North Carolina Supreme Court Removes Precedent Shielding Nurses from Medical Liability Claims

The Supreme Court of North Carolina overturned a 90-year-old state court precedent that protected nurses from civil liability when they were working under a physician’s supervision.

The underlying case, Connette v. Charlotte-Mecklenburg Hospital Authority, involved then three-year-old Amaya Gullatte, who suffered permanent brain damage, cerebral palsy and “profound developmental delay” after undergoing a procedure for a heart condition at Carolinas Medical Center.

An emergency room visit in 2010 for an upper respiratory infection revealed that Gullatte was tachycardic, and the child’s pediatrician referred her to a cardiologist. The cardiologist determined cardiomyopathy was the cause of Gullatte’s elevated heart rate and recommended an “ablation procedure” to address the disorder.

The child was admitted to a Carolinas Medical Center facility where an anesthetics team consisting of an anesthesiologist and a certified registered nurse anesthetist (CRNA) utilized a mask to administer the anesthetic sevoflurane to Gullatte prior to the surgical procedure. Shortly after she was induced with sevoflurane, Gullatte entered cardiac arrest. While resuscitation drugs and cardiopulmonary resuscitation revived Gullatte, she experienced approximately 13 minutes of oxygen deprivation that resulted in her permanent injuries. Plaintiff Edward Connette, as Gullatte’s guardian ad litem, filed a lawsuit against the anesthesiologist, the CRNA, the Charlotte-Mecklenburg Hospital Authority and two additional physicians who treated Gullatte.

The initial trial in 2016 spanned three months and concluded with a verdict in favor of the two additional treating physicians, but the jury failed to reach a decision on the claims against the anesthesiologist and CRNA. The anesthesiologist ultimately settled with the plaintiff.

During a second trial against the CRNA and his hospital employer in 2018, the plaintiffs intended to present expert testimony evidence that the manner in which the CRNA’s “formulation of, affirmation of and contribution to the decision to administer sevoflurane” by mask induction rather than an intravenous method breached the CRNA’s professional standard of care.

However, the trial court determined that evidence of a professional standard of care for CRNAs was precluded by precedent first set in Byrd v. Marion General Hospital. Under the state Supreme Court’s 1932 ruling, a nurse may not be held liable for following a doctor’s order unless “such order was so obviously negligent as to lead any reasonable person to anticipate that substantial injury would result to the patient from the execution of such order or performance of such direction.”

Excluding the expert testimony, the trial court observed that a nurse “may be liable for independent actions taken against a plaintiff but could not be held liable for planning and selecting the appropriate anesthesia technique because nurses operate under the compulsory supervision of physicians licensed to practice medicine.”

The North Carolina Court of Appeals affirmed the lower court’s exclusion of standard-of-care evidence in a unanimous decision because “the Byrd court’s holding is categorical, and it is controlling here.” Connette appealed the ruling to the Supreme Court of North Carolina.

The state Supreme Court diverged from the lower court rulings, arguing that “the nursing profession evolved tremendously over the 90 years since Byrd,” with the training, licensure, responsibility and scope of practice for nurses expanding greatly.

“The trial court’s evidentiary ruling, and the Court of Appeals’ affirmance of it, was dictated by the application of the principle entrenched by Byrd … which categorically establishes that nurses do not owe a duty of care in the diagnosis and treatment of patients while working under the supervision of a physician licensed to practice medicine in North Carolina,” wrote Justice Michael Morgan for the state Supreme Court’s majority. “Due to the evolution of the medical profession’s recognition of the increased specialization and independence of nurses in the treatment of patients over the course of the ensuing 90 years since this Court’s issuance of the Byrd opinion, we determine that it is timely and appropriate to overrule Byrd as it is applied to the facts of this case.”

As such, the high court reversed the lower courts’ exclusion of the standard of care testimony in Connette v. Charlotte-Mecklenburg Hospital Authority, remanding the case to the trial court for a new trial.