In a community as small as Powellsville, where fewer than 200 people call the town home, losing a patient to an overdose is not a distant headline. The North Carolina Medical Board has formally reprimanded local family physician Dr. Steven Wallace Ferguson after finding that lapses in his opioid prescribing preceded a patient’s fatal overdose on January 5, 2024. According to the board’s public order, Ferguson wrote high-dose opioid prescriptions for several patients without sufficiently documented histories, testing or follow-up.
What the board found
In a consent order from the North Carolina Medical Board, investigators refer to one individual as Patient A, who died on January 5, 2024, from an accidental overdose that involved multiple illicit drugs, including fentanyl and heroin. The order states that Ferguson prescribed oxycodone at roughly 135 morphine milligram equivalents per day, written as 30 milligrams every eight hours, and failed to document urine drug screenings, a thorough medical history or a review of the state prescription-monitoring database. The board concluded that these omissions departed from the standard of care and could have hidden signs of illicit substance use.
Other patients and missed safeguards
As reported by The Charlotte Observer, the board’s review extended beyond Patient A. Regulators found irregular opioid prescribing for at least three additional patients, including two who were prescribed the equivalent of 120 milligrams of oxycodone per day and another who received 240 milligrams of morphine daily. The outlet also notes that the board faulted Ferguson for failing to document discussions about naloxone and for not prescribing it to a high-dose morphine patient, despite what the order described as a clear overdose risk.
Guidance and the wider crisis
Federal recommendations point physicians toward nonopioid treatments for many types of chronic pain and call for built-in safeguards, including periodic urine drug testing and routine checks of prescription-monitoring databases. Those are among the risk-mitigation steps the board says were not consistently documented in Ferguson’s charts. The CDC’s 2022 clinical practice guideline outlines these measures and stresses that opioid therapy should be carefully tailored and closely monitored over time. That guidance exists against a sobering backdrop: national survey data from SAMHSA indicate that in recent years millions of Americans have been living with opioid use disorder, a reminder of how dangerous it can be when prescribing oversight falls short.
Board action and what comes next
The consent order does not suspend Ferguson’s license but does put conditions on it. The board issued a formal reprimand and directed him to complete at least 20 hours of comprehensive, live Category I continuing medical education focused on safe opioid prescribing within six months, according to the North Carolina Medical Board consent order. Regulators warned that if he fails to meet those requirements, he could face more serious discipline, including the possible suspension or revocation of his medical license.
Small-town impact
Ferguson practices in Powellsville, a Bertie County town with just under 180 residents, where access to medical care is limited and a single practice can feel like a lifeline. Attempts to reach him about the board’s action were unsuccessful: the local office phone was disconnected and emails were not returned, according to The Charlotte Observer. The paper also notes that Ferguson has been licensed to practice in North Carolina since 1993 and holds additional medical licenses in California and Virginia.
