North Carolina Supreme Court Sets New Precedent for Medical Malpractice Liability
In a recent decision by the North Carolina Supreme Court, liability for nurses was modified, specifically in the instant case as to Certified Registered Nurse Anesthetists (CRNAs), who “participate in the decision-making” with the supervising physician.
In Connette Ex. Rel. Gullatte v. Charlotte-Mecklenburg Hosp. Auth., plaintiffs petitioned the North Carolina Supreme Court for discretionary review of a decision by the North Carolina Court of Appeals wherein the Court of Appeals affirmed the trial court’s exclusion of plaintiffs’ evidence attempting to prove that the defendant CRNA, Gus C. VanSoestbergen, breached his duty of care with regard to his participation in the preparation and administration of a course of anesthesia to minor plaintiff.
The minor plaintiff, Amaya Gullatte, was being treated for cardiomyopathy. Prior to an ablation procedure, the anesthetics team administered anesthetic sevoflurane via a mask to the minor plaintiff. The anesthetics team included defendant CRNA VanSoestbergen and defendant anesthesiologist, James M. Doyle, M.D. Shortly after the administration of sevoflurane, minor plaintiff went into cardiac arrest. She was resuscitated, but the approximate 13-minute oxygen deprivation resulted in the onset of permanent brain damage, cerebral palsy, and profound developmental delay.
The plaintiffs brought an action for medical malpractice naming, among others, Dr. Doyle and CRNA VanSoestbergen. Ultimately, Dr. Doyle and his anesthesiology practice reached a settlement of plaintiffs’ claims against them, but CRNA VanSoestbergen’s claims remained. During the trial on the remaining claims, the plaintiffs attempted to admit evidence through an expert CRNA of a safer alternative to sevoflurane, namely intravenous introduction of etomidate instead of sevoflurane via mask. Plantiffs contended that it was a breach of the applicable standard of care to administer the latter to a patient with cardiomyopathy.
The pertinent testimony from defendants included Dr. Doyle’s testimony that he and CRNA VanSoestbergen collaborated on minor plaintiff’s plan of care as both medical professionals independently and identically determined that sevoflurane mask induction was the appropriate course of anesthesia to use. CRNA VanSoestbergen agreed with Dr. Doyle’s final decision to order this method of anesthesia to minor plaintiff after the two consulted.
Ultimately, trial court determined that the introduction of evidence concerning the professional standard of care that should apply to CRNA VanSoestbergen was precluded by prior case law, namely Byrd v. Marion Hospital, 202 N.C. 337 (1932). Verdict was entered in favor of CRNA VanSoestbergen and his hospital employer. The plaintiffs appealed and the Court of Appeals affirmed the trial court’s exclusion of the plaintiffs’ CRNA expert testimony. The Supreme Court thereafter granted the plaintiffs’ petition for discretionary review.
North Carolina Supreme Court’s Analysis
Throughout the Supreme Court’s analysis and reasoning in this case, it discussed the history of Byrd, the medical malpractice statutes, and the developments in the medical professional field in support of its opinion that a CRNA could be held liable for discharging his/her duties even while doing so under the supervision of a physician.
Byrd held that nurses do not owe a duty of care in the diagnosis and treatment of patients while working under supervision of a physician licensed to practice medicine in North Carolina. Byrd at 341-43. The Supreme Court reasoned in Byrd that “[n]urses are not supposed to be experts in the technique of diagnosis or mechanics of treatment” but rather “the physician is solely responsible for the diagnosis and treatment of his patient.” Id. at 341-42. As such, nurses could only be held liable for negligent treatment of a patient if (1) the nurse acted independently without the direction from and outside of the presence of a physician, or (2) the nurse undertook to carry out an order from a physician that “was so obviously negligent as to lead any reasonable person to anticipate that substantial injury would result.” Id. at 343, 341.
The Supreme Court then reasoned in the instant case that the medical malpractice statutes “collectively create the requirement of registered nurses to act in accordance with applicable and appropriate standards of practice and establish the burden of proof which a plaintiff must satisfy in order to demonstrate that a registered nurse has violated the expected applicable professional standard of care.” [emphasis added]
The Court went on to discuss the progression of the regulation of the nursing field, noting its tremendous evolvement over the past ninety years. The Supreme Court pointed out that the North Carolina Board of Nursing now oversees the additional licensing of certain types of specialized nurses, including CRNAs. Such additional categories require additional, advanced and focused education and certifications to practice in specialty areas of healthcare.
Finally, the Supreme Court pointed out a series of Court of Appeals cases that hesitated to apply Byrd following the development of the responsibilities placed on nurses to further support its decision to modify the rule in Byrd and reverse the decision of the Court of Appeals in the instant case. The resulting new rule is that “even in circumstances where a registered nurse is discharging duties and responsibilities under the supervision of a physician, a nurse may be held liable for negligence and for medical malpractice in the event that the registered nurse is found to have breached the applicable standard of care.”
In sum, it can be argued that this new precedent opens the door to additional claims in litigation against nurses. On the other hand, it also appears from the Supreme Court’s lengthy discussion that the decision should be limited to areas of specialized nursing. For that reason, it will be important to continue to follow the courts’ application and analyses on this issue, as this case will undoubtedly be the source for additional appeals and litigation in other cases.
 Specifically noting that it was not modifying the portion in Byrd that nurses may be held liable if a physician’s order is so obviously negligent as to lead any reasonable person to anticipate that substantial injury would result to the patient from execution of such order.