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

John Edwards, former U.S. senator and Democratic presidential candidate, argues before the N.C. Supreme Court. (Image from YouTube)

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  • In a 3-2 decision, the N.C. Supreme Court overturned a 90-year-old precedent that protected nurses from some forms of legal liability.
  • Dissenting Justice Tamara Barringer wrote that her colleagues should have deferred to the General Assembly to change legal standards involving nurses.

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.”

“[P]laintiffs contend that due to developments in medicine, Byrd is now obsolete and should be overruled,” Barringer added. “However, adhering to the principles of stare decisis, this Court should not disturb settled precedent that clearly defines the liability of doctors and nurses when treating or diagnosing patients. Of course, the legislature, which is not bound by stare decisis, could have at any time in the last ninety years enacted a different rule of liability to account for changes in the medical profession. As summarized previously, it did not.”

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

“In this case, departing from Byrd by expanding nurse liability would require us to determine which nurses’ training and responsibilities are so advanced or specialized as to warrant liability and which nurses, if any, remain not liable under Byrd,” she wrote. “Neither the statutes nor
caselaw provide a clear guideline for making this determination. Further, dramatically expanding liability requires the type of factor weighing and interest balancing that are quintessential policy determinations for the legislature to make, not the courts.”

The dissent points toward judicial overreach.

“The legislature, as the policy making body of our government, has adopted and codified the holdings in Byrd in its statutes and regulations rather than supplanting them,” Barringer wrote. “Thus, the majority’s holding not only overturns this Court’s precedent without sufficient cause but also ignores the plain language of the statutes and regulations. In doing so, three Justices of this Court substitute their judgment of the public welfare for that of the General Assembly and create instability in the medical profession by striking down ninety years of precedent without providing a discernible standard.”

“No justification exists to depart from our prior holdings, especially when doing so involves policymaking beyond the authority of this Court, creates more questions than it answers, and is adopted 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 court proceedings, including last November’s oral arguments before the state Supreme Court.