A divided North Carolina Supreme Court has voted to overturn a 90-year-old state court precedent that shielded nurses from legal liability. Given that the majority decision got just three votes on the seven-member tribunal, it’s unclear how the latest decision will affect future cases.

Connette v. Charlotte-Mecklenburg Hospital Authority follows action taken in 2010. Amaya Gullatte, then 3, suffered permanent brain damage, cerebral palsy and ‘profound developmental delay’ after surgery for heart disease at the Carolinas Medical Center.

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

A trial judge in 2018 blocked testimony that allegedly challenged CRNA decisions in the Amaya case. The judge cited court precedent that stemmed from the 1932 case Byrd v. Marion General Hospital. It protected nurses from legal liability when working under the supervision of a doctor. In 2020, a unanimous panel of the North Carolina Court of Appeals upheld the trial court’s decision to exclude evidence regarding CRNA’s work.

“The trial court’s decision on evidence, and the confirmation of it by the Court of Appeal, were dictated by the application of the principle enshrined in Byrd…and his progeny which establishes categorically that nurses n ‘have no duty of care in diagnosing and treating patients while working under the supervision of a physician licensed to practice medicine in North Carolina,’ Judge Michael Morgan wrote for the 3-2 majority of the state Supreme Court.” 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 ensuing ninety years publication by this Court of the Byrd Opinion, we determine that it is timely and proper to set aside Byrd as applied to the facts of this case.

Morgan writes that the court “deems it appropriate” to revisit the 90-year-old Byrd precedent “in light of the increased and influential roles that nurses have in medical diagnosis and treatment. We believe that even in circumstances where a registered nurse performs her duties and responsibilities under the supervision of a physician, a nurse may be liable for negligence and medical malpractice if the registered nurse is found to have breached the applicable professional standard of care.”

Judges “take care to avoid any intrusion into the exclusive authority of the legislature to reach complex political judgments” and enact legislation relating to the legal liability of nurses, Morgan wrote. Yet “the legislative body has remained silent” on the issue as nursing standards have evolved.

Judges Phil Berger Jr. and Sam “Jimmy” Ervin IV did not participate in the Connette case. Of the remaining five judges, three agreed with Morgan’s findings.

Judge Tamara Barringer wrote for the two dissenters. “The issue before this Court is whether a certified registered nurse anesthetist (CRNA) who collaborates with a physician in selecting an anesthesia treatment can be held liable for negligence in the selection of that treatment. Since 1932, this Court has ruled no, and Parliament has never required otherwise. By judicially altering this standard, the three-judge majority appears to create non-causal liability – allowing a nurse to be held liable for negligent cooperation in the treatment ultimately chosen by the physician. Such a political choice should be made by the legislature, not just by three judges of this Court. »

“[P]plaintiffs argue that due to developments in medicine, Byrd is now obsolete and should be rescinded,” Barringer added. “However, in adhering to the principles of stare decisis, this Court should not upset established case law that clearly defines the responsibility of doctors and nurses when treating or diagnosing patients. Of course, the legislator, who is not bound by stare decisis, could have, at any time during the last ninety years, enacted a different rule of liability to take account of the evolution of the profession. medical. As summarized earlier, this is not the case.

Barringer points to potential problems for the Supreme Court overturning its Byrd precedent.

“In this case, deviating from Byrd in expanding the liability of nurses would require us to consider which nurses’ training and responsibilities are so advanced or specialized as to justify liability and which nurses, if any, are not responsible in virtue of Byrd,” she wrote. “Neither the statutes nor
the case law provides a clear guideline for making this decision. Moreover, the dramatic expansion of liability requires the kind of weighing of factors and balancing of interests that are quintessential political decisions for legislators, not courts, to make.

Dissent points to judicial excess.

“The Legislature, as the policy-making arm of our government, adopted and codified Byrd’s holdings in its statutes and regulations rather than superseding them,” Barringer wrote. “Thus, the majority decision not only overturns the jurisprudence of our Court without sufficient reason, but also ignores the plain language of the statutes and regulations. In doing so, three judges of this Court are substituting their judgment of public welfare for that of the General Assembly and creating instability in the medical profession by reversing ninety years of precedent without providing a discernable standard.

“No justification exists for departing from our previous positions, particularly when it involves policy-making beyond the authority of this Court, creates more questions than it answers, and is passed by less than a majority of this Court,” she concluded.

Friday’s decision calls for a new trial in the Connette case. Former U.S. Senator and Democratic presidential candidate John Edwards has represented Amaya’s family in legal proceedings, including last November’s oral arguments in the state Supreme Court.