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Medical Malpractice and Corporate Negligence in North Carolina

On Tuesday, I discussed the difference between medical malpractice and ordinary negligence when making a claim against an individual health care provider. What is the difference when making a claim against a corporation or hospital?

First, let’s review why it is important to determine whether a case involves medical malpractice or ordinary negligence. Rule 9(j) of the North Carolina Rules of Civil Procedure requires a heightened pleading for complaints alleging medical malpractice. Any case that alleges medical malpractice must be “reviewed by a person who is reasonably expected to qualify as an expert witness” or “by a person that the complainant will seek to have qualified as an expert witness by motion” and “who is willing to testify that the medical care did not comply with the applicable standard of care.” Complaints alleging ordinary negligence do not need to be reviewed by an expert witness.

North Carolina statute G.S 90-21.11(2) defines a “medical malpractice action” as either one of the following:

a.  A civil action for damages for personal injury or death arising out of the furnishing or failure to furnish professional services in the performance of medical, dental, or other health care by a health care provider.

b.  A civil action against a hospital, a nursing home licensed under Chapter 131E of the General Statutes, or an adult care home licensed under Chapter 131D of the General Statutes for damages for personal injury or death, when the civil action (i) alleges a breach of administrative or corporate duties to the patient, including, but not limited to, allegations of negligent credentialing or negligent monitoring and supervision and (ii) arises from the same facts or circumstances as a claim under sub-subdivision a. of this subdivision.

Hospitals can have two types of liability for negligence: 1) liability under the theory of respondeat superior from an individual health care provider’s actions, and 2) liability resulting from its own corporate negligence. If a hospital is liable under the theory of respondeat superior, the distinction between medical malpractice and ordinary negligence follows the reasoning we discussed in the first article. However, if a hospital is liable as a result from its own corporate negligence, there is a different analysis.

The North Carolina Court of Appeals has distinguished between two types of corporate negligence claims asserted against a hospital: “(1) those relating to negligence in clinical care provided by the hospital directly to the patient, and (2) those relating to negligence in the administration or management of the hospital.” If the claim relates to the “negligence in clinical care provided by the hospital directly to the patient,” “courts have applied the medical malpractice statutory standard of care and required expert testimony.” However, if the claim relates to “negligence in the administration or management of the hospital,” “the courts have instead applied the reasonably prudent person standard of care.” Examples of claims relating to the negligence in the administration or management of the hospital are “granting or continuing hospital privileges, failing to monitor or oversee performance of the physicians, credentialing, and failing to follow hospital policies.”

Below is a review of some North Carolina cases that have looked at this issue.

Tripp v. Pate (1980): The plaintiff alleged that the “hospital was negligent in not reporting promptly the results of certain tests ordered by plaintiff's doctors after her surgery, thereby causing a delay in the diagnosis of plaintiff's condition.” Because the “[p]laintiff failed to present any evidence of the standard of care for a hospital in [that city] or similar communities regarding time necessary to report test results,” the Court of Appeals upheld a directed verdict in favor of the hospital.

Bost v. Riley (1980): The Court of Appeals applied the reasonably prudent person standard to a negligence claim in which the patient alleged that the hospital was negligent in selecting the doctors who performed the patient’s surgery.

Paris v. Kreitz (1985): An emergency room patient was observed and examined upon arrival. The nurses determined that that “his condition was not urgent enough to warrant being seen by the on-duty physician” even though the patient’s daughter repeatedly requested that the patient be seen by the doctor. The Court of Appeals held that the plaintiff did not present any “standard by which the Hospital's handling of the case could be judged by a jury; no indication from persons qualified to testify as to what should have been done under the circumstances.”

Blanton v. Moses H. Cone Hosp., Inc. (1987): The plaintiff was injured from a series of surgeries. The claim against the hospital alleged that the hospital “failed to monitor and supervise the doctor's overall performance in the hospital on an ongoing basis” and “permitted the doctor "to perform a series of surgeries ... for which she was not properly qualified without requiring that she be supervised or assisted by a properly qualified member of its medical staff."” The North Carolina Supreme Court held that “that what has previously been called corporate negligence is nothing more than an application of negligence principles” and applied the reasonably prudent person standard to the hospital’s actions.

Clark v. Perry (1994): The patient, who was a Jehovah’s Witness, received a blood transfusion without first giving his informed consent. The plaintiff sued the hospital alleging that the hospital should have obtained the patient’s informed consent prior to administering the transfusion. The Court of Appeals held that the plaintiff was required to present expert testimony regarding the standard of care used by health care facilities similar to the hospital when administering blood transfusions.

Muse v. Charter Hospital (1995): The patient was hospitalized for depression and suicidal thoughts. The hospital had a policy which required doctors to discharge their patients when their insurance expired. Before the doctor could determine the correct dosage of the patient’s medication, the patient’s insurance expired and he was discharged in accordance with the hospital policy, despite the doctor’s request to extend the patient’s hospital stay. A couple weeks later, the patient overdosed on one of his prescribed medications and died. The Court of Appeals applied the reasonably prudent person standard in determining that a hospital has a duty to its patients to not “institute policies or practices which interfere with the doctor's medical judgment.”

Estate of Waters v. Jarman (2001): A patient died as a result of failing to diagnose appendicitis. The plaintiff sued the hospital alleging that the hospital was negligent in “failing to adequately assess the physicians' credentials before granting hospital privileges, by continuing the physicians' privileges at the hospital, by failing to monitor and oversee the physicians' performances, and by failing to follow its own procedures.” The Court of Appeals held that “[b]ecause these claims assert administrative and management deficiencies and do not arise out of the furnishing of professional services in the performance of medical, dental or other health care, they are not claims for medical malpractice. Accordingly, Rule 9(j) certification is not required.”

Acosta v. Byrum (2006): The patient’s doctor allowed the office manager to use his medical access code to access the patient’s confidential psychiatric records. The officer manager provided information contained in the records to a third party. The patient’s claim against the doctor alleged that he improperly allowed the office manager to use his access code. The Court of Appeals held that “[p]roviding an access code to access certain medical files qualifies as an administrative act, not one involving direct patient care” and Rule 9(j) certification was not required.

Estate of Ray v. Keith Forgy, M.D., P.A. (2013): A patient was injured and died as a result of surgery. The plaintiff sued the hospital alleging that the hospital was “not reasonably diligent in reviewing [the doctor’s] qualifications” when it renewed the doctor’s surgical privileges. The Court of Appeals cited Estate of Waters in holding that Rule 9(j) certification was not required because a claim involving the granting of hospital privileges involves “policy, management or administrative decisions” and is rooted in ordinary negligence.

If you have been injured from medical negligence, contact an attorney at Rosensteel Fleishman, PLLC (704) 714-1450 to discuss your options.

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