North Carolina Supreme Court ruling could increase liability for nurses

(The Center Square) — North Carolina nurses face increased liability for how they treat patients after the state Supreme Court overturned a 90-year-old precedent that shielded those working under a doctor’s supervision.

The North Carolina Supreme Court ruled 3-2 on Aug. 19 to strike down precedent set in the 1932 case Byrd v. Marion General Hospital, which for 90 years protected nurses who execute doctors’ orders.

Justice Michael Morgan cited advances by the medical profession for overruling Byrd, which was leveraged at trial to exclude evidence about an allegedly negligent anesthesia plan that led to a child’s permanent brain damage during a 2010 ablation procedure.

“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 wrote in the majority opinion.

The family of the child involved in the ablation procedure previously settled out of court with the anesthesiologist, but a jury in 2018 sided with a nurse anesthetist and hospital that employed him after expert testimony on the nurse’s involvement was excluded at trial, MedPageToday reports.

The child’s family appealed the verdict, alleging the expert testimony would have detailed how the nurse and physician worked together on the negligent anesthesia plan, then appealed to the Supreme Court when an appellate court affirmed the verdict in 2020.

Morgan wrote that revisiting Byrd was appropriate “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 standards of care,” he wrote.

Morgan wrote that while the opinion reverses the Byrd precedent, the court majority “expressly note that our decision in the present case does not disturb in any way the principle enunciated in Byrd that ‘nurses, in the discharge of their duties,’ when they ‘obey and diligently execute the orders of the physician or surgeon in charge of the patient,’ may be held liable when ‘such order was so obviously negligent as to lead any reasonable person to anticipate that substantial injury would result to the patient from the execution of such order or performance of such direction.”

Justices ordered a new trial and sent the case to the court of appeals for remand to the trial court.

Stacy Yancey, president of the North Carolina Association of Nurse Anesthetists, told MedPageToday the case demonstrates the ambiguity medical providers face in the absence of clear state guidelines on their authority.

She pointed to legislation approved by the state Senate in June, known as the SAVE Act, to modernize regulations to allow advanced practice registered nurses to work to the full extent of their training and education.

“There is so much about CRNA practice in North Carolina that can be unclear,” Yancey said. “I think it needs to be addressed by the legislature. I don’t think it is a good thing for North Carolina that these justices are having to look at 90-year-old precedent because there’s nothing in state statute about CRNA practice.”

Yancey noted the legislation would also provide relief to rural hospitals that rely heavily on nurses.

“In this time of the labor shortage and people having trouble accessing healthcare, everyone needs to be able to do everything that they are trained and educated to do,” she said.

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