North Carolina § 90-18 - 1. Limitations on physician assistants.

§ 90-18. 1. Limitations on physician assistants.

Any person who is licensed under the provisions of G.S. 90-9.3 to perform medical acts, tasks, and functions as a physician assistant may use the title "physician assistant" or "PA." Any other person who uses the title in any form or holds out to be a physician assistant or to be so licensed, shall be deemed to be in violation of this Article. Physician assistants are authorized to write prescriptions for drugs under the following conditions: The North Carolina Medical Board has adopted regulations governing the approval of individual physician assistants to write prescriptions with such limitations as the Board may determine to be in the best interest of patient health and safety. The physician assistant holds a current license issued by the Board. Repealed by Session Laws 2019-191, s. 35, effective October 1, 2019. The supervising physician has provided to the physician assistant written instructions about indications and contraindications for prescribing drugs and a written policy for periodic review by the physician of the drugs prescribed. A physician assistant shall personally consult with the supervising physician prior to prescribing a targeted controlled substance as defined in Article 5 of this Chapter when all of the following conditions apply: The patient is being treated by a facility that primarily engages in the treatment of pain by prescribing narcotic medications. The therapeutic use of the targeted controlled substance will or is expected to exceed a period of 30 days. Physician assistants are authorized to compound and dispense drugs under the following conditions: The function is performed under the supervision of a licensed pharmacist. Rules and regulations of the North Carolina Board of Pharmacy governing this function are complied with. The physician assistant holds a current license issued by the Board. Physician assistants are authorized to order medications, tests and treatments in hospitals, clinics, nursing homes, and other health facilities under the following conditions: The North Carolina Medical Board has adopted regulations governing the approval of individual physician assistants to order medications, tests, and treatments with such limitations as the Board may determine to be in the best interest of patient health and safety. The physician assistant holds a current license issued by the Board. The supervising physician has provided to the physician assistant written instructions about ordering medications, tests, and treatments, and when appropriate, specific oral or written instructions for an individual patient, with provision for review by the physician of the order within a reasonable time, as determined by the Board, after the medication, test, or treatment is ordered. The hospital or other health facility has adopted a written policy about ordering medications, tests, and treatments, including procedures for verification of the physician assistants' orders by nurses and other facility employees and such other procedures as are in the interest of patient health and safety. Any prescription written by a physician assistant or order given by a physician assistant for medications, tests, or treatments shall be deemed to have been authorized by the physician approved by the Board as the supervisor of the physician assistant and the supervising physician shall be responsible for authorizing the prescription or order. Any medical certification completed by a physician assistant for a death certificate shall be deemed to have been authorized by the physician approved by the Board as the supervisor of the physician assistant, and the supervising physician shall be responsible for authorizing the completion of the medical certification. Any registered nurse or licensed practical nurse who receives an order from a physician assistant for medications, tests, or treatments is authorized to perform that order in the same manner as if it were received from a licensed physician. Any person who is licensed under G.S. 90-9.3 to perform medical acts, tasks, and functions as a physician assistant shall comply with each of the following: Maintain a current and active license to practice in this State. Maintain an active registration with the Board. Have a current Intent to Practice form filed with the Board. A physician assistant serving active duty in the Armed Forces of the United States is exempt from the requirements of subdivision (g)(3) of this section. A physician assistant's license shall become inactive any time the holder fails to comply with the requirements of subsection (g) of this section. A physician assistant with an inactive license shall not practice medical acts, tasks, or functions. The Board shall retain jurisdiction over the holder of the inactive license. When a targeted controlled substance prescribed in accordance with this subdivision is continuously prescribed to the same patient, the physician assistant shall consult with the supervising physician at least once every 90 days to verify that the prescription remains medically appropriate for the patient. History (1975, c. 627; 1977, c. 904, s. 1; 1977, 2nd Sess., c. 1194, s. 1; 1995, c. 94, s. 20; 1997-511, s. 5; 2007-346, ss. 24, 25; 2011-183, s. 56; 2011-197, s. 1; 2017-74, s. 4; 2019-191, s. 35; 2021-70, s. 1(a).) Editor's Note. - Session Laws 2017-74, provides in its preamble: "Whereas, the General Assembly recognizes the substantial impact the nationwide opioid epidemic continues to have on the State of North Carolina; and "Whereas, North Carolina has seen a 442% increase in overdose deaths caused by commonly prescribed opioids between 1999 and 2015; and "Whereas, the General Assembly fully recognizes the appropriate use of opioids in the treatment of acute and chronic pain; Now, therefore," Session Laws 2017-74, s. 1, provides: "This act shall be known and may be cited as the 'Strengthen Opioid Misuse Prevention Act of 2017' or the 'STOP Act.'" 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 2007-346, ss. 24 and 25, effective October 1, 2007, substituted "90-9.3" for "90-11" in subsection (a); added subsections (g), (h), and (i). Session Laws 2011-183, s. 56, effective June 20, 2011, substituted "Armed Forces of the United States" for "United States military" in subsection (h). Session Laws 2011-197, s. 1, effective October 1, 2011, and applicable to certifications signed on or after that date, added subsection (e1). Session Laws 2017-74, s. 4, effective July 1, 2017, added subdivision (b)(5). Session Laws 2019-191, s. 35, effective October 1, 2019, deleted "an assistant to" following "functions as" in subsection (a) and the introductory paragraph of subsection (g); in the first sentence of subsection (a), inserted "assistant" and substituted "assistant' or 'PA'" for "assistant'"; deleted subdivision (b)(3); substituted "policy" for "policy, approved by the medical staff after consultation with the nursing administration" in subdivision (d)(4); and inserted "assistant" in the introductory paragraph of subsection (g). Session Laws 2021-70, s. 1(a), effective October 1, 2021, substituted "narcotic medications” for "narcotic medications or advertises in any medium for any type of pain management services” in subdivision (b)(5)a. Legal Periodicals. - For note, "Nurse Malpractice in North Carolina: The Standard of Care," see 65 N.C.L. Rev. 579 (1987).