Connette v. The Charlotte-Mecklenburg Hosp. Auth., 331PA20

Docket Nº331PA20
Citation2022 NCSC 95
Case DateAugust 19, 2022
CourtUnited States State Supreme Court of North Carolina

2022-NCSC-95

EDWARD G. CONNETTE, as guardian ad litem for AMAYA GULLATTE, a Minor, and ANDREA HOPPER, individually and as parent of AMAYA GULLATTE, a Minor,
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.

No. 331PA20

Supreme Court of North Carolina

August 19, 2022


Heard in the Supreme Court on 8 November 2021.

On discretionary review pursuant to N.C. G.S. § 7A-31 of a unanimous decision of the Court of Appeals, 272 N.C.App. 1 (2020), finding no error in a judgment entered on 20 August 2018 by Judge Robert C. Ervin in Superior Court, Mecklenburg County.

Edwards Kirby, LLP, by Mary Kathryn Kurth, John R. Edwards, and Kristen L. Beightol, for plaintiff-appellants.

Robinson, Bradshaw &Hinson, P.A., by Matthew W. Sawchak, Jonathan C. Krisko, Stephen D. Feldman, Erik R. Zimmerman, and Travis S. Hinman; and Gallivan, White & Boyd, P.A., by Christopher M. Kelly, for defendant-appellees.

McGuireWoods LLP, by Mark E. Anderson, Joan S. Dinsmore, and Linwood L. Jones, for North Carolina Healthcare Association, amicus curiae.

Smith, Anderson, Blount, Dorsett, Mitchell &Jernigan, L.L.P., by J. Mitchell Armbruster, for North Carolina Society of Anesthesiologists, amicus curiae.

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MORGAN, Justice

¶ 1 Plaintiffs petitioned this Court for discretionary review of the unanimous opinion rendered by the Court of Appeals in Connette ex rel. Gullatte v. Charlotte-Mecklenburg Hospital Authority, 272 N.C.App. 1 (2020), in which the lower appellate court found no error in the trial court's exclusion of evidence proffered by plaintiffs at trial in an effort to show that defendant VanSoestbergen breached the professional duty of care which governed his participation in the preparation and administration of a course of anesthesia which resulted in profound injuries being suffered by plaintiff Amaya Gullatte. 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 v. Marion General Hospital, 202 N.C. 337 (1932) 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. Id. at 341-43. 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. Accordingly, we reverse and remand this matter to the trial court for further proceedings consistent with this opinion.

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I. Factual and Procedural Background

¶ 2 On 11 September 2010, an emergency room visit for an upper respiratory infection revealed that three-year-old Amaya Gullatte was tachycardic, prompting Amaya's pediatrician to refer the child to a cardiologist. The cardiologist's examination of Amaya disclosed that the youngster was plagued by the heart disease known as cardiomyopathy, an affliction which enlarges the heart and makes it difficult for the heart to pump blood correctly. The cardiologist recommended the performance of an "ablation procedure" on Amaya's heart in order to address the disorder. The child was admitted to a Carolinas Medical Center facility on 20 October 2010, where an anesthetics team consisting of anesthesiologist James M. Doyle, M.D. and Certified Registered Nurse Anesthetist (CRNA) Gus C. VanSoestbergen utilized a mask to administer the anesthetic sevoflurane to Amaya prior to the surgical procedure. Shortly after she was induced with the sevoflurane, Amaya went into cardiac arrest. Although the introduction of resuscitation drugs and the performance of cardiopulmonary resuscitation (CPR) by Dr. Doyle was able to revive Amaya, still the approximately thirteen minutes of oxygen deprivation which was experienced by the child resulted in the onset of permanent brain damage, cerebral palsy, and profound developmental delay. Plaintiff Edward Connette, as Amaya's guardian ad litem, and plaintiff Andrea Hopper, as Amaya's mother, filed a lawsuit against Dr. Doyle, CRNA VanSoestbergen, the Charlotte-Mecklenburg Hospital Authority, and

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two additional physicians who treated Amaya.

¶ 3 The trial spanned three months and concluded in February 2016. While the jury returned a verdict in favor of the two additional treating physicians, the jury failed to reach a verdict on the claims against Dr. Doyle and CRNA VanSoestbergen. Dr. Doyle and his anesthesiology practice proceeded to settle plaintiffs' claims against them.

¶ 4 A second trial commenced in May 2018, in which plaintiffs asserted a number of claims based on negligence against CRNA VanSoestbergen and the hospital as VanSoestbergen's employer. In plaintiffs' opening statement during the second trial, their counsel referenced a leading pharmacology textbook's description of a process known as intravenous introduction of etomidate, which was depicted as a safer alternative to the method of introducing sevoflurane through the usage of a mask into a patient who has cardiomyopathy. Witnesses testified that Dr. Doyle, in his capacity as the anesthesiologist for the procedure, and CRNA VanSoestbergen, in his respective role as the nurse anesthetist for the surgery, collaborated on Amaya's plan as both medical professionals independently and identically determined that sevoflurane mask induction was the appropriate course of action to implement. CRNA VanSoestbergen concurred with Dr. Doyle's final decision to order this method of the introduction of the anesthetic into Amaya's system after the two consulted with one another about the plan. While the ultimate decision to order the chosen

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anesthesiological procedure rested with the physician Dr. Doyle, the certified registered nurse anesthetist VanSoestbergen advised the physician, agreed with the physician, and participated with the physician in the election and administration of the anesthetic sevoflurane through a mask.

¶ 5 Plaintiffs were prepared to present evidence through certified registered nurse anesthetist Dean Cary acting as an expert witness on the manner in which CRNA VanSoestbergen's formulation of, affirmation of, and contribution to the decision to administer sevoflurane to Amaya by utilizing the mask induction procedure rather than by utilizing an intravenous method to induce anesthesia, allegedly breached the professional standard of care applicable to VanSoestbergen. However, the trial court determined that the introduction of evidence regarding a professional standard of care which should apply to VanSoestbergen in his capacity as a certified registered nurse anesthetist was precluded by Daniels v. Durham County Hospital Corp., 171 N.C.App. 535 (2005), disc. rev. denied, 360 N.C. 289 (2006), a case which directly applied this Court's holding in Byrd to govern the outcome in Daniels and which the trial court, in turn, directly applied to the present case. Specifically, the trial court prohibited the introduction of testimony from plaintiffs' expert witness Cary which would have tended to show that the standard practice of CRNAs under the medical facts of Amaya's case would have expressly prohibited the course of action followed by CRNA VanSoestbergen. If allowed by the trial court to do so, the expert would

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have testified that an intravenous introduction of a drug other than sevoflurane, such as etomidate, would have complied with the applicable professional standard of care for a certified registered nurse anesthetist like VanSoestbergen, while the use of sevoflurane mask induction in this instance would breach the applicable professional standard of care. In its ruling which excluded this aspect of evidence from the testimony rendered by the expert witness Cary, the trial court observed that a nurse may be liable for independent actions taken against a plaintiff but could not be held liable for planning and selecting the appropriate anesthesia technique because nurses operate under the compulsory supervision of physicians licensed to practice medicine.

¶ 6 On 17 July 2018, pursuant to North Carolina General Statutes Section 1A-1, Rule 48, the parties stipulated on the record to the validity of a trial verdict rendered by nine or more jurors. The jury returned a verdict in favor of VanSoestbergen and, correspondingly, his hospital employer, and the trial court entered judgment memorializing the jury's verdict on 20 August 2018. Plaintiffs appealed, among other matters, the trial court's exclusion of plaintiffs' proffered expert testimony regarding CRNA VanSoestbergen's involvement in the determination and implementation of the allegedly negligent anesthesia plan as a claimed breach of the applicable professional standard of care. On 16 June 2020, the Court of Appeals affirmed the trial court's exclusion of the evidence at issue in a unanimous decision. Connette, 272 N.C.App. at 5, 13.

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Plaintiffs filed a Petition for Discretionary Review of the lower appellate court's determination, and this Court allowed the petition on 10 March 2021.

II. Analysis

¶ 7 A trial court's determination as to the admissibility of evidence, particularly when such admissibility is called into question on the issue of relevance, is generally reviewed for abuse of discretion. See, e.g., State v. Williams, 363 N.C. 689, 701-02 (2009), cert. denied 562 U.S. 864 (2010); State v. Jacobs, 363 N.C. 815, 823 (2010). The trial court's exclusion of plaintiffs' proffered testimony in the case sub judice was governed by the...

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