Connette v. Charlotte-Mecklenburg Hosp. Auth.

• Decision Date: 16 June 2020
• Docket Number: No. COA19-354,COA19-354
• Citation: 845 S.E.2d 168
• Parties: Edward G. CONNETTE, as guardian ad litem for Amaya Gullatte, a Minor, and Andrea Hopper, individually and as parent of Amaya Gullatte, a Minor, Plaintiffs, v. The CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY d/b/a Carolinas Healthcare System, and/or the Charlotte-Mecklenburg Hospital Authority d/b/a Carolinas Medical Center, and/or the Charlotte-Mecklenburg Hospital Authority d/b/a Levine Children's Hospital, and Gus C. VanSoestbergen, CRNA, Defendants.
• Court: North Carolina Court of Appeals

845 S.E.2d 168

Edward G. CONNETTE, as guardian ad litem for Amaya Gullatte, a Minor, and Andrea Hopper, individually and as parent of Amaya Gullatte, a Minor, Plaintiffs,

v.The CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY d/b/a Carolinas Healthcare System, and/or the Charlotte-Mecklenburg Hospital Authority d/b/a Carolinas Medical Center, and/or the Charlotte-Mecklenburg Hospital Authority d/b/a Levine Children's Hospital, and Gus C. VanSoestbergen, CRNA, Defendants.

No. COA19-354

Court of Appeals of North Carolina.

Filed: June 16, 2020

Edwards Kirby, L.L.P., by Mary Kathryn Kurth, Raleigh, and John R. Edwards, for plaintiffs-appellants.

Gallivan, White & Boyd, P.A., by Janice Holmes and Christopher M. Kelly, Charlotte, for defendants-appellees.

DIETZ, Judge.

Nearly a century ago, our Supreme Court rejected the notion that nurses can be liable for medical malpractice based on their diagnosis and treatment of patients. The Court reasoned that nurses "are not supposed to be experts in the technique of diagnosis or the mechanics of treatment." Byrd v. Marion Gen. Hosp. , 202 N.C. 337, 162 S.E. 738, 740 (1932). Medicine is quite different today than in the early twentieth century and so, too, is the knowledge and skill of nurses in their varying fields and specializations.

Plaintiffs Edward Connette and Andrea Hopper argue that the nurse anesthetist in this case participated in the treatment plan for Hopper's young daughter to such a degree, and with such an exercise of expertise and discretion, that the nurse effectively was treating the patient and thus should be subject to legal claims for medical malpractice.

We must reject this argument. Had Byrd left room for evolving standards as the field of medicine changed, this may be a different case. But the Byrd court's holding is categorical, and it is controlling here. If this Court were free to reject Supreme Court precedent that we felt did not age well, it would destabilize our position as an intermediate appellate court. On issues where our Supreme Court already has spoken, we do not make law, we follow it.

Plaintiffs also challenge a series of discretionary decisions by the trial court during the trial. As explained below, under the limited standard of review we apply to these arguments, the trial court acted well within its sound discretion. Accordingly, we find no error in the trial court's judgment.

Facts and Procedural History

In the fall of 2010, Andrea Hopper took her three-year-old daughter Amaya to an emergency room for an upper respiratory infection and an ear infection. While treating Amaya, medical professionals discovered that her heartrate was higher than normal, or "tachycardic," so they referred Amaya to a cardiologist, Dr. Nicholas B. Sliz, at a hospital affiliated with Defendant Charlotte-Mecklenburg Hospital Authority.

Dr. Sliz determined that Amaya's increased heart rate caused her heart to develop cardiomyopathy, a disease which makes it hard for the heart to pump blood to the body and enlarges the heart. Because Amaya's cardiac output was severely depressed, Dr. Sliz recommended she undergo an "ablation procedure" to fix her irregular heart rhythm. Dr. Sliz was confident that the ablation procedure would be a success and scheduled a surgery for Amaya.

Dr. James M. Doyle, an anesthesiologist, and Defendant Gus C. VanSoestbergen, a certified registered nurse anesthetist, administered Amaya's anesthesia. Doyle and VanSoestbergen decided to induce Amaya with a mask to avoid the stress that might be caused by pricking her with a needle and inducing her intravenously. The two also chose to induce her with "sevoflurane," an anesthetic that can cause one's blood pressure to drop and cardiac output to decrease.

Soon after the anesthesia team administrated the sevoflurane, Amaya went into cardiac arrest. After about thirteen minutes, Amaya's treatment team was able to revive her, but the oxygen deprivation left her with permanent brain damage, cerebral palsy, and profound developmental delay.

In 2011, Plaintiffs filed a complaint against various medical professionals involved in Amaya's treatment. The case went to trial in 2015. The jury failed to reach a verdict on the claims against Doyle and VanSoestbergen in this first trial. Before the second trial, Doyle and his anesthesiology practice settled the claims against them. Thus, the only remaining parties in the second trial were VanSoestbergen, who is a certified registered nurse anesthetist, and the hospital that employed VanSoestbergen.

The second trial began in 2018. Plaintiffs asserted a number of negligence-based claims, including a claim that VanSoestbergen breached the applicable standard of care by agreeing, during the anesthesia planning stage, to induce Amaya with sevoflurane using the mask induction procedure. Plaintiffs asserted that certified registered nurse anesthetists are highly trained and have greater skills and treatment discretion than regular nurses. Moreover, they asserted, nurse anesthetists often use those skills to operate outside the supervision of an anesthesiologist. Plaintiffs also argued that VanSoestbergen was even more specialized than an ordinary nurse anesthetist because he belonged to the hospital's "Baby Heart Team" that focused on care for young children.

The trial court refused to admit Plaintiffs’ evidence of this claim. The court determined that this theory of liability was precluded by Daniels v. Durham County Hosp. Corp. , 171 N.C. App. 535, 615 S.E.2d 60 (2005), a decision that analyzed and applied the Supreme Court's holding in Byrd v. Marion Gen. Hosp. , 202 N.C. 337, 162 S.E. 738 (1932).

The trial court concluded that a nurse may be liable for improperly administering a drug, but not for breaching a duty of care for planning the anesthesia procedure and selecting the appropriate technique or drug protocol. Thus, the trial court excluded all expert testimony suggesting that VanSoestbergen breached a standard of care by agreeing to mask inhalation with sevoflurane. The trial court submitted Plaintiffs’ other claims against VanSoestbergen to the jury. The jury found VanSoestbergen not liable for Amaya's injuries. Plaintiffs timely appealed.

Analysis

I. Nurse's liability for treatment decisions

Plaintiffs first argue that the trial court erred by excluding evidence that VanSoestbergen "shared responsibility with Dr. Doyle for both planning and administering anesthesia to Amaya." Plaintiffs contend that a certified registered nurse anesthetist is "not a mere appendage of the anesthesiologist" but instead an "independent collaborator" who owes a duty of care to the patient when participating in the creation of a patient's treatment plan.

The trial court rejected this argument after concluding that it was barred by settled precedent. As explained below, this Court, too, is bound by that precedent and we therefore find no error in the trial court's ruling.

Nearly a century ago, a plaintiff sought to hold a nurse liable for decisions concerning diagnosis and treatment. Byrd v. Marion Gen. Hosp. , 202 N.C. 337, 162 S.E. 738, 740 (1932). Specifically, the plaintiff was suffering from convulsions and alleged that she was severely burned after the nurse placed her in a "sweat cabinet" or "sweating machine" as part of her treatment. Id.

Our Supreme Court declined to recognize the plaintiff's legal claim, explaining that "nurses, in the discharge of their duties, must obey and diligently execute the orders of the physician or surgeon in charge of the patient." Id. The Court held that the "law contemplates that the physician is solely responsible for the diagnosis and treatment of his patient. Nurses are not supposed to be experts in the technique of diagnosis or the mechanics of treatment." Id.

Since Byrd , this Court repeatedly has rejected legal theories and claims based on nurses’ decisions concerning diagnosis and treatment of patients. In 1985, for example, this Court cited Byrd to reject a claim that a nurse owed a separate duty of care to the patient because any "disagreement or contrary recommendation she may have had as to the treatment prescribed would have necessarily been premised on a separate diagnosis, which she was not qualified to render." Paris v. Michael Kreitz, Jr., P.A. , 75 N.C. App. 365, 381, 331 S.E.2d 234, 245 (1985).

Similarly, in 2005, this Court rejected a theory that a registered nurse was part of the "delivery team" in obstetrics and engaged in a "collaborative process with joint responsibility." Daniels v. Durham County Hosp. Corp. , 171 N.C. App. 535, 539, 615 S.E.2d 60, 63 (2005). We observed that, although "medical practices, standards, and expectations have certainly changed since 1932 and even since 1987, this Court is not free to alter the standard set forth in Byrd. " Id. We therefore affirmed summary judgment in favor of the nurse because "plaintiffs present a medical dispute regarding diagnosis and treatment that nurses are not qualified to resolve." Id. at 540, 615 S.E.2d at 63.

In short, as this Court repeatedly has held in the last few decades, trial courts (and this Court) remain bound by Byrd , despite the many changes in the field of medicine since the 1930s. Thus, the trial court properly determined that Plaintiffs’ claims based on VanSoestbergen's participation in developing an anesthesia plan for Amaya are barred by Supreme Court precedent.

We acknowledge that Plaintiffs have presented many detailed policy arguments for why the time has come to depart from Byrd . We lack the authority to consider those arguments. We are "an error-correcting body, not a policy-making or law-making one." Davis v. Craven County ABC Bd. , 259 N.C. App. 45, 48, 814 S.E.2d 602, 605 (2018). And, equally important, Byrd is a Supreme Court opinion. We have no authority to modify Byrd ’s comprehensive holding simply because times have changed. Only the Supreme Court can do that. State v. Scott , 180 N.C. App. 462, 465, 637 S.E.2d 292, 294 (2006). Thus, we decline to...