North Carolina's licensed physical therapists (PTs) and assistants (PTAs) are essential to patients for much-needed rehabilitative needs and recovery goals throughout the state. Whether working in a busy downtown hospital in Charlotte, Greensboro, or Winston-Salem, a rehabilitative clinic in Durham or Asheville, or a private practice in Hillsborough or the Outer Banks, they are vital members of the healthcare community.
Along with patient duties and keeping abreast of development in the field, PTs and PTAs must adhere to rules and regulations from the North Carolina Board of Physical Therapy Examiners (NCPT Board). While the state agency aims to foster ethical and effective practice, those same regulatory safeguards can lead to serious repercussions when allegations of misconduct arise. The NCPT has extensive authority to launch intrusive investigations into the lives of licensees and can levy harsh disciplinary action—even for seemingly minor violations—such as:
- Failing to document a patient's condition changes
- Forgetting to supervise an aide under delegation
- Missed notes in service records that misalign with insurance reimbursements
When North Carolina PTs and PTAs are notified that the board seeks adverse action, they must turn to the Lento Law Firm to defend their authority to practice. Whether addressing investigators, managing disciplinary hearings, or pursuing appeals, our Professional License Defense Team will provide the assistance they need. Call us at 888-535-3686 now or fill out our confidential consultation form, and we will contact you.
NCPT Board Regulated Scope of Practice
From its headquarters in Raleigh, the board uses the state's adopted Physical Therapy Practice Act to govern the profession, including licensing individuals as PTs and PTAs. Since North Carolina is a member of the multi-state PT Compact, it also issues credentials through reciprocity to healthcare professionals more than three dozen other states. Additionally, the eight-member NCPT Board sets the standards for the scope of practice for PTs, PTAs, and unlicensed support personnel.
Licensed PTs are responsible for directing patient evaluations, interpreting physician recommendations and referrals, and creating patient care plans. PTAs implement treatment components that the supervising PT has delegated, and act in an assistive role. Unlicensed support personnel, such as physical therapy aides, have a far narrower assignment of duties, such as:
- Patient-related tasks: preparing treatment areas, patient transport, routine assistance that does not involve skilled intervention
- Non-patient-related tasks: administrative duties, equipment maintenance, clinical inventory control
Aides may not engage in any activity or duty that requires clinical judgement, such as decision-making and patient evaluation. While they may document some items—vital signs, height and weight—it's at the discretion of the PT in charge.
Delegation and Supervision
Licensees are required to adhere to guidelines governing delegation and supervision of physical therapy services. PTs may delegate interventions within the PTA's competence and scope of practice—as long as the intervention does not require advanced clinical judgment.
For PTs supervising PTAs, the board asserts the following guidelines:
- Always maintain responsibility for adequate supervision
- Be immediately available to the PTA with first-hand patient knowledge
- Reevaluate patients and care plans as appropriate
- Commit to discharge planning
- Remain confident in the PTA's competency to perform all delegated tasks
PTs and even PTAs may delegate certain tasks to physical therapy aides that do not require clinical decision-making, such as patient transport or equipment setup. Those delegating tasks to aides must always provide on-site supervision, meaning they must be immediately available to the delegatee and maintain continued involvement in all aspects of treatment sessions. If a PTA or aide is involved in the patient care plan (in any part), the supervising PT must reassess the patient every 60 days or 13 visits, whichever occurs first.
Physical Therapist Prohibited Actions and Unlawful Acts
North Carolina PTs and PTAs focus mainly on the medical and rehabilitative side of patient care. However, services include far more than the latest joint rehabilitation techniques and injury recovery strategies. Licensees are bound to follow numerous professional standards and must avoid a long list of prohibited actions.
Although it's not an exhaustive list, licensees may not engage in the following while in the practice of physical therapy services:
- Promoting an unnecessary device, treatment intervention, nutritional supplement, product, or service for financial gain for themselves or a third party
- Revealing a patient's identifiable data without prior consent, except as required by law
- Guaranteeing that a patient will benefit from physical therapy services
- Failure to supervise delegates
- Billing for services not performed
- Failure to file a report, filing a false report, or failure to respond to the board within 30 days
- Soliciting or engaging in sexual activities with a patient while under care
- Willfully or intentionally communicating false or misleading information to patients
- Physically or verbally abusing, harassing, or intimidating anyone while practicing
PTs and PTAs are under strict orders to keep legible, up-to-date records for all services rendered to patients. Failing to record patient data within a reasonable period of time after initial evaluation, diagnosis, reevaluation, care plan alterations, or discharge will result in a violation of the North Carolina Physical Therapy Practice Act.
Failure to abide by the board's standards can lead to disciplinary measures, including fines, probation, or even license revocation. Yet, the NCPT has further "unlawful acts" that serve as grounds for disciplinary action, which includes the following:
- Engaging in fraud, deceit, or misrepresentation to renew a license
- Using drugs or intoxicating liquors to an extent that affects professional competency
- Felony convictions and other criminal offenses involving moral turpitude or narcotics laws until proof of rehabilitation
- Court findings of insanity or incompetency until proof of recovery
- Aiding, abetting, or assisting in violations of board rules
- Malpractice, gross negligence, or incompetence in the practice of physical therapy
Critically, disciplinary action can come even if the alleged behavior causes no actual harm. As part of the board's grounds for disciplinary action, investigations only need to substantiate that "could" have resulted in harm or injury to the public, not actual damage. Therefore, there could be an instance when the NCPT Board has launched an investigation into the conduct the licensees who are completely unaware of it until they're subject to inquiry.
Investigation Process and Informal Discipline
The first step in the NCPT Board's grievance process is when a patient, a patient's family member, colleague, assistant, or supervisor files a complaint. The board will not move forward with sanctions for anonymous complaints.
The board's Investigation Committee will screen the complaint to ensure it falls within its jurisdiction, meaning a violation of the state's Physical Therapy Practice Act or related NCPT rules. Upon establishing a potential violation, the board notifies the licensee (respondent), who has 30 days to reply, typically with acknowledgment of the action taken and a written statement providing an explanation for their side of the alleged event.
Investigators gather evidence, including interviewing patients (potentially their families) and analyzing records like notes made under evaluation, services billed to insurance, and anything else related to the complaint. The eight-member board then meets to discuss the committee's report, which will determine whether the allegations are substantiated. If there are no findings of misconduct, the complaint is dismissed, and notification is sent to the parties named in the complaint. However, if the NCPT believes a violation occurred through a "preponderance of the evidence" standard, it schedules a meeting with the respondent to discuss sanctions.
Informal resolutions serve as an opportunity to negotiate without the board filing formal charges. However, that does not mean PTs and PTAs should choose this option believing it to be a way to avoid serious punishment. Licensees will accept responsibility for the alleged violations or complaints, with 30 days to agree to the punishment imposed, which is then codified into a legally binding consent order.
While PTs and PTAs will have a period of discussion to explain their side of the events, they are not granted due process provisions like they would be during a contested case hearing. Without formal proceedings, licensees risk unfair punishment.
Contested Case Hearings
Whenever potential sanctions can result in a change of license status—suspension or revocation—the board must provide licensees with the opportunity for a contested case hearing. PTs and PTAs may also petition the North Carolina Office of Administrative Hearings (OAH) when they seek to challenge the NCPT's determinations.
Within five days of filing, OAH assigns an Administrative Law Judge (ALJ) to the case. The first meeting between the licensee and the board's representation (usually a member of the Attorney General's Office) is typically a pre-hearing or settlement conference—scheduled within 10 days of the petition filing. The ALJ uses this time to discuss scheduling, with proceedings lasting no more than 45 days. Additionally, parties can re-enter into negotiation to strike an agreement that can be filed as a final legal order, for which a mediator may present.
During OAH procedures, both parties have the right to submit evidence and testimony. They may give opening and closing statements and cross-examine subpoenaed witnesses to ultimately compel the ALJ's decision in their favor, which is one of the following:
- Affirming the NCPT Board's decision and sanctions imposed
- Reversing or modifying the board's final determination
- Remanding the case back to the board for further adjudication
After the ALJ's decision,each party has the right to petition for judicial review. PTs and PTAs will file with the Superior Court of the county where they reside. Nevertheless, appeals will only address procedural issues and excessive sanctions.
NCPT Board Sanctions
The board has the discretion to consider a licensee's prior record with levying discipline. Specific penalties depend on the seriousness of the offense, including aggravating or mitigating factors.
PTs and PTAs can be subject to one or more of the following:
- Reprimand: A formal notice documenting the licensee's responsibility for minor violations, such as falsifying records or practicing without an active license.
- Fines: Penalties may not exceed $1,000 per violation and are often imposed in conjunction with other sanctions.
- Probation Conditions: Mandatory practice under strict conditions or with limitations, often after a short-term suspension, and levied for communicating false information to patients or attempting to seek unlawful financial gain.
- License Suspension: A temporary ban on the authority to practice, with reinstatement subject to approval, often for substance abuse and incompetent practice.
- License Revocation: Permanent loss of a license to practice, often for major malpractice, gross negligence, or when conduct harms a patient or the public.
As part of its decision, the board may also charge the reasonable costs of the investigation and hearing to those disciplined. Disciplinary action against a licensee, their name, and a brief statement of the conduct will appear on the board's web page for a period corresponding with the length of the sanctions, or at least one year. Additionally, licensees with consent orders who fail to meet the conditions may remain visible until all requirements are met.
Protect Your North Carolina Physical Therapist License
The Lento Law Firm knows that any North Carolina PT or PTA deserves the best counsel when board allegations and complaints arise. In an increasingly competitive marketplace, any negative mark on a licensee's record can diminish their ability to practice freely. Some may think engaging an attorney may be too extreme of a measure to take when responding to the NCPT Board, but our Professional License Defense Team is the resource they require.
The processes involved in defending against complaints and Physical Therapy Practice Act violations are rarely straightforward. Success demands a deep understanding of administrative law, board-specific procedures, and the investigation protocols that govern disciplinary cases. For someone who has invested years of study, field experience, and top-tier patient care into their careers, the Lento Law Firm has what it takes to protect the credentials they need to practice.
We understand how to advocate effectively on your behalf, from responding to the board to providing representation in OAH hearings through appeals. No matter where in North Carolina PTs or PTAs work, we are dedicated to their best outcome. Call the Lento Law Firm Professional License Defense Team at 888-535-3686 today or fill out our confidential consultation form, and we will contact you.
