The Court of Appeals of North Carolina (“North Carolina Appellate Court”) stated in its opinion dated June 16, 2020: “Nearly a century ago, our Supreme Court rejected the notion that nurses can be liable for medical malpractice based on their diagnosis and treatment of patients. The Court reasoned that nurses “are not supposed to be experts in the technique of diagnosis or the mechanics of treatment.” Byrd v. Marion Gen. Hosp., 202 N.C. 337, 162 S.E. 738, 740 (1932) [“Byrd“]. Medicine is quite different today than in the early twentieth century and so, too, is the knowledge and skill of nurses in their varying fields and specializations.”
“Plaintiffs Edward Connette and Andrea Hopper argue that the nurse anesthetist in this case participated in the treatment plan for Hopper’s young daughter to such a degree, and with such an exercise of expertise and discretion, that the nurse effectively was treating the patient and thus should be subject to legal claims for medical malpractice.”
“We must reject this argument. Had Byrd left room for evolving standards as the field of medicine changed, this may be a different case. But the Byrd court’s holding is categorical, and it is controlling here. If this Court were free to reject Supreme Court precedent that we felt did not age well, it would destabilize our position as an intermediate appellate court. On issues where our Supreme Court already has spoken, we do not make law, we follow it.”
The Underlying Facts
The plaintiffs’ 3-year-old daughter had an irregular heartbeat for which she underwent an ablation procedure. Dr. James M. Doyle, an anesthesiologist, and Gus C. VanSoestbergen, a certified registered nurse anesthetist, administered the child’s anesthesia. Doyle and VanSoestbergen decided to induce the child with a mask to avoid the stress that might be caused by pricking her with a needle and inducing her intravenously. They also chose to induce her with “sevoflurane,” an anesthetic that can cause a drop in blood pressure and cardiac output to decrease.
Soon after the anesthesia team administrated the sevoflurane, the child went into cardiac arrest. After about thirteen minutes, her treatment team was able to revive her, but the oxygen deprivation left her with permanent brain damage, cerebral palsy, and profound developmental delay.
Doyle and his anesthesiology practice ultimately settled the North Carolina medical malpractice claims against them before the second trial (the jury in the first North Carolina medical malpractice trial failed to reach a verdict). Therefore, the only remaining parties in the second trial were VanSoestbergen, the certified registered nurse anesthetist, and the hospital that employed him.
The plaintiffs asserted that certified registered nurse anesthetists are highly trained and have greater skills and treatment discretion than regular nurses. Moreover, they asserted that nurse anesthetists often use those skills to operate outside the supervision of an anesthesiologist. The plaintiffs further argued that VanSoestbergen was even more specialized than an ordinary nurse anesthetist because he belonged to the hospital’s “Baby Heart Team” that focused on care for young children.
The trial court concluded that a nurse may be liable for improperly administering a drug, but not for breaching a duty of care for planning the anesthesia procedure and selecting the appropriate technique or drug protocol. Thus, the trial court excluded all expert testimony suggesting that VanSoestbergen breached a standard of care by agreeing to mask inhalation with sevoflurane. The trial court submitted the plaintiffs’ other claims against VanSoestbergen to the jury, which found VanSoestbergen not liable for the plaintiffs’ daughter’s injuries. The plaintiffs timely appealed.
North Carolina Appellate Court Opinion
In Byrd, the North Carolina Supreme Court declined to recognize the plaintiff’s legal claim, explaining that “nurses, in the discharge of their duties, must obey and diligently execute the orders of the physician or surgeon in charge of the patient.” The North Carolina Supreme Court held that the “law contemplates that the physician is solely responsible for the diagnosis and treatment of his patient. Nurses are not supposed to be experts in the technique of diagnosis or the mechanics of treatment.”
The North Carolina Appellate Court held: “as this Court repeatedly has held in the last few decades, trial courts (and this Court) remain bound by Byrd, despite the many changes in the field of medicine since the 1930s. Thus, the trial court properly determined that Plaintiffs’ claims based on VanSoestbergen’s participation in developing an anesthesia plan for Amaya are barred by Supreme Court precedent.”
Source Connette v. The Charlotte-Mecklenburg Hosp. Auth., No. COA19-354.
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