South Carolina Code of Regulations Chapter 81 - DEPARTMENT OF LABOR, LICENSING AND REGULATION STATE BOARD OF MEDICAL EXAMINERS
I. Purpose and Legal Authority of Chapter 81
Chapter 81 implements and enforces the South Carolina Medical Practice Act (Title 40, Chapter 47, SC Code).
Its purpose is to:
Protect the public health, safety, and welfare
Establish licensure requirements for physicians and certain allied medical professionals
Regulate professional conduct, discipline, and scope of practice
Provide procedural rules for investigations, hearings, and sanctions
The Board’s authority is administrative, not criminal, but its decisions can profoundly affect a physician’s ability to practice.
II. Organization of Chapter 81 (Functional Breakdown)
While numbering may shift with amendments, Chapter 81 consistently covers the following regulatory domains:
1. Licensure Requirements
Initial licensure
Endorsement/reciprocity
Temporary or limited licenses
Educational and postgraduate training standards
Examination requirements (e.g., USMLE or equivalent)
Key regulatory principle:
Licensure is a privilege, not a right, but once granted, it becomes a protected property interest under due process law.
2. Standards of Professional Conduct
Chapter 81 defines what constitutes unprofessional conduct, including:
Fraud or misrepresentation
Practicing beyond authorized scope
Gross negligence or incompetence
Substance abuse affecting practice
Sexual misconduct with patients
Failure to maintain proper records
Violations of state or federal law related to medical practice
The Board has broad discretion to interpret professional standards, but that discretion is not unlimited.
3. Investigations and Complaints
Regulations authorize the Board to:
Receive and investigate complaints
Issue subpoenas
Require medical records
Use expert reviewers
Initiate disciplinary proceedings
Confidentiality is generally maintained during investigations, but disclosure may occur during formal proceedings.
4. Disciplinary Procedures
Chapter 81 outlines:
Notice requirements
Hearing procedures
Rights to counsel
Presentation of evidence
Cross-examination
Administrative law judge involvement
Final Board orders
Sanctions may include:
Reprimand
Probation
Suspension
Revocation
Fines
Mandatory education or treatment
5. Reinstatement and Monitoring
The regulations also address:
Reinstatement after suspension or revocation
Conditions imposed on practice
Monitoring programs
Continuing medical education (CME)
III. Constitutional and Administrative Law Framework
South Carolina courts consistently analyze Chapter 81 cases under:
1. Due Process (State and Federal)
A physician is entitled to:
Adequate notice of allegations
A meaningful opportunity to be heard
An impartial decision-maker
Decisions supported by evidence
2. Substantial Evidence Standard
Courts do not retry the case.
They ask whether the Board’s decision is supported by substantial evidence in the administrative record.
3. Deference to Agency Expertise
Medical boards receive heightened deference because:
Medicine is technical
The Board includes licensed physicians
The legislature delegated professional oversight authority
However, courts will intervene if the Board:
Acts arbitrarily or capriciously
Exceeds statutory authority
Violates constitutional rights
IV. South Carolina Case Law Themes (Illustrative)
Rather than risky verbatim holdings, below are well-established judicial principles drawn from South Carolina appellate decisions reviewing medical and professional licensing boards.
A. Licensure as a Protected Property Interest
South Carolina courts recognize that:
Once licensed, a physician has a property interest
Discipline triggers due process protections
Courts reject arguments that medical licenses can be revoked without formal procedures.
B. Board Discretion in Defining “Unprofessional Conduct”
Courts consistently uphold:
Broad regulatory definitions
The Board’s interpretation of professional norms
However, discipline may be overturned if:
The regulation is applied inconsistently
The physician lacked fair notice that conduct was prohibited
C. Expert Testimony Is Not Always Required
Courts have held that:
The Board may rely on its own expertise
Formal expert testimony is not mandatory in every case
But the record must still contain competent evidence, not speculation.
D. Substantial Evidence, Not Perfection
Courts will affirm Board decisions even if:
Conflicting evidence exists
The physician presents credible defenses
So long as reasonable minds could reach the Board’s conclusion, the decision stands.
E. Sanctions Must Be Proportionate
While courts defer to sanction choices, they may reverse or remand if:
Punishment is grossly disproportionate
Similar cases received drastically different treatment
The Board failed to explain its reasoning
V. Interaction with Administrative Procedures Act (APA)
Chapter 81 operates alongside the South Carolina Administrative Procedures Act, which governs:
Judicial review
Record requirements
Standards of review
Remand authority
Courts may:
Affirm
Reverse
Modify
Remand for further findings
VI. Practical Legal Consequences
Violations of Chapter 81 can lead to:
Permanent loss of licensure
Mandatory reporting to national databases
Collateral consequences in other states
Employment termination
Civil liability exposure
For this reason, South Carolina courts emphasize procedural compliance by the Board.
VII. Summary
Chapter 81 is not merely technical regulation—it is the backbone of medical professional discipline in South Carolina.
Key takeaways:
The Board has broad but reviewable authority
Physicians are entitled to constitutional due process
Courts defer to the Board’s expertise but enforce fairness
Discipline must be evidence-based and proportionate
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