In recent months, I’ve sent emails
to all North Carolina Medical Board
(NCMB or the Board) licensees to
make them aware of the Board’s
recent effort to increase oversight of
opioid prescribing, the Safe Opioid
Prescribing Initiative (SOPI). Many
physicians and physician assistants
(PAs) are concerned about the
prospect of being investigated in
relation to the initiative. It is my
expectation that SOPI will impact
a small fraction of NCMB’s 45,000
licensees (to date, approximately
70 cases have been opened through
the new initiative). Nonetheless,
some prescribers have contacted the
Board with questions and concerns,
indicating they are unsure what
NCMB expects of licensees who treat
pain.
Coming to terms
with opioid
prescribing:
Safe treatment
is the goal
Pascal O. Udekwu, MD
SPOTLIGHT
MD: 34,248
NCMB’s eforts to expand
outreach are bearing fruit. As of
the first half of 2016, the Board
had increased the number of
presentations given by 75 percent
compared to the same period in
2015.
Trending topic: Urine drug
screening ................................... 3
Coming soon: Mandatory
NCCSRS registration .................. 5
Seeking help for depression,
without fear ............................... 6
New position statement:
Corporate ownership ............... 7
Easing challenges associated
with reentry ................................ 8
FROM THE PRESIDENT
FORUM North Carolina Medical Board
ISSUE NO. 2 | SUMMER 2016
NCMB approaches matters related
to quality of care with the conviction
that, given good information about
standards and expectations, the
vast majority of licensees will act
appropriately. Opioid prescribing is
no exception. NCMB has no desire
to see chronic and acute pain go
untreated or undertreated for fear of
regulatory intervention. The Board
wants pain to be efectively treated,
including treatment with opioids,
in a responsible manner. That is
NCMB’s ultimate goal.
Prescribers in this state are granted
the discretion, by the Board
and through NC law, to exercise
appropriate professional judgment
in managing patient care, including
opioid prescribing. Some states
have taken a more heavy-handed
approach, enacting laws to limit
the number of days of opioid
medications patients can receive, or
establishing legal limits on opioid
dosages. New York is the most
recent to pass an opioids law, and
several other states in the Northeast
have enacted similar ones.
Put simply, the Board expects its
licensees to practice in accordance
Continued on pg 2
IN THIS ISSUE
2016 2015
12
21
0 5 10 15 20
NCMB outreach (Jan - June)
with generally accepted standards of medical practice
in NC whenever they prescribe opioids. NCMB does
not tell its licensees in advance whether to prescribe
opioids, or specify what dosage or amount of opioids
should be prescribed. NCMB encourages safe
and appropriate practice by directing licensees to
resources that can be used to guide opioid prescribing
decisions. These resources include policies developed
by the Board, as well as information and instructional
modules developed by government and/or
independent clinical and educational organizations.
I am in the process of completing the Safe and
Competent Opioid Prescribing Education (SCOPE
of Care) modules created by Boston University and
have found them to be excellent. This free course and
other resources are available at www.ncmedboard.
org/safeopioids
There’s no doubt opioid prescribing is currently
subject to an unprecedented level of scrutiny. I
expect that will continue, as will the Board’s eforts to
proactively address this issue. The best advice I can
give licensees is to keep the focus on providing safe
and appropriate care. This will serve you, and your
patients, well.
Board Officers
President
Pascal O. Udekwu, MD | Raleigh
President Elect
Eleanor E. Greene, MD | High Point
Secretary/Treasurer
Timothy E. Lietz, MD | Charlotte
Immediate Past President
Cheryl Walker-McGill, MD | Charlotte
Board Members
Michael J. Arnold, MBA | Wake Forest
Debra A. Bolick, MD | Hickory
Reamer L. Bushardt, PharmD, PA-C |Winston-Salem
A. Wayne Holloman | Greenville
Venkata Jonnalagadda, MD | Greenville
Bryant A. Murphy, MD | Chapel Hill
Jerri L. Patterson, NP | West Elm
Barbara E. Walker, DO | Kure Beach
Ralph A. Walker, LLB | Greensboro
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
Designer
Sydney Little
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. 2
Pascal O. Udekwu, MD
NCMB President
Sincerely,
The Board approved its leadership team for the 2016-2017 operating year during the July Board Meeting.
In accordance with NCMB’s Bylaws, the current
President-elect of the Board, Eleanor E. Greene,
MD, will automatically become Board President
efective Nov. 1. The Board voted to approve the
following slate of other oficers. Along with the
Board President and Immediate Past President,
these individuals make up the Executive Committee
of the Board.
President-elect: Timothy E. Lietz, MD
Secretary-treasurer: Barbara E. Walker, DO
At-large member: Michael J. Arnold, MBA
Board confirms officer slate for 2016-2017
2016 North Carolina Medical Board
FORUM | Issue 2 2016 	 3
Current standards of care relat-ed
to opioid prescribing encour-age
physicians and physician
assistants to take appropriate
steps to monitor their patients.
Urine drug screening (UDS) is
a popular monitoring method.
Other methods include regular
use of the state’s prescription
database to check patient pre-scription
histories, or requiring
regular pill counts.
The Board has recently noticed
an increase in patient calls in
regards to UDS in particular.
Concerns raised by patients in-clude
overuse of UDS, poor or
nonexistent insurance cover-age,
alleged incorrect interpre-tation
of test results, and poor
communication of practice pol-icies
related to UDS.
UDS can be a useful tool when
administered and interpreted
correctly. Licensees are encour-aged
to fully inform themselves
about this monitoring method
to ensure its benefit. Presented
at right are a few examples of
calls related to UDS that have
been handled by Board staf in
recent months.
Possible overuse of UDS
Scenario: A patient contacts the Board, stating that the medical practice
providing pain management care requires routine monthly UDS of all opioid
patients. The patient indicates that medical insurance has deemed monthly
UDS medically unnecessary and declines to cover it. The practice has advised
that future UDS must be paid for out-of-pocket. The patient is reluctant,
stating that all UDS tests have come back within accepted ranges.
Discussion: The Board does not have a policy that provides specific
guidance on the administration of UDS. Providers are expected to use
their professional judgment to determine the appropriate frequency of
UDS, if they choose to use it. NCMB encourages licensees to educate
themselves about current accepted practices. UDS and other monitor-ing
methods are covered in detail in many opioid CME courses. Check
www.ncmedboard.org/safeopioids for a selection of free or very low
cost CME opportunities.
Possible misinterpretation of UDS results
Scenario: A patient is prescribed and uses Fioricet with Codeine to manage
migraines. At the request of the prescribing physician, the patient completes
a UDS. The results come back positive for morphine. The patient states that,
upon receipt of the UDS results, the practice sent a dismissal letter, citing
alleged morphine use. The patient is adamant the only medication used prior
to the UDS was Fioricet with Codeine. The patient finds information that
indicates morphine is a normal codeine metabolite. The patient wants the
practice to reconsider its decision to dismiss.
Discussion: This example highlights the importance of thoroughly
educating oneself about appropriate use and interpretation of UDS
results, and related pharmacology. False-positive or misinterpreted
UDS results may occur with ofice-based UDS and many commonly
prescribed medications. In the instance described above, the patient
was advised to write a letter to the prescribing physician explaining the
circumstances that resulted in the positive UDS results.
No or poor communication to patients regarding UDS
Scenario: A patient contacts the Board after learning that UDS will be
required before monthly refills of opioid prescriptions will be issued. The
caller states patients were previously directed to request refills approximately
three days before needed. The patient is disabled and opioid dependent and
relies on a spouse for transportation to medical appointments. The patient
is concerned it will not be possible to complete UDS before a refill is needed
and indicates interest in filing a complaint.
Discussion: The Board does not have an established policy on how
and when patients should be notified of changes in practice policy. This
example is ofered as an instance of how a communication issue can
spiral into serious patient dissatisfaction. In this instance, the patient
was advised that filing a complaint could result in the patient’s dismiss-al.
The patient was advised to contact the practice to request a partial
refill to allow additional time for the patient to comply with the UDS
policy.
Urine Drug Screening
TRENDING AT NCMB
Avoiding problems and miscommunications
with UDS: Three scenerios
Expanded access to overdose “rescue” drug
BOARD NEWS Physician fee increases
The bill raises the physician license application and
physician annual renewals fees in NC for the first
time since 2005. Effective Oct. 1, the physician
license application will be $400 (currently $350)
and the physician annual renewal fee will be $250
(currently $175). The Board expects the fee increase
to raise annual operating revenues by approximately
$3.7 million.
Expanded protections for NCPHP
participants
HB728 also modernizes and updates statutory
language regarding the NC Physicians Health
Program (NCPHP). New language requires that
NCPHP participants have the opportunity to request
written copies of any assessment or treatment
recommendations, including information about the
basis for recommendations. NCPHP currently has a
procedure in place to fulfill this requirement.
Requirement to report medical records
suspensions lifted
The bill repeals the requirement for hospitals to
report suspensions due to delinquent medical
records to NCMB. The Board found that these
reports did not provide meaningful information.
NCMB believes these issues are best handled at the
facility/health system level.
Email communication with licensees
HB728 includes language to authorize the Board
to use or make email addresses available for the
purpose of disseminating or soliciting information
“affecting public health or the practice of medicine.”
This provision will allow NCMB to communicate
more freely with its licensees via email. For example,
NCMB may elect to email occasional policy updates
and other news to licensees. The Board will not send
frivolous or excessive email communications.
2016 Legislative update
A new state law signed in June by Gov. Pat McCrory
authorizes NC’s State Health Director to issue a
statewide standing order for the opioid overdose-reversal
medication naloxone,
clearing the way for pharmacies
in the state to provide the drug
without a prescription.
The law allows pharmacies
to provide naloxone to opioid
users and/or family
members of opioid
users. Previously,
the medication could be dispensed only with a
prescription or with a standing order issued by a
physician. Session Law 2016-17 took efect June 20.
North Carolina is the third state in the country to
issue a statewide standing prescription order for
naloxone.
Naloxone prevents opioid overdose by blocking the
brain’s opioid receptors. This averts respiratory
depression, which is the typical cause of death in
cases of opioid overdose. Naloxone is harmless to
people who are not experiencing opioid overdose.
Legislation passed in the final days of the recently
adjourned session of the NC General Assembly –
HB728 – made several changes that afect NCMB,
its licensees and the practice of medicine.
The North Carolina Legislative
Building in downtown Raleigh
BOARD NEWS
FORUM | Issue 2 2016 	 5
The state appropriations bill
includes a provision to require
mandatory registration with
the NC Controlled Substances
Reporting System (NCCSRS) of
all licensed medical professionals
who are authorized to prescribe
controlled substances. Licensees
would be required to register for
access to the NCCSRS within 30
days of issuance or annual renewal
of their NC professional license.
The requirement will not be in
efect until NCCSRS completes
certain technical upgrades and
the system is fully operational
within the NC Department of
Health and Human Services and
Coming soon: Mandatory registration with state
controlled substances database
• Visit www.ncmedboard.org
• Select Update licensee informa-tion
page (under Resources, bot-tom
left of home page)
• Log in and select Training & CSRS
Q: How do you use the
NCCSRS to monitor your
patients?
A: I query the database when
considering any controlled
substances for patients with
risk factors for misuse of
these agents. Evidence-based
medicine shows that age less than 40, psychiatric and
substance abuse history and benzodiazepine use are
particularly high risk factors. ED recidivism, unusual
“allergy” lists and tobacco smoking are other risk factors.
Cigarette smoking is commonly overlooked yet increases
opioid misuse risk threefold. On average, I query the
system 2-4 times per shift.
Q: When you do an NCCSRS query, what
information are you looking for in particular
and how do you use it?
A: I first make certain that I pull the proper NCCSRS
profile for each patient, though NCCSRS is incredibly
One physician’s experience using NCCSRS
Dr. Patrick Burnside practices emergency medicine in Charlotte, NC. He shared his thoughts
on using the state’s prescription drug database in daily practice. Dr. Burnside has been us-ing
the system since 2009. Reach Dr. Burnside at burnside.patrick@gmail.com
accurate. Then I use the system to 1. Help me counsel
patients with concerning prescription profiles and 2.
Potentially tailor my therapy to the safest analgesic
practices for this subgroup. I look for patterns of poly-provider
and poly-hospital utilization, as well as specific
prescriptions with negligible clinical value/abuse
potential ratios (carisoprodol is a great example). A very
common yet dangerous prescribing pattern to identify is
benzodiazepine-opioid overlap.
Q: Many prescribers complain that NCCSRS is
too cumbersome and time-consuming for busy
clinicians to use. Do you agree? How have you
overcome this in your practice?
A: These are unfounded concerns, given current
technology. Clinicians in current practice have heavy
data entry and computer interface burdens, but voice
recognition software drastically shortens access time. It
takes about five minutes to create a voice command and it
takes 20-30 seconds to load NCCSRS at the beginning of
a shift. Pulling a profile then takes 20-25 seconds.
connected to the statewide health
information exchange.
However, there’s no need to wait
to register. NCMB encourages all
controlled substances prescribers
to register for access to NCCSRS
and regularly use the system to
monitor patients’ prescription
histories. The database is a valu-able
tool that can help prescribers
avoid inappropriately prescrib-ing
to a patient who is abusing
or diverting medications. Yet,
according to the system’s admin-istrators,
well under half of NC
prescribers who hold valid DEA
registrations are currently regis-tered
for access. To make signing
up for access easier, NCMB built
an online NCCSRS registration
form that allows licensees to reg-ister
through their licensee infor-mation
page, or during annual
license renewal.
Patrick Burnside, MD
NCCSRS REGISTRATION
Every year when physicians and physician assistants
complete their annual license renewals with the
Board, they are confronted with a question, which
asks, “Since you last renewed have you become
aware of any medical condition that impairs or
limits, or could possibly impair or limit, your ability
to practice medicine safely? Medical condition
includes…psychiatric or psychologic conditions or
disorders…”
If you are depressed or contemplating seeking help
how should you answer this question? If you are see-ing
a physician or psychiatrist and stable on med-ication
what should your answer be? And, just as
important, what will the Medical Board do with the
information you provide?
This article is intended to encourage physicians
and other NCMB licensees to seek help free of the
unwarranted concern that doing so will automatically
lead to Board intervention, discipline, or licensure
limitation.
It is recognized that individuals who consider
suicide may lose the ability to think clearly or to
develop a plan to cope with the situation. These
individuals often end up believing self-destruction
is the only solution. Most psychiatrists concede that
often nobody really knows why someone commits
Seeking help for depression, without fear
Scott Kirby, MD, Chief Medical Officer
ARTICLE SUMMARY
• Licensees should not forgo treatment for depression for
fear of medical board interference
• Licensees who are stable under treatment typically do not
need to reveal their diagnosis to the Board at renewal
• Licensees who are stable under treatment for depression
may skip the NCMB renewal question on medical condi-tions
Licensees who are in stable treatment for de-pression
can remain anonymous to the Board.
suicide, and survivors are left with many unanswered
questions and inadequate answers. Despite this,
something can be done to help.
There are resources available to physicians and
other medical professionals who are struggling with
depression. The North Carolina Physicians Health
Program (NCPHP) can provide non-disciplinary and
confidential assistance that ensures the physician’s
identity is protected, provided patient care has
not been negatively impacted by the physician’s
behavior. The NCMB renewal question specifically
states, “If you are an anonymous participant in the
NC Physicians Health Program and in compliance
with your contract, you do not need to list any
medical conditions related to that contract.” In other
words, a licensee who reaches out to NCPHP for help
with depression or other psychological problems is
generally not required to disclose his or her mental
health issues to the Board. Physicians are allowed to
remain anonymous so long as NCPHP can establish
they are safe to practice, are not an imminent danger
to the public, or have not committed sexual boundary
violations. Self-referrals to NCPHP are encouraged,
especially when it results in licensees seeking help
earlier in their illnesses. If you are burned out,
depressed, under severe stress, or considering
suicide, the Board’s primary concern is that you get
the help you need.
Licensees who seek treatment independent of
NCPHP may also remain confidential to the Board.
A physician or PA who is currently under the care
of a physician for a stable psychiatric condition that
does not impair or limit his or her ability to practice
medicine is not required to report that condition or
treatment during renewal.
Even if depression or other psychological issues have
already negatively impacted your practice or patient
care, there are resources available to help you heal
and rebuild. NCPHP boasts many, many stories of
successful participants who return to productive
personal and professional lives after receiving the
help they need. Where appropriate and necessary,
NCPHP is willing to advocate on behalf of successful
participants to help them obtain licensure or rein-statement
with the Board.
If a licensee reports a condition at license renewal,
the Board will review the answer with the intent
to determine if there is a clear connection between
the reported condition and the licensee’s ability
to practice safely and competently. On occasion
the Board may request additional information or
clarification, such as a fitness to practice letter from
a treating physician. The Board expects licensees
who report conditions to act in a professional and
ethical manner and appropriately self-limit practice
as needed.
The important point is to avoid the impulse to let a
serious problem go untreated due to unwarranted
concerns about Medical Board interference. Obtain-ing
timely assistance may, in
fact, be essential to preserv-ing
both your life and liveli-hood.
North Carolina Physicians
Health Program (NCPHP)
For more information about
NCPHP and the services it
provides visit:
www.ncphp.org/
FORUM | Issue 2 2016 	 7
NCMB regularly investigates and
takes action in cases that involve
aiding the unlicensed practice of
medicine in NC due to unlawful
practice ownership arrangements.
The Board adopted a position
statement, Corporate practice of
medicine, in March 2016 to clarify
its expectations.
As a general rule, the North Carolina
Professional Corporations Act
(N.C. Gen. Stat. ¶55B, et. seq.)
requires corporations that provide
certain professional service to be
owned entirely by licensees of that
profession. Applying this general
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).
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. A
physician or PA who practices in
an arrangement not in compliance
with the Professional Corporation
Act may be found to have aided the
unlicensed practice of medicine.
Also, licensees may be held
accountable for following clinical
protocols established by corporate
owners if such protocols result in
substandard patient care.
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 non-physician.
In this arrangement, a
physician is made the shareholder
of the corporation on paper to
New position statement addresses practice ownership
DEPRESSION
disguise the fact that real control
and decision-making authority in
the practice resides with a non-physician.
In many instances,
the physician straw owner signs
a management agreement with a
non-physician whereby the bulk
of the practice’s revenue goes
to the non-physician. In these
situations, the physician straw
owner can still face disciplinary
action by NCMB for aiding and
abetting the unlicensed practice
of medicine, as well as unethical
fee-splitting.
NCMB recognizes medical prac-tices
owned by hospitals, or health
maintenance organizations as ex-ceptions.
State law authorizes
these licensed and regulated enti-ties
to provide direct patient care.
The full Corporate practice of
medicine position statement can
be found online at:
www.ncmedboard.org
Physician reentry into the work-force
is a topic that has received
greater attention in recent years,
gaining recognition as an im-portant
workforce issue in 2002.
Mark et al. defined reentry as
“returning, after an extended ab-sence,
to the professional activi-ty/
clinical practice for which one
has been trained, certified or li-censed.”
The past decade has seen a
significant rise in the number of
clinicians, both male and female,
who have chosen to leave active
practice for periods of time that
often exceed two years. Reasons
vary from starting a family, caring
for elderly parents, burnout or
personal health and wellness
needs.
Easing challenges associated with reentering the
practice of medicine
ARTICLE SUMMARY
• Clinicians who seek relicensure af-ter
an extended break are often
unaware of obstacles to reentry
• Careful planning before inactivat-ing
the professional license can
help ease reentry
• NC reentry applicants are responsi-ble
for demonstrating competence
to practice
Eleanor E. Greene, MD, MPH, and Karen Burke Haynes, MD
Clinicians who choose to cease
active clinical practice are often
unaware of the potential hurdles
they may encounter when reentry
into practice is attempted.
In North Carolina, physicians and
physician assistants (PAs) who
allow their professional licenses
to lapse for a length of time greater
than two years may face barriers
to successful reinstatement. For
some, the acquisition of hospital
privileges and professional
liability insurance coverage may
not be assured without additional
training or some other reentry
activity. A review of the literature
regarding the subject reveals
a wide variation in the criteria
used by state licensing boards
regarding the length of time a
medical professional is allowed to
be inactive before reentry/fit for
duty requirements apply.
Clinicians who are unaware of
reentry policies are often blind-sided
by the significant require-ments
that typically must be met
to obtain reinstatement of an in-active
NC license or issuance of a
new NC license and reestablish
practice. Additionally, research
in the area of performance after
an absence from active patient
care has established a decline in
clinical skills that may impact
patient outcomes. These facts
suggest that maintaining fitness
for duty during absence from ac-tive
practice would be beneficial.
This requires preparation and
commitment to staying abreast
of educational needs, changes in
clinical practice and administra-tive
requirements related to the
reentry in one’s state of residence
intended practice.
For approximately the past de-cade,
NCMB’s practice was to
work with individuals on a case-by-
case basis to determine spe-cific
needs to be addressed upon
reentering practice. This process
typically resulted in a reentry
program that involved the licens-ee
securing a professional mentor
and completing a phased reen-try
process that culminated with
the reentry candidate practicing
independently. In recent years,
however, it became obvious to
the Board that reentry candidates
needed more attention and ex-pertise
than NCMB can provide.
Administrative rule 21 NCAC 32B
.1370 states the Board’s current
reentry requirement and process.
Although NCMB no longer takes
PRACTICE REENTRY
Clinicians may face challenges when returning
to practice after an extended break.
FORUM | Issue 2 2016 	 9
PRACTICE REENTRY
an active role in developing or
directly supervising reentry pro-grams,
the Board has an interest
in informing both inactive clini-cians
who are pondering reentry
to active practice and licensees
who may be considering a break
about current expectations.
The American Academy of
Pediatrics (AAP) and associated
organizations have led the
charge in better understanding
the demographics of clinicians
who choose to take time of from
active practice and the obstacles
to reentry they encounter. These
organizations have also led the
way in developing strategies for
making the reentry process more
attainable, and less stressful.
The authors recommend the Phy-sician
Reentry into the Work-force
website sponsored by the
AAP as an excellent resource.
Practitioners can use this site
to research the topic of reen-try,
educate themselves about
developments and access tools
for planning. Perhaps the most
promising resource is the reentry
portal developed for physicians.
Topics covered include strategies
for exiting practice, activities to
pursue while out of practice, and
information regarding the safe
practice of medicine. While the
needs of all subspecialties are not
addressed with this tool, it is a
valuable starting point.
NCMB recognizes that the cur-rent
medical practice environ-ment
places great demands on
clinicians, many of whom may
value a season away from clini-cal
care. If this is something you
are considering, understand that
planning and preparation will
ease the pathway to reentry when
you are ready to resume practice.
For current reentry rules and re-entry
resources see the box to the
right.
CURRENT REENTRY RULES
NCMB adopted administrative rule 21 NCAC 32B .1370 in March 2016.
The rule sets out the Board’s expectations for clinicians seeking reentry
to active clinical practice. The Board requires applicants who have not
held an active license for two or more years to comply with the rule.
Factors that may affect the length and scope of the reentry plan in-clude:
1. The applicant’s amount of time out of practice;
2. The applicant’s prior intensity of practice;
3. The reason for the interruption in practice;
4. The applicant’s activities during the interruption in practice,
including the amount of practice-relevant continuing medi-cal
education;
5. The applicant’s previous and intended area(s) of practice;
6. The skills required of the intended area(s) of practice;
7. The amount of change in the intended area(s) of practice
during the time the applicant has been out of continuous
practice;
8. The applicant’s number of years of graduate medical edu-cation;
9. The number of years since the applicant completed gradu-ate
medical education; and
10. As applicable, the date of the most recent ABMS, AOA or
National Commission on Certification of Physician Assistant
certification or recertification.
Source: 21 NCAC 32B .1370
REENTRY RESOURCES ONLINE
Access information about reentry on NCMB’s website at:
www.ncmedboard.org/licensure/reentry
Q: What advice would you give to someone
entering the medical profession?
A: I like the comment by Dr. Andrew Taylor Still, the found-er
of osteopathy, who said, “To find health should be the ob-ject
of the doctor. Anyone can find disease.” Focus on the
healthy patient with the illness and guide them back to their
health. It’s an amazing journey.
Q: What are the biggest
challenges facing medicine or
medical regulation?
A: Physicians have lost much of
the control over how we prac-tice.
There are constant changes
in medical regulation, along with
constant changes in therapeu-tics.
Focusing on the patient and
on preventive health as we move
forward must be a priority. We
also need to reeducate pa-tients
that it is not the
goal of medicine to
make life pain-free.
Daily life and activi-ties
will cause some
pain, especially as
we become more
“age-gifted”. The
goal is not to
eliminate the pains
of life, but to guide
patients to adap-tations
for func-tional
living.
Q: Why did you want to serve on the Medical Board?
A: My years of family medicine experience in both military
and civilian practice environments, as well as in academic
medicine, prepared me well for serving on the Board. I also
believe it is important to have osteopathic representation on
the Board. This is especially important with the presence of
an osteopathic medical school at Campbell University and
the growing osteopathic physician base in North Carolina.
Q: What do you find most rewarding about
practicing medicine?
A: As an osteopathic family physician, I have been honored
to have patients share their pain and concerns as well as
to be included in their joys and celebrations. From singing
“Happy Birthday” at the delivery of an infant, to watching
that child grow, to caring for their parents and grandpar-ents,
it is an amazing privilege to share so many moments
with patients.
Q: What is the best lesson you have learned from
your personal or professional life experiences?
A: It is important to focus on the positive aspects of life. I
love the Cherokee story of the old grandfather Indian Chief
who tells his grandson, “A fight is going on inside of me.
It is between two wolves. One is anger, envy, sorrow, re-gret,
greed, arrogance, self-pity, guilt, resentment, inferior-ity,
lies, self-pride, superiority, and ego. The other is good
- he is joy, peace, love, hope, serenity, humility, kindness,
benevolence, empathy, generosity, truth, compassion, and
faith. The same fight is going on inside you, and inside every
other person, too.” The grandson thinks about it for a min-ute
and then asks his grandfather, “Which one will win?”
The old Cherokee replies, “The one you feed!” It reminds
me to continue to feed the good in my life.
Five Questions: Barbara Walker, DO
GETTING TO KNOW THE PEOPLE OF THE NC MEDICAL BOARD
FAMILY PRACTICE & OMT | SOUTHEAST AREA HEALTH EDUCATION CENTER(SEAHEC) | APPOINTED 2013 | BOARD MEMBER
BULLETIN BOARD
NCMB will host a roundtable dis-cussion
in November to explore
challenges specific to physicians
who work in salaried positions,
as opposed to independent solo
or group practice.
As more physicians have moved
to employment arrangements,
NCMB has noticed that policies
Board to explore issues facing employed physicians
and protocols put in place by em-ployers
sometimes make it chal-lenging
for the employed licensee
to comply with individual pro-fessional
obligations to patients.
For example, when a physician
retires or departs a practice, the
Board’s expectation is that the
physician will be permitted to
provide appropriate notice to pa-tients,
ensure continuity of care,
and allow patient selection.
The roundtable is tentatively
scheduled for the afternoon of
Tuesday Nov. 15. Do you have
suggestions for issues related to
employed physicians that should
be discussed at this event? Send
them to forum@ncmedboard.org
Name/license #/location Date of action Cause of action Board action
ANNULMENTS
NONE
SUMMARY SUSPENSIONS
LIETZKE, Christiana Marie, MD
(201400017) Rutledge, TN
03/18/2016 MD sufers from a medical condition that,
left untreated, makes her unfit to prac-tice
medicine. Medical professionals have
opined that MD is not currently fit to prac-tice.
Summary Suspension of License
REVOCATIONS
NONE
SUSPENSIONS
CHAPMAN, (III), William H. Harrison, MD
(009401392) Greenville, NC
03/18/2016 MD inappropriately prescribed controlled
substances to a family member and to his
girlfriend. MD asked multiple individuals
he worked with and supervised to pre-scribe
controlled substances and non-con-trolled
substances to his girlfriend, a fam-ily
member and to himself, knowing that
the prescribing would occur outside of an
established and appropriately document-ed
physician-patient relationship.
MD’s license is suspended from October
12, 2015, to April 17, 2016. MD has entered
into a contract with NCPHP to help him
better understand appropriate boundaries
to avoid inappropriate prescribing in fu-ture.
LIETZKE, Christiana Marie, MD
(201400017) Rutledge, TN
04/28/2016 MD is unfit to practice medicine due to
symptoms consistent with bipolar disor-der,
manic phase, which MD declines to
control with medication.
Indefinite suspension
MARCHETTI, Louis Joseph, MD
(000017224) Vass, NC
04/14/2016 MD wrote prescriptions in the names of
three patients who were unaware that
these prescriptions were issued, with the
understanding that the medication would,
in fact, be provided to a member of MD’s
family.
Indefinite suspension
OUDEH, Ibrahim Naim, MD
(000034428) Dunn, NC
03/17/2016 Concerns about quality of care; MD treat-ed
a family member and prescribed con-trolled
substances to a family member.
Indefinite suspension, stayed. MD must
enter into an agreement to be monitored
and mentored by an organization approved
by the Board for a period of no less than
two years. If the monitoring company
opines that MD is practicing below accept-ed
standards, the Board has the right to
summarily suspend MD’s license. MD is
restricted from prescribing controlled sub-stances
in Schedules I, II/IIN and III/IIIN.
SASS, Maria, LP
(100000203) Durham, NC
04/15/2016 In March 2016, LP consumed tramadol, a
controlled substance that was not lawful-ly
prescribed for her, in violation of her
NCPHP monitoring contract. This fol-lowed
two prior instances of violating the
NCPHP contract, after which no public
action was taken.
LP is indefinitely suspended, immediately
stayed, except for a period of 30 days.
SHANNON, (Jr.), Walter Daniel, MD
(200301170) Kinston, NC
04/29/2016 MD prescribed for and treated psychiatric
patients in NC during an extended stay in
Hawaii. In some instances, MD prescribed
controlled substances in the face of signs
that patients were abusing and/or divert-ing
the medications. MD failed to respond
in the face of aberrant urine drug screens.
MD billed for complex medical visits when
the care he provided via telemedicine did
not justify it. Documentation of medical
visits did not consistently correspond with
billing.
MD’s license is suspended for 12 months,
immediately stayed except for a period
of 30 days. MD’s active suspension is
deemed already served, as he ceased
practice for a period of at least 30 days
while under investigation by the Board.
MD shall pay a $3,000 fine and complete
the ProBe course on ethics within six
months of the date of the order. MD must
complete CME in medical recordkeeping
and comply with other conditions.
North Carolina Medical Board
Quarterly Board Actions Report | February 2016 - April 2016
This report lists public adverse actions of the Board. A complete listing of all public actions, adverse and non-adverse,
can be found on the Board’s website. Visit www.ncmedboard.org and select “Access recent Board
actions” under Topics of Interest (bottom right corner of the home page.)
BOARD ACTIONS
FORUM | Issue 2 2016 	 11
BOARD ACTIONS
Name/license #/location Date of action Cause of action Board action
SMITH, Bryan Dorsey, MD
(200201531) Durham, NC
03/03/2016 Relapse of alcohol use disorder; MD con-sumed
alcohol, amphetamines and benzo-diazepines.
Indefinite suspension
WAHBA, Wasseem John, PA
(000102441) Cary, NC
04/01/2016 PA video recorded a female patient during
a physical examination using his cell
phone camera.
Indefinite suspension
WOLICKI-SHANNON, Joanna, MD
(200001033) Kinston, NC
04/29/2016 MD prescribed for and treated psychiatric
patients in NC during an extended stay
in Hawaii. In some instances, MD pre-scribed
controlled substances in the face
of signs that patients were abusing and/or
diverting the medications. MD billed for
complex medical visits when the care she
provided via telemedicine did not justify
it. Documentation of medical visits did not
consistently correspond with billing.
MD’s license is suspended for 12 months,
immediately stayed except for a period
of 30 days to run from May 1, 2016, until
May 15, 2016. MD is given credit for a 15
day period during the investigation, during
which she did not practice. MD shall pay a
$3,000 fine and complete the ProBe course
on ethics within six months of the date of
the order. MD shall complete CME in med-ical
recordkeeping and comply with other
conditions.
PROBATION/LIMITATIONS/CONDITIONS
MELINE, Lewis John, MD
(201500165) Spokane, WA
02/26/2016 Boundary violation/professional sexual
misconduct. While practicing in Wash-ington,
MD entered into a sexual rela-tionship
with a patient who is a prostitute.
MD inappropriately prescribed controlled
substances to this patient and also pro-vided
between $50,000 and $60,000 of
financial support to the patient. This con-duct
led MD to enter into an order with
the medical board in Washington, which
placed MD’s license on probation.
MD is placed on probation; MD must com-ply
with Washington medical board order.
REPRIMANDS
GARG, Shyam Lal, MD
(000026531) Hampstead, NC
04/21/2016 Quality of care; inappropriate prescribing
of controlled substances, inadequate doc-umentation.
Reprimand; $2,000 fine; MD must com-plete
10 hours of CME in controlled sub-stances
prescribing and medical record
keeping.
JACOBS, James William, MD
(009401420) Cary, NC
03/02/2016 MD did not employ appropriate pharma-covigilance
in monitoring a patient whose
ADD was being managed with narcotics.
Prescribing of narcotics increased in the
face of possible drug diversion behavior by
the patient, who eventually died of heroin
overdose.
Reprimand; MD shall continue changes
made in practice to ensure proper phar-macovigilance
with patients who are pre-scribed
controlled substances.
KELLY, Timothy Gerald, MD
(000033074) Wilmington, NC
04/12/2016 Quality of care; MD failed to treat a pa-tient’s
intraocular pressure in a timely
manner.
Reprimand
LALLINGER, Gunther Josef, MD
(000025928) Chapel Hill, NC
03/17/2016 MD failed to timely and appropriately di-agnose
testicular torsion in a 14 year old
male, contributing to the eventual devel-opment
of necrosis and loss of the testicle.
Reprimand; $1,000 fine
LITTLE, (Jr.), James Conrad, MD
(000015968) Climax, NC
02/12/2016 MD hired a woman he was dating to work
as his ofice manager and as a clinical as-sistant
in his practice. MD occasionally
directed this person, who had no prior
clinical training or experience, to write
prescriptions, which MD signed. An inves-tigation
determined that the woman wrote
seven prescriptions, all for controlled sub-stances,
for herself and two family mem-bers
without MD’s knowledge or consent.
MD failed to appropriately supervise and
ensure that the employee was assigned
duties commensurate with her education,
training and experience.
Reprimand
SEITZ, Kent, MD
(200900067) Charlotte, NC
03/18/2016 Quality of care, inappropriate prescribing
of controlled substances; MD allowed an
unlicensed staf member to use undated,
unsigned prescription blanks to issue pre-scriptions,
including for Suboxone, when
he was unavailable. MD failed to appro-priately
respond to patients’ positive urine
drug screens.
Reprimand; $2,000 fine; MD shall com-plete
a course in appropriate prescribing of
Suboxone.
SKEEN, James Thomas, MD
(009801061) Greensboro, NC
03/17/2016 MD self-prescribed on two occasions;
Medical records were inaccurate and/or
insuficient; History of prescribing con-trolled
substances
Reprimand; MD shall attend a proctored
medical records course approved by the
Board within six months of the date of the
order.
BOARD ACTIONS
Name/license #/location Date of action Cause of action Board action
THOMBS, Everette Bernard, MD
(000025194) Kings Mountain, NC
04/21/2016 Quality of care; deficiencies in MD’s medi-cal
record documentation, management of
co-morbid conditions and controlled sub-stances
prescribing practices.
Reprimand; MD must obtain a practice
monitor as specified in the order and
complete CME in medical record keeping
and controlled substances prescribing.
In future, if the Board finds that MD’s
controlled substances prescribing does
not meet accepted standards, the Board
reserves the right to summarily suspend
MD’s controlled substances prescribing
privileges.
TOLMAN, Phillip William, PA
(000103958) Wilmington, NC
02/12/2016 PA was disciplined by the South Carolina
medical board related to allegations that
he sexually harassed a female coworker.
PA’s NC physician assistant license is rein-stated,
with a reprimand
DENIALS OF LICENSE/APPROVAL
ROBERTSON, Valerie Jean, MD
(NONE) Tucson, AZ
02/08/2016 MD made false statements and misrepre-sentations
on her NC license application,
related to a malpractice payment made on
her behalf in January 2014.
Denial of application for NC medical
license.
SURRENDERS
ACOSTA, Daniel, MD
(200100499) Washington, NC
04/25/2016 Voluntary Surrender of NC medical
license
FITZGERALD, Dwight Melvin, MD
(000020792) Taylorsville, NC
03/08/2016 History of disruptive conduct. License surrendered, via non-Disciplinary
Consent Order
HERNANDEZ, Mario Augusto, MD
(201000567) Charlotte, NC
02/04/2016 Voluntary surrender of NC medical license
JENNINGS, Christopher Ray, MD
(201502283) Anderson, SC
03/31/2016 Voluntary surrender of NC medical license
WATFORD, Douglas Elry, MD
(000035546) Kinston, NC
04/19/2016 Voluntary surrender of NC medical license
PUBLIC LETTERS OF CONCERN
AHMED, Syed Fakruddin Ali, MD
(200801321) Rocky Mount, NC
04/15/2016 The Board is concerned MD failed to ad-equately
monitor the potassium level of a
patient admitted with sepsis. The patient
was admitted with elevated potassium
and received treatment that returned
potassium levels to a normal range. MD
assumed care of the patient and oversaw
the patient’s treatment for six days, during
which the patient’s potassium levels
dropped. The patient eventually died from
cardiac arrhythmia, which may have been
caused by potassium deficiency.
Public letter of concern
ALBRIGHT, Elizabeth Rae Bakisae, PA
(001004908) Fayetteville, NC
03/07/2016 PA consumed alcohol in violation of
NCPHP contract; PA has successfully
completed inpatient treatment.
Public letter of concern; PA shall maintain
NCPHP contract and abide by all terms.
BERCHUCK, Andrew, MD
(000031435) Durham, NC
04/05/2016 MD failed to timely diagnose and treat a
patient’s uterine cancer. The Board notes
that this was a dificult case with a poor
prognosis regardless of when the diagno-sis
was made.
Public letter of concern
BEURSKENS, Maureen Leonie, MD
(000035584) Charlotte, NC
02/02/2016 The Board is concerned that MD’s treat-ment
of a patient who presented with a
fibroid and 1.1 mm endometrial stripe may
not have conformed to accepted standards
of care. An expert reviewer opined that
MD should have ordered a biopsy when
the fibroid and endometrial stripe were
detected, which might have resulted in a
more timely diagnosis of the patient’s en-dometrial
cancer.
Public letter of concern
BYRNE, Thomas John, MD
(000025001) New York, NY
02/26/2016 Concerns about quality of care and his-tory
of Board actions in other states; MD
presented evidence that he is currently li-censed
without restriction in these states.
Public letter of concern
DIXON, Donovan Dave, MD
201001347) Pembroke, NC
02/16/2016 Unprofessional conduct; MD broke the
terms of a lease for his medical ofice
space, resulting in a judgment against him
for $64,000.
Public letter of concern
ELLIOTT, John Daniel, DO
(201201920) Elizabeth City, NC
02/12/2016 The Board is concerned that DO failed to
appropriate diagnose and manage a pa-tient’s
lower leg arterial insuficiency. The
patient ultimately underwent below the
knee amputation.
Public letter of concern
FORUM | Issue 2 2016 	 13
BOARD ACTIONS
Name/license #/location Date of action Cause of action Board action
FISHER-BECK, Jason Andrew, PA
(001003399) Sacramento, CA
02/16/2016 PA failed to ensure that a patient’s surgi-cal
wrap was removed in an appropriate
and timely manner. PA assisted in the
patient’s hip surgery; it is typically the re-sponsibility
of the OR nurse or the surgi-cal
assistant to remove the surgical wrap.
The wrap remained in place for six days
and the patient developed extremity vas-cular
compromise resulting in foot ulcers.
Ultimately, the patient required lower leg
amputation.
Public letter of concern
GILLMAN, John Frederick, MD
(009300475) Tacoma, WA
02/29/2016 Action taken by Washington medical
board; MD engaged in a sexual relation-ship
with a patient.
Public letter of concern
KREITZ, (Jr.), Michael, PA
(000100004) High Point, NC
03/31/2016 Professional boundary violation; A pa-tient
alleged that PA viewed photos of an
intimate and personal nature on her cell
phone without her permission.
Via consent order, PA is issued a public
letter of concern
LUGO-SANTIAGO, Irving Amilcar, MD
(000030835) Greensboro, NC
02/16/2016 MD and his family developed a close social
relationship with a patient under MD’s
care. MD eventually hired the patient to
work in his practice and the individual re-mained
in MD’s care, receiving prescrip-tions
for controlled substances among
other care. Administrative rules prohibit a
licensee from prescribing to someone with
whom he has a close personal relationship.
Public letter of concern
MCGINN, (Jr.), Joseph Thomas, MD
(201600697) Monroe, NC
04/14/2016 The Board is concerned that an indepen-dent
expert medical reviewer raised con-cerns
about certain aspects of two CABG
procedures performed by MD that the
Board requested be reviewed. The Board
notes that MD provided expert reviews
that support his approach to the cases.
MD is issued a NC license, with a public
letter of concern
MEEHAN-DE LA CRUZ, Kathleen, MD
(009900813) Norwalk, OH
04/19/2016 MD wrote prescriptions to a person she is
involved in a romantic relationship with.
MD has since completed remediation
courses. She is cautioned not to repeat
similar conduct in future.
License reinstated, with a public letter of
concern
SPOHN, Peter John, MD
(201000005) Deridder, LA
03/14/2016 MD placed a left sided trochanteric nail
in a patient undergoing surgery to repair
a hip fracture, instead of a right sided nail
as intended.
Public letter of concern
VAN ZANDT, Stephanie, MD
(201401271) Clearwater, FL
04/26/2016 The Board is concerned that MD was in-suficiently
aware of preeclampsia in a
patient who presented in early preterm
labor; The Board is concerned that MD’s
management of the patient failed to meet
current accepted standards.
Public letter of concern; Within six months
of the date of this letter, MD must complete
the ACOG course on Fetal Heart Rate Mon-itoring
and complete the ACOG Task Force
Publication on Hypertensive Disorders in
Pregnancy Status.
WILLIAMSON, (Jr.), Charles Edward, MD
(000039500) Roanoke Rapids, NC
04/05/2016 MD failed to consider a recurrence of
methicillin-resistant staphylococcus au-reus
as a possible cause of a patient’s fe-ver,
back pain, leg numbness and other
symptoms. The patient has been treated
three weeks prior by another physician,
who drained the patient’s axillary abscess,
diagnosed methicillin-resistant staphylo-coccus
aureus and prescribed antibiotics.
MD diagnosed the patient with an acute
lumbosacral strain and prescribed pain
medication. The patient returned to the
ER 12 hours later and was ultimately di-agnosed
with an epidural abscess. The
patient underwent decompressive surgery
and is now a parapalegic.
Public letter of concern
MISCELLANEOUS ACTIONS
CARTER, Richard Ford, MD
(200800397) Highlands, NC
03/18/2016 History of alcohol use disorder; MD failed
to comply with NCPHP monitoring agree-ment.
MD’s license is made inactive
ELSTER, (II), Allen William, MD
(201600181) Johnson City, TN
02/08/2016 History of alcohol abuse; history of arrest
for indecent exposure (while under the in-fluence
of alcohol).
MD is issued a resident training license,
must comply with NCPHP contract. MD
has successfully completed inpatient treat-ment
and is continuing with outpatient
therapy.
Name/license #/location Date of action Cause of action Board action
LATTERNER, Kim Marie, PA
(001003471) Matthews, NC
03/30/2016 PA has been charged with multiple counts
of statutory rape.
Interim Non-Practice Agreement
THOMASSON, Lori Anne, PA
(001003333) Norfolk, VA
03/17/2016 Action by another state medical board;
PA’s Virginia license was summarily sus-pended
in January 2016.
PA enters into a public Non-Practice
Agreement
CONSENT ORDERS AMENDED
SPIVEY, David Lee, MD
(000030582) Winston-Salem, NC
02/18/2016 MD is compliant with all aspects of his
September 2015 order
Amended Consent Order: the stayed sus-pension
portion of MD’s September 11,
2015, order is lifted efective March 1, 2016.
TEMPORARY/DATED LICENSES: ISSUED, EXTENDED, EXPIRED, OR REPLACED BY FULL LICENSES
THOMPSON, Joel Wesley, PA
(000101018) Charlotte, NC
03/29/2016 PA is issued a dated license to expire on
03/29/2017.
COURT APPEALS/STAYS
NONE
DISMISSALS
NONE
Annulment: Retrospective and prospective cancel-lation
of the practitioner’s authorization to practice.
Conditions: A term used to indicate actions or
requirements a licensee must complete and/or
comply with as a condition of continued licensure.
Consent Order: An order of the Board that states
the terms of a negotiated settlement to an enforce-ment
case; A method for resolving a dispute without
a formal hearing.
Denial: Decision denying an application for initial
licensure or reinstatement, or reconsideration of a
Board action.
Dismissal: Board action dismissing a contested case.
Inactive Medical License: Licensees must renew the
professional license annually to practice lawfully in
the state of NC. The Board may negotiate a provid-er’s
agreement to go inactive as part of the resolu-tion
of a disciplinary case.
Public Letter of Concern (PubLOC): A letter in the
public record expressing the Board’s concern about
a practitioner’s behavior or performance. A public
letter of concern is not considered disciplinary in na-ture;
similar to a warning.
Revocation: Cancellation of authorization to prac-tice.
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,
either indefinitely or for a stipulated period of time.
Temporary/Dated License: 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 in-vestigation.
Surrender does not preclude the Board
bringing charges against the practitioner.
Glossary of Terms
BOARD ACTIONS
FORUM | Issue 2 2016 	 15
North Carolina Medical Board
1203 Front Street
Raleigh, NC 27609
Prsrt Std
US Postage
PAID
Permit No. 2172
Raleigh, NC
NCMB’s plans to require continuing medical education (CME) in pain management and related topics of all
licensees who prescribe controlled substances took another step forward at the Board’s July meeting.
The final version of the proposed rule includes an important change to the efective date of the CME requirement.
The Board voted to make the requirement efective July 1, 2017, instead of Jan. 1, 2017, as originally planned.
The Board made this change to allow NCMB staf ample time to communicate with afected licensees about the
new CME requirement and provide additional time for licensees to comply.
As proposed, the rule changes would require physicians who
prescribe controlled substances to complete three hours of CME
during each three-year CME cycle. Physician assistants would
be required to complete two hours of CME during each two-year
cycle. To meet the requirement, courses would have to cover
“controlled substances prescribing practices, recognizing signs
of the abuse or misuse of controlled substances, and controlled
substance prescribing for chronic pain management.”
The NC Rules Review Commission is expected to decide whether
to grant final approval to the CME rule changes at its meeting on
August 18.
Rule change update: Opioid prescribing CME requirement
September 21-23, 2016 (Full Board) | October 20-21, 2016 (Hearing) | November 16 -18, 2016 (Full Board)
Meeting agendas, minutes and a full list of meeting dates can be found on the Board’s website:
www.ncmedboard.org
CONNECT WITH NCMB ON SOCIAL MEDIA
Facebook.com/ncmedboard | Twitter: @NCMedBoard
BOARD MEETING DATES
Learn more about the new CME requirement
at www.ncmedboard.org/prescribingCME