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  • Writer's pictureW. Cory Reiss

Nurses face new liability for treatment decisions.

The North Carolina Supreme Court on Friday instituted the equivalent of the Spider-Man rule for North Carolina registered nurses by imposing liability on their expanding role in health care decisions.

Popularized by Peter Parker’s Uncle Ben, the rule is this: With great power comes great responsibility.

The state Supreme Court reversed 90 years of precedent that absolved nurses of liability for their contributions to diagnoses and treatment decisions. Under a decision rendered in 1932, nurses in this state could be liable for their negligent performance of orders from treating physicians but not their own decisions about how to treat patients.

We previously wrote about the Court of Appeals decision affirming dismissal of claims against a certified nurse anesthetist whose treatment decisions involving a young girl with a heart problem allegedly put her into cardiac arrest, leading to severe brain damage. The court complained that precedent dictated its decision despite the professional evolution of nursing since the rule was set in the 1932 case, which involved a nurse’s negligent use of a “sweat machine” to treat convulsions.

In its new decision, Connette Ex Rel. Gullatte v. Charlotte-Mecklenburg Hosp. Auth., the Supreme Court heeded the lower court’s suggestion to revisit the law and reversed its rule barring negligence claims arising from registered nurses’ treatment decisions or their contributions to treatment collaborations with physicians. Based on major changes in the nursing profession, progressively more advanced educational and licensing requirements, advanced “certifications” for specialties such as in anesthesia, establishment of standards of nursing care, and the medical establishment’s sheer reliance on nurses, the Supreme Court decided it’s time to modernize malpractice law accordingly.

“As a certified registered nurse anesthetist,” the Court held, “defendant VanSoestbergen in the instant case is a beneficiary of these heightened responsibilities which have been accorded to registered nurses and, with these heightened powers and the autonomy recognized by law come heightened responsibilities recognized by law.”

The Spider-Man rule has major consequences for nursing as well as medical institutions such as hospitals and nursing homes. Previously, nurses were deemed to operate completely under the supervision and direction of treating physicians though they are often actually employed by medical facilities. Doctors treating patients in hospitals often are employed by third-party practices. That meant even though a nurse might have contributed to a negligent treatment decision, the hospital was insulated from liability because the decision was deemed to be the doctor’s as a matter of law, and therefore not attributable to the nurse or her employing facility.

Medical facilities can no longer count on that protection if their nurses contribute to or make treatment decisions in breach of the standard of care for nurses in similar circumstances.

The impact for patients could be equally profound. They now have a new path through the labyrinth of legal obstacles to accountability for negligent care. In a state where the legislature has erected numerous special protections for medical professionals to hinder or prevent claims by injured patients, this decision is a rare show of heroism for them.

Hopefully, hospitals, nursing homes, and other health care facilities that employ registered nurses will respond by adding resources and support to reduce opportunities for medical negligence to happen on their watch.

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