South Carolina Code of Regulations Chapter 81 - DEPARTMENT OF LABOR, LICENSING AND REGULATION STATE BOARD OF MEDICAL EXAMINERS
🔷 Overview: Chapter 81 – State Board of Medical Examiners
Chapter 81 of the South Carolina Code of Regulations governs the State Board of Medical Examiners, which regulates the licensure, discipline, and oversight of medical professionals in the state, including:
Medical doctors (MDs)
Osteopathic physicians (DOs)
Physician assistants (PAs)
Anesthesiologist assistants (AAs)
Respiratory therapists
Acupuncturists
The Board operates under the South Carolina Department of Labor, Licensing and Regulation (LLR) and implements statutory provisions from the South Carolina Code of Laws, primarily under Title 40 – Professions and Occupations.
🔑 Key Regulatory Functions of Chapter 81
1. Licensure and Certification
Chapter 81 outlines rules for:
Initial licensure of physicians and other allied medical professionals.
Examination and educational requirements.
Licensure by endorsement or reciprocity.
Temporary and limited licenses.
Renewal procedures and continuing medical education (CME) requirements.
Requirements for MD/DO Licensure Include:
Graduation from an accredited medical school.
Passage of USMLE or COMLEX exams.
Completion of postgraduate training (residency).
Background check and moral character assessment.
2. Scope of Practice and Supervision
Chapter 81 defines the permitted scope of practice for:
Physician Assistants (PAs) – Must work under a supervising physician. Their duties, delegation protocols, and supervisory agreements are regulated.
Anesthesiologist Assistants (AAs) – Must be directly supervised by a licensed anesthesiologist.
Acupuncturists – Require certification and compliance with Board-approved standards and protocols.
Rules detail what each professional can do, who can supervise them, and under what conditions.
3. Continuing Education
Chapter 81 mandates CME for license renewal.
Specific rules govern:
Number of CME hours.
Subject matter (e.g., ethics, opioid prescribing).
Documentation and audits.
Failure to complete CME may result in disciplinary action or license non-renewal.
4. Professional Conduct and Discipline
Chapter 81 governs:
Ethical standards and professional behavior.
Prohibited conduct: substance abuse, sexual misconduct, negligence, fraud.
The process for filing, investigating, and adjudicating complaints.
Disciplinary measures may include:
Reprimand
Fines
Probation
Suspension or revocation of license
Mandatory rehabilitation or retraining
5. Administrative Hearings and Appeals
Medical professionals facing disciplinary action are entitled to an administrative hearing.
The Board’s decisions can be appealed to the Administrative Law Court and subsequently to the state’s judicial system under the South Carolina Administrative Procedures Act (APA).
⚖️ Legal Principles and Case Law Context
Although most disputes involving medical licensing are administrative in nature, they are subject to constitutional and statutory standards, including due process, equal protection, and judicial review.
🔸 1. Due Process in Disciplinary Proceedings
Medical professionals have a protected property interest in their license. Before revocation or significant restriction, they are entitled to:
Advance notice of allegations
An impartial hearing
The right to present evidence and cross-examine witnesses
Case Principle (Analogous):
In cases like Goldberg v. Kelly (U.S. Supreme Court), courts established that a government cannot deprive an individual of a benefit (like a license) without fair procedural safeguards.
🔸 2. Substantial Evidence Standard
Courts will affirm a decision by the Board if it is supported by substantial evidence in the record and is not arbitrary or capricious.
Hypothetical Example:
Dr. Smith is suspended for overprescribing opioids. He appeals, claiming insufficient evidence. The court finds the Board relied on patient records, pharmacy data, and expert testimony — a solid basis. The court upholds the decision.
🔸 3. Scope of Practice Disputes
Professionals may challenge restrictions on their scope of practice as being overly narrow or exceeding statutory authority.
Hypothetical Example:
A physician assistant argues a Board rule is too restrictive in requiring direct supervision for certain tasks. A court would assess whether the rule is consistent with the enabling statute and whether it reasonably protects public safety.
🔸 4. Equal Protection and Licensing
If the Board applies rules inconsistently or discriminatorily, affected professionals may raise constitutional challenges.
Example:
Treating foreign-trained physicians more harshly than U.S.-trained physicians without justification may violate equal protection.
🧑⚖️ Hypothetical Case Examples
Case 1: In re License of Dr. Johnson
Issue: Dr. Johnson’s license is revoked for unethical conduct (patient boundary violation).
Procedure: Board provides notice, hearing, and opportunity to respond.
Court Review: Upholds revocation based on substantial evidence and procedural compliance.
Case 2: Doe v. SC Board of Medical Examiners
Issue: A physician assistant challenges a rule requiring physician presence for routine procedures.
Claim: The rule exceeds statutory authority.
Outcome: Court rules the regulation is within the Board’s discretion to protect patient safety.
📋 Summary Table
| Area | Details |
|---|---|
| Licensure | Initial, endorsement, temporary; exams and credentials required |
| Scope of Practice | Specific to MDs, DOs, PAs, AAs, acupuncturists; governed by written protocols |
| CME Requirements | Mandatory for renewal; includes ethics and controlled substance training |
| Discipline | Misconduct, negligence, impairment; due process applies |
| Administrative Hearings | Right to appeal Board decisions under APA |
| Legal Standards | Due process, substantial evidence, equal protection |
✅ Conclusion
South Carolina Code of Regulations Chapter 81 provides a comprehensive framework for regulating medical professionals through the State Board of Medical Examiners. The rules are designed to safeguard public health, ensure professional competence, and allow for fair disciplinary processes. Judicial review ensures that the Board acts within its authority and respects constitutional and statutory rights.
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