Case Title: N.C. Dep't of Corr. v. N.C. Med. Bd.

Citation: 363 N.C. 189

Docket Number: 51PA08

State: north-carolina

Court: North Carolina Supreme Court

Date: 2009-05-01T00:00:00Z

Document:
NORTH CAROLINA DEPARTMENT OF CORRECTION; THEODIS BECK, Secretary
of the North Carolina Department of Correction, in his official
capacity; and GERALD J. BRANKER, Warden of Central Prison, in his
official capacity v. NORTH CAROLINA MEDICAL BOARD
No. 51PA08  
FILED: 1 MAY 2009
1.
Declaratory Judgments–standing–justiciable controversy
Plaintiffs had standing in a declaratory judgment action involving defendant’s
position statement on physicians and executions.  The actions of two governmental entities, both
seeking to fulfill their statutory duties, were in irreconcilable conflict so that a justiciable
controversy exists.
2.
Declaratory Judgments–physician participation in executions–ripeness
A declaratory judgment action involving defendant N.C. Medical Board’s
position statement on physicians and executions was ripe for decision.  The existence of pending
litigation about an ancillary matter does not render the issue presented here  nonjusticiable, nor
does the fact that defendant has not yet disciplined a medical doctor for participating in an
execution.  The determinative point is that plaintiffs are hindered in their ability to perform their
statutory duties because they are unable to find a physician willing to subject himself or herself
to discipline for participating in an execution.
3.
Declaratory Judgments–court’s statement–not an erroneous statement of
fact
The trial court did not erroneously decide a question of fact in a declaratory
judgment action concerning physician participation in executions by a statement regarding the
historical practice.  The court’s order does not demonstrate that its decision was based on this
statement, the statement was not designated as a finding or conclusion and can be considered
surplusage, and the decision rested solely upon conclusions of law and stated no findings.
4.
Sentencing–capital–physician participation
N.C.G.S. § 15-190, by its plain language, envisions physician participation in
executions in some professional capacity, and defendant N.C. Medical Board’s position
statement exceeds its authority because it directly contravenes specific requirement of physician
presence found in that statute.
Justice HUDSON dissenting.
Chief Justice PARKER and Justice TIMMONS-GOODSON join in this
dissenting opinion.
On discretionary review pursuant to N.C.G.S. § 7A-31,
prior to a determination by the Court of Appeals, of an amended
order granting plaintiffs’ request for declaratory relief and
denying defendant’s motion to dismiss entered on 5 October 2007
by Judge Donald W. Stephens in Superior Court, Wake County.  On
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1 At the time this action was commenced, Theodis Beck was
the Secretary of the North Carolina Department of Correction and
brought suit in his official capacity.  Alvin W. Keller, Jr. is
the current Secretary of the North Carolina Department of
29 April 2008, the Supreme Court allowed defendant’s petition for
discretionary review as to additional issues.  Heard in the
Supreme Court 18 November 2008.
Roy Cooper, Attorney General, by Thomas J. Pitman,
Special Deputy Attorney General, and Joseph Finarelli,
Assistant Attorney General, for plaintiff-appellees.
D. Todd Brosius and Thomas W. Mansfield for defendant-
appellant.
Nelson Mullins Riley & Scarborough LLP, by Wallace C. 
Hollowell, III, for American Medical Association,
amicus curiae.
Timothy C. Miller for Federation of State Medical
Boards of the U.S., Inc., amicus curiae.
Womble Carlyle Sandridge & Rice, PLLC, by Sarah L.
Buthe, for Physicians for Human Rights, amicus curiae.
BRADY, Justice.
In January 2007 the North Carolina Medical Board
(Medical Board) issued a Position Statement on physician
participation in executions.  This statement prohibits physicians
licensed to practice medicine in North Carolina, under the threat
of disciplinary action, from any participation other than
certifying the fact of the execution and simply being present at
the time of the execution.  Because of this Position Statement,
physicians have declined to participate in executions in any
manner, which has resulted in a de facto moratorium on executions
in North Carolina.  To rectify this situation, plaintiffs North
Carolina Department of Correction, Theodis Beck, and Marvin Polk1
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Correction.  Additionally, Marvin Polk was Warden of Central
Prison at the time of suit.  The current Warden of Central Prison
is plaintiff Gerald J. Branker, who was substituted as a party
for former Warden Polk on 24 July 2007.
brought suit seeking injunctive relief prohibiting the Medical
Board from taking any disciplinary action against physicians for
participating in an execution and a declaratory judgment
delineating the rights and obligations of plaintiffs and the
Medical Board with regards to executions.
This case presents four issues:  First, whether a
justiciable case or controversy exists between plaintiffs and the
Medical Board; second, whether any such case or controversy is
ripe for decision; third, whether the trial court impermissibly
made a finding of fact without accepting evidence from defendant;
and fourth, whether the Position Statement is inconsistent with
the manifest intent of the General Assembly in enacting N.C.G.S.
§ 15-190, which requires a physician to be present at all
executions.  We hold that plaintiffs have standing, that this
case is ripe for decision, that the trial court did not make an
improper finding of fact, and that the Position Statement is
inconsistent with N.C.G.S. § 15-190.  Accordingly, we affirm the
order of the trial court.
FACTUAL AND PROCEDURAL BACKGROUND
Brown v. Beck
The genesis of the present controversy was a case in
the United States District Court for the Eastern District of
North Carolina challenging the constitutionality of North
Carolina’s lethal injection protocol.  In Brown v. Beck, a
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condemned prisoner filed a 42 U.S.C. § 1983 action seeking
injunctive relief to allow time to review the protocol and
procedures the State intended to employ in his upcoming
execution.  2006 WL 3914717 (E.D.N.C. Apr. 7, 2006) (No.
5:06CT3018 H).  The plaintiff contended that the protocol and
procedures the defendant agents of the Department of Correction
intended to use were constitutionally deficient because of (1)
their failure to “ensure that the personnel responsible for
anesthesia are appropriately trained and qualified,” and (2)
their lack of “adequate standards for administering injections
and monitoring consciousness.”  Id. at *1.  The plaintiff also
objected to the defendants’ failure “to make adequate efforts to
identify and address contingencies that may arise during
execution.”  Id.  Judge Malcolm J. Howard conditionally denied
the plaintiff’s motion for a preliminary injunction, but found
that the plaintiff “has raised substantial questions as to
whether North Carolina’s execution protocol creates an undue risk
of excessive pain.”  Id. at *8.  The court found “that the
questions raised could be resolved by the presence of medical
personnel who are qualified to ensure that Plaintiff is
unconscious at the time of his execution,” and it ordered
defendants to promptly “file with this Court and serve upon
Plaintiff a notice setting forth the plans and qualifications of
such personnel.”  Id.  On 12 April 2006, the defendants submitted
a revised execution protocol requiring the use of additional
equipment to monitor the prisoner’s level of consciousness and
specifying that the equipment would be “observed and its values
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2 The Position Statement, according to defendant, is a “non-
binding interpretive statement that merely warns that a physician
actively participating in [a] judicial execution ‘may be subject
to disciplinary action’ by the Medical Board.”
read by” both a licensed registered nurse and a licensed
physician.  On 17 April 2006, the court found the plaintiff’s
objections to the revised protocol to be without merit and denied
the injunctive relief sought, stating, inter alia, that the court
“is satisfied by the State’s plan to use a licensed registered
nurse and a licensed physician to monitor the level of
plaintiff’s consciousness.”  Brown (Apr. 17, 2006) (Final Order). 
The Issuance of the Medical Board’s Position Statement
In April 2006 the Medical Board received a complaint
alleging that a physician was scheduled to participate in an
execution.  The Medical Board investigated this complaint and
determined it was unfounded.  Following other inquiries about the
Medical Board’s position on executions, the Medical Board issued
the following Position Statement2 in January 2007:
CAPITAL PUNISHMENT
The North Carolina Medical Board takes the
position that physician participation in
capital punishment is a departure from the
ethics of the medical profession within the
meaning of N.C. Gen. Stat. § 90-14(a)(6). 
The North Carolina Medical Board adopts and
endorses the provisions of AMA Code of
Medical Ethics Opinion 2.06 printed below
except to the extent that it is inconsistent
with North Carolina state law.
The Board recognizes that N.C. Gen. Stat. §
15-190 requires the presence of “the surgeon
or physician of the penitentiary” during the
execution of condemned inmates.  Therefore,
the Board will not discipline licensees for
merely being “present” during an execution in
conformity with N.C. Gen. Stat. § 15-190. 
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However, any physician who engages in any
verbal or physical activity, beyond the
requirements of N.C. Gen. Stat. § 15-190,
that facilitates the execution may be subject
to disciplinary action by this Board. 
Relevant Provisions of AMA Code of 
Medical Ethics Opinion 2.06
An individual’s opinion on capital punishment
is the personal moral decision of the
individual.  A physician, as a member of a
profession dedicated to preserving life when
there is hope of doing so, should not be a
participant in a legally authorized
execution.  Physician participation in
execution is defined generally as actions
which would fall into one or more of the
following categories:  (1) an action which
would directly cause the death of the
condemned; (2) an action which would assist,
supervise, or contribute to the ability of
another individual to directly cause the
death of the condemned; (3) an action which
could automatically cause an execution to be
carried out on a condemned prisoner.
Physician participation in an execution
includes, but is not limited to, the
following actions:  prescribing or
administering tranquilizers and other
psychotropic agents and medications that are
part of the execution procedure; monitoring
vital signs on site or remotely (including
monitoring electrocardiograms); attending or
observing an execution as a physician; and
rendering of technical advice regarding
execution.
In the case where the method of execution is
lethal injection, the following actions by
the physician would also constitute physician
participation in execution:  selecting
injection sites; starting intravenous lines
as a port for a lethal injection device;
prescribing, preparing, administering, or
supervising injection drugs or their doses or
types; inspecting, testing, or maintaining
lethal injection devices; and consulting with
or supervising lethal injection personnel.
The following actions do not constitute
physician participation in execution:  (1)
testifying as to medical history and
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diagnoses or mental state as they relate to
competence to stand trial, testifying as to
relevant medical evidence during trial,
testifying as to medical aspects of
aggravating or mitigating circumstances
during the penalty phase of a capital case,
or testifying as to medical diagnoses as they
relate to the legal assessment of competence
for execution; (2) certifying death, provided
that the condemned has been declared dead by
another person; (3) witnessing an execution
in a totally nonprofessional capacity; (4)
witnessing an execution at the specific
voluntary request of the condemned person,
provided that the physician observes the
execution in a nonprofessional capacity; and
(5) relieving the acute suffering of a
condemned person while awaiting execution,
including providing tranquilizers at the
specific voluntary request of the condemned
person to help relieve pain or anxiety in
anticipation of the execution.
Official Change in Protocol
On 25 January 2007, a preliminary injunction staying
all executions was entered by the Superior Court, Wake County, in
a case separate from the case at bar.  The Superior Court
concluded in its order that the earlier change in protocol made
by the Department of Correction and Warden Polk must be submitted
to and approved by the Governor and Council of State.  Thus, on 6
February 2007, the Department of Correction and Warden Polk
presented an updated Execution Protocol to the Governor and
Council of State pursuant to N.C.G.S. § 15-188.  The submitted
Protocol contained the following section on personnel:
The Warden shall ensure that the lethal
injection procedure is administered by
personnel who are qualified to set up and
prepare the injections described above,
administer the preinjections, insert the IV
catheter, and to perform other tasks required
for this procedure in accordance with the
requirements of Article 19 [of Chapter 15 of
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the General Statutes] and this Execution
Protocol.  Medical doctors, physician
assistants, advanced degree nurses,
registered nurses, and emergency medical
technician-paramedics, who are licensed or
certified by their respective licensing
boards and organizations, shall be deemed
qualified to participate in the execution
procedure.  As required by Article 19, a
licensed medical doctor shall be present at
each execution.  The doctor shall monitor the
essential body functions of the condemned
inmate and shall notify the Warden
immediately upon his or her determination
that the inmate shows signs of undue pain or
suffering.  The Warden will then stop the
execution.  The doctor shall also be
responsible for certifying the death of the
inmate at such time as he or she determines
the procedure has been completed as required
by N.C.G.S. § 15-192.
That same day, the Governor and Council of State approved the
proposed Protocol.   
In Warden Polk’s second affidavit, filed in conjunction
with plaintiff’s amended complaint, Warden Polk affirmed:
14.  On behalf of Plaintiffs, I have
solicited physicians licensed by the State of
North Carolina and employed by or contracting
with the North Carolina Department of
Correction in an effort to locate a licensed
physician who would be willing to participate
or otherwise be involved in executions of
condemned inmates in North Carolina despite
the impending threat of disciplinary action
by the [Medical] Board for violation of the
Position Statement and the ethics of the
medical profession.
15.  My solicitation efforts have been
unsuccessful as all licensed physicians I
have contacted, including current employees
of the North Carolina Department of
Correction, have advised that they refuse to
subject themselves to disciplinary action by
the [Medical] Board for participating or
otherwise being involved in a judicial
execution.
16.  The potential for disciplinary
action against licensed physicians has
prevented plaintiffs from locating a licensed
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physician willing to be present for the
execution of any condemned inmate as required
by N.C. Gen. Stat. § 15-190.  Further, the
absence of a licensed physician from an
execution by lethal injection would violate
N.C. Gen. Stat. § 15-190.
Because plaintiffs believed they could not carry out their
statutory responsibility to execute condemned inmates because of
the Medical Board’s Position Statement, plaintiffs filed suit
against the Medical Board, seeking injunctive relief and a
declaratory judgment.  The Medical Board filed a Motion to
Dismiss pursuant to Rule 12(b)(6) of the North Carolina Rules of
Civil Procedure and also argued that plaintiffs lacked standing
and that there was no justiciable case or controversy.
Following arguments by the parties, Judge Donald
Stephens of the Superior Court, Wake County, made the following
declarations of law on 1 October 2007:
7.  Logic and common sense would suggest
that the requirements in N.C. Gen. Stat. §§
15-190 and -192, -- imposing a specific duty
and task upon the surgeon or physician of
Central Prison to be “present” for executions
and to “certify the fact of the execution” --
are indicative of a statutory intent by the
General Assembly to require the attendance
and professional participation of a physician
by reason of that individual’s occupation,
training and expertise in medicine.  The
legislature intended that a physician be
present to perform medical tasks attendant to
an execution for which the physician is
uniquely qualified, including:  (1) ensuring,
to the extent possible, that the condemned
inmate is not subjected to unnecessary and
excessive pain which could constitute cruel
and unusual punishment prohibited by the
Eight[h] Amendment to the United States
Constitution and Section 27 of the North
Carolina Constitution; and (2) examining the
inmate at the conclusion of the procedure for
the purpose of determining and pronouncing
death.
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8.  The plain language of the Medical
Board’s Position Statement prohibits any
professional conduct by the surgeon or
physician to assess and prevent unnecessary
or excessive pain experienced by the inmate,
including such activities as:  (1) monitoring
the essential body functions of the inmate;
(2) observing the monitoring equipment
assessing those body functions; (3) providing
professional expertise and medical advice to
correctional staff participating in the
execution; (4) notifying the Warden or other
correctional staff members of any perceived
problems with the establishment or
maintenance of the intravenous sites or with
the preparation and administration of the
required chemicals or with the adequacy of
the dosage units of those chemicals to be
administered to a particular inmate to
insured [sic] that the inmate would be
rendered unconscious and unlikely to
experience pain during the execution process. 
The physician is prohibited from treating any
medical problem or issue that might arise
during an execution and from actually
examining the inmate for any medical purpose,
including determining and pronouncing that
death has occurred.
9.  By the Medical Board’s Position
Statement, the Board has declared that the
medical activities outlined in paragraph 8
above, whether or not those activities are
required by the law and Constitutions of the
United States and North Carolina, violated
the ethics of the medical profession.  The
Board’s Position Statement prohibits such
activities and gives notice that any
physician participating in that conduct will
be subject to discipline even where the
activities are performed in accordance with
State law.
The trial court further declared that there was “a ripe and
justiciable case and controversy” between plaintiffs and
defendant and concluded as a matter of law that:
The Medical Practices Act of 1858, which
forms the origin of N.C. Gen. Stat. § 90-2,
was not intended to give to the North
Carolina Medical Board the authority to
prohibit doctors from performing specific
statutory tasks enacted by the legislature in
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other statutes including tasks which are
currently embodied in N.C. Gen. Stat. §§ 15-
190 and -192.  In creating those tasks in
1909, the legislature clearly intended that a
physician attend and provide professional
medical assessment, assistance and oversight
in every judicial execution compelled by law
upon inmates convicted and sentenced to death
by jury verdict in the superior courts of
this State.
Although the current effort by the
Medical Board to prohibit physician
participation in execut[ions] may well be
viewed as humane and noble, such a decision
rests entirely with representatives elected
by the citizens of this State, the North
Carolina General Assembly.  As of this date,
the legislature has taken no such action. 
Therefore, the trial court allowed plaintiffs’ requests for
preliminary and injunctive relief and declared that executions
are not medical procedures and thus are outside the scope of
Chapters 90 and 131E of the North Carolina General Statutes.
The Medical Board gave notice of appeal from the trial
court’s order, but on 6 February 2008, plaintiffs sought review
by this Court prior to the determination of the matter by the
Court of Appeals.  The Medical Board filed a petition for
discretionary review as to additional issues on 18 February 2008. 
We allowed plaintiffs’ petition on 10 April 2008 and the Medical
Board’s petition on 29 April 2008.  We now affirm the trial
court’s decision.
ANALYSIS
Existence of a Case or Controversy
[1] We first address defendant’s arguments that the
trial court erred in determining that a justiciable case or
controversy exists.  
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The Superior Court has jurisdiction to
render a declaratory judgment only when the
pleadings and evidence disclose the existence
of a genuine controversy between the parties
to the action, arising out of conflicting
contentions as to their respective legal
rights and liabilities under a deed, will,
contract, statute, ordinance, or franchise.
Nationwide Mut. Ins. Co. v. Roberts, 261 N.C. 285, 287, 134
S.E.2d 654, 656-57 (1964) (citations omitted).  Thus, we must
determine whether there exists a genuine controversy between
plaintiffs and defendant “arising out of conflicting contentions
as to their respective legal rights and liabilities under a . . .
statute.”  Id.  
Section 15-188 provides in pertinent part:
The superintendent of the State penitentiary
shall also cause to be provided, in
conformity with this Article and approved by
the Governor and Council of State, the
necessary appliances for the infliction of
the punishment of death and qualified
personnel to set up and prepare the
injection, administer the preinjections,
insert the IV catheter, and to perform other
tasks required for this procedure in
accordance with the requirements of [Article
19 of Chapter 15 of the General Statutes].
N.C.G.S. § 15-188 (2007).  Moreover, our General Statutes provide
that: 
The execution shall be under the general
supervision and control of the warden of the
penitentiary, who shall from time to time, in
writing, name and designate the guard or
guards or other reliable person or persons
who shall cause the person, convict or felon
against whom the death sentence has been
pronounced to be executed as provided by this
Article and all amendments thereto.  At such
execution there shall be present the warden
or deputy warden . . . and the surgeon or
physician of the penitentiary.  
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Id. § 15-190 (2007).  Thus, the General Assembly has mandated
that the Warden of Central Prison ensure the execution of inmates
condemned to death by requiring the Warden to “cause to be
provided . . . qualified personnel . . .  to perform other tasks
required for this procedure.” Id. § 15-188.  The General Assembly
has also required that the “surgeon or physician of the
penitentiary” be “present” when the death sentence is executed. 
Id. § 15-190. 
Chapter 90 of our General Statutes places
responsibility on defendant “to regulate the practice of medicine
and surgery for the benefit and protection of the people of North
Carolina,” id. § 90-2(a) (2007), which includes the authority to
discipline physicians for failure to adhere to “the ethics of the
medical profession,” id. § 90-14(a)(6) (2007).
Plaintiffs, in attempting to fulfill their statutory
duty while also complying with the constraints of the North
Carolina and United States Constitutions, produced a protocol
envisioning physician participation in administering the death
penalty, which was presented to and approved by the Governor and
the Council of State.  The Medical Board, seeking to fulfill its
statutory duty to promote the ethical practice of medicine,
developed a Position Statement which prohibits physician
participation in an execution.  Thus, the actions of two
governmental entities, both seeking to fulfill their statutory
duties, are in irreconcilable conflict.  Plaintiffs cannot carry
out their statutory duty to execute condemned inmates under the
Execution Protocol without subjecting a physician to discipline
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by the Medical Board.  As such, there is a genuine controversy
between plaintiffs and defendant “arising out of conflicting
contentions as to their respective legal rights and liabilities
under a . . . statute.”  Roberts, 261 N.C. at 287, 134 S.E.2d at
656-57.  We agree with the trial court’s declaration of law that
plaintiffs have standing to litigate this issue.  Accordingly,
defendant’s assignments of error are overruled.
Ripeness
[2] Next, defendant argues that any case and
controversy  between the parties is not yet ripe for decision
because (1) there is pending litigation challenging the
procedures used by the Council of State in approving the current
protocol and (2) defendant “has not yet had before it a matter
involving active participation by a physician in a judicial
execution.”  We disagree.  The existence of pending litigation
involving a matter ancillary to the case at bar does not render
the issue presented here unripe.  There is no standing court
order that would otherwise prohibit plaintiffs from performing
their statutory duty to conduct executions.  Instead, the only
issue currently preventing plaintiffs from fulfilling their
statutory duties is their inability to find a physician willing
to participate in an execution in contravention of defendant’s
Position Statement.  Simply put, the existence of litigation at a
lower level that may later affect plaintiff’s ability to fulfill
their statutory duties does not render the instant issue of
statutory interpretation nonjusticiable.  Moreover, this issue is
not unripe simply because defendant has not yet disciplined a
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medical doctor for participating in an execution.  The
determinative point is that plaintiffs are hindered in their
ability to perform their statutory duties because they are unable
to find a physician willing to subject himself or herself to
discipline for participating in an execution.  Accordingly, it is
irrelevant that a specific case addressing such conduct has not
yet come before the Medical Board.  We conclude that this matter
is ripe for judicial review, and defendant’s assignments of error
are thus overruled.
The Trial Court’s Statement on Physician Participation
[3] Defendant argues that the trial court erroneously
decided a question of fact or a mixed question of law and fact
when the trial judge stated during the hearing:  “I believe that
historically whether required by statute or not, physicians have
taken an active role in this procedure.  I can’t believe in 1907
that the physician required (inaudible) to observe and be present
at an execution did not examine the deceased and pronounce the
deceased dead.”  Defendant asserts that the trial court lacked
any evidence to support its statement and that the court erred in
refusing defendant’s request to offer evidence on the role
physicians have historically played in executions.  Defendant’s
argument is without merit.  First, the trial court’s order
evinces nothing that demonstrates or even intimates that the
trial court based its decision, in whole or in part, upon whether
physicians took an active role in executions before passage of
the 1909 statute.  Moreover, the trial court’s statement was not
designated as a finding of fact, nor was it included in the trial
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court’s declarations of law or conclusions of law in its order. 
Therefore, the statement is not essential to the trial court’s
decision and can be considered surplusage.  Finally, our
conclusion is consistent with the mandate to the trial court that
it “find the facts specially and state separately its conclusion
of law thereon” when the action is “tried upon the facts without
a jury.”  N.C.G.S. § 1A-1, Rule 52(a) (2007).  Here, the trial
court’s order stated no findings of fact, and its decision did
not determine or rest upon any disputed facts, but solely upon
declarations and conclusions of law.  Defendant’s assignments of
error are overruled.  
The Validity of the Position Statement
[4] Having concluded that a genuine case or controversy
exists and that this matter is ripe for decision, we turn to the
overriding issue in the instant case--the meaning of the word
“present” in N.C.G.S. § 15-190.  
When the language of a statute is clear
and without ambiguity, it is the duty of this
Court to give effect to the plain meaning of
the statute, and judicial construction of
legislative intent is not required.  However,
when the language of a statute is ambiguous,
this Court will determine the purpose of the
statute and the intent of the legislature in
its enactment.
Diaz v. Div. of Soc. Servs., 360 N.C. 384, 387, 628 S.E.2d 1, 3
(2006) (citing Burgess v. Your House of Raleigh, Inc., 326 N.C.
205, 209, 388 S.E.2d 134, 136 (1990) and Coastal Ready-Mix
Concrete Co. v. Bd. of Comm’rs, 299 N.C. 620, 629, 265 S.E.2d
379, 385 (1980) (“The best indicia of that intent are the
language of the statute or ordinance, the spirit of the act and
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what the act seeks to accomplish.”)).  Because the actual words
of the legislature are the clearest manifestation of its intent,
we give every word of the statute effect, presuming that the
legislature carefully chose each word used.  See Rhyne v. K-Mart
Corp., 358 N.C. 160, 188, 594 S.E.2d 1, 20 (2004) (stating that
“this Court does not read segments of a statute in isolation”).  
Applying these long-standing rules of statutory
construction, we determine that the statutes at issue are clear
and unambiguous.  Therefore, there is no need for us to resort to
other rules of statutory construction, but simply to apply the
statutes as written to the case at bar.  Diaz, 360 N.C. at 387,
628 S.E.2d at 3.   
In support of its argument that the General Assembly
never intended a physician to actively participate in an
execution, defendant asserts that we should consider the
legislative history of Sections 15-190 and 15-192 and the two-
decade-long interpretation of the statute by plaintiffs.  This we
decline to do.  Initially, we note that defendant’s recitation of
the legislative history of Sections 15-190 and 15-192 relies
heavily upon the modification of the mode of execution in North
Carolina from asphyxiation to lethal injection in 1983. 
Specifically, defendant relies on the decision of the 1983 Senate
Judiciary Committee to not include a provision requiring that a
physician administer the ultrashort-acting barbiturate and
chemical paralytic agent that cause the condemned inmate’s death. 
However, this decision of a legislative committee consisting of a
small percentage of a single house of our bicameral legislature
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seventy-three years after the enactment of the statutory language
at issue carries no weight in our determination of the intent of
the enacting legislature. 
First, this Court has previously recognized the rule
“that ordinarily the intent of the legislature is indicated by
its actions, and not by its failure to act.”  Styers v. Phillips,
277 N.C. 460, 472-73, 178 S.E.2d 583, 589-91 (1971) (“‘Courts can
find the intent of the legislature only in the acts which are in
fact passed, and not in those which are never voted upon in
Congress, but which are simply proposed in committee.’” (quoting 
United States v. Allen, 179 F. 13, 19 (8th Cir. 1910), aff’d as
modified on other grounds by Goat v. United States, 224 U.S. 458
(1912), and by Deming Inv. Co. v. United States, 224 U.S. 471
(1912))).  That a legislature declined to enact a statute with
specific language does not indicate the legislature intended the
exact opposite.  Id. at 472, 178 S.E.2d at 589 (declining “‘to
attribute any such attitude to the Legislature’” and noting that
a party’s argument as to why a bill failed to pass “‘can be
nothing more than conjecture’” and “‘[m]any other reasons for
legislative inaction readily suggest themselves’” (quoting Moore
v. Bd. of Chosen Freeholders, 76 N.J. Super. 396, 404, 184 A.2d
748, 752, modified on other grounds, 39 N.J. 26, 186 A.2d 676
(1962))).  Finally, “[i]n determining legislative intent, this
Court does not look to the record of the internal deliberations
of committees of the legislature considering proposed
legislation.”  Elec. Supply Co. of Durham v. Swain Elec. Co., 328
N.C. 651, 657, 403 S.E.2d 291, 295 (1991).  For all of these
-19-
reasons, the committee’s decision to not present the bill with
language requiring that a physician administer the lethal agents 
bears no weight on whether the General Assembly foreclosed any
physician participation.  Moreover, plaintiffs’ prior
interpretation of the statute at issue is irrelevant in our
determination of the intent of the legislation as derived from
the plain language of the statute. 
Additionally, defendant asserts that the history
surrounding the 1909 enactment of N.C.G.S. § 15-190 supports its
position that the legislature did not envision physician
participation in any way during the condemned inmate’s execution. 
Specifically, defendant argues that in 1909 the method of
execution was changed from hanging by the sheriff in the county
of conviction to electrocution at Central Prison, and thus, the
physician was only required to be present to certify the death of
the condemned inmate.  See N.C.G.S. § 15-192 (2007) (which has
remained unchanged since it was enacted in 1909 and reads in
pertinent part:  “The Warden, together with the surgeon or
physician of the penitentiary, shall certify the fact of the
execution of the condemned prisoner . . . .”).  Defendant argues
that it would have been impossible for a physician to participate
in an execution by using monitoring equipment in 1909 to measure
the progress of, and any possible undue pain and suffering caused
by, the electrocution.  We observe that to the contrary, it would
not be necessary for a physician to be present at the execution
itself to certify the death of the condemned inmate.  The deaths
of our citizenry are certified all across this State on a daily
-20-
3 Or, as stated during oral arguments, “a potted plant.”
basis, and rarely, if ever, is the professional certifying death
present at the time the death occurs.  Moreover, the absence of
monitoring equipment in 1909 did not diminish a physician’s
special skill and knowledge of the human body and his or her
ability to recognize when a human being is suffering an
inordinate amount of pain.  To accept defendant’s interpretation
of the 1909 statute would require us to determine that the 1909
legislature merely intended that a licensed medical doctor be
present only as an uninvolved onlooker3 during an inmate’s
execution.  Common sense dictates otherwise.
Section 15-190 requires a physician to be present at
the execution of a condemned inmate.  The General Assembly did
not include such a requirement simply to have a “professional”
present at the time of the execution without that individual
supplying some sort of professional assistance.  The warden or
his designee is required to be present to perform his duty to
carry out the execution.  The condemned inmate’s legal counsel
may be present, certainly in his or her professional capacity.  A
clergy member may be present, certainly in his or her
professional capacity.  Two of the three learned professions
(attorneys and clergy) are allowed to attend an execution and are
presumably permitted to act in a manner commensurate with the
duties of their profession, but, according to defendant, the
third (physician) is required simply to be present and not act in
any professional capacity.  See N.C.G.S. § 15-190; Patronelli v.
Patronelli, 360 N.C. 628, 630, 636 S.E.2d 559, 561 (detailing the
-21-
three learned professions).  To assert that the physician is to
merely occupy space in a non-professional capacity is simply
illogical and renders unintelligible the requirement that “the
surgeon or physician of the penitentiary” be present.  N.C.G.S. §
15-190.
Thus, the General Assembly has specifically envisioned
some sort of medical participation in the execution process,  and
defendant’s Position Statement runs afoul of N.C.G.S. § 15-190 by
completely prohibiting physician participation in executions. 
While defendant would retain disciplinary power over a licensed
medical doctor who participates in an execution, see N.C.G.S. §
90-14, defendant may not discipline or threaten discipline
against its licensees solely for participating in the execution
alone.  To allow defendant to discipline its licensees for mere
participation would elevate the created Medical Board over the
creator General Assembly.
Moreover, the language of the Protocol itself, as
submitted by the Warden and approved by the Governor and Council
of State does not overstep the statutory authority of those
officials to determine and approve the exact means of execution. 
Exceptional care was taken when drafting the Protocol to ensure
that it would not cause a physician to violate the Hippocratic
Oath.  Under the Protocol, the physician is not required to
administer the lethal agents, nor is the physician required to do
anything other than “monitor the essential body functions of the
condemned inmate and [ ] notify the Warden immediately upon his
or her determination that the inmate shows signs of undue pain or
-22-
suffering.”  The physician is given authority in the Protocol to
ensure that no undue harm is inflicted on the condemned inmate:
if the physician determines there is undue pain or suffering,
“[t]he Warden will then stop the execution.”  Certainly, the
Protocol’s requirement that a physician help prevent “undue pain
or suffering” is consistent with the physician’s oath to “do no
harm.”  The Warden is well within his authority to require such
monitoring, and defendant is without power to prevent the Warden
from doing so.  Defendant’s assignments of error are overruled.
CONCLUSION
Accordingly, we hold that N.C.G.S. § 15-190, by its
plain language, envisions physician participation in executions
in some professional capacity.  Defendant’s Position Statement
exceeds its authority under Chapter 90 of the North Carolina
General Statutes because the Statement directly contravenes the
specific requirement of physician presence found in N.C.G.S. §
15-190.  Because plaintiffs have standing, a genuine controversy
exists, the issue is ripe for decision, and the trial court did
not impermissibly decide questions of fact or fail to allow
additional presentation of evidence; and because the Position
Statement is an invalid exercise of defendant’s statutory powers,
we affirm the decision of the trial court.
AFFIRMED. 
Justice HUDSON dissenting.
Because I believe that changes in statutory language
and definitions are fundamentally tasks for the legislature, not
-23-
the courts, I respectfully dissent.  Here, the General Assembly
has given defendant, the North Carolina Medical Board, broad
authority to discipline physicians, and in my view, the
nonbinding Position Statement at issue comports with that
authority.  The Statement is also entirely consistent with the
requirements of N.C.G.S. §§ 15-190 and -192, in that it indicates
that a physician will not be disciplined for “merely being
‘present’ during an execution,” as required by the plain language
of those statutes.  Nevertheless, the majority’s holding here
oversteps our role by fashioning a definition of “present” that
would create a conflict between two governmental entities where
there currently is none.  I would instead find that no genuine
case or controversy appropriate for the courts exists between
these parties.
The General Assembly granted the following authority to
defendant:
(a) The Board shall have the power to
place on probation with or without
conditions, impose limitations and conditions
on, publicly reprimand, assess monetary
redress, issue public letters of concern,
mandate free medical services, require
satisfactory completion of treatment programs
or remedial or educational training, fine,
deny, annul, suspend, or revoke a license, or
other authority to practice medicine in this
State, issued by the Board to any person who
has been found by the Board to have committed
any of the following acts or conduct, or for
any of the following reasons:
. . . .
(6)
Unprofessional conduct, including,
but not limited to, departure from,
or the failure to conform to, the
standards of acceptable and
prevailing medical practice, or the
ethics of the medical profession,
irrespective of whether or not a
-24-
patient is injured thereby, or the
committing of any act contrary to
honesty, justice, or good morals,
whether the same is committed in
the course of the physician’s
practice or otherwise, and whether
committed within or without North
Carolina.
N.C.G.S. § 90-14(a)(6) (2007) (emphases added).  This sweeping
authority, by its plain language, permits defendant to discipline
licensees even for actions not committed during the course of
medical practice and for matters occurring outside of our state. 
This statute, which has been a part of North Carolina law in one
form or another since the Medical Practices Act of 1858, reflects
our legislature’s intention to confer on defendant broad powers
to regulate its own profession.  Nevertheless, in a holding that
finds the Position Statement in question to be “an invalid
exercise of defendant’s statutory powers,” the majority fails to
recognize or even discuss the comprehensive nature of the
“statutory powers” granted to defendant by the General Assembly.
In their amended complaint, plaintiffs allege that
because of defendant’s Position Statement, physicians are
“compelled . . . to choose between jeopardizing their employment
. . . or subjecting themselves to potential disciplinary action
by Defendant.”  Plaintiffs contend that, as a direct result of
this fear of discipline, plaintiffs have been unable to locate a
physician “willing to participate or otherwise be involved in a
judicial execution,” leading to their being “unable to carry out
those duties the laws of North Carolina empower and require
[them] to complete.”  Plaintiffs then asked the trial court (1)
to enjoin defendant from disciplining any licensed physicians for
-25-
involvement in executions carried out by plaintiffs; (2) to
“declare the rights and obligations” of the parties; and (3) to
declare that “a judicial execution is not a medical procedure”
and thus “outside the authority of Defendant [under N.C.G.S. §
14-90] . . . to oversee or regulate, despite the involvement of a
licensed physician.”  The trial court entered an order granting
all three of these requests. 
As recounted by the majority and by defendant in its
brief to this Court, “[t]he genesis of the present controversy”
was the order entered in Brown v. Beck, 2006 WL 3914717 (E.D.N.C.
Apr. 7, 2006) (No. 5:06CT3018 H), in which a federal district
court judge compelled these plaintiffs to file “a notice setting
forth the plans and qualifications of such [medical] personnel”
“who are qualified to ensure that [a condemned prisoner] is
unconscious at the time of his execution.”  Id., at *8.  The
revised protocol submitted by these plaintiffs included a
provision that a condemned prisoner’s level of consciousness
would be monitored by a “licensed medical doctor.” 
Following entry of the final order in Brown, and in
direct response to “several inquiries from physicians . . .
seeking guidance,” defendant “[r]ealiz[ed] that the proper role
of physicians in executions would likely be a recurrent issue”
and “determined that it would be appropriate to consider issuing
a Position Statement regarding the ethical implications and
potential disciplinary consequences” of such a role.  Beginning
in the latter half of 2006, defendant undertook to draft and
-26-
issue this Position Statement and ultimately adopted it in
January 2007, pursuant to its statutory authority.
According to defendant, its Position Statement
“attempted to harmonize the Medical Board’s obligation to enforce
the ethics of the medical profession with the statutory
requirements of sections 15-190 and -192 . . . that a physician
be ‘present’ at a judicial execution and certify the execution.” 
Although the majority erroneously characterizes the Position
Statement as “prohibit[ing] physicians licensed to practice
medicine in North Carolina, under the threat of disciplinary
action, from any participation” in an execution, it does not.  In
fact, the nonbinding, interpretive Statement provides only that
“any physician who engages in any verbal or physical activity,
beyond the requirements of N.C. Gen. Stat. § 15-190, that
facilitates the execution may be subject to disciplinary action
by this Board.” (Emphasis added.) The statement prohibits no
conduct, but merely acknowledges the possibility that defendant
could discipline a physician who acts beyond the statutory
requirement of being “present,” and provides defendant’s guidance
as to what might constitute participation beyond that statutory
requirement.
Moreover, the Statement explicitly provides that the
Board “will not discipline licensees for merely being ‘present’
during an execution in conformity with N.C. Gen. Stat. § 15-190.” 
The portion of the Statement defining “physician participation”
in executions was adopted from an American Medical Association’s
(AMA) Code of Medical Ethics opinion “except to the extent that
-27-
it is inconsistent with North Carolina state law,” thereby
ensuring that a licensed physician will not run afoul of the
Position Statement if her “participation” falls within statutory
guidelines set forth by our legislature.  Indeed, I believe
defendant succeeded in walking the fine line between its
statutory mandate to “regulate the practice of medicine,”
N.C.G.S. § 90-2(a) (2007), including disciplining licensed
physicians for failing to adhere to “the ethics of the medical
profession,” id. § 90-14(a)(6), and the statutory requirement
that a physician be “present” at all executions, id. § 15-190
(2007). 
Contrary to plaintiffs’ contentions and the majority’s
analysis, the plain language of defendant’s Position Statement is
consistent with both the broad grant of authority outlined in
N.C.G.S. § 90-14(a)(6) and the specific requirement of being
“present” in N.C.G.S. § 15-190.  In fact, it is the majority’s
attempts to discern the legislature’s intent and meaning by the
word “present,” and defendant’s use of the word “participation,”
that create a conflict between the statute and the Position
Statement.  I note as well that plaintiffs, when arguing before
the trial court in this case, likewise averred that defendant’s
Position Statement “changes nothing.  The doctor can still be
present.  He can still sign the death certificate.”  
It was only when plaintiffs sought to allay the Eighth
Amendment concerns of the federal judge in the Eastern District
of North Carolina, by assuring him that the condemned prisoner
would be unconscious during the administration of lethal drugs,
-28-
that plaintiffs promised the more active participation
(“monitoring”) by physicians in executions.  That representation-
-again, by plaintiffs, not defendant--gave rise to North Carolina
physicians’ uncertainty as to their proper role in executions and
defendant’s corresponding need to issue a nonbinding,
interpretive Position Statement that reiterated the statutory
requirement of being “present” but cautioned that further actions
should be limited by physicians’ ethical responsibilities as
medical professionals.
This case was brought under the Uniform Declaratory
Judgment Act, which gives courts the power to “determine[] any
question of construction or validity arising under the
instrument, statute, ordinance, contract, or franchise” in which
a party is “interested” or “affected.”  N.C.G.S. § 1-254 (2007). 
We have previously held that before our courts acquire
jurisdiction under the Act a “genuine controversy between the
parties” must exist.  Nationwide Mut. Ins. Co. v. Roberts, 261
N.C. 285, 287, 134 S.E.2d 654, 656 (1964) (citations omitted). 
As noted by Justice Ervin:
There is much misunderstanding as to the
object and scope of [the Uniform Declaratory
Judgment Act].  Despite some notions to the
contrary, it does not undertake to convert
judicial tribunals into counsellors and
impose upon them the duty of giving advisory
opinions to any parties who may come into
court and ask for either academic
enlightenment or practical guidance
concerning their legal affairs.  This
observation may be stated in the vernacular
in this wise:  The Uniform Declaratory
Judgment Act does not license litigants to
fish in judicial ponds for legal advice.
-29-
Lide v. Mears, 231 N.C. 111, 117, 56 S.E.2d 404, 409 (1949)
(internal citations omitted).
In the context of a challenge to the constitutionality
of a city ordinance, this Court noted:
“The validity or invalidity of a statute in
whole or in part, is to be determined in
respect of its adverse impact upon personal
or property rights in a specific factual
situation. . . .”
Our Uniform Declaratory Judgment Act
does not authorize the adjudication of mere
abstract or theoretical questions.  Neither
was this act intended to require the Court to
give advisory opinions when no genuine
controversy presently exists between the
parties. 
Angell v. City of Raleigh, 267 N.C. 387, 391-92, 148 S.E.2d 233,
236 (1966) (emphasis added) (citations omitted).  In Angell, we
found no such “genuine justiciable controversy” between the
parties because the City of Raleigh had “issued no license
pursuant to the provisions of the ordinance alleged to be
unconstitutional” at the time of the lawsuit.  Id. at 392, 148
S.E.2d at 236.  This Court has also held:
Although it is not necessary that one
party have an actual right of action against
another to satisfy the jurisdictional
requirement of an actual controversy, it is
necessary that litigation appear unavoidable. 
Mere apprehension or the mere threat of an
action or a suit is not enough. 
Gaston Bd. of Realtors, Inc. v. Harrison, 311 N.C. 230, 234, 316
S.E.2d 59, 61-62 (1984) (emphasis added) (citations omitted).
Plaintiffs essentially ask the courts to redefine
“present,” as used in N.C.G.S. § 15-190, to include
“participation” as used in defendant’s Position Statement, in
order to create a controversy entitling them to a declaratory
-30-
judgment.  Such “bootstrapping” may not generally provide the
basis for declaratory judgment.  See Griffin v. Fraser, 39 N.C.
App. 582, 587, 251 S.E.2d 650, 654 (1979) (holding that a
complaint seeking a ruling creating a new interpretation of the
Internal Revenue Code that would then create a genuine
controversy between the parties “[did] not suffice for the
jurisdictional prerequisites of a declaratory judgment action”). 
Instead, the genuine controversy must appear from the complaint
and the record.  See, e.g., Hubbard v. Josey, 267 N.C. 651, 652,
148 S.E.2d 638, 639 (1966) (per curiam) (“The test of the
sufficiency of a complaint in a declaratory judgment proceeding
is not whether the complaint shows that the plaintiff is entitled
to the declaration of rights in accordance with his theory, but
whether he is entitled to a declaration of rights at all, so that
even if the plaintiff is on the wrong side of the controversy, if
he states the existence of a controversy which should be settled,
he states a cause of suit for a declaratory judgment.” (quotation
and citation omitted)).  To the extent there is a controversy
here, it was created by plaintiffs when they included in the 2007
Execution Protocol the requirement that a licensed physician
monitor the consciousness of the condemned inmate.  
Further, it is far from clear how enjoining defendant
from disciplining physicians will achieve the result sought by
plaintiffs, namely, the resumption of executions.  The court
order below neither requires that physicians be involved at
executions nor that executions proceed.  While the majority is
certainly correct in its assertion that the parties have
-31-
“conflicting contentions as to their respective legal rights and
liabilities under a . . . statute,” Roberts, 261 N.C. at 287, 134
S.E.2d at 656-57, the controversy concerns primarily whether
defendant’s authority to discipline physicians for their conduct
includes their participation in executions.  Until evidence shows
that a physician is actually facing discipline, or refuses to be
present at an execution solely because of fears of discipline,
preventing defendant from disciplining physicians will not
necessarily result in a physician serving at an execution, in
light of the AMA Code of Medical Ethics.  Thus, plaintiffs fail
to show that the declaratory judgment they seek can redress their
alleged injury.  See, e.g., Allen v. Wright, 468 U.S. 737, 751,
82 L. Ed. 2d 556, 569 (1984) (holding that, to establish
standing, “[a] plaintiff must allege personal injury fairly
traceable to the defendant’s allegedly unlawful conduct and
likely to be redressed by the requested relief.” (citation
omitted)).  
In addition, unless and until litigation related to the
2007 Execution Protocol has ended, we are unable to determine
with any accuracy what precise role is required of a physician in
an execution in North Carolina.  More significantly, we cannot
know if there is a conflict between that role and the provisions
of defendant’s Position Statement.  The majority’s holding here,
or any attempt by this Court to interpret N.C.G.S. § 15-190 and
the word “present,” has the effect of redefining--and essentially
dictating--that role, a task that is better left to the
legislature.  The General Assembly granted defendant broad
-32-
authority to regulate the medical profession, and may limit that
authority, should it so desire, to exclude participation in
executions.  Indeed, our legislature has recognized its
responsibility in this regard, as bills are currently pending in
both the House and Senate that would remove executions from
defendant’s authority and prohibit defendant from taking any
disciplinary action against a licensed physician who provides
professional assistance at such an execution.  See S. 161, 149th
Gen. Assem., 2009 Sess. (N.C. 2009) (“Execution/Physician
Assistance Authorized”); H. 784, 149th Gen. Assem., 2009 Sess.
(N.C. 2009) (“Execution/Physician Assistance Authorized”).  It is
not for this Court to do so, nor is it a proper application of
the Uniform Declaratory Judgment Act and the courts’ power to
enjoin.
For this Court to issue a ruling now in this matter
would run afoul of the prohibition against advisory opinions and
would lead instead to recklessly “entangling [our]selves in
abstract disagreements over administrative policies.”  Nat’l Park
Hospitality Ass’n v. Dep’t of Interior, 538 U.S. 803, 807, 155 L.
Ed. 2d 1017, 1024 (2003) (citations omitted).  Rather, we should
seek to “protect the agencies from judicial interference until an
administrative decision has been formalized and its effects felt
in a concrete way by the challenging parties.”  Id. at 807-08,
155 L. Ed. 2d at 1024 (citations omitted).  As “ripeness is
peculiarly a question of timing,” Reg’l Rail Reorg. Act Cases,
419 U.S. 102, 140, 42 L. Ed. 2d 320, 351 (1974), perhaps we will
be presented with these issues again at a future date.  For
-33-
4 The lack of evidence in the record before us on several
critical questions also shows why this matter is not yet ripe for
judicial review.  No evidence was allowed to show what
“participation” has entailed for the last one hundred years.  Nor
do we have any showing, beyond plaintiffs’ hearsay assertions,
that the non-binding, interpretive Position Statement is the sole
reason that licensed physicians in North Carolina have declined
to be present at executions, rather than because of their own
individual opposition to the death penalty, scheduling conflicts,
discomfort with the way their role has been defined in the
revised 2007 Execution Protocol, or some other reason.  “It is
not our practice to decide causes where essential facts wander
elusively in the realm of surmise.”  Boswell v. Boswell, 241 N.C.
515, 519, 85 S.E.2d 899, 902 (1955). 
example, a proper court challenge to defendant’s Position
Statement might be brought by a North Carolina licensed physician
who is present at an upcoming execution and receives notice of
disciplinary action for his “participation,” whatever that
entails.  Such a scenario would provide us with the concrete
facts necessary to determine whether the application of
defendant’s Position Statement, pursuant to its statutory
authority under section 90-14(a)(6), runs afoul of the General
Assembly’s specific provision in section 15-190 for the presence
of a physician at executions.  Unlike the majority’s holding
here, we would not be fashioning our own definitions in the
absence of any evidence as to what “participation” has been,
essentially allowing plaintiffs to “‘put [a purely advisory
opinion] on ice to be used if and when occasion might arise.’”4 
Harrison, 311 N.C. at 234, 316 S.E.2d at 62 (citation omitted).
The majority’s analysis of the statutes in question
illustrates the hazards we risk by engaging in such speculation. 
While I agree with the majority’s statement, “[t]hat a
legislature declined to enact a statute with specific language
-34-
does not indicate the legislature intended the exact opposite,”
surely it must also be the case that the failure to enact a
provision must be taken as an indication that the legislature
did, in fact, intend not to have the effect of the specific
language it rejected.  We know that our General Assembly refused
to require a physician to administer the drugs involved in
executions, yet the majority’s holding here today would ignore
that explicit rejection as immaterial to the question of “medical
participation.”  Instead, it would graft upon the word “present”
some professional responsibilities, despite the legislature’s
failure to refer to “physicians” at all in the detailed language
of N.C.G.S. § 15-188 concerning how lethal injections should be
administered.  As these matters of wording are the result of
legislative action, they are best left to the General Assembly to
clarify.
Again, however, I emphasize that defendant’s
nonbinding, interpretive Position Statement, and its provision
that physicians “may be subject to disciplinary action” for
activities beyond the requirements of N.C.G.S. § 15-190, are not
inconsistent with either the plain language of N.C.G.S. § 15-190
or the broad authority granted by N.C.G.S. § 90-14(a)(6).  That
issue--not the meaning of the word “present,” nor that of
“participation”--is the primary question before this Court,
contrary to the majority’s interpretation of N.C.G.S. § 15-190.
Plaintiffs’ complaint specifically sought a declaration
“as to whether a judicial execution is not a medical procedure
and thus outside both the scope of Chapters 90 and 131E of the
-35-
North Carolina General Statutes and the authority of Defendant .
. . to oversee or regulate, despite the involvement of a licensed
physician.”  Defendant’s brief here asserts error in the trial
court’s finding, denominated as a conclusion and made without
benefit of any evidence, that an execution is not a medical event
or procedure.  While the trial court appears to have viewed this
conclusion as fundamental to its holding that the Statement “is
an invalid exercise of defendant’s statutory powers,” I disagree. 
The plain language of Section 90-14(a)(6) does not limit
defendant’s disciplinary authority to “medical procedures”; in
fact, it specifically provides the opposite, that defendant may
discipline licensees for unprofessional conduct whether
“committed in the course of the physician’s practice or
otherwise.”  N.C.G.S. § 90-14(a)(6) (emphasis added).  I would
hold that the Position Statement is a valid exercise of
defendant’s statutory authority.  Any change in that authority--
which is the practical effect of the majority opinion--is a
matter for the General Assembly which granted it, not for the
courts.
I believe defendant has carefully attempted to carry
out its duties under N.C.G.S. § 90-14(a)(6) and has done so in a
manner consistent with N.C.G.S. §§ 15-190 and -192.  By issuing
its Position Statement, defendant has neither prevented
plaintiffs from conducting an execution nor prohibited a
physician from being present at--or even participating in--such
an execution.  Reconciling these statutes and the Position
Statement, an execution could proceed if the Protocol allows and
-36-
plaintiffs locate a physician willing to be “present,” or to
“participate” and risk discipline.  If plaintiffs desire the
General Assembly to limit the authority it granted to defendant
under N.C.G.S. § 90-14(a)(6), they must ask the legislature, not
the courts, to do so.  Indeed, the central “fact” to the injury
alleged by plaintiffs is that defendant, in adopting the Position
Statement, “unilaterally acted to alter public policy to the
exclusion of the General Assembly, and bypassed the courts.” 
Thus, plaintiffs in their own pleading acknowledge the
legislative nature of their concern.
Because I conclude that this matter is properly for the
General Assembly and does not present a justiciable controversy
for declaratory judgment, I would reverse the trial court’s order
and remand for dismissal of this lawsuit.  Thus, I respectfully
dissent.
Chief Justice PARKER and Justice TIMMONS-GOODSON join
in this dissenting opinion.