Under tort reform law, nurse’s paperwork mix-up was med-mal

Claims for administrative negligence against a health care provider must meet the heightened pleading requirements for a medical malpractice claim, rather than the more forgiving standards for general negligence claims, the North Carolina Court of Appeals has ruled.

The court’s Dec. 4 ruling is the first time it has considered the pleading requirements for administrative negligence claims since the legislature enacted sweeping tort reform legislation in 2011. The judges said a trial judge had erred in letting a lawsuit against Carolinas Medical Center go to trial under such a theory, but the error didn’t prejudice the jury’s $680,000 verdict against the hospital for medical malpractice.

For unrelated reasons, the court vacated a $5.5 million dollar verdict against the hospital for non-economic damages and ordered a new trial for those damages only. It said that the trial court had erred by allowing the jury to award damages for pain and suffering when the plaintiff’s only evidence of pain and suffering was merely speculative.

Paramedics took Anthony Savino to CMC-Northeast in April 2012 after he complained of chest pains. The admitting nurse was provided a report of the paramedics’ treatment of Savino, but failed to relay that report to doctors. Savino was discharged from the hospital later that day. Shortly after returning home, he suffered a fatal heart attack.

Savino’s estate sued CMC in Cabarrus County Superior Court, alleging that had the hospital followed its own protocol and provided the report to doctors, Savino likely would have been admitted and would have had a good chance of surviving.

The estate alleged two theories of negligence: medical malpractice and administrative negligence. But the appeals court ruled that the tort reform law expanded the definition of medical malpractice so that it now encompasses actions alleging a breach of administrative duties to a patient. Judge John Arrowood, writing for the court, said that the legislature’s intent was not to create a new cause of action, but to re-classify administrative negligence claims against a hospital as medical malpractice actions subject to the stricter pleading rules.

Arrowood wrote that the estate’s initial complaint failed to allege any breach of administrative duties that would put CMC on notice of an administrative negligence claim, even under the state’s liberal pleading rules. (An amended complaint did contain the allegations, but was filed after the statute of limitations had elapsed.) As such, the estate should not have been allowed to present that theory to a jury.

Nevertheless, the court denied CMC’s request for a new trial on the medical malpractice claim. CMC had argued that the evidence and jury instructions for the two theories were so “intermingled” that “the jury’s determination on the medical negligence claim … was tainted by the trial court’s error.”

Arrowood said that CMC had failed to present enough evidence that the jury’s verdict likely would have been different absent the court’s error where “ample evidence was presented that defendant failed to follow its policies and that the attending emergency department nurse did not collect or communicate pertinent medical information for decedent’s care.”

The appeals court also denied CMC’s request to overturn the verdict because the estate had failed to establish the standard of care for medical negligence because its only expert witness on that issue was a doctor from Albany, New York, who had never practiced in North Carolina. But the appeals court ruled that the witness’s opinion was based on extensive research into the local standard of care, and that this was an acceptable basis on which he could form an opinion.

But the court did grant the hospital’s request for a new trial on the much larger award of non-economic damages. Superior Court Judge Julia Lynn Gullett allowed the jury to consider Savino’s pain and suffering in its deliberations. The appeals court agreed that this was improper since there were no eyewitnesses to Savino’s death, and the only evidence of his pain and suffering was “speculative” testimony by another expert witness.

Because the jury’s verdict for non-economic damages didn’t break down the award by categories, it was impossible to tell what portion of the award was for pain and suffering, and so the appeals court vacated the entire award.

Matthew Nis Leerberg and Matthew Krueger-Andes of Fox Rothschild in Raleigh and Charlotte, respectively; Kimberly Sullivan of Horack, Talley, Pharr & Lowndes in Charlotte and Rob Marcus of Bradley Arant Boult Cummings in Charlotte represented the hospital.

Matthew Ballew, Robert Zaytoun, and John Taylor of Zaytoun Law Firm in Raleigh and R. Kent Brown, Jon Moore, and Paige Pahlke of Brown, Moore & Associates in Charlotte represented the estate.

The 48-page decision is Estate of Savino v. Charlotte-Mecklenburg Hospital Authority (Lawyers Weekly No. 011-365-18). The full text of the opinion is available online at nclawyersweekly.com.

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