N.C. Supreme Court tosses precedent

A recent ruling by the North Carolina Supreme Court that overturned a 90-year-old precedent could alter physician/nurse relationships in the future. 

The Supreme Court’s ruling, which was handed down Aug. 18, also brings into focus the changing nature of the health care industry and the evolving role of registered nurses during medical procedures. 

In 2010, then-3-year-old Amaya Gullatte underwent a procedure at Carolinas Medical Center for cardiomyopathy – a condition that enlarges the heart and makes it difficult for the heart to pump blood correctly, according to the N.C. Supreme Court Opinion.  

Her anesthetics team consisted of anesthesiologist Dr. James M. Doyle, and Certified Registered Nurse Anesthetist Gus C. VanSoestbergen. They used a mask to administer the anesthetic sevoflurane to Gullatte prior to the surgical procedure. Shortly after she received the anesthesia, Gullatte went into cardiac arrest.  

Although the use of resuscitation drugs and the performance of CPR Doyle was able to revive Gullatte, the approximately 13 minutes of oxygen deprivation led to permanent damage.  

“There were a number of allegations of negligence, but the core allegations were that they use the wrong anesthesia given by the wrong method,” said John Edwards, attorney for the Gullatte family. “In other words, they gave the anesthesia by mask, as opposed to by IV – because there are types of anesthesia that you can give by IV that have very little or no cardiovascular effects.”  

Gullatte’s family went to trial court against Doyle, VanSoestbergen, the Charlotte-Mecklenburg Hospital Authority, and two other physicians that treated Gullatte.  

“The anesthesia that was given to her is well known to have cardiovascular side effects, the most significant being on the cardiac output, and she already had a very low cardiac output,” said Edwards, who is a partner at Edwards Kirby LLP in Raleigh, N.C. “So, they started the anesthesia by mask and her cardiac output – not surprisingly – went down, and eventually her heart stopped, and she had to be resuscitated. Her resuscitation lasted about 13 minutes. 

“And at the end of the resuscitation, they were able to get her heartbeat back. But at that point, because of blood and oxygen deprivation to the brain, Amaya suffered a permanent and very serious brain injury.” 

In 2018, a trial court jury ruled in favor of the defense after the trial judge blocked testimony that called into question VanSoestbergen’s decision in Gullatte’s case, citing a case from 1932 called Byrd v. Marion General Hospital, 202 N.C. 337.  

Byrd v. Marion General Hospital was brought to the court of appeals following a medical malpractice case in which a 3-year-old suffered permanent brain damage, cerebral palsy and profound developmental delay due to the procedure. 

The resulting ruling created a precedent that nurses cannot be held liable for executing physician orders unless it is apparent that injury would result 

The Supreme Court’s ruling on the Gullatte case now brings that precedent into question. 

“We have certain evidence about what the CRNA should have done,” Mary Kathryn Kurth, an attorney for the Gullatte family, said. “That evidence was not allowed by the judge because the judge was applying a case called Byrd which was good law in North Carolina, and essentially said that when a nurse is following doctor’s orders, there is no liability. So, in applying Byrd and another case called Daniels to this case, the choice of anesthesia was a choice by the anesthesiologist and the anesthesiologist alone. So, the CRNA had no liability for that choice of anesthesia and administration of anesthesia.” 

The plaintiffs appealed the trial court’s decision and the N.C. Supreme Court overturned Byrd v. Marion General Hospital, stating that even in circumstances where a registered nurse is discharging duties and responsibilities under the supervision of a physician, the nurse may be held liable for negligence and for medical malpractice if the registered nurse is found to have breached the applicable professional standard of care. 

“Byrd was a case that was decided back when advanced practice nurses like CRNAs didn’t even exist,” Kurth, who is also with Edwards Kirby Law firm, said. “The justices that sat on the court at that time [of Byrd] couldn’t even conceive the way that medicine is practice today and the role that nurses play today – which they did not play back in the time for. So, our case, which applies to these facts, the court overturned Byrd and in our view, made the case law more consistent with the way that medicine is practiced today and recognizes the significant contributions of nurses, especially advanced practice nurses like CRNA.” 

The effect of this ruling on nurses and medical malpractice cases in North Carolina raises many questions, including what procedure will be when nurses and physicians disagree on proper treatment of a patient.  

“Our primary concern for my client was making sure that the court didn’t upset the statutory scheme that governs doctors and nurses,” Mitch Armbruster, attorney for North Carolina Society of Anesthesiologists, said. “And that includes the concept of physician supervision, which is part of North Carolina law. So, we were pleased to see that the majority does recognize that nurses have to work under physician supervision, thought at the end of the day, I think the decision might create a little uncertainty.” 

Justice Tamara Barringer and Chief Justice Paul Newby dissented on the opinion; Justices Samuel Ervin IV and Philip Berger Jr. did not participate in the consideration or decision of the opinion. 

The overturning of Byrd now calls for a new trial for the case between Gullatte and the Charlotte-Mecklenburg Hospital Authority.