# Title 50 — North Dakota Board of Medicine

## Article 50-01.1 — Definitions

## Chapter 50-01.1-01 — Grounds for Discipline - Definitions

### § 50-01.1-01-01. Grounds for discipline - Definitions.

The following definitions apply to grounds for discipline for licenses under the jurisdiction of the
board.
1. "Chaperone" means a third individual who is present during a medical examination, with the
patient's consent.
2. "Conduct" includes:
a. Behaviors, gestures, or expressions, whether verbal or physical; or
b. The creation, receipt, exchange, saving, or sending of images or communications,
whether verbal or written, via a telecommunications device.
3. "Former patient" means one of the following:
a. An individual for whom the licensee has not rendered health care services since the
licensee-patient relationship was terminated; or
b. An individual who has otherwise been admitted, discharged, or referred to another
licensee for care subsequent to receipt of health care services by a licensee in an
emergency setting or on an episodic basis, and such action has been recorded in the
individual's medical record or chart.
4. "Health care services" means examination, consultation, health care, treatment, or other
services provided by a licensee under the legal authority conferred by a license, certificate, or
registration issued by the board.
5. "Intimate examination" means an examination of the pelvic area, genitals, rectum, breast, or
prostate.
6. "Key third party" means an individual closely involved in the patient's decisionmaking
regarding health care services, including the patient's spouse or partner, parent, child, sibling,
or guardian. An individual's status as a key third party ceases upon the termination of the
licensee-patient relationship or upon termination of the individual's relationship with the
patient.
7. "Licensee" means any professional licensed under the jurisdiction of the board of medicine.
8. "Patient" means an individual for whom the licensee has provided health care services,
whether provided by mutual consent or implied consent, or provided without consent pursuant
to a court order. Once a licensee-patient relationship is established, an individual remains a
patient until the relationship is terminated. The determination of whether an individual is a
patient is made on a case-by-case basis with consideration given to a number of factors,
including the nature, extent, and context of the professional relationship between the licensee

and the individual. The fact that an individual is not actively receiving treatment or professional
services is not the sole determining factor. The term includes:
a. An individual who is receiving or has received health care services from the licensee
without termination of the licensee-patient relationship; or
b. A key third party, as that term is defined in this section.
9. "Sexual abuse, misconduct, or exploitation" means conduct that exploits the licensee-patient
relationship in a sexual way, whether verbal or physical, and may include the expression of
thoughts, feelings, or gestures that are sexual or that reasonably may be construed by a
patient or key third party as sexual. Sexual abuse, misconduct, or exploitation include:
a. "Sexual impropriety" means conduct by the licensee that is seductive, sexually
suggestive, disrespectful of patient privacy, or sexually demeaning to a patient, including
the following:
(1) Neglecting to employ disrobing or draping practices respecting the patient's privacy;
(2) Subjecting a patient to an intimate examination in the presence of a third party,
other than a chaperone, without the patient's consent or if consent has been
withdrawn;
(3) Making comments that are not clinically relevant about or to the patient, including
making sexual comments about a patient's body or underclothing; making
sexualized or sexually demeaning comments to a patient, criticizing the patient's
sexual orientation, or making comments about potential sexual performance;
(4) Soliciting a date or romantic relationship with a patient;
(5) Participation by the licensee in conversation regarding the sexual problems, sexual
preferences, or sexual fantasies of the licensee;
(6) Requesting details of the patient's sexual history, sexual problems, sexual
preferences, or sexual fantasies if not clinically indicated for the type of health care
services; and
(7) Failing to offer the patient the opportunity to have a third individual or chaperone in
the examining room during an intimate examination or failing to provide a third
individual or chaperone in the examining room during an intimate examination upon
the request of the patient.
b. "Sexual contact" includes the following:
(1) Touching a breast, genital, or any body part that has sexual connotation for the
licensee or patient, for any purpose other than appropriate health care services, or if
the patient has refused or has withdrawn consent; and
(2) Examining or touching of the patient's genitals without the use of gloves.
c. "Sexual interaction" means conduct between a licensee and patient, whether or not
initiated by, consented to, or participated in by a patient, that is sexual or may be
reasonably interpreted as sexual, including:
(1) Sexual intercourse or genital to genital contact;
(2) Oral to genital contact;

(3) Oral to anal contact or genital to anal contact;
(4) Kissing in a romantic or sexual manner;
(5) Encouraging the patient to masturbate in the presence of the licensee or
masturbation by the licensee while the patient is present;
(6) Offering to provide health care services, including drugs, in exchange for sexual
favors;
(7) Performing an intimate examination without clinical justification; or
(8) Conduct that is sexually demeaning to a patient or which demonstrates a lack of
respect for the patient's privacy.
d. Conduct described in paragraph 1 of subdivision a, paragraph 2 of subdivision a,
paragraph 7 of subdivision a, and paragraph 1 of subdivision b of this rule does not
constitute sexual abuse, misconduct, or exploitation if the following criteria are met:
(1) The conduct occurred during the rendering of health care services in an emergency
setting;
(2) The health care services rendered were clinically necessary;
(3) The patient was unconscious or otherwise unable to consent to health care
services; and
(4) The patient's clinical condition required immediate action and the licensee's violation
of paragraph 1 of subdivision a, paragraph 2 of subdivision a, paragraph 7 of
subdivision a, or paragraph 1 of subdivision b of this rule was due to circumstances
not within the licensee's control.
e. This section does not prohibit conduct required for medically recognized diagnostic or
treatment purposes if the conduct meets the standard of care appropriate to the
diagnostic or treatment situation.
f. It is not a defense that the patient, former patient, or key third party initiated or consented
to the conduct, or that the conduct occurred outside the professional setting.
10. "Unethical conduct" means conduct contrary to the following codes of ethics for each licensed
profession:
a. For medical doctors, the 2016 code of medical ethics adopted by the American medical
association;
b. For osteopathic doctors, the 2016 code of ethics adopted by the American osteopathic
association;
c. For physician assistants, the 2018 guidelines for ethical conduct for the physician
associates profession adopted by the American academy of physician associates;
d. For genetic counselors, the 2017 code of ethics adopted by the national society of
genetic counselors; and
e. For naturopaths, the 2015 code of ethics adopted by the American association of
naturopathic physicians.
History: Effective January 1, 2025.

General Authority: NDCC 43-17-07.1(10), 43-58-03.1, 43-60-06
Law Implemented: NDCC 43-17-02.1(1), 43-17-02.5, 43-17-31(1), 43-58-11(2)(o), 43-60-07(1)(o)
