North Carolina Supreme Court Establishes New Liability for Nurses

Supreme Court of North Carolina overturns Byrd v. Marion General Hospital

In Gullatte v. The Charlotte-Mecklenburg Hospital Authority, North Carolina Supreme Court establishes new liability for nurses

Opinion filed: August 19, 2022
Attorneys for the case: John Edwards and Mary Kathryn Kurth (Edwards Kirby, LLP); Kristen L. Beightol (Edwards Beightol, LLC)

On August 19, 2022, the Supreme Court of North Carolina overturned Byrd v. Marion General Hospital, 202 N.C. 337 (1932). Byrd, a 90-year-old case, exempted nurses from exposure to liability for negligence when acting under the direction of a supervising physician. In 1932, when Byrd was decided, advanced practice nurses like CRNAs did not exist. The case presented before the court involved allegations of negligence by a CRNA in his planning and administration of anesthesia to a three-year-old child. Over the past nine decades, the practice of medicine has changed dramatically. Advanced practice nurses, like CRNAs, have increased autonomy and involvement in decisions about patient care. The Court now recognizes that with that increased autonomy and involvement comes liability.

The facts of the Byrd case are notable and certainly illustrate its obsolescence. Mrs. Byrd was sent to the hospital to be treated for “convulsions” in a “sweat cabinet.” The doctor told the nurse to leave Mrs. Byrd in the sweat cabinet for thirty minutes, and the nurse complied. Mrs. Byrd suffered severe burns. The jury returned a verdict against the nurse, which the North Carolina Supreme Court reversed. The Supreme Court held that the nurse could not be personally liable for following the doctor’s order unless “such order was so obviously negligent as to lead any reasonable person to anticipate substantial injury,” such as “order[ing] a nurse to stick fire to a patient.” 202 N.C. at 341-42.

The trial court, applying Byrd, excluded evidence of the professional standard of care applicable to CRNAs in their planning and selection of anesthesia—since, per the holding in Byrd, a CRNA could have no liability for decisions related to the anesthesia plan. The Court of Appeals affirmed the trial court’s exclusion of evidence in a unanimous decision, and plaintiffs petitioned the Supreme Court for discretionary review.

In its opinion released last Friday, the Supreme Court acknowledged “the evolution of the medical profession’s recognition of the increased specialization and independence of nurses in the treatment of patients.” The Court held 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.”

The modern healthcare system is increasingly reliant on nurses, particularly advanced practice nurses like CRNAs and nurse practitioners. Patients deserve trust that advanced practice nurses will be held to professional standards and held accountable when they violate those standards. At last, North Carolina’s case law has been reconciled with modern medicine and recognizes the nursing profession’s significant role in healthcare—with that significant role naturally comes liability.

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