regulation of Medicine


Roe v. Wade Ruling: Guidance, Support and Resources for Physicians

October 4, 2022

North Carolina Abortion Law


In August 2013, North Carolina passed a law banning abortion after the 20th week of pregnancy. In 2019, this law was blocked by a federal judge in North Carolina, allowing abortion up to fetal viability, which is typically 24 to 26 weeks. However, in August 2022, the same federal judge ruled that the law can no longer be blocked and that abortion is illegal after the 20th week of pregnancy due to the overturning of Roe v. Wade.[1]

An abortion after the 20th week is only permitted in North Carolina if the mother is likely to die or suffer substantial and irreversible harm due to the pregnancy. Unlike other states with similar bans, North Carolina does not make exceptions for fetal abnormalities, incest, rape or human trafficking.

As your professional liability insurance company, we believe it is important for you to understand how North Carolina abortion law may change your legal exposure.

Changes in Your Exposure [2]

The table below highlights some of the changes that you should be aware of as a physician, how they differ from prior law and potential implications for liability exposure.

New Provision

How Differs from Prior Law

Potential Exposure for MMIC Insureds

Abortions are illegal after the 20th week of pregnancy unless the exception applies.[3]

Note that while abortions after 16 weeks are legal, these abortions must be reported in accordance with the cited law.[4]

Also, note that removing ectopic pregnancies and deceased fetuses is allowed regardless of gestational age.

Abortions were previously legal up to fetal viability, which typically falls between 24 and 26 weeks of pregnancy.
This increases liability exposure for the physician because abortion care after 20 weeks is punishable by criminal penalties with only one exception and physicians must report abortive care after 16 weeks to remain in compliance with the law. 

Exception: A physician can perform an abortion if that physician determines an abortion is necessary to preserve the mother’s life or prevent a serious health risk to the mother.

Note, that a physician performing an abortion under this exception must for each abortive procedure provide the North Carolina Department of Health and Human Services a report explaining the medical emergency that warranted the abortion after the 20th week.[5]

    This exception existed in prior law.

    No new significant exposure.

    Potential Penalties

    Typically, medical liability policies do not cover violations of state law. A person found guilty of violating this North Carolina law is subject to a class H felony and must be imprisoned for four to 25 months depending on the severity and frequency of the offense and can be subject to fine.[6]


    Risk Management Techniques

    The following risk management techniques can help physicians mitigate their liability in this area:

    • Ensure that the medical record and laboratory results support the physician’s clinical decision-making process. Referencing North Carolina’s abortion laws and specific tenets alert the reader of awareness and compliance. An example of this may be: “Adhering to North Carolina’s abortion laws, the abortion is necessary to prevent the death or serious risk of a substantial physical impairment of the patient because of severe preeclampsia.”
    • Carefully review the hospital’s bylaws to ensure compliance with the facility’s rules regarding abortion and engage the hospital’s ethicist or medical ethics committee in challenging cases.
    • Ensure that the opinions about clinical impressions and medical necessity of abortion care are uniform across the healthcare team and that all providers document in the medical record in a consistent manner.
    • Some medical organizations recommend being as proactive as possible to potential patients with presentations that are not as straightforward. Some organizations are recommending that hospitals create a task force (including a lawyer familiar with applicable regulatory law, a physician and a maternal fetal medicine specialist) and an on-call representative to address these emergency situations that may not fit clearly within the legislation. This committee should be afforded the necessary legal protections.


      At MagMutual, we have always stood by our physicians and always will. You are our owners and we exist to serve and support you.  If you're a MagMutual policyholder and have questions about how a particular situation in your practice may be im­pacted by this law, please contact us in MyMagMutual via your My Account page.

      MagMutual Resources

      Roe v. Wade Overruled: What MagMutual's PolicyOwners Need to Know Now

      [1] The case, Dobbs v. Jackson Women’s Health Organization, overturned the 49-year precedent set in Roe v. Wade, declaring that the Constitution does not confer any right to abortion and that abortion care should be left to the states to decide.

      [2] This article and the information contained herein does not constitute legal advice and cannot replace legal advice. It does not summarize all of the changes to the current requirements nor all of the obligations contained in North Carolina’s abortion laws. We strongly urge you to contact your personal attorney for a detailed account of, and legal advice pertinent to, all the specific changes, requirements and consequences. This article is strictly for informational purposes. Nothing in this article shall create any type of attorney-client relationship.

      [3] N.C. Gen. Stat. § 14-45.1(b).

      [4] N.C. Gen. Stat. § 14-45.1(b1).

      [5] N.C. Gen. Stat. § 14-45.1(b1).

      [5] N.C. Gen. Stat. § 14-44; N.C. Gen. Stat. § 15A-1340.17.


      The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.