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Court of Appeals Declines To Extend ‘Sudden Emergency Doctrine’ To Healthcare Providers

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 he circumstances are, which includes sudden
emergencies.”

The full text of the North Carolina Court of Appeals decision may be
read at http://appellate.nccourts.org/opinions/?c=2&pdf=31455