North Carolina § 90-18 - Practicing without license; penalties.

§ 90-18. Practicing without license; penalties.

No person shall perform any act constituting the practice of medicine or surgery, as defined in this Article, or any of the branches thereof, unless the person shall have been first licensed and registered so to do in the manner provided in this Article. Any person who practices medicine or surgery without being duly licensed and registered, as provided in this Article, shall not be allowed to maintain any action to collect any fee for such services. Any person so practicing without being duly licensed and registered in this State shall be guilty of a Class 1 misdemeanor. Any person so practicing without being duly licensed and registered in this State and who is falsely representing himself or herself in a manner as being licensed or registered under this Article or any Article of this Chapter shall be guilty of a Class I felony. Any person so practicing without being duly licensed and registered in this State and who is an out-of-state practitioner shall be guilty of a Class I felony. Any person who has a license or approval under this Article that is inactive due solely to the failure to complete annual registration in a timely fashion as required by this Article or any person who is licensed, registered, and practicing under any other Article of this Chapter shall be guilty of a Class 1 misdemeanor. Repealed by Session Laws 2007-346, s. 23, effective October 1, 2007. The following shall not constitute practicing medicine or surgery as defined in this Article: The administration of domestic or family remedies. The practice of dentistry by any legally licensed dentist engaged in the practice of dentistry and dental surgery. The practice of pharmacy by any legally licensed pharmacist engaged in the practice of pharmacy. The provision of drug therapy management by a licensed pharmacist engaged in the practice of pharmacy pursuant to an agreement that is physician, pharmacist, patient, and disease specific when performed in accordance with rules and rules developed by a joint subcommittee of the North Carolina Medical Board and the North Carolina Board of Pharmacy and approved by both Boards. Drug therapy management shall be defined as: (i) the implementation of predetermined drug therapy which includes diagnosis and product selection by the patient's physician; (ii) modification of prescribed drug dosages, dosage forms, and dosage schedules; and (iii) ordering tests; (i), (ii), and (iii) shall be pursuant to an agreement that is physician, pharmacist, patient, and disease specific. The practice of medicine and surgery by any surgeon or physician of the United States Army, Navy, or Public Health Service in the discharge of his official duties. The treatment of the sick or suffering by mental or spiritual means without the use of any drugs or other material means. The practice of optometry by any legally licensed optometrist engaged in the practice of optometry. The practice of midwifery as defined in G.S. 90-178.2. The practice of podiatric medicine and surgery by any legally licensed podiatric physician when engaged in the practice of podiatry as defined in Article 12A of this Chapter. Repealed by Session Laws 2019-191, s. 34, effective October 1, 2019. The practice of chiropractic by any legally licensed chiropractor when engaged in the practice of chiropractic as defined by law, and without the use of any drug or surgery. The practice of medicine or surgery by any nonregistered reputable physician or surgeon who comes into this State, either in person or by use of any electronic or other mediums, on an irregular basis, to consult with a resident registered physician or to consult with personnel at a medical school about educational or medical training. This proviso shall not apply to physicians resident in a neighboring state and regularly practicing in this State. The practice of medicine or surgery by any physician who comes into this State to practice medicine or surgery so long as: The physician or surgeon has an oral or written agreement with a sports team to provide general or emergency medical care to the team members, coaching staff, or families traveling with the team for a specific sporting event taking place in this State; and The physician or surgeon does not provide care or consultation to any person residing in this State other than an individual described in sub-subdivision a. of this subdivision. Any person practicing radiology as hereinafter defined shall be deemed to be engaged in the practice of medicine within the meaning of this Article. "Radiology" is a specialty branch of the practice of medicine in which illness or disease is diagnosed or treated using various techniques or modalities, including radiant energy or ionizing radiation, and ultrasound and magnetic resonance. The education and training for the practice of radiology includes extensive study in the physics of radiant energy and medical imaging, radiation protection, and the application of ionizing radiation in the diagnosis and treatment of disease. The performance of any medical acts, tasks, and functions by a licensed physician assistant at the direction or under the supervision of a physician in accordance with rules adopted by the Board. This subdivision shall not limit or prevent any physician from delegating to a qualified person any acts, tasks, and functions that are otherwise permitted by law or established by custom. The Board shall authorize physician assistants licensed in this State or another state to perform specific medical acts, tasks, and functions during a disaster. The practice of nursing by a registered nurse engaged in the practice of nursing and the performance of acts otherwise constituting medical practice by a registered nurse when performed in accordance with rules and regulations developed by a joint subcommittee of the North Carolina Medical Board and the Board of Nursing and adopted by both boards. The practice of dietetics/nutrition by a licensed dietitian/nutritionist under the provisions of Article 25 of this Chapter. The practice of acupuncture by a licensed acupuncturist in accordance with the provisions of Article 30 of this Chapter. The use of an automated external defibrillator as provided in G.S. 90-21.15. The practice of medicine by any nonregistered physician residing in another state or foreign country who is contacted by one of the physician's regular patients for treatment by use of any method of communication while the physician's patient is temporarily in this State. The practice of medicine or surgery by any physician who comes into this State to practice medicine or surgery at a camp that specializes in providing therapeutic recreation for individuals with chronic illnesses, as long as all the following conditions are satisfied: The physician provides documentation to the medical director of the camp that the physician is licensed and in good standing to practice medicine in another state. The physician provides services only at the camp or in connection with camp events or camp activities that occur off the grounds of the camp. The physician receives no compensation for the services. The physician provides those services within this State for no more than 30 days per calendar year. The camp has a medical director who holds an unrestricted license to practice medicine and surgery issued under this Article. The provision of anesthesia services by a licensed anesthesiologist assistant under the supervision of an anesthesiologist licensed under Article 1 of this Chapter in accordance with rules adopted by the Board. The exemption shall remain in force while the physician or surgeon is traveling with the team. The exemption shall not exceed 10 days per individual sporting event. However, the executive director of the Board may grant a physician or surgeon additional time for exemption of up to 20 additional days per individual sporting event. History (1858-9, c. 258, s. 2; Code, s. 3122; 1885, c. 117, s. 2; c. 261; 1889, c. 181, ss. 1, 2; Rev., ss. 3645, 4502; C.S., s. 6622; 1921, c. 47, s. 7; Ex. Sess. 1921, c. 44, s. 8; 1941, c. 163; 1967, c. 263, s. 1; 1969, c. 612, s. 5; c. 929, s. 3; 1971, c. 817, s. 1; c. 1150, s. 6; 1973, c. 92, s. 1; 1983, c. 897, s. 2; 1993, c. 303, s. 2; c. 539, s. 615; 1994, Ex. Sess., c. 24, s. 14(c); 1995, c. 94, ss. 18, 19; 1997-511, s. 4; 1997-514, s. 1; 1999-290, s. 2; 2000-113, s. 2; 2001-27, s. 2; 2003-109, s. 1; 2005-415, s. 2; 2007-146, s. 3; 2007-346, s. 23; 2011-183, s. 127(b); 2011-194, s. 1; 2019-191, s. 34.) Cross References. - As to unauthorized practice; penalty for violation of Article, see G.S. 90-118.11 . Editor's Note. - Session Laws 1983, c. 897, which substituted "as defined in G.S. 90-178.2 " for "by any woman who pursues the vocation of midwife" in subdivision (7), provides, in s. 3: "This act shall become effective October 1, 1983. Any person who on October 1, 1983, had been a practicing midwife in North Carolina for more than 10 years may continue to assist at childbirth without approval under this Article. Any other person authorized to practice midwifery on September 30, 1983, may continue to practice midwifery without approval under this Article until April 1, 1984. No annual fee shall be collected for 1983." G.S. 90-129 , referred to in subdivision (c)(9), was repealed by Session Laws 2009-447, s. 2, effective June 19, 2009. Session Laws 2011-183, s. 127(b) provides: "The Revisor of Statutes is authorized to insert, consistent with this act, the words 'United States' before references to the 'army,' 'navy,' 'marine corps,' 'coast guard,' and 'air force,' wherever these terms appear in the General Statutes, when referring to a branch or branches of the Armed Forces of the United States, and to capitalize those terms." Pursuant to that provision, a conforming change has been made in subdivision (c)(4). The phrase "army, navy, or public health" was changed to "Army, Navy, or Public Health." Session Laws 2020-3, s. 3A.1(a), provides: "Unless the context clearly indicates otherwise, the following definitions apply in this Part: "(1) CDC. - The federal Centers for Disease Control and Prevention. "(2) COVID-19. - Coronavirus disease 2019. "(3) COVID-19 diagnostic test. - A test the federal Food and Drug Administration has authorized for emergency use or approved to detect the presence of the severe acute respiratory syndrome coronavirus 2. "(4) COVID-19 emergency. - The period beginning March 10, 2020, and ending on the date the Governor signs an executive order rescinding Executive Order No. 116, Declaration of a State of Emergency to Coordinate Response and Protective Actions to Prevent the Spread of COVID-19. "(5) COVID-19 antibody test. - A serological blood test the federal Food and Drug Administration has authorized for emergency use or approved to measure the amount of antibodies or proteins present in the blood when the body is responding to an infection caused by the severe acute respiratory syndrome coronavirus 2." Session Laws 2020-3, s. 3D.5(a)-(e), as amended by Session Laws 2021-3, s. 2.17, provides: "(a) For purposes of this section, the following definitions apply: "(1) Quality improvement plan rules. - The rules regulating the quality improvement process for physician assistants and nurse practitioners found in 21 NCAC 32S.0213, 21 NCAC 32M.0110, and 21 NCAC 36.0810. "(2) Application fee rules. - The portions of rules found in 21 NCAC 32S.0204, 21 NCAC 32M.0115, and 21 NCAC 36.0813 that require the payment of an application fee. "(3) Annual review rules. - The portions of rules requiring the annual review or renewal of a practice arrangement between a physician and a physician assistant or nurse practitioner found in 21 NCAC 32S.0201, 21 NCAC 32M.0110, and 21 NCAC 36.0806. "(b) Notwithstanding any other provision of law to the contrary, neither the North Carolina Medical Board nor the North Carolina Board of Nursing shall enforce any provision of the quality improvement plan rules to the extent they require any of the following: "(1) Quality improvement process meetings between a physician and a physician assistant or nurse practitioner, provided that the physician assistant or nurse practitioner was practicing within the scope of his or her license prior to February 1, 2020, and continues to practice within the scope of his or her license while this section is effective. "(2) Monthly quality improvement process meetings between a physician and a physician assistant or nurse practitioner during the first six months of the practice arrangement between the physician and the physician assistant or nurse practitioner. "(c) Notwithstanding any other provision of law to the contrary, neither the North Carolina Medical Board nor the North Carolina Board of Nursing shall enforce any provision of the quality improvement plan rules or the application fee rules to the extent they require any individual to fill out an application or pay a fee, provided that individual is providing volunteer health care services within the scope of his or her license in response to the COVID-19 pandemic state of emergency declared by the Governor of North Carolina on March 10, 2020. "(d) Notwithstanding any other provision of law to the contrary, neither the North Carolina Medical Board nor the North Carolina Board of Nursing shall enforce any provision of the annual review rules. "(e) This section is effective when it becomes law and expires December 31, 2022." Session Laws 2020-3, s. 5, is a severability clause. Effect of Amendments. - Session Laws 2005-415, s. 2, effective December 1, 2005, added the exception at the end of subsection (a). Session Laws 2007-146, s. 3, effective June 29, 2007, added subdivision (c)(20). Session Laws 2007-346, s. 23, effective October 1, 2007, deleted "practicing defined" in the section heading; in subsection (a), substituted "perform any act constituting the practice of medicine or surgery, as defined in this Article," for "practice medicine or surgery" and deleted "nor in any case prescribe for the cure of diseases" following "thereof" in the first sentence; deleted subsection (b) regarding the definition of practicing; substituted "this Article" for "subsection (b) of this section" in the introductory paragraph of subsection (c); deleted "in cases of emergency" at the end of subdivision (c)(1); in subdivision (c)(8), substituted "podiatric medicine and surgery" for "chiropody," "podiatric physician" for "chiropodist," and "podiatry as defined in Article 12A of this Chapter" for "chiropody, and without the use of any drug"; added subdivision (c)(11a). Session Laws 2011-183, s. 127(b), effective June 20, 2011, substituted "Army, Navy, or Public Health Service" for "army, navy, or public health service" in subdivision (c)(4). Session Laws 2011-194, s. 1, effective December 1, 2011, and applicable to offenses committed on or after that date, rewrote subsection (a). Session Laws 2019-191, s. 34, effective October 1, 2019, deleted subdivision (c)(9); rewrote subdivision (c)(12); and substituted "any method of communication" for "the Internet or toll-free telephone number" in subdivision (c)(18). Legal Periodicals. - For 1997 legislative survey, see 20 Campbell L. Rev. 469 (1998).