(b)	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.
(c)	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."
SECTION 3.  G.S. 90‑14.13 reads as rewritten:
"§ 90‑14.13.  Reports of disciplinary action by health care institutions; reports of professional liability insurance awards or settlements; immunity from liability.
(a)	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 physicians who practice medicine in the State, shall, after consultation with the chief of staff of that institution, report to the Board any revocation, suspension, or limitation of a physician's privileges to practice in that institution within 30 days, whether or not the action has been appealed. A hospital is not required to report the suspension of a physician's privileges for failure to timely complete medical records unless the suspension is the third within the calendar year for failure to timely complete medical records. Upon reporting the third suspension, the hospital shall also report the previous two suspensions. The institution shall also report to the Board resignations from practice in that institution by persons licensed under this Article. The Board shall report all violations of this subsection 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 monetary penalty of not less than five hundred dollars ($500.00) nor more than one thousand dollars ($1,000), for each violation, from any institution that fails to make a report as required.
(b)	Any licensed physician who does not possess professional liability insurance 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.
(c)	The chief administrative officer of each insurance company providing professional liability insurance for physicians who practice medicine in North Carolina, 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:
(1)	Any award of damages or settlement of any claim or lawsuit affecting, involving, or in any way implicating the care provided by a physician, physician assistant, or nurse practitioner it insures, or
(2)	Any cancellation or nonrenewal of its professional liability coverage of a physician, if the cancellation or nonrenewal was for cause.
(d)	The Board shall report all violations of this paragraph to the Commissioner of Insurance. The Commissioner of Insurance is authorized to order the payment of a monetary penalty of not less than five hundred dollars ($500.00) nor more than one thousand dollars ($1,000), for each violation, from any person or entity that fails to make a report as required.
(e)	The Board may request details about any action covered by this section, and the officers shall promptly furnish the requested information. The reports required by this section are privileged and shall not be open to the public. Any person making a report required by this section 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."
SECTION 4.(a)  The subcommittee of the North Carolina Medical Board and the subcommittee of the Board of Nursing, directed to work jointly to develop rules to govern the performance of medical acts by registered nurses pursuant to G.S. 90‑6(b), shall examine adding the provisions of G.S. 90‑14(a) to their joint rules that set forth grounds for action against a registered nurse's approval to perform medical acts.
SECTION 4.(b)  The subcommittee of the North Carolina Medical Board and the subcommittee of the North Carolina Board of Pharmacy, directed to work jointly to develop rules to govern the performance of medical acts by clinical pharmacist practitioners pursuant to G.S. 90‑6(c), shall examine adding the provisions of G.S. 90‑14(a) to the joint rules that set forth grounds for action against a clinical pharmacist practitioner's approval to perform medical acts.
SECTION 4.(c)  The North Carolina Medical Board, the Board of Nursing, and the North Carolina Pharmacy Board shall report to the Chairs of the House Committee on Health, the Senate Committee on Health Care, the House Select Committee on Health Care, and the Subcommittee on Patient Safety, Quality and Accountability of the House Select Committee on Health Care on the adoption of the provisions of G.S. 90‑14(a) as part of the joint rules governing the practice of medical acts for nurse practitioners and clinical pharmacist practitioners.  The boards shall file their reports no later than August 1, 2006. 
SECTION 5.  Section 4 of this act is effective when it becomes law. The remainder of this act becomes effective October 1, 2006. Section 1 applies to acts or omissions that occur on or after the effective date. Section 2 applies to hearings held on or after the effective date.  Section 3 applies to awards entered or settlements entered into on or after the effective date.