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NC Court of Appeals Declines ‘Sudden Emergency Doctrine’ to Healthcare Providers

From North Carolina Lawyers Weekly, July 14, 2014

In a hospital, a patient’s condition can change from stable to dire in an instant. But even as conditions change, the standard to which healthcare providers are held in medical malpractice suits will still remain the same, the North Carolina Court of Appeals ruled on July 1.

In a case of first impression, the court decided that the “sudden emergency doctrine,” which says that people faced with life-threatening emergencies aren’t required to employ the same judgment that would be expected in normal situations, does not apply to medical malpractice suits. The court unanimously held that the existing rules are flexible enough to accommodate the unique facts of each specific case.

Lakisha Wiggins was admitted to Chowan Hospital in Edenton in 2005 for labor and delivery of her son, Roy. Nurses there failed to perform a vaginal exam, as required by hospital protocols, before administering a labor-inducing drug. When nurses finally performed the exam several hours later, they discovered part of the umbilical cord protruding from Wiggins’ body. Hospital staff began preparing for an emergency Caesarian section delivery, although it took 16 minutes to move Wiggins to the operating room. Roy now suffers permanent cognitive impairments that Wiggins alleges were caused by a failure to perform the C-section in a timely manner.

Wiggins sued the hospital and the attending doctor. At trial, the judge granted the defendants’ request to instruct the jury on the sudden emergency doctrine. The jury found in favor of the defendants, and Wiggins appealed the decision to give the jury the instruction. The appeals court agreed and remanded the case for a new trial.

More Than Reasonable

Ordinarily, a plaintiff can prove negligent provision of medical care by establishing a violation of any one of three duties that healthcare professionals must meet-use of their best judgment in the treatment and care of their patient, use of reasonable care and diligence in applying their knowledge and skill to their patient’s care, and provision of care consistent with standards of practice among members of the same profession with similar training.

But under the sudden emergency doctrine, a defendant only needs to make decisions that a reasonable and prudent person would make under the same or similar conditions-a much lower bar for a defendant to clear.

The judges declined to join appellate courts in three other states that have extended the sudden emergency doctrine to healthcare professionals. Instead, the court noted that the rule had never been applied that way in North Carolina and found that even in cases where alleged medical malpractice could presumably be categorized as sudden medical emergencies, the general standard of care for healthcare professionals has been sufficient to assess liability.

“The application of the healthcare professional standard of care to a wide range of factual scenarios is not accidental,” Judge Robert C. Hunter wrote for the court. “Part of the standard developed at common law is to examine a healthcare professional’s conduct in light of the factual circumstances of the case.”

“The standard of care for healthcare professionals … is designed to accommodate the factual exigencies of any given case, including those that may be characterized as medical emergencies.”

Emergencies Already Included

Hunter went on to add that even if the sudden emergency doctrine applied in medical negligence cases, the instruction given to the jury in Wiggins’ case would still require a new trial because it asked jurors to consider what a reasonable and prudent person would do, rather than what a reasonable healthcare professional would do, which is the test in the other states that apply the doctrine in medical malpractice cases.

Since Wiggins’ stay at Chowan, the state legislature has amended the laws concerning proof of medical malpractice in the event of an emergency. Under the new law, a plaintiff suing over treatment of an emergency medical condition must prove malpractice by clear and convincing evidence, rather than by the greater weight of the evidence, which is the typical, and a lower, standard. The court noted that the legislature chose to address the issue by raising the standard of proof rather than lowering the standard of care. Because the events at issue in the case took place before the new law went into effect, Wiggins will only have to meet the older, lower burden of proof.

Charles Monnett of Charlotte represented the plaintiffs. Charles Simpson and Thomas Harris of Harris, Creech, Ward, and Blackerby in New Bern represented the defendants.

Monnett said that the instruction about sudden emergencies, especially the way it was phrased by the trial court to discuss a reasonably prudent person, made it significantly tougher for his client to prove malpractice.

“The whole concept of sudden emergency is already included within the standard of reasonable care, so there was no need to adopt the doctrine for malpractice cases,” Monnett said. “Doctors are already judged by what the circumstances are, which includes sudden emergencies.”

Click here to read the full text of the North Carolina Court of Appeals decision. 


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