Nurse Practice Act; Emergency Medical Services Act of 1973

Subject:

Requested By: I. O. Wilkerson, Jr., Director, Division of Facility Services Department of Human Resources

Questions: Who has the ultimate authority to establish regulations pertaining to the functioning and certification of mobile intensive care nurses?

 

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2. Do the statutes require the involvement of a joint subcommittee of the Board of Medical Examiners and the Board of Nursing in the development of regulations pertaining to mobile intensive care nurses and the subsequent adoption of regulations by both Boards?

    

Conclusions: The ultimate authority and responsibility to establish regulations pertaining to the functioning and certification of emergency medical services personnel, including "medical intensive care nurses" is, pursuant to G.S. 143-514, in the Board of Medical Examiners.

 

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2. No. Under G.S. 143-514 emergency medical services personnel may, in the course of such duties, perform medical acts for which they are trained ". . . and as provided in the rules and regulations of such Board (of Medical Examiners), regardless of other provisions of law." Those certified and serving in the position of "mobile intensive care nurse" under the regulations of that Board are "emergency medical services personnel" within the meaning of that statute. Therefore, involvement of the joint subcommittee of the Board of Medical Examiners and the Board of Nursing is not required in the development of regulations pertaining to their emergency medical services duties.

    

The Emergency Medical Services Act of 1973 (G.S. Chapter 143, Article 56) establishes a comprehensive emergency medical services program in the Department of Human Resources.

G.S. 143-507. The Department is required to establish a program to improve and upgrade emergency medical services and to consolidate all State functions relating thereto, both regulatory and development, under auspices of this program. G.S. 143-508. Upon successful completion of training programs established by the Department (and other programs approved by the Board of Medical Examiners) ". . . emergency medical services personnel may, in the course of their emergency medical services duties, perform such acts, tasks and functions as they have been trained to perform and as provided in rules and regulations of such Board, regardless of other provisions of law." G.S. 143-514. (Emphasis supplied)

The inquiry concerns "mobile intensive care nurses", a term which is not defined in the Act. However, G.S. 143-507(c) defines "emergency medical services" to ". . . include all services rendered in responding to the individual’s need for immediate medical care in order to prevent loss of life or further aggravation of physiological or psychological illness or injury." It is our opinion that personnel serving in the area coming within the definition of "emergency medical services", and certified and functioning as provided for in said Act and the rules and regulations of the Board of Medical Examiners are "emergency medical services personnel" who may perform medical acts permitted thereunder, regardless of other provisions of law.

The regulations of the Board of Medical Examiners pertaining to mobile intensive care promulgated pursuant to the Act gave the definition and functions of a "mobile intensive care nurse" and provide for certification by that Board upon recommendation by the Department. 21

N.C.A.C. 32G. The position is an integral part of a mobile intensive care program as contemplated and provided for in those regulations. The mere fact that the Board’s regulations provide that a certain position shall be held by a registered nurse does not take that position out of the scope of the Emergency Medical Services Act and the provision that such personnel may perform such acts that they have been trained to perform and as provided in the rules and regulations of the Board.

Therefore, it is our opinion that "mobile intensive care nurses" are "emergency medical services personnel" within the meaning of the Emergency Medical Services Act. They may perform acts, tasks, and functions in the area of emergency medical services, under the certification and accordance with the rules and regulations of the Board of Medical Examiners, regardless of other provisions of law. The involvement of the joint subcommittee of the Board of Medical Examiners of the Board of Nursing in the development of regulations pertaining to "mobile intensive care nurses", is not required.

Further, we are of the opinion that there is no conflict between the Emergency Medical Services Act and G.S. 90-18(14) and G.S. 90-18.2 as these laws pertain to the requirement for a registered nurse to be certified and function under rules and regulations promulgated by a particular Board or Boards. G.S. 90-18 is a punitive statute making it unlawful to practice medicine without a license but establishing certain exceptions to the definition of the practice of medicine. One of these covers ". . . the performance of acts otherwise constituting medical practice by registered nurse when a joint subcommittee of the Board of Medical Examiners and the Board of Nursing and adopted by both boards." There is nothing, however, which would prevent the General Assembly from legislating further exceptions or exemptions which might be codified in this or other sections of the General Statutes. It is our opinion that G.S. 143-514 establishes a further exemption to G.S. 90-18. It seems certain that no person could be successfully prosecuted under

G.S.

90-18 for practicing medicine without a license when that person is acting in full compliance with G.S. 143-514 and the rules and regulations of the Board of Medical Examiners lawfully promulgated thereunder.

G.S.

90-18.2 imposes certain conditions upon those nurses (authorized to use the title "nurse

practitioner") who are approved to perform medical acts in accordance with regulations jointly adopted by the Board of Medical Examiners and the Board of Nursing. Nothing in this section precludes the General Assembly from making other and different provisions for individuals, including registered nurses, permitting them to lawfully perform medical acts in specialized fields of practice and other certification.

Rufus L. Edmisten Attorney General

William F. Briley Assistant Attorney General