Understanding NC Medical Board Position Statements

The North Carolina Medical Board‘s Position Statements serve as interpretive guidelines that define professional standards and establish criteria used in investigations and disciplinary proceedings. These aren’t just suggestions—violations can lead to public discipline, license suspension, revocation, or other serious sanctions.

If you’re a healthcare professional licensed in North Carolina, understanding the North Carolina Medical Board’s Position Statements is critical to protecting your license to practice. As an attorney who focuses on representing healthcare professionals in medical board investigations, I’ve helped countless physicians, physician assistants, and nurse practitioners navigate these complex regulations.

What Are Position Statements and To Whom Do They Apply?

The North Carolina Medical Board’s Position Statements apply to all persons licensed or approved by the Board to render medical care, including:

• Physicians (MDs and DOs)
• Physician Assistants (PAs)
• Nurse Practitioners (NPs)

Four Critical Things to Know About Position Statements:

1. They reflect existing standards, not new rules.  Many represent traditional professional standards applied to modern practice.
2. They’re not comprehensive.  Absence of a position statement doesn’t mean there’s no enforceable standard.
3. Existence doesn’t indicate enforcement priority.  The Board evaluates each case individually.
4. Standards remain active.  A lack of recent enforcement doesn’t mean abandonment of principles.

 

Essential Position Statements Every Healthcare Professional Must Know

1. The Licensee-Patient Relationship

Why This Matters: Your first responsibility is to your patients. The North Carolina Medical Board expects you to provide competent, compassionate care while maintaining appropriate professional boundaries.

Key Requirements:

• Patient welfare must always take priority over economic interests
• Maintain mutual trust through appropriate communication
• Document all significant findings in medical records
• Respect patient autonomy and confidentiality
• Provide neither more nor less care than medically required

Common Violations I See:

• Allowing financial incentives to influence medical judgment
• Inadequate documentation of patient encounters
• Failure to communicate adequately with patients
• Boundary violations in the professional relationship

2. Sexual Misconduct—Zero Tolerance

This is Non-Negotiable: In the eyes of the North Carolina Medical Board, sexual misconduct with patients is unprofessional conduct that will result in Board discipline. Period.

What Constitutes Sexual Misconduct:

The Board recognizes a continuum of severity, from “grooming” behaviors to physical contact:

Grooming Behaviors:

• Inappropriate gift-giving
• Special treatment beyond medical necessity
• Sharing personal information inappropriately, often via texting or social media applications
• Acts meant to gain patient trust for later exploitation

Verbal/Non-Physical Misconduct:

• Sexually suggestive comments
• Comments about patient’s body or appearance for nonmedical reasons
• Soliciting dates or romantic relationships with patients
• Discussing the licensee’s sexual preferences for nonmedical reasons
• Performing intimate exams without clinical justification

Physical Misconduct:

• Any sexual contact with patients
• Touching sexual body parts without medical necessity
• Examinations without proper consent
• Inappropriate physical contact of any kind

Critical Point: Even when a physical examination of a sensitive area is medically necessary, communication with the patient is key, and be sure to implement appropriate chaperonage.

3. Medical Records—Documentation Standards

Why Documentation Matters: Inadequate medical records are one of the most common issues I see in Medical Board investigations. Good encounter notes and a solid medical record are key.

Required Elements in ALL Medical Records:

• Purpose of each patient encounter
• Appropriate history and examination findings
• Treatment plan and care provided
• Past medical history, including problem list
• Documentation of medication allergies
• Informed consent when appropriate
• Date of each entry
• Author identification on all entries

Electronic Health Records (EHR) Specific Issues:

The Board has identified common EHR problems that lead to disciplinary action:

1. Over-reliance on templates: Copy-and-paste documentation must be relevant to the current encounter
2. Failure to review auto-populated information: You’re responsible for all documentation, even if generated by software
3. Access issues: Ensure you can always access patient records, even during vendor disputes
4. Communication breakdowns: Patient portal messages require timely responses

Medical Record Retention:

• Maintain records to serve patient interests
• Notify patients how long records will be retained
• Respond timely to record requests
• Never withhold records due to unpaid bills

4. Prescribing Standards

Before Prescribing, You Must:

• Establish an appropriate licensee-patient relationship
• Perform adequate history and physical examination
• Make a diagnosis
• Formulate a therapeutic plan
• Document the entire process

Limited Exceptions:

• Admission orders for hospitalized patients
• Taking calls for another provider’s patients
• Short-term continuation for new patients before first appointment
• Appropriate telemedicine encounters
• Expedited partner therapy for certain STIs

Absolute Prohibitions:

• Pre-signing prescriptions (written or electronic)
• Prescribing controlled substances for yourself or family members
• Internet prescribing based solely on questionnaires
• Prescribing outside an established relationship (with narrow exceptions)

Opioid Prescribing:

The Board has endorsed the CDC Guidelines for Prescribing Opioids for Chronic Pain. While not regulations, these represent best practices. Failure to follow appropriate pain management standards can result in discipline.

5. Telemedicine Standards

Same Standard of Care: The Board doesn’t endorse a separate standard for telemedicine. You’ll be held to the same standards as in-person care.

Critical Requirements:

• Verify patient identity and location
• Provide your name, location, and credentials
• Perform appropriate evaluation using sufficient technology
• Maintain complete medical records
• Ensure availability for follow-up care
• Obtain proper informed consent

Prescribing via Telemedicine:

• Follow “Contact with Patients Before Prescribing” position statement
• Generally inappropriate to prescribe controlled substances for pain when telemedicine is the only patient contact
• Must comply with federal and state laws
• Participate in Controlled Substances Reporting System

6. Practice Closure or Departure

Your Obligations When Leaving a Practice:

Whether you’re retiring, changing jobs, or closing your practice, you have continuing obligations:

Notice Requirements:

• Provide at least 30 days advance notice
• Notify active patients (generally those seen within past 1-2 years)
• Use multiple notification methods appropriate to your practice
• Clearly explain patients’ right to choose their provider
• Provide information on accessing medical records

Critical Distinction: Both the departing licensee AND the practice have independent duties to notify patients. Don’t assume the practice will handle everything.

Written Policies Recommended:

• Patient notification procedures and timeline
• Medical record retention schedule
• Record access procedures
• Emergency contact information
• Confidentiality and data integrity protection

7. Self-Treatment and Treatment of Family Members

General Rule: Don’t treat yourself or immediate family members for chronic conditions or prescribe controlled substances.

Limited Exceptions:

1. Emergency situations when no other qualified provider is available
2. Urgent situations for short-term prescriptions when access is limited
3. Acute minor illnesses within your clinical competence
4. Over-the-counter recommendations (as any layperson might)

Standards Apply: When you do provide care under these exceptions, you’re held to the same standard of care for unrelated patients, and maintaining appropriate medical records is key.

8. Office-Based Procedures

Level Classifications:

The Board classifies procedures by complexity and anesthesia requirements:

• Level I: Local/topical anesthesia, minimal complications risk
• Level II: Conscious sedation, moderate complications risk
• Level III: Deep sedation/general anesthesia, moderate complications risk

Key Requirements (Levels II & III):

• Appropriate credentialing and training
• Written policies and procedures
• Emergency transfer protocols
• Proper equipment and monitoring
• Qualified personnel with appropriate certifications
• Documentation of informed consent
• Performance improvement programs

Patient Selection Standards:

• Appropriate medical evaluation
• Risk assessment based on ASA classification
• Adequate support system for follow-up care
• Proper informed consent

Common Violations:

• Inadequate personnel training or certification
• Insufficient emergency equipment
• Performing procedures beyond training/competence
• Inadequate monitoring during procedures
• Failure to maintain proper documentation

9. Supervision of Other Healthcare Professionals

Your Supervisory Responsibilities:

When supervising PAs or NPs, you maintain ultimate responsibility for patient care, quality, and safety.

Factors Determining Appropriate Supervision:

• Number of supervisees
• Geographic distance
• Practice settings
• Medical specialties involved
• Supervisee training and experience
• Scope of practice and procedures performed
• Quality and frequency of ongoing education
• Duration of working relationship

Critical Requirements:

• Written collaborative practice agreement or protocols
• Only supervise within your areas of competence
• Maintain appropriate professional boundaries
• Don’t request medical treatment from your supervisees

Prohibited: Practices owned solely by PAs or NPs cannot hire physicians to practice medicine on behalf of the practice (though they may contract for required supervision).

The Bottom Line

North Carolina Medical Board position statements aren’t optional guidelines; they represent enforceable professional standards. Violations can result in serious consequences, including loss of your medical license and livelihood.

If you’re facing a Board investigation or complaint, early intervention by an experienced medical board defense attorney can make the difference between a minor issue and a career-ending sanction.

About Our Medical Board Defense Practice

I have extensive experience representing physicians, physician assistants, and nurse practitioners before the North Carolina Medical Board. My practice focuses on healthcare professional licensing and regulatory matters.

I understand the standards the Board applies, the investigation and hearing process, and how to effectively defend healthcare professionals facing allegations of violations. Whether you’re dealing with a patient complaint, prescribing investigation, scope of practice issue, or any other Board matter, I provide skilled, strategic representation to protect your license and your career.

Contact Information

If you’re facing a Medical Board investigation or have concerns about your compliance with Board position statements, contact me for a free and confidential consultation.

Disclaimer: This article is for informational purposes only and does not constitute legal advice. Every case is unique and requires individual analysis. If you’re facing a Medical Board investigation or complaint, consult with an attorney experienced in medical board defense immediately.