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N.C. Supreme Court overrules 90-year-old precedent protecting nurses from legal liability

Image by Yerson Retamal from Pixabay

Staff Report

Carolina Journal

A split N.C. Supreme Court has voted to overturn a 90-year-old state court precedent that protected nurses from legal liability. Because the majority decision secured just three votes on the seven-member court, it’s unclear how the latest ruling will affect future cases.

The case Connette v. Charlotte-Mecklenburg Hospital Authority followed actions taken in 2010. Then 3-year-old Amaya Gullatte suffered permanent brain damage, cerebral palsy, and “profound developmental delay” after a procedure for a heart condition at Carolinas Medical Center.

Amaya’s family sued the hospital, three doctors, and the certified registered nurse anesthetist who took part in the procedure. Only the CRNA and hospital remain as defendants in the current case.

A trial judge blocked testimony in 2018 that would have questioned the CRNA’s decisions in Amaya’s case. The judge cited a court precedent that stemmed from the 1932 case Byrd v. Marion General Hospital. It protected nurses from legal liability when they were working under a doctor’s supervision. In 2020 a unanimous N.C Appeals Court panel affirmed the trial court’s decision to exclude evidence about the CRNA’s work.

“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 … and its progeny 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 3-2 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 ninety 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.”

Morgan writes that the court “deems it to be opportune” to revisit the 90-year-old Byrd precedent “in light of the increased, influential roles which nurses occupy in medical diagnosis and treatment. We hold 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 professional standard of care.”

Justices “are mindful to avoid any intrusion upon the exclusive authority of the Legislature to reach complex policy judgments” and enact laws related to nurses’ legal liability, Morgan wrote. Yet “the law-making body has been silent” on the issue as nursing standards have evolved.

Justices Phil Berger Jr. and Sam “Jimmy” Ervin IV did not take part in the Connette case. Of the remaining five justices, three endorsed Morgan’s findings.

Justice Tamara Barringer wrote for the two dissenters. “The issue before this Court is whether a certified registered nurse anesthetist (CRNA) who collaborates with a doctor to select an anesthesia treatment can be liable for negligence in the selection of that treatment. Since 1932, this Court has held no, and the legislature has never required otherwise. In judicially changing this standard, the three-justice majority appears to create liability without causation — allowing a nurse to be held liable for negligent collaboration in the treatment ultimately chosen by the physician. Such a policy choice should be made by the legislature, not merely three Justices of this Court.”

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