Peer review committee defined.
For the purposes of §§ 36-4-25, 36-4-26.1 and 36-4-43, a peer review committee is one or more persons acting as any committee of a state or local
professional association or society, any committee of a licensed health care facility or the medical
staff of a licensed health care facility, or any committee comprised of physicians within a medical
care foundation, health maintenance organization, preferred provider organization, independent
practice association, group medical practice, provider sponsored organization, or any other
organization of physicians formed pursuant to state or federal law, that engages in peer review
activity. For the purposes of this section, a peer review committee is also one or more persons acting
as an administrative or medical committee, department, section, board of directors, shareholder or
corporate member, or audit group, including the medical audit committee, of a licensed health care
Peer review activities defined.
For the purposes of §§ 36-4-25, 36-4-26.1 and 36-4-42, peer review activity is the procedure by which peer review committees monitor, evaluate, and
recommend actions to improve the delivery and quality of services within their respective facilities,
agencies, and professions, including recommendations, consideration of recommendations, actions
with regard to recommendations, and implementation of actions. Peer review activity and acts or
proceedings undertaken or performed within the scope of the functions of a peer review committee
Matters affecting membership of a health professional on the staff of a health care facility
The grant, delineation, renewal, denial, modification, limitation, or suspension of clinical
privileges to provide health care services at a licensed health care facility;
Matters affecting employment and terms of employment of a health professional by a
health maintenance organization, preferred provider organization, independent practice
association, or any other organization of physicians formed pursuant to state or federal
Matters affecting the membership and terms of membership in a health professional
association, including decisions to suspend membership privileges, expel from
membership, reprimand, or censure a member, or other disciplinary actions;
Review and evaluation of qualifications, competency, character, experience, activities,
conduct, or performance of any health professional, including the medical residents of
health care facility; and
Review of the quality, type, or necessity of services provided by one or more health
professionals or medical residents, individually or as a statistically significant group, or
SL 1998, ch 172, § 2.
36-4-44 Interstate Medical Licensure Compact adopted.
Interstate Medical Licensure Compact adopted.
The Interstate Medical Licensure
Compact is enacted into law and entered into with all other jurisdictions that legally join the
compact, which is substantially as follows:
INTERSTATE MEDICAL LICENSURE COMPACT
SECTION 1: PURPOSE
In order to strengthen access to health care, and in recognition of the advances in the delivery of
health care, the member states of the Interstate Medical Licensure Compact have allied in common
purpose to develop a comprehensive process that complements the existing licensing and regulatory
authority of state medical boards, provides a streamlined process that allows physicians to become
licensed in multiple states, thereby enhancing the portability of a medical license and ensuring the
safety of patients. The compact creates another pathway for licensure and does not otherwise change
a state's existing Medical Practice Act. The compact also adopts the prevailing standard for licensure
and affirms that the practice of medicine occurs where the patient is located at the time of the
physician-patient encounter, and therefore, requires the physician to be under the jurisdiction of the
state medical board where the patient is located. State medical boards that participate in the compact
retain the jurisdiction to impose an adverse action against a license to practice medicine in that state
issued to a physician through the procedures in the compact.
SECTION 2: DEFINITIONS
In this compact:
"Bylaws" means those bylaws established by the Interstate Commission pursuant to
section 11 for its governance, or for directing and controlling its actions and conduct.
"Commissioner" means the voting representative appointed by each member board
pursuant to section 11.
"Conviction" means a finding by a court that an individual is guilty of a criminal offense
through adjudication, or entry of a plea of guilt or no contest to the charge by the offender.
Evidence of an entry of a conviction of a criminal offense by the court shall be considered
final for purposes of disciplinary action by a member board.
"Expedited License" means a full and unrestricted medical license granted by a member
state to an eligible physician through the process set forth in the compact.
"Interstate Commission" means the interstate commission created pursuant to section 11.
"License" means authorization by a state for a physician to engage in the practice of
medicine, which would be unlawful without the authorization.
"Medical Practice Act" means laws and regulations governing the practice of allopathic
and osteopathic medicine within a member state.
"Member Board" means a state agency in a member state that acts in the sovereign
interests of the state by protecting the public through licensure, regulation, and education
of physicians as directed by the state government.
"Member State" means a state that has enacted the compact.
"Practice of Medicine" means the clinical prevention, diagnosis, or treatment of human
disease, injury, or condition requiring a physician to obtain and maintain a license in
compliance with the Medical Practice Act of a member state.
"Physician" means any person who:
Is a graduate of a medical school accredited by the Liaison Committee on Medical
Education, the Commission on Osteopathic College Accreditation, or a medical
school listed in the International Medical Education Directory or its equivalent;
Passed each component of the United States Medical Licensing Examination
(USMLE) or the Comprehensive Osteopathic Medical Licensing Examination
(COMLEX-USA) within three attempts, or any of its predecessor examinations
accepted by a state medical board as an equivalent examination for licensure
Successfully completed graduate medical education approved by the Accreditation
Council for Graduate Medical Education or the American Osteopathic Association;
Holds specialty certification or a time-unlimited specialty certificate recognized by
the American Board of Medical Specialties or the American Osteopathic
Association's Bureau of Osteopathic Specialists;
Possesses a full and unrestricted license to engage in the practice of medicine
issued by a member board;
Has never been convicted, received adjudication, deferred adjudication, community
supervision, or deferred disposition for any offense by a court of appropriate
Has never held a license authorizing the practice of medicine subjected to
discipline by a licensing agency in any state, federal, or foreign jurisdiction,
excluding any action related to nonpayment of fees related to a license;
Has never had a controlled substance license or permit suspended or revoked by
a state or the United States Drug Enforcement Administration; and
Is not under active investigation by a licensing agency or law enforcement authority
in any state, federal, or foreign jurisdiction.
"Offense" means a felony, gross misdemeanor, or crime of moral turpitude.
"Rule" means a written statement by the Interstate Commission promulgated pursuant to
section 12 of the compact that is of general applicability, implements, interprets, or
prescribes a policy or provision of the Compact, or an organizational, procedural, or
practice requirement of the Interstate Commission, and has the force and effect of
statutory law in a member state, and includes the amendment, repeal, or suspension of an
"State" means any state, commonwealth, district, or territory of the United States.
"State of Principal License" means a member state where a physician holds a license to
practice medicine and which has been designated as such by the physician for purposes
of registration and participation in the compact.
SECTION 3: ELIGIBILITY
(a) A physician must meet the eligibility requirements as defined in section 2(k) to receive an
expedited license under the terms and provisions of the compact.
(b) A physician who does not meet the requirements of section 2(k) may obtain a license to
practice medicine in a member state if the individual complies with all laws and requirements, other
than the compact, relating to the issuance of a license to practice medicine in that state.
SECTION 4: DESIGNATION OF STATE OF PRINCIPAL LICENSE
(a) A physician shall designate a member state as the state of principal license for purposes of
registration for expedited licensure through the compact if the physician possesses a full and
unrestricted license to practice medicine in that state, and the state is:
The state of primary residence for the physician; or
The state where at least twenty-five percent of the practice of medicine occurs; or
The location of the physician's employer; or
If no state qualifies under subsection (1), subsection (2), or subsection (3), the state
designated as state of residence for purpose of federal income tax.
(b) A physician may redesignate a member state as state of principal license at any time, as long
as the state meets the requirements in subsection (a).
(c) The Interstate Commission is authorized to develop rules to facilitate redesignation of another
member state as the state of principal license.
SECTION 5: APPLICATION AND ISSUANCE OF EXPEDITED LICENSURE
(a) A physician seeking licensure through the compact shall file an application for an expedited
license with the member board of the state selected by the physician as the state of principal license.
(b) Upon receipt of an application for an expedited license, the member board within the state
selected as the state of principal license shall evaluate whether the physician is eligible for expedited
licensure and issue a letter of qualification, verifying or denying the physician's eligibility, to the
Static qualifications, which include verification of medical education, graduate medical
education, results of any medical or licensing examination, and other qualifications as
determined by the Interstate Commission through rule, shall not be subject to additional
primary source verification where already primary source verified by the state of principal
The member board within the state selected as the state of principal license shall, in the
course of verifying eligibility, perform a criminal background check of an applicant,
including the use of the results of fingerprint or other biometric data checks compliant
with the requirements of the Federal Bureau of Investigation, with the exception of federal
employees who have suitability determination in accordance with U.S. C.F.R. § 731.202.
Appeal on the determination of eligibility shall be made to the member state where the
application was filed and shall be subject to the law of that state.
(c) Upon verification in subsection (b), physicians eligible for an expedited license shall
complete the registration process established by the Interstate Commission to receive a license in a
member state selected pursuant to subsection (a), including the payment of any applicable fees.
(d) After receiving verification of eligibility under subsection (b) and any fees under subsection
(c), a member board shall issue an expedited license to the physician. This license shall authorize
the physician to practice medicine in the issuing state consistent with the Medical Practice Act and
all applicable laws and regulations of the issuing member board and member state.
(e) An expedited license shall be valid for a period consistent with the licensure period in the
member state and in the same manner as required for other physicians holding a full and unrestricted
license within the member state.
(f) An expedited license obtained though the compact shall be terminated if a physician fails to
maintain a license in the state of principal licensure for a nondisciplinary reason, without
redesignation of a new state of principal licensure.
(g) The Interstate Commission is authorized to develop rules regarding the application process,
including payment of any applicable fees, and the issuance of an expedited license.
SECTION 6: FEES FOR EXPEDITED LICENSURE
(a) A member state issuing an expedited license authorizing the practice of medicine in that state
may impose a fee for a license issued or renewed through the compact.
(b) The Interstate Commission is authorized to develop rules regarding fees for expedited
SECTION 7: RENEWAL AND CONTINUED PARTICIPATION
(a) A physician seeking to renew an expedited license granted in a member state shall complete
a renewal process with the Interstate Commission if the physician:
Maintains a full and unrestricted license in a state of principal license;
Has not been convicted, received adjudication, deferred adjudication, community
supervision, or deferred disposition for any offense by a court of appropriate jurisdiction;
Has not had a license authorizing the practice of medicine subject to discipline by a
licensing agency in any state, federal, or foreign jurisdiction, excluding any action related
to nonpayment of fees related to a license; and
Has not had a controlled substance license or permit suspended or revoked by a state or
the United States Drug Enforcement Administration.
(b) Physicians shall comply with all continuing professional development or continuing medical
education requirements for renewal of a license issued by a member state.
(c) The Interstate Commission shall collect any renewal fees charged for the renewal of a license
and distribute the fees to the applicable member board.
(d) Upon receipt of any renewal fees collected in subsection (c), a member board shall renew the
(e) Physician information collected by the Interstate Commission during the renewal process will
be distributed to all member boards.
(f) The Interstate Commission is authorized to develop rules to address renewal of licenses
obtained through the compact.
SECTION 8: COORDINATED INFORMATION SYSTEM
(a) The Interstate Commission shall establish a database of all physicians licensed, or who have
applied for licensure, under section 5.
(b) Notwithstanding any other provision of law, member boards shall report to the Interstate
Commission any public action or complaints against a licensed physician who has applied or
received an expedited license through the compact.
(c) Member boards shall report disciplinary or investigatory information determined as necessary
and proper by rule of the Interstate Commission.
(d) Member boards may report any nonpublic complaint, disciplinary, or investigatory
information not required by subsection (c) to the Interstate Commission.
(e) Member boards shall share complaint or disciplinary information about a physician upon
request of another member board.
(f) All information provided to the Interstate Commission or distributed by member boards shall
be confidential, filed under seal, and used only for investigatory or disciplinary matters.
(g) The Interstate Commission is authorized to develop rules for mandated or discretionary
sharing of information by member boards.
SECTION 9: JOINT INVESTIGATIONS
(a) Licensure and disciplinary records of physicians are deemed investigative.
(b) In addition to the authority granted to a member board by its respective Medical Practice Act
or other applicable state law, a member board may participate with other member boards in joint
investigations of physicians licensed by the member boards.
(c) A subpoena issued by a member state shall be enforceable in other member states.
(d) Member boards may share any investigative, litigation, or compliance materials in furtherance
of any joint or individual investigation initiated under the compact.
(e) Any member state may investigate actual or alleged violations of the statutes authorizing the
practice of medicine in any other member state in which a physician holds a license to practice
SECTION 10: DISCIPLINARY ACTIONS
(a) Any disciplinary action taken by any member board against a physician licensed through the
compact shall be deemed unprofessional conduct which may be subject to discipline by other
member boards, in addition to any violation of the Medical Practice Act or regulations in that state.
(b) If a license granted to a physician by the member board in the state of principal license is
revoked, surrendered or relinquished in lieu of discipline, or suspended, then all licenses issued to
the physician by member boards shall automatically be placed, without further action necessary by
any member board, on the same status. If the member board in the state of principal license
subsequently reinstates the physician's license, a license issued to the physician by any other member
board shall remain encumbered until that respective member board takes action to reinstate the
license in a manner consistent with the Medical Practice Act of that state.
(c) If disciplinary action is taken against a physician by a member board not in the state of
principal license, any other member board may deem the action conclusive as to matter of law and
fact decided, and:
Impose the same or lesser sanction(s) against the physician so long as such sanctions are
consistent with the Medical Practice Act of that state; or
Pursue separate disciplinary action against the physician under its respective Medical
Practice Act, regardless of the action taken in other member states.
(d) If a license granted to a physician by a member board is revoked, surrendered or relinquished
in lieu of discipline, or suspended, then any license(s) issued to the physician by any other member
board(s) shall be suspended, automatically and immediately without further action necessary by the
other member board(s), for ninety days upon entry of the order by the disciplining board, to permit
the member board(s) to investigate the basis for the action under the Medical Practice Act of that
state. A member board may terminate the automatic suspension of the license it issued prior to the
completion of the ninety day suspension period in a manner consistent with the Medical Practice Act
of that state.
SECTION 11: INTERSTATE MEDICAL LICENSURE COMPACT COMMISSION
(a) The member states hereby create the Interstate Medical Licensure Compact Commission.
(b) The purpose of the Interstate Commission is the administration of the Interstate Medical
Licensure Compact, which is a discretionary state function.
(c) The Interstate Commission shall be a body corporate and joint agency of the member states
and shall have all the responsibilities, powers, and duties set forth in the compact, and such
additional powers as may be conferred upon it by a subsequent concurrent action of the respective
legislatures of the member states in accordance with the terms of the compact.
(d) The Interstate Commission shall consist of two voting representatives appointed by each
member state who shall serve as commissioners. In states where allopathic and osteopathic
physicians are regulated by separate member boards, or if the licensing and disciplinary authority is
split between multiple member boards within a member state, the member state shall appoint one
representative from each member board. A commissioner shall be a(n):
Allopathic or osteopathic physician appointed to a member board;
Executive director, executive secretary, or similar executive of a member board; or
Member of the public appointed to a member board.
(e) The Interstate Commission shall meet at least once each calendar year. A portion of this
meeting shall be a business meeting to address such matters as may properly come before the
commission, including the election of officers. The chairperson may call additional meetings and
shall call for a meeting upon the request of a majority of the member states.
(f) The bylaws may provide for meetings of the Interstate Commission to be conducted by
telecommunication or electronic communication.
(g) Each commissioner participating at a meeting of the Interstate Commission is entitled to one
vote. A majority of commissioners shall constitute a quorum for the transaction of business, unless
a larger quorum is required by the bylaws of the Interstate Commission. A commissioner shall not
delegate a vote to another commissioner. In the absence of its commissioner, a member state may
delegate voting authority for a specified meeting to another person from that state who shall meet
the requirements of subsection (d).
(h) The Interstate Commission shall provide public notice of all meetings and all meetings shall
be open to the public. The Interstate Commission may close a meeting, in full or in portion, where
it determines by a two-thirds vote of the commissioners present that an open meeting would be likely
Relate solely to the internal personnel practices and procedures of the Interstate
Discuss matters specifically exempted from disclosure by federal statute;
Discuss trade secrets, commercial, or financial information that is privileged or
Involve accusing a person of a crime, or formally censuring a person;
Discuss information of a personal nature where disclosure would constitute a clearly
unwarranted invasion of personal privacy;
Discuss investigative records compiled for law enforcement purposes; or
Specifically relate to the participation in a civil action or other legal proceeding.
(i) The Interstate Commission shall keep minutes which shall fully describe all matters discussed
in a meeting and shall provide a full and accurate summary of actions taken, including record of any
roll call votes.
(j) The Interstate Commission shall make its information and official records, to the extent not
otherwise designated in the compact or by its rules, available to the public for inspection.
(k) The Interstate Commission shall establish an executive committee, which shall include
officers, members, and others as determined by the bylaws. The executive committee shall have the
power to act on behalf of the Interstate Commission, with the exception of rulemaking, during
periods when the Interstate Commission is not in session. When acting on behalf of the Interstate
Commission, the executive committee shall oversee the administration of the compact including
enforcement and compliance with the provisions of the compact, its bylaws and rules, and other such
duties as necessary.
(l) The Interstate Commission may establish other committees for governance and administration
of the compact.
SECTION 12: POWERS AND DUTIES OF THE INTERSTATE COMMISSION
The Interstate Commission shall have the duty and power to:
Oversee and maintain the administration of the compact;
Promulgate rules which shall be binding to the extent and in the manner provided for in
Issue, upon the request of a member state or member board, advisory opinions concerning
the meaning or interpretation of the compact, its bylaws, rules, and actions;
Enforce compliance with compact provisions, the rules promulgated by the Interstate
Commission, and the bylaws, using all necessary and proper means, including but not
limited to the use of judicial process;
Establish and appoint committees including, but not limited to, an executive committee
as required by section 11, which shall have the power to act on behalf of the Interstate
Commission in carrying out its powers and duties;
Pay, or provide for the payment of the expenses related to the establishment, organization,
and ongoing activities of the Interstate Commission;
Establish and maintain one or more offices;
Borrow, accept, hire, or contract for services of personnel;
Purchase and maintain insurance and bonds;
Employ an executive director who shall have such powers to employ, select or appoint
employees, agents, or consultants, and to determine their qualifications, define their
duties, and fix their compensation;
Establish personnel policies and programs relating to conflicts of interest, rates of
compensation, and qualifications of personnel;
Accept donations and grants of money, equipment, supplies, materials and services, and
to receive, utilize, and dispose of it in a manner consistent with the conflict of interest
policies established by the Interstate Commission;
Lease, purchase, accept contributions or donations of, or otherwise to own, hold, improve
or use, any property, real, personal, or mixed;
Sell, convey, mortgage, pledge, lease, exchange, abandon, or otherwise dispose of any
property, real, personal, or mixed;
Establish a budget and make expenditures;
Adopt a seal and bylaws governing the management and operation of the Interstate
Report annually to the Legislatures and Governors of the member states concerning the
activities of the Interstate Commission during the preceding year. Such reports shall also
include reports of financial audits and any recommendations that may have been adopted
by the Interstate Commission;
Coordinate education, training, and public awareness regarding the compact, its
implementation, and its operation;
Maintain records in accordance with the bylaws;
Seek and obtain trademarks, copyrights, and patents; and
Perform such functions as may be necessary or appropriate to achieve the purposes of the
SECTION 13: FINANCE POWERS
(a) The Interstate Commission may levy on and collect an annual assessment from each member
state to cover the cost of the operations and activities of the Interstate Commission and its staff. The
total assessment must be sufficient to cover the annual budget approved each year for which revenue
is not provided by other sources. The aggregate annual assessment amount shall be allocated upon
a formula to be determined by the Interstate Commission, which shall promulgate a rule binding
upon all member states.
(b) The Interstate Commission shall not incur obligations of any kind prior to securing the funds
adequate to meet the same.
(c) The Interstate Commission shall not pledge the credit of any of the member states, except by,
and with the authority of, the member state.
(d) The Interstate Commission shall be subject to a yearly financial audit conducted by a certified
or licensed public accountant and the report of the audit shall be included in the annual report of the
SECTION 14: ORGANIZATION AND OPERATION OF THE INTERSTATE COMMISSION
(a) The Interstate Commission shall, by a majority of commissioners present and voting, adopt
bylaws to govern its conduct as may be necessary or appropriate to carry out the purposes of the
compact within twelve months of the first Interstate Commission meeting.
(b) The Interstate Commission shall elect or appoint annually from among its commissioners a
chairperson, a vice-chairperson, and a treasurer, each of whom shall have such authority and duties
as may be specified in the bylaws. The chairperson, or in the chairperson's absence or disability, the
vice-chairperson, shall preside at all meetings of the Interstate Commission.
(c) Officers selected in subsection (b) shall serve without remuneration from the Interstate
(d) The officers and employees of the Interstate Commission shall be immune from suit and
liability, either personally or in their official capacity, for a claim for damage to or loss of property
or personal injury or other civil liability caused or arising out of, or relating to, an actual or alleged
act, error, or omission that occurred, or that such person had a reasonable basis for believing
occurred, within the scope of Interstate Commission employment, duties, or responsibilities;
provided that such person shall not be protected from suit or liability for damage, loss, injury, or
liability caused by the intentional or willful and wanton misconduct of such person.
The liability of the executive director and employees of the Interstate Commission or
representatives of the Interstate Commission, acting within the scope of such person's
employment or duties for acts, errors, or omissions occurring within such person's state,
may not exceed the limits of liability set forth under the constitution and laws of that state
for state officials, employees, and agents. The Interstate Commission is considered to be
an instrumentality of the states for the purposes of any such action. Nothing in this
subsection shall be construed to protect such person from suit or liability for damage, loss,
injury, or liability caused by the intentional or willful and wanton misconduct of such
The Interstate Commission shall defend the executive director, its employees, and subject
to the approval of the attorney general or other appropriate legal counsel of the member
state represented by an Interstate Commission representative, shall defend such Interstate
Commission representative in any civil action seeking to impose liability arising out of
an actual or alleged act, error or omission that occurred within the scope of Interstate
Commission employment, duties or responsibilities, or that the defendant had a
reasonable basis for believing occurred within the scope of Interstate Commission
employment, duties, or responsibilities, provided that the actual or alleged act, error, or
omission did not result from intentional or willful and wanton misconduct on the part of
To the extent not covered by the state involved, member state, or the Interstate
Commission, the representatives or employees of the Interstate Commission shall be held
harmless in the amount of a settlement or judgment, including attorney's fees and costs,
obtained against such persons arising out of an actual or alleged act, error, or omission
that occurred within the scope of Interstate Commission employment, duties, or
responsibilities, or that such persons had a reasonable basis for believing occurred within
the scope of Interstate Commission employment, duties, or responsibilities, provided that
the actual or alleged act, error, or omission did not result from intentional or willful and
wanton misconduct on the part of such persons.
SECTION 15: RULE-MAKING FUNCTIONS OF THE INTERSTATE COMMISSION
(a) The Interstate Commission shall promulgate reasonable rules in order to effectively and
efficiently achieve the purposes of the compact. Notwithstanding the foregoing, in the event the
Interstate Commission exercises its rule-making authority in a manner that is beyond the scope of
the purposes of the compact, or the powers granted hereunder, then such an action by the Interstate
Commission shall be invalid and have no force or effect.
(b) Rules deemed appropriate for the operations of the Interstate Commission shall be made
pursuant to a rule-making process that substantially conforms to the Model State Administrative
Procedure Act of 2010, and subsequent amendments thereto.
(c) Not later than thirty days after a rule is promulgated, any person may file a petition for
judicial review of the rule in the United States District Court for the District of Columbia or the
federal district where the Interstate Commission has its principal offices, provided that the filing of
such a petition shall not stay or otherwise prevent the rule from becoming effective unless the court
finds that the petitioner has a substantial likelihood of success. The court shall give deference to the
actions of the Interstate Commission consistent with applicable law and shall not find the rule to be
unlawful if the rule represents a reasonable exercise of the authority granted to the Interstate
SECTION 16: OVERSIGHT OF INTERSTATE COMPACT
(a) The executive, legislative, and judicial branches of state government in each member state
shall enforce the compact and shall take all actions necessary and appropriate to effectuate the
compact's purposes and intent. The provisions of the compact and the rules promulgated hereunder
shall have standing as statutory law but shall not override existing state authority to regulate the
practice of medicine.
(b) All courts shall take judicial notice of the compact and the rules in any judicial or
administrative proceeding in a member state pertaining to the subject matter of the compact which
may affect the powers, responsibilities or actions of the Interstate Commission.
(c) The Interstate Commission shall be entitled to receive all service of process in any such
proceeding, and shall have standing to intervene in the proceeding for all purposes. Failure to
provide service of process to the Interstate Commission shall render a judgment or order void as to
the Interstate Commission, the compact, or promulgated rules.
SECTION 17: ENFORCEMENT OF INTERSTATE COMPACT
(a) The Interstate Commission, in the reasonable exercise of its discretion, shall enforce the
provisions and rules of the compact.
(b) The Interstate Commission may, by majority vote of the commissioners, initiate legal action
in the United States District Court for the District of Columbia, or, at the discretion of the Interstate
Commission, in the federal district where the Interstate Commission has its principal offices, to
enforce compliance with the provisions of the compact, and its promulgated rules and bylaws,
against a member state in default. The relief sought may include both injunctive relief and damages.
In the event judicial enforcement is necessary, the prevailing party shall be awarded all costs of such
litigation including reasonable attorney's fees.
(c) The remedies herein shall not be the exclusive remedies of the Interstate Commission. The
Interstate Commission may avail itself of any other remedies available under state law or the
regulation of a profession.
SECTION 18: DEFAULT PROCEDURES
(a) The grounds for default include, but are not limited to, failure of a member state to perform
such obligations or responsibilities imposed upon it by the compact, or the rules and bylaws of the
Interstate Commission promulgated under the compact.
(b) If the Interstate Commission determines that a member state has defaulted in the performance
of its obligations or responsibilities under the compact, or the bylaws or promulgated rules, the
Interstate Commission shall:
Provide written notice to the defaulting state and other member states, of the nature of the
default, the means of curing the default, and any action taken by the Interstate
Commission. The Interstate Commission shall specify the conditions by which the
defaulting state must cure its default; and
Provide remedial training and specific technical assistance regarding the default.
(c) If the defaulting state fails to cure the default, the defaulting state shall be terminated from
the compact upon an affirmative vote of a majority of the commissioners and all rights, privileges,
and benefits conferred by the compact shall terminate on the effective date of termination. A cure
of the default does not relieve the offending state of obligations or liabilities incurred during the
period of the default.
(d) Termination of membership in the compact shall be imposed only after all other means of
securing compliance have been exhausted. Notice of intent to terminate shall be given by the
Interstate Commission to the Governor, the majority and minority leaders of the defaulting state's
Legislature, and each of the member states.
(e) The Interstate Commission shall establish rules and procedures to address licenses and
physicians that are materially impacted by the termination of a member state, or the withdrawal of
a member state.
(f) The member state which has been terminated is responsible for all dues, obligations, and
liabilities incurred through the effective date of termination including obligations, the performance
of which extends beyond the effective date of termination.
(g) The Interstate Commission shall not bear any costs relating to any state that has been found
to be in default or which has been terminated from the compact, unless otherwise mutually agreed
upon in writing between the Interstate Commission and the defaulting state.
(h) The defaulting state may appeal the action of the Interstate Commission by petitioning the
United States District Court for the District of Columbia or the federal district where the Interstate
Commission has its principal offices. The prevailing party shall be awarded all costs of such
litigation including reasonable attorney's fees.
SECTION 19: DISPUTE RESOLUTION
(a) The Interstate Commission shall attempt, upon the request of a member state, to resolve
disputes which are subject to the compact and which may arise among member states or member
(b) The Interstate Commission shall promulgate rules providing for both mediation and binding
dispute resolution as appropriate.
SECTION 20: MEMBER STATES, EFFECTIVE DATE AND AMENDMENT
(a) Any state is eligible to become a member state of the compact.
(b) The compact shall become effective and binding upon legislative enactment of the compact
into law by no less than seven states. Thereafter, it shall become effective and binding on a state
upon enactment of the compact into law by that state.
(c) The Governors of nonmember states, or their designees, shall be invited to participate in the
activities of the Interstate Commission on a nonvoting basis prior to adoption of the compact by all
(d) The Interstate Commission may propose amendments to the compact for enactment by the
member states. No amendment shall become effective and binding upon the Interstate Commission
and the member states unless and until it is enacted into law by unanimous consent of the member
SECTION 21: WITHDRAWAL
(a) Once effective, the compact shall continue in force and remain binding upon each and every
member state; provided that a member state may withdraw from the compact by specifically
repealing the statute which enacted the compact into law.
(b) Withdrawal from the compact shall be by the enactment of a statute repealing the same, but
shall not take effect until one year after the effective date of such statute and until written notice of
the withdrawal has been given by the withdrawing state to the Governor of each other member state.
(c) The withdrawing state shall immediately notify the chairperson of the Interstate Commission
in writing upon the introduction of legislation repealing the compact in the withdrawing state.
(d) The Interstate Commission shall notify the other member states of the withdrawing state's
intent to withdraw within sixty days of its receipt of notice provided under subsection (c).
(e) The withdrawing state is responsible for all dues, obligations and liabilities incurred through
the effective date of withdrawal, including obligations, the performance of which extend beyond the
effective date of withdrawal.
(f) Reinstatement following withdrawal of a member state shall occur upon the withdrawing state
reenacting the compact or upon such later date as determined by the Interstate Commission.
(g) The Interstate Commission is authorized to develop rules to address the impact of the
withdrawal of a member state on licenses granted in other member states to physicians who
designated the withdrawing member state as the state of principal license.
SECTION 22: DISSOLUTION
(a) The compact shall dissolve effective upon the date of the withdrawal or default of the member
state which reduces the membership in the compact to one member state.
(b) Upon the dissolution of the compact, the compact becomes null and void and shall be of no
further force or effect, and the business and affairs of the Interstate Commission shall be concluded
and surplus funds shall be distributed in accordance with the bylaws.
SECTION 23: SEVERABILITY AND CONSTRUCTION
(a) The provisions of the compact shall be severable, and if any phrase, clause, sentence, or
provision is deemed unenforceable, the remaining provisions of the compact shall be enforceable.
(b) The provisions of the compact shall be liberally construed to effectuate its purposes.
(c) Nothing in the compact shall be construed to prohibit the applicability of other interstate
compacts to which the states are members.
SECTION 24: BINDING EFFECT OF COMPACT AND OTHER LAWS
(a) Nothing herein prevents the enforcement of any other law of a member state that is not
inconsistent with the compact.
(b) All laws in a member state in conflict with the compact are superseded to the extent of the
(c) All lawful actions of the Interstate Commission, including all rules and bylaws promulgated
by the commission, are binding upon the member states.
(d) All agreements between the Interstate Commission and the member states are binding in
accordance with their terms.
(e) In the event any provision of the compact exceeds the constitutional limits imposed on the
Legislature of any member state, such provision shall be ineffective to the extent of the conflict with
the constitutional provision in question in that member state.
Source: SL 2015, ch 198, § 1.
36-4-45 Use of general funds to support Interstate Medical Licensure Compact prohibited.
Use of general funds to support Interstate Medical Licensure Compact prohibited.
No state general funds shall be used to support the Interstate Medical Licensure Compact.
Source: SL 2015, ch 198, § 2.
36-4-46 Practice of certified professional midwife.
Practice of certified professional midwife.
Nothing in this chapter restricts the right
of a certified professional midwife to practice in accordance with chapter 36-9C.
Source: SL 2017, ch 172, § 36.