The Board recently surveyed a ran-dom
sample of its licensees to get
input on a range of topics related to
the practice of medicine, including
professional burnout. About 45 per-cent
of survey respondents indicated
they have experienced symptoms of
burnout that lasted more than three
months, which is consistent with
national trends. More eye-opening
was a related question that asked
licensees with burnout to say wheth-er
they had sought assistance. Some
67 percent indicated that they did
nothing to alleviate their burnout.
When asked why, the most common
response was that burnout is “just
part of the job.”
A few years ago, I would probably
have agreed with that statement.
As an obstetrician and gynecologist,
I worked long hours and was
Resolve to
fight burnout
and reclaim
satisfaction in
life, work
Eleanor E. Greene, MD, MPH
SPOTLIGHT
According to the NC Controlled
Substances Reporting System,
during the 4th Quarter of 2016
prescribers ordered a prescrip-tion
history 28 percent of the time
when prescribing controlled sub-stances.
Find courses to satisfy the new
CME requirement....................... 3
2016 Position Statement
review.......................................... 4
Infographic: Licensee survey
results .......................................... 6
Changes to NCMB’s opioid
investigations program ..............8
Q & A: Using NCCSRS .............. 11
FROM THE PRESIDENT
FORUM North Carolina Medical Board
ISSUE NO. 4 | WINTER 2017
frequently called to the hospital at
night to deliver babies. I rarely got
enough sleep, didn’t have time to
exercise and wasn’t eating well. I’d
started noticing that my knees and
back ached if I spent more than an
hour or so on my feet, and I was
pretty sure surgery was in my future.
My blood sugar level and blood
pressure were creeping up. I started
to ask myself, “How do I get off this
merry-go-round?”
I knew I needed to make some
changes. I did not want to continue
on a path to burnout and further
deterioration of my physical and
emotional health. So, I took three
months off to self-reflect, travel and
put my desires and interests first for
once. I knew I had to put my own
health first – advice I often gave
my patients but was not, in fact,
following. I got a personal trainer
and started to work out regularly
and make healthier meal choices. I
made the dificult decision to give
up obstetrics, to make it possible to
get better sleep. After three months,
I reopened my practice but changed
the focus to women’s health and
wellness, and I reduced to part time
hours. With the help of my doctor,
Continued on pg 2
IN THIS ISSUE
CONTROLLED SUBSTANCES
PRESCRIPTIONS
CSRS
QUERIES
508,000
1.8
MILLION
I was able to lose 50 pounds over a period of three
years. Losing weight and exercising resolved the knee
and back pain, returned my blood sugar and blood
pressure to normal and my sleep apnea went away.
Most important, I’m enjoying practicing medicine
again, and I’m much happier.
I recognize that I’m fortunate that I am at a point in
life where it was possible to make drastic changes
to improve my life and practice. Not everyone can
do that. At the same time, I want to encourage you,
my colleagues, to reject the notion that burnout is
inevitable and inescapable.
NCMB hosted a roundtable discussion on physician
wellness in 2015, in response to rising rates of
physician burnout. One of the actions the Board
took after that meeting was to collect and post
wellness resources, particularly resources related to
identifying and addressing symptoms of burnout,
on its website, as www.ncmedboard.org/wellness. I
hope you’ll take a few minutes to review them. You
may just find something that inspires you to make
some positive changes.
Also in 2015, NCMB joined the NC Consortium for
Physician Resilience and Retention, which brings
together stakeholders, including the NC Medical
Society, Cone Health, the NC Physicians Health
Program, and other organizations that deal with the
impact of rising physician burnout. The Consortium
is committed to identifying opportunities to address
mental health, wellness, and burnout among
medical professionals in the state. Participation in
the Consortium influenced NCMB’s recent decision
to stop asking licensees completing annual renewal
to disclose medical conditions that might impair or
limit ability to practice. NCMB hopes this change
will encourage licensees who need help to obtain it,
without fear of attracting Board scrutiny.
If you’re interested in viewing summary results from
the recent licensee survey, you’ll find a feature on
page 6 of this issue of the newsletter.
Board Officers
President
Eleanor E. Greene, MD | High Point
President Elect
Timothy E. Lietz, MD | Charlotte
Secretary/Treasurer
Barbara E. Walker, DO | Kure Beach
Immediate Past President
Pascal O. Udekwu, MD | Raleigh
Board Members
Debra A. Bolick, MD | Hickory
Bryant A. Murphy, MD | Chapel Hill
A. Wayne Holloman | Greenville
Ralph A. Walker, LLB | Greensboro
Shawn P. Parker, JD, MPA | Raleigh
Venkata Jonnalagadda, MD | Greenville
Jerri L. Patterson, NP | West Elm
Cheryl Walker-McGill, MD | Charlotte
Contact Us
Street Address:
1203 Front Street
Raleigh, NC 27609
Telephone:
(800) 253-9653
Fax:
(919) 326-1130
Website:
www.ncmedboard.org
Email:
info@ncmedboard.org
Have something for the editor?
forum@ncmedboard.org
Forum Staff
Publisher
NC Medical Board
Editor
Jean Fisher Brinkley
Editor Emeritus
Dale G. Breaden
The Forum of the North Carolina Medical Board is published four times a year. Articles appearing in the Forum, including
letters and reviews, represent the opinions of the authors and do not necessarily reflect the views of the North Carolina Med-ical
Board, its members or staf, or the institutions or organizations with which the authors are afiliated. Oficial statements,
policies, positions, or reports of the Board are clearly identified.
We welcome letters to the editor addressing topics covered in the Forum. They will be published in edited form depending
on available space. A letter should include the writer’s full name, address, and telephone number.
FROM THE PRESIDENT
North Carolina Medical Board Forum Credits VOLUME XX | No. 4
Eleanor E. Greene, MD, MPH
Board President
Be well,
Dr. Greene was sworn in as President by Immediate Past
President Pascal O. Udekwu, MD, in November.
Now that 2017 is here, many physicians and physician assistants (PAs)
are actively looking for continuing medical education (CME) courses
that can help them satisfy the new requirement for controlled substances
prescribers. Any prescriber whose CME cycle renews on or after July 1,
2017, will be expected to have met the new requirement.
Physicians who prescribe controlled substances (including non-opioids)
must complete three hours of eligible CME during each cycle and PAs
must complete two hours. These hours are part of the licensee’s total CME
requirement for the cycle, not in addition to it.
One CME provider physicians and PAs should be aware of is the U.S.
Centers for Disease Control and Prevention, which currently offers seven
free prerecorded modules on safe opioid prescribing. CME credit can be
obtained after viewing or listening to any CDC module by completing an
online evaluation and post-test. Titles ofered include, “Assessing Benefits
and Harms of Opioid Therapy,” “ Dosing and Titration of Opioids,” “Risk
Mitigation to Reduce Opioid Overdose,” “Efectively Communicating with
Patients about Opioid Therapy,” and “Overview of the CDC Guideline
for Prescribing Opioid for Chronic Pain.” Courses are certified for credit
through December 2017.
Find the series of CDC opioid modules at
https://emergency.cdc.gov/coca/calls/opioidresources.asp
Additional CME courses and information about the new controlled
substances requirement can be found at:
www.ncmedboard.org/prescribingCME
To support physicians and PAs, the Board has partnered with Wake
AHEC to create free CME that will cover the required topics. CME will
be available this spring and will consist of a webinar and four live panel
sessions. NCMB will publish details about how to access this CME once
details are set.
Will my CME qualify?
To count towards the new requirement, a course must:
• Be Category 1 certified
• Cover one or more of the following education topics:
1. Controlled substances prescribing practices
2. Controlled substance prescribing for chronic
pain management
3. Recognizing signs of the abuse or misuse
of controlled substances
Note: Each education topic must be covered
at least once during each CME cycle. In
other words, every course completed need
not cover all three topics.
Finding controlled substances CME courses
TRENDING AT NCMB
FORUM | Issue 4 | 2017 	 3
The Board voted in January to
accept the Allied Health Commit-tee’s
recommendation to change
its name to Advanced Practice
Providers and Allied Health
Committee (APPAHC).
The committee is responsible for
reviewing matters involving phy-sician
assistants, nurse practi-tioners,
midwives, clinical phar-macist
practitioners, emergency
medical service (EMS) providers,
anesthesiologist assistants and
perfusionists who are regulated,
directly or indirectly, by NCMB.
The Committee also handles mat-ters
related to polysomnographic
technologists or “sleep techs”.
Sleep techs are not licensed by
the Board but are required to reg-ister
with NCMB annually.
The name change more accurate-ly
reflects the range of medical
professionals who fall under the
scope of the committee’s work.
The APPAHC meets during each
Board Meeting.
Board updates
committee name
APPAHC Chairperson Jerri L. Patterson, NP,
with fellow Board Member Ralph A. Walker, JD
Position statement review: what changed in 2016?
New position statements
The Board adopted one new position statement in
2016, entitled, Corporate practice of medicine.
As a general rule, the North Carolina Professional
Corporations Act (N.C. Gen. Stat. § 55B, et.
seq.) requires corporations that provide certain
professional services to be owned entirely by
licensees of that profession. As a rule, medical
practices must be owned by licensed physicians.
Under some circumstances, a medical practice
may be jointly owned by a combination of other
authorized clinicians as listed in N.C. Gen. Stat.
§ 55B-14(c). NCMB recognizes medical practices
owned by hospitals or health maintenance
organizations as exceptions because state law
authorizes these licensed and regulated entities to
provide direct patient care.
Why was this position statement needed?
Often, NCMB will investigate situations where a
licensee is employed to work in a practice owned by
medical professionals who are not licensed in NC or
that is owned by individuals who are not medical
professionals. Another common pitfall NCMB sees
frequently is the problem of “straw ownership” of
medical practices. A straw ownership arrangement
is one in which a licensed physician is made the sole
shareholder of a practice controlled and operated
by a nonphysician. The new position statement
can help licensees better understand the Board’s
expectations with regard to practice ownership
and, potentially avoid regulatory problems that
arise from becoming involved in an inappropriate
practice arrangement.
POSITION STATEMENTS
The Board reviews position statements at least once every four years, or more frequently if new information
or issues come to light that may necessitate reconsideration, expansion or revision of an existing NCMB
position. Here’s what the Board worked on in 2016:
Amended position statements
The Board approved revisions to the following
position statements:
• The Physician-Patient Relationship
• Medical Testimony
• End-of-life Responsibilities and Palliative Care
The Physician-Patient Relationship
What Changed?
The position statement was updated to reflect
circumstances faced by employed physicians.
For example the position clarifies the Board’s
expectation that, if an employer terminates a
physician, either the physician or the employer
provide patients with the physician’s new contact
information. In addition, patients should be given
the choice to continue to be seen by the physician
in his or her new practice setting or to be treated by
another physician still working with the employer.
Medical Testimony
What changed?
The position was updated to include most recent
version of the AMA Ethics Opinion on medical
testimony.
End-of-life Responsibilities and Palliative Care
What Changed?
The position statement was expanded to state that
physicians and physician assistants should address
Advanced Care Planning, including the establishing
of a Health Care Power of Attorney and Advanced
Directives, as appropriate.
All position statements as well as a downloadable pdf copy
of the complete position statements are available online at:
www.ncmedboard.org/positionstatements
Position statements available online
POSITION STATEMENTS
FORUM | Issue 4 | 2017 	 5
NCMB voted at its January Board Meeting to replace its existing
position statement on the use of opiates to treat pain with the CDC
Guideline for Prescribing Opioids for Chronic Pain.
The Board was motivated by a desire to offer licensees who prescribe
opioids a comprehensive and current resource to assist them in
providing appropriate care to their patients with pain. NCMB’s
Policy for the Use of Opiates for the Treatment of Pain was adopted
in 2014, while CDC’s opioid guidance was released in March 2016.
Please follow the link to the right to read the Board’s formal comments,
which note that the recommendations contained in the CDC policy
may not meet the needs of all patients. The Board encourages licensees
who prescribe opioids to familiarize themselves with the CDC policy
and use it to guide - but not dictate - their treatment decisions.
NCMB’s primary goal relative to opioid prescribing is to prevent
inappropriate prescribing, not to disrupt the treatment of patients
with a legitimate need for pain management. It is up to each clinician
providing patient care to develop treatment plans that are both
clinically appropriate and in the best interest of their patients.
NCMB adopts CDC opioid guidelines
Website
Reviewed, no changes
The Board reviewed all of the following position
statements and determined that no changes are
needed at this time.
• Advanced Directives and Patient Autonomy
• Availability of licensees to their patients
• Ofice-based procedures
• The Retired Physician/Licensee
Repealed
The Board voted to repeal its position statement
entitled, Competence and Reentry to the Active
Practice of Medicine.
Why was this repealed?
This statement is no longer relevant due to changes
to 21 NCAC 32B .1370, which took efect January 1,
2016. Applicants who have not actively practiced
clinical medicine for two or more years are required
to demonstrate their competence to practice
medicine upon application for a North Carolina
license. Applicants may be required to complete
a program of reentry before a license is issued.
Overall, reentry is now a more individualized process
developed on a case-by-case basis depending on the
strengths, weaknesses, needs and practice plans of
the individual seeking reentry. Learn more about
reentry to the practice of medicine on NCMB’s
website: www.ncmedboard.org/licensure/reentry.
The North Carolina Medical Board’s Position Statements are interpretive statements that attempt to define
or explain the meaning of laws or rules that govern the practice of physicians, physician assistants, and
nurse practitioners in North Carolina, usually those relating to discipline. They also set forth criteria or
guidelines used by the Board’s staff in investigations and in the prosecution or settlement of cases.
What are the position statements of the Board and to whom do they apply?
Access the CDC Guideline for Pre-scribing
Opioids for Chronic Pain on
the Board’s website:
www.ncmedboard.org/CDCpolicy
Licensee survey: here’s what you told us
In October, NCMB sent emails to 10,000 randomly selected licensees requesting their input on topics
impacting the practice of medicine, including physician wellness/burnout, longevity in practice, and issues
facing employed physicians versus those in private practice. We also shared the survey with several groups
to distribute to their members, including NC Medical Society, NC Osteopathic Medical Association, NC
Academy of Physician Assistants, and the Old North State Medical Society.
NCMB staff will be working over the next few months to see what else can be gleaned from the data and to
determine how representative the information is for physicians and PAs in North Carolina. The Board is
grateful to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina, Chapel
Hill, and to the NC Physicians Health Program, which have both offered assistance in further analyzing the
information. Thank you to all physicians and PAs who participated in the survey! If you have any questions
or comments, send them to forum@ncmedboard.org.
1,855 licensees responded, and much of the information provided mirrors national trends. The initial
findings included the following:
Of those who respond-ed
Indicated they have
plans to retire in the next
10 years.
40%
When breaking down the data, the
more experience a physician/PA has,
the less rewarding the pay in private
practice becomes
Employed physicians, PAs,
and 35-54 year olds re-ported
higher dissatisfac-tion
with work/life balance
than other age groups.
Nearly 45% indicated they have
experienced burnout that lasted
more than 3 months
67% of those who reported ex-periencing
burnout DID NOT seek
assistance. The most frequent rea-son
cited was that burnout is just
part of the job.
Common side effects of burnout
were negativity, exhaustion, self-doubt
and anxiety, although 6%
indicated they have had suicidal
thoughts.
Of employed physicians
reporting dissatisfaction
regarding work/life bal-ance
were women.
Burnout was about the same be-tween
employed physicians and
those in private practice
60%
For physicians/PAs in private
practice, pay was listed as
both a top 5 benefit (#5)
and a top 5 challenge (#3).
The Basics
Professional Burnout
65% of those that responded
rated their overall experience
with NCMB on a 5 point scale as
“good” or “excellent”
Visiting the
NCMB Website:
65%
Accessing the
Licensee Page:
45%
Reading articles
in the Forum:
42%
The top three forms of interaction reported by 1,811 licensees
includes: Good
20% Excellent
45%
How can the Board better serve
patients and public education?
How can the Board better serve
licensees?
Responses included: Responses included:
“Offer solutions to burnout, real
solutions. Things people can do to
help themselves and change their
practice if that is even possible. ”
“License renewal that lasts longer than 1 year”
or “streamline the 23 step process for renewal”
Interactions with NCMB
View the full survey: scan the QR code with your
smartphone or go to http://tinyurl.com/jh2dxjh
“Educate the population on
the importance of high quality
physicians and the danger of
losing high quality physicians”
“More education around
controlled substances”
FORUM | Issue 4 | 2017 	 7
Applicants are needed for two physician seats on the
Board, for terms beginning Nov. 1.
Two seats must be filled by the process set down
in statute (N.C. Gen. Stat. 90-2 and 90-3), which
requires interested parties to apply via the Review
Panel. The Review Panel is an independent body
that nominates candidates for consideration by the
Gov. Roy Cooper. By law, the Review Panel must
nominate two candidates for each open seat.
Call for applicants: physicians needed to serve on NCMB
Applications will be accepted online through July 1,
beginning March 1. For more information visit:
http://www.ncmedboardreviewpanel.com/
The Review Panel will consider only physicians (MDs
or DOs) who hold active, unrestricted NC medical
licenses. Applicants must be actively practicing
clinical medicine at least part time and must have
no history of disciplinary action within the past five
years.
After evaluating preliminary results from its opioid
investigations program, the Safe Opioid Prescribing
Initiative (SOPI), the Board voted in January to
refine the selection criteria that determine who
will be investigated. Any changes to the rules for
this program will be submitted to the Rules Review
Committee after the public comment period (now
through May 1).
Currently SOPI, which was implemented in April
2016, investigates NCMB licensees who have had
multiple patient deaths due to opioid overdose
AND licensees who write large numbers of high-dose
opioid prescriptions (See “Current SOPI
investigative criteria” below). The Board has
proposed rule changes to amend the existing
selection criteria. The Board is also contemplating
new selection criteria to identify prescribers whose
medical practices display characteristics associated
with potentially inappropriate opioid prescribing.
Board votes to modify opioid investigations
program
NCMB welcomes feedback on the proposed rule
changes. A public hearing is scheduled for May 1 at
the Board’s Raleigh offices. Written comments may
be submitted to rules@ncmedboard.org.
How does NCMB want to change the “patient
deaths” criteria?
Currently, the Board opens investigations into
physicians or PAs who have had two or more patient
deaths due to opioid poisoning within a 12-month
period. NCMB wants to modify these criteria so
that investigations would only be opened if the
prescriber a) authorized 30+ tablets of an opioid to
the decedent AND b) the opioid prescriptions were
written within 60 days of the patient’s death.
Why does the Board want to make changes
to the “patient deaths” criteria?
In the vast majority of cases where the prescriber
authorized some type of controlled substance in the
Current SOPI investigative criteria:
• Top one percent prescribing 100
milligrams of morphine equivalents
(MME) per patient per day.
• Top one percent prescribing 100
MMEs per patient per day in combi-nation
with any benzodiazepine and
within the top one percent of all con-trolled
substance prescribers by vol-ume.
• Prescribers with two or more patient
deaths within a 12–month period due
to opioid poisoning.
Revised SOPI investigative criteria:
• Top two percent prescribing 100 morphine
milligram equivalents (MME) per patient per
day.
• Top two percent prescribing 100 MMEs per patient
per day in combination with any benzodiazepine
and within the top one percent of all controlled
substance prescribers by volume.
• Prescribers with two or more patient deaths
within a 12–month period due to opioid poisoning
AND authorized 30+ tablets of an opioid to the
decedent AND scripts were written within 60 days
of the patient’s death.
OPIOID PROGRAM
12 months preceding the death, the prescribing did
not contribute to the death. Adding filters to ensure
that opioids were prescribed in close proximity to
the death will ensure that cases are only opened
on physicians or PAs who authorized recent opioid
prescriptions.
How does NCMB want to change the “high-volume,
high-dose” criteria?
Currently NCMB investigates the top ONE percent
of licensees prescribing 100 morphine milligram
equivalents (MMEs) per patient, per day. The Board
also looks at prescribers who meet this criteria and
also prescribe in combination with a benzodiazepine.
The Board wants to begin opening cases into the top
TWO percent of such prescribers.
Why does the Board want to expand the
“high-volume, high-dose” criteria?
A majority of cases opened based on these criteria
resulted in either private or public action, based
on Board findings of substandard practice or other
concerns regarding quality of care. The Board
believes expanding these criteria to the top TWO
percent of clinicians prescribing 100 MMEs per
patient, per day, will likely identify additional
prescribers who may not be practicing consistent
with current accepted standards of care.
What other changes to the selection criteria
is NCMB considering?
The Board is interested in creating a new set of
selection criteria to identify prescribers whose
practices display certain characteristics (See
“Potential SOPI investigative criteria” below). The
Board voted in January to test the proposed criteria
before seeking rule changes to formally establish
them.
How will these proposed changes affect the
number of SOPI cases opened?
The Board expects to open fewer cases based on
patient deaths than it did under existing criteria. It
expects an increase in the number of cases related to
the changes to the “high-volume, high dose” criteria.
As the vast majority of SOPI cases to date have been
opened based on the patient deaths criteria, the
Board expects the net effect of the rule changes to
be a smaller but more specific and sensitive report
of licensees meeting any investigative criteria.
FORUM | Issue 4 | 2017 	 9
Potential SOPI investigative criteria *
NCMB would investigate prescribers who meet at
least three of the following criteria:
1. At least 25 percent of the prescriber’s patients
receiving opioids reside at least 100 miles from
the prescriber’s practice location;
2. The prescriber has more than 30 patients
receiving the same opioid and benzodiazepine
combination;
3. A majority of the prescriber’s patients receiving
opioids self-pay for the prescription;
4. Prescriber allows an early opioid prescription
refill more than twice in the last 12 months;
5. More than 50% of the prescriber’s patients
receive opioid doses of 100 MME or greater per
day; or
6. The prescriber has more than ten patients who
use three or more pharmacies within a year to
obtain opioids.
* NCMB will study this criteria to determine its feasibility and
value before pursuing rule changes.
The SOPI rule changes are available on the NCMB
website in the Rule Change Tracker:
www.ncmedboard.org/SOPIRules
Percent of cases
opened based on
prescribing criteria
Percent of cases opened based on 2+
patient deaths due to opioid poisoning
74%
26%
As of January 2017 NCMB has completed 62 based
on SOPI criteria. These cases have directly impacted
.2% of the licensee population.
Cases Opened
mentor if you do not listen to others. I think by working
on listening to others’ ideas and positions I have become
more balanced in my decisionmaking and understand
that my ideas, concerns and solutions are not the only way
things can be accomplished.
What is the last book you read?
A: In high school I was not much of a
reader so most of the classic literature did
not receive the time and effort it deserved.
I thought that I would go back and start
reading now that I have no pressure to
finish in a relatively short period of
time. I have read the Count of Monte
Cristo, All Quiet on the Western
Front, In Cold Blood, Catcher
in the Rye, and I am currently
reading The Grapes of Wrath.
Who inspires you?
A: My wife. She has had a full
time OB/GYN practice for 22
years, raised three children,
and is a supportive spouse
and a great cook. She is now
is starting a new practice
with additional training in
Functional Medicine and
Wellness. She has done
all this with a dignity
and grace that I admire
and try to emulate.
What do you wish the public or other medical
professionals understood about the Board?
A: For medical professionals, I want them to really think
about our mission of protecting the public. Medical
professionals need to understand that by protecting the
public we are protecting the integrity of our profession.
The public needs to understand we are here for their
protection and that we are a resource when they encounter
questionable professional behavior or questionable
clinical competence.
What is the biggest challenge facing medicine or
medical regulation?
A: That more physicians are working for large health
care organizations in an employed model. Physicians
are measured by productivity and by metrics that have
been placed on them by the organizations and the federal
government. Physicians are increasingly measured and
graded by best business practices and these often do not
measure the value of the patient-physician relationship.
Since their paychecks come from the larger organization,
physicians are not working for their patients and business
partners as they did in the past, but for the corporation. I
believe this is causing collegiality between physicians and
the doctor-patient relationship to be compromised.
What is the best lesson you have learned from
your personal or professional life experiences?
A: To always work on being a good listener. Early in my
career I had a respected colleague counsel me about not
listening well to the concerns of our nursing leadership.
It was a wake-up call. You cannot be a good leader or
Five Questions: Timothy E. Lietz, MD
GETTING TO KNOW THE PEOPLE OF THE NC MEDICAL BOARD
BULLETIN BOARD The Review Panel for the NC
Medical Board interviewed sev-eral
candidates for the open phy-sician
assistant (PA) seat on the
Board on Jan. 28.
The Panel, which under state law
is responsible for nominating
candidates for NCMB seats for
consideration by the Governor, is
expected to select two candidates
sometime in February. Barring
Update on PA Board Member appointment
any unforeseen delays, NCMB
hopes to have a new PA Board
Member seated in time to attend
the meeting scheduled for March
15-17.
NCMB has a total of 13 members,
including eight seats held by phy-sicians,
one seat held by a nurse
practitioner, one seat reserved
for a PA and three seats held by
members of the public.
EMERGENCY MEDICINE | MID-ATLANTIC EMERGENCY MEDICAL ASSOCIATES | APPOINTED 2013 | PRESIDENT ELECT
PRESCRIBING
Q: How long did it take for you to fully incorporate CSRS into your patient care?
A: Probably about a year. It’s a process. The most important thing is not to give up. Of the patients dying from
prescription opioids, 85 to 90 percent have obtained them from a physician, directly or through family members.
You want to make sure you are not contributing to the
problem without knowing it.
Q: Many prescribers comment that they just don’t
have time to add checking CSRS to the list of things
they do before or during a patient visit. What do
you say to people with this view?
A: That I understand. A lot of physicians don’t want to
do another bloody thing. But they don’t have to–have
someone else do it. One the great things about CSRS is
that you can delegate access. Assign a staf member to
learn the system and do the queries for you. They can
have them waiting for you in the patient’s chart.
Q: Some prescribers are aware of CSRS but aren’t
sure how it can be used to improve the care they
provide. Can you offer some guidance?
A: CSRS is designed to help me understand what other
prescribers have done and what I have actually done with
this particular patient. You know what you’ve prescribed,
but do you know what the patient has actually done? For
example, let’s say I authorize three one-month scripts.
Are the scripts filled early? Does the patient fill one and
then nothing for six weeks? You can start to see patterns
and develop a better understanding of what’s actually
occurring.
Q: Can you offer some specific advice about when
prescribers should check CSRS?
A: The first time you write an opiate for a patient, you
need to check CSRS. After that, at a minimum, check
CSRS every six months. Every time I do a urine drug
screen, I check CSRS – they go together. And finally,
I check whenever my gut tells me to. It’s going to be
different for every patient.
Using NCCSRS to improve opioid prescribing
Tips from the director of Duke Health’s Medical Pain Service
This year, the NC Controlled Substances Reporting System (CSRS) will celebrate its 10th
anniversary. The system is a valuable resource that can help prescribers monitor patient
behavior and avoid issuing prescriptions to patients who may be abusing or misusing
the medications. Yet CSRS remains an underused resource in NC, with less than half of
prescribers with a valid DEA registration currently signed up for access. Forum editor Jean
Fisher Brinkley asked Dr. Steven D. Prakken, director of the Medical Pain Service for Duke
Health and an early adopter of CSRS, for his thoughts on why – and how – prescribers
should use the system.
Mandatory Registration for CSRS
FORUM | Issue 4 | 2017 	 11
Dr. Steven D. Prakken
A 2016 state law will eventually require all licensees
who hold a valid DEA registration to register for access
to the NC Controlled Substances Reporting System.
The requirement will not be in effect until DHHS
makes technical upgrades and meets performance
targets; however, NCMB encourages licensees to
register now. Here’s what you need to know:
• NCMB ofers a streamlined online registration
process for CSRS here:
www.ncmedboard.org/LicenseeInformation
Log in and select Training & CSRS to find the
form.
• Current law requires registration only, not use.
• Problems or questions about registering for ac-cess
via the NCMB website? Call 919-326-1100.
• Questions about using CSRS? Call 919-733-1765.
Delegate access
NC General Statute 90-113.74 (c) 1 authorizes licensed
medical professionals to designate a delegate who may
retrieve NC CSRS data for review by the prescriber.
Some basics:
• The delegate can be any licensed or non-licensed
person who is supervised by the prescriber.
• The prescriber is responsible for all delegate ac-tivity
• Delegates may not use the prescriber’s login in-formation
to access CSRS; They must have their
own accounts.
North Carolina Medical Board
Quarterly Board Actions Report | August 2016 - October 2016
The Board actions listed below are published in an abbreviated format. The report does not include non-prejudicial
actions such as reentry agreements and non-disciplinary consent orders. A complete listing of recent Board actions is
available at www.ncmedboard.org/BoardActions.
BOARD ACTIONS
Name/license #/location Date of action Cause of action Board action
ANNULMENTS
NONE
SUMMARY SUSPENSIONS
HAMEL, John David, MD
(009300141) Nebo, NC
10/10/2016 MD violated his August 2014 consent order by
performing certain surgical procedures pro-hibited
by the order; MD performed cosmetic
surgery in a manner that does not meet current
accepted standards and that resulted in patient
harm and subjected patients to unnecessary
risk; MD falsified medical records to conceal
that he was performing procedures prohibited
by his consent order; and finally, MD has a his-tory
of alcohol abuse and was recently arrested
for DWI.
Summary suspension of NC
medical license.
REVOCATIONS
WILSON, Wayne Vincent, MD
(000033444) Hickory, NC
09/13/2016 MD was convicted of two counts of felony health
care fraud in United States of America vs. Wayne
Vincent Wilson, M.D., case number 5-15cr57.
Entry of Revocation
SUSPENSIONS
CLARKE, Michael Thomas, MD
(200700737) Dewitt, NY
08/04/2016 Action based on another jurisdiction’s disci-plinary
action; While practicing in New York,
MD made comments of a sexual nature to op-erating
room staff and hospital staff; MD is also
alleged to have physically struck patients on the
hip area prior to operating, for the purposing of
determining that they were fully under anesthe-sia,
in a manner not consistent with standards
of care.
MD’s license is suspended for
three years, immediately stayed;
$3,000 fine. MD must comply
with the terms of his New York
order. MD is placed on proba-tion,
to run concurrent with the
terms of his New York order.
HERNANDEZ, Mario Augusto, MD
(201000567) Charlotte, NC
09/02/2016 Allegations of professional sexual misconduct;
MD was arrested and charged in December 2015
with three counts of 2nd degree sexual offense.
Indefinite suspension of NC
medical license
KPEGLO, Maurice Kobla, MD
(000029314) Greensboro, NC
10/13/2016 Quality of care; inappropriate prescribing of
controlled substances for the treatment of pain.
In addition, MD was convicted of DWI on Feb-ruary
21, 2016. MD was previously convicted of
DWI in 1992 and has a prior diagnosis of alcohol
use disorder.
Indefinite suspension of NC
medical license
LASSITER, Paulette Denise, MD
(200001401) Derby, KS
10/19/2016 MD engaged in a romantic relationship with a
patient she treated for alcoholism, depression
and anxiety. This is a violation of professional
boundaries and of the ethics of the psychiatric
profession.
Indefinite suspension of NC
medical license
WELLS, Wendell D’Alton, MD
(000026479) Rockingham, NC
09/26/2016 MD inappropriately prescribed controlled sub-stances
to a patient with whom MD was en-gaged
in an inappropriate relationship with.
This relationship included personal texts with
the patient and touching not related to any med-ical
treatment.
Indefinite suspension of NC
medical license
PROBATION/CONDITIONS
MCQUEEN, (Jr.), Fred Douglas, MD
(000019375) Hamlet, NC
09/21/2016 History of substance use/abuse. MD must maintain NCPHP con-tract
and abide by all terms.
ZELLER, Kathleen Elizabeth, MD
(200700068) High Point, NC
09/08/2016 History of alcohol abuse; MD has completed
both inpatient and intensive outpatient treat-ment
and is under a monitoring contract with
NCPHP.
MD must maintain contract
with NCPHP and abide by all
terms.
FORUM | Issue 4 | 2017 	 13
BOARD ACTIONS
Name/license #/location Date of action Cause of action Board action
REPRIMANDS
FUENTES, Edwin Laserna, DO
(009701749) Danville, VA
10/02/2016 Action taken by another state medical board;
An audit of DO’s billing practices conducted by
the Virginia board found that 68 percent of DO’s
billing was inappropriate or excessive.
Reprimand
HUSSEIN, Diaa Eldin, MD
(200000467) Morganton, NC
08/16/2016 A patient complained to the Board that MD
touched her inappropriately during an exam-ination,
made inappropriate comments regard-ing
her appearance and offered her his person-al
cell phone number. MD states that it is his
normal practice to provide patients with his
personal cell phone number. MD denies that he
touched the patient inappropriately and states
that he did not make inappropriate comments.
MD acknowledges that he may have done or
said things during the course of the examination
that the patient perceived to be inappropriate.
Reprimand; MD must use a fe-male
chaperone who has read
this Board order, be present any
time MD is in an examination
room with a female patient.
MILLER, Bruce Loring, PA
(001004644)
09/08/2016 PA prescribed a variety of medications, includ-ing
controlled substances, to his fiancee, using
prescription blanks from a former employer’s
practice in NY but written on the authority of
his NC license.
Reprimand
STONECIPHER, Karl Gene, MD
(000034914) Greensboro, NC
09/19/2016 MD prescribed controlled and non-controlled
drugs to family members and to a co-worker
without performing or documenting an appro-priate
medical examination. Administrative
rules specifically prohibit the prescribing of con-trolled
substances to family members.
Reprimand
DENIALS OF LICENSE/APPROVAL
NONE
SURRENDERS
BECERRA, Gonzalo Daniel, MD
(201101599) Goldsboro, NC
08/02/2016 Voluntary Surrender of License
MITCHELL, James Alistair, MD
(200400921) Stillwater, OK
09/08/2016 Voluntary Surrender of License
PUBLIC LETTERS OF CONCERN
BULLARD, Dennis Eugene, MD
(000026088) Raleigh, NC
10/17/2016 The Board is concerned that MD’s care of a pa-tient
who underwent decompression surgery
with placement of an interbody cage for treat-ment
of symptomatic spondylolisthesis may
have been below accepted standards.
Public letter of concern
CRAWFORD, (Jr), Clifford Addison, MD
(201001488) Duluth, GA
08/10/2016 Action taken by Georgia medical board; The
Board is concerned that MD’s license was sus-pended
by the Georgia board for defaulting on
his federal student loans; MD’s Georgia license
was reinstated after MD showed evidence that
he had entered into a repayment plan.
Public letter of concern
COOK, John Edmund, MD
(000026647) Dakota Dunes, SD
10/21/2016 MD entered into a public agreement with anoth-er
state medical regulatory board; While prac-ticing
in Nebraska, MD allowed medical radiog-raphers
to administer Propofol intravenously
for sedation purposes. MD agreed not to do this.
Public letter of concern
HAGA, Edward Wayne, MD
(201602223) Jacksonville, NC
10/11/2016 The Virginia medical board took action against
MD due to the fact that MD engaged in a sexual
relationship with a patient in 2004.
MD is issued a NC medical li-cense,
with a Public Letter of
Concern.
HEIMBINDER, David Allan, MD
(201601792) Shelton, CT
08/01/2016 Action taken by Connecticut medical board,
based on wrong-side application of nerve block
anesthetic.
Public letter of concern
LYNCH, Christopher Robert, MD
(201601803) Tulsa, OK
08/03/2016 The Board is concerned about MD’s history of
substance use, which it learned of due to a board
order issued by the Oklahoma medical board.
MD has entered a monitoring contract with
NCPHP and is obliged to abide by all terms.
Public Letter of Concern
MANDHARE, Vijaysinha Ashok, MD
(200800275) Raleigh, NC
08/15/2016 MD performed epidural injections on a fami-ly
member with chronic pain caused by severe
spinal stenosis. The fifth procedure performed
resulted in complications that necessitated a
hospitalization for the family member.
Public letter of concern; MD is
urged to read the Board’s po-sition
statement on Self Treat-ment
and Treatment of Family
Members.
BOARD ACTIONS
Name/license #/location Date of action Cause of action Board action
MCNEEL, Don Frederick, MD
(009800634) Greenville, SC
08/19/2016 The Board is concerned that MD prescribed an-tibiotics
to a five year old child who developed
ear pain following seven days of head conges-tion
after a telephone consultation. An expert
reviewer opined that it is not consistent with
standards of care to prescribe antibiotics to ev-ery
patient with ear pain and cold symptoms.
Public letter of concern
MORSE, Eric Dalton, MD
(009901445) Raleigh, NC
09/22/2016 MD prescribed Suboxone to a patient after the
patient moved out of state, with only sporadic
face-to-face interaction with the patient. The
Board is concerned that this is not consistent
with current standards of care.
Public Letter of Concern; Within
30 days of the date of this letter,
MD must arrange to attend 10
hours of CME in Suboxone pre-scribing.
OGUNNIYI, Sola Egberanmwen, MD
(001003067) Knightdale, NC
08/31/2016 The Board is concerned that MD permitted his
brother, who is not a licensed health care pro-fessional,
to perform range of motion measure-ments
on a female patient that involved placing
hands on the patient. The examination was
unchaperoned. MD acknowledged to a Board
investigator that he permitted his brother to
perform these examinations on other patients
as well.
Public letter of concern
OKWARA, Benedict Onwukwe, MD
(000033878) Monroe, NC
09/07/2016 Quality of care; MD ordered a thyroid function
test for a patient and then neglected to make the
patient aware that the results were consistent
with hyperthyroidism. The patient was subse-quently
seen by another physician and diag-nosed
with a grossly enlarged thyroid.
Public Letters of Concern; MD
must complete a comprehensive
personal assessment in Internal
Medicine within six months of
the date of this order and com-plete
all recommendations for
remediations within one year of
the date of the order.
RIZVI, Syed Asif Raza, MD
(009401482) Fayetteville, NC
08/22/2016 The Board is concerned that MD prescribed
growth hormone at a level that was too high for
a pediatric patient and in a manner not consis-tent
with accepted standards of care.
Public Letter of Concern
SUHR, Christopher, MD
(000036128) Jacksonville, NC
10/28/2016 The Board is concerned about the circumstanc-es
involving an operating room fire resulting in
burn injury to the patient. In preparation for
removal of a lipoma on the patient’s posterior
neck, the surgery area and the hairline were
treated with an alcohol based antibacterial
solution. During the procedure, which was per-formed
using open oxygen under monitored an-esthesia
care, strands of patient’s hair covered
with solution residue were ignited from electro-cautery.
The cause of the fire was multifactorial;
however, the Board believes that the surgeon is
ultimately responsible for the patient’s safety
during an operation. The Board believes that
MD responded appropriately to the intraoper-ative
emergency and notes that MD sustained
second degree burns to his hands trying to ex-tinguish
the flames. The Board also acknowl-edges
that the operating team’s rapid response
minimized the harm to the patient. The Board
also acknowledges that MD has since imple-mented
appropriate risk reduction procedures
to reduce the risk of future operating room fires.
Public Letter of Concern; $1,000
administrative fine
MISCELLANEOUS ACTIONS
NONE
CONSENT ORDERS AMENDED
NONE
TEMPORARY/DATED LICENSES: ISSUED, EXTENDED, EXPIRED, OR REPLACED
NONE
BOARD ACTIONS
Annulment: Retrospective and prospective cancellation
of the practitioner’s authorization to practice.
Conditions: Actions or requirements a licensee must
complete and/or comply with as a condition of licensure.
Consent Order: An order of the Board that states the
terms of a negotiated settlement to an enforcement case;
A method for resolving a dispute without a formal hearing.
Denial: Decision denying an application for licensure, re-instatement,
or reconsideration of a Board action.
Dismissal: Board action dismissing a contested case.
Inactive Medical License: Licenses must be renewed
annually in NC. The Board may negotiate a provider’s
agreement to go inactive as part of the resolution of a dis-ciplinary
case.
Public Letter of Concern (PubLOC): A public record
expressing the Board’s concern about a practitioner’s be-havior
or performance. A public letter of concern is not
considered disciplinary in nature; similar to a warning.
Glossary of Terms Revocation: Cancellation of authorization to practice.
Authorization may not be reissued for at least two years.
Stay: Full or partial stopping or halting of a legal action,
such as suspension, on certain stipulated grounds.
Summary Suspension: Immediate cancellation of
authorization to practice; Ordered when the Board finds
the public health, safety, or welfare requires emergency
action.
Suspension: Withdrawal of authorization to practice, ei-ther
indefinitely or for a stipulated period of time.
Temporary/Dated License: A License to practice for a
specific period of time. Often accompanied by conditions
contained in a Consent Order.
Voluntary Surrender: The practitioner’s relinquishing
of authorization to practice pending or during an investi-gation.
Surrender does not preclude the Board bringing
charges against the practitioner.
Limitation: A restriction placed on a licensee’s practice.
When practicing under a restriction, it is not lawful for the
licensee to engage in the prohibited activity. Example: Dr.
Smith is restricted from prescribing Schedule II and III
medications.
2016 PA compliance checks
FORUM | Issue 4 | 2017 	 15
Three-quarters of all physician assistants (PAs) reviewed during the Board’s 2016 PA compliance checks
were in full compliance with all applicable laws and rules.
The remaining 25 percent of PAs reviewed were found to be noncompliant with rules related to prescribing
medications and with requirements for both frequency and documentation of quality improvement meet-ings.
In all cases, the PAs corrected the deficiencies noted. The Board issued private letters of concerns to
both the PA and his or her primary supervising physician in 75 percent of cases where deficiencies were
documented.
The Board conducts random site visits at PA practice sites each year to encourage compliance with NC law
and administrative rules that govern PA practice in the state. The Board has selected PAs for site visits to
be conducted in 2017. PAs will be contacted by a Board field investigator, who will
schedule the site visit. During the visit, PAs will be asked to produce certain
documents that are required
to be kept on file at each of the PA’s practice locations.
Are you in compliance?
A complete description of the information PAs should expect to provide during
a compliance review is available on the PA Site Visit Checklist. This document, as
well as PA rules, FAQs and other information, are available on the Board’s website
at www.ncmedboard.org/PAResources
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BOARD MEETING DATES
March 15-17, 2017 (Full Board)
April 27-28, 2017 (Hearing)
May 17-19, 2017 (Full Board)
June 15-16,2017 (Hearing)
July 19-21, 2017 (Full Board)
Meeting agendas, minutes and
a full list of meeting dates can be
found on the Board’s website:
www.ncmedboard.org
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