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Medical Malpractice and the Sudden Emergency Doctrine in North Carolina

The North Carolina Court of Appeals recently looked at whether the sudden emergency doctrine should be applied in the context of a medical malpractice action, in Wiggins v. East Carolina Health-Chowan, Inc. (2014). There is plenty of case law discussing the sudden emergency doctrine in common law negligence actions in North Carolina. However, the court of appeals noted in Wiggins that whether to apply the doctrine in a medical negligence action was an issue of first impression. After considering the issue, the court held that the standard of care under which the actions of the healthcare provider are evaluated accounts for medical emergencies and the sudden emergency doctrine should not be separately considered in medical negligence cases.

In Wiggins, the plaintiff was admitted to the hospital for labor and delivery. Before arriving at the hospital, there was no sign that there was any issue with the pregnancy. The plaintiff was induced and started on the drug Pitocin. At that time, there was no vaginal examination, even though this was required by hospital protocol. Almost five hours after the plaintiff was started on Pitocin, the nurse performed a vaginal exam and discovered that the umbilical cord was protruding from the vagina, which can restrict blood and oxygen to the baby. The nurse immediately called the doctor, and the patient was delivered by C-section about half an hour after the nurse discovered the umbilical cord. The plaintiff alleged that the baby suffered cognitive impairments and loss of motor control due to the birth complications.

The trial court issued jury instructions, using the pattern jury instructions, on the issue of medical negligence, which provided that the plaintiff needed to prove that the defendant violated one of the following duties:

(1) The duty to use their best judgment in the treatment and care of their patient;

(2) The duty to use reasonable care and diligence in the application of their knowledge and skill to their patient's care; and

(3) The duty to provide healthcare in accordance with the standards of practice among members of the same healthcare profession with similar training and experience situated in the same or similar communities at the time the healthcare is rendered.

At trial, several experts testified that this particular complication was not common and qualified as a medical emergency. The defendant requested that the court give the jury an instruction regarding the sudden emergency doctrine, which lessens the defendant’s standard of care in emergency situations. The trial court also issued jury instructions, using the pattern jury instructions, on the issue of the sudden emergency doctrine, as follows:

A person who, through no negligence of his own, is suddenly and unexpectedly confronted with imminent danger to himself and others, whether actual or apparent, is not required to use the same judgment that would be required if there were more time to make a decision. The person's duty is to use that degree of care which a reasonable and prudent person would use under the same or similar circumstances. If, in a moment of such emergency, a person makes a decision that a reasonable and prudent person would make under the same or similar conditions, he does all that the law requires, even if in hindsight some different decision would have been better or safer.

The jury found in favor of the defendant, and the plaintiff appealed.

On appeal, the plaintiff argued that medical emergencies are built into the standard of care and therefore, “the trial court's charge to consider a what a ‘reasonable and prudent person’ would do in a medical emergency was misleading to the jury, where they were also instructed to consider defendant's actions ‘in accordance with the standards of practice among members of the same healthcare profession.’”

Because there were no North Carolina cases applying the sudden emergency doctrine to medical malpractice cases, the defendant relied upon cases from three other states which permitted the application of the sudden emergency doctrine to medical negligence cases.

In its analysis, the court noted that “[i]n North Carolina, the sudden emergency doctrine has been applied only to ordinary negligence claims, mostly those arising out of motor vehicle collisions, and has never been utilized in a medical negligence case.” The court also noted that even in cases where there is arguably a medical emergency, North Carolina courts have determined that “the general standard of care for healthcare professionals has been sufficient to assess liability.”

The court went on to state that

The application of the healthcare professional standard of care to a wide range of factual scenarios is not accidental. Our Supreme Court has described the standard for medical professionals as "completely unitary in nature, combining in one test the exercise of 'best judgment,' 'reasonable care and diligence' and compliance with the 'standards of practice among members of the same health care profession with similar training and experience situated in the same or similar communities.'" 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 court determined that the standard of care relevant for medical malpractice actions, as defined by both the common law and North Carolina statute, is “designed to accommodate the factual exigencies of any given case, including those that may be characterized as medical emergencies.” The court, therefore, held that “the sudden emergency doctrine is unnecessary and inapplicable in such cases.”

The court also noted that even those cases from other jurisdictions which permitted the sudden emergency doctrine to be applied in medical negligence actions limited the instructions to consider what a “reasonable healthcare professional” would do, not merely a “reasonable person” as the trial court’s instructions had. Therefore, the case was remanded for a new trial.

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

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