Case Law Update: Negligence Claims in the Medical Context

The North Carolina Court of Appeals recently issued an opinion that draws a notable distinction between medical malpractice claims and traditional negligence actions.  The distinction is noteworthy in part because of the heightened pleading standards required for medical malpractice actions.  Rule 9(j) of the North Carolina Rules of Civil Procedure requires that medical malpractice claims certify that the medical care at issue was reviewed by a qualified professional who would be willing to testify that the injurious acts or omissions fell below the requisite standard of care.  Accordingly, knowing whether a claim will fall under the medical malpractice category is critical in preventing a Complaint from being dismissed for failure to comply with the Rules of Civil Procedure.

In the case, a plaintiff patient was undergoing cardiovascular surgery and, while opened up and with surgical tools inside her body, fell off the operating table and sustained serious injuries including concussion, double vision, bruises, and emotional trauma.  The Plaintiff filed a complaint alleging that Defendants Duke and Southeastern Medical Center acted negligently by retaining physicians and nurses who allowed the accident to occur.  On appeal, the Court considered whether Plaintiff’s claim sounded in ordinary negligence, or whether it took the form of a malpractice claim that demanded more stringent pleading standards which, if not met, would result in the dismissal of the plaintiff’s complaint.

In North Carolina, the distinction between ordinary negligence and medical malpractice claims is determined by statute.  A medical malpractice claim is a “civil action for personal injuries or death arising out of the furnishing or failure to furnish professional services in the performance of . . . health care by a health care provider.”  North Carolina General Statute Section 90-21.11(2)(a).  The term “professional services” is not defined by statute, but North Carolina courts have referred to it as an act arising out of some vocation, calling, occupation, or endeavor that involves some level of specialized knowledge or skill: a skill that is intellectual rather than manual or physical.  Conversely, ordinary negligence claims in the medical setting arise from acts or omissions that do not implicate some specialized assessments or clinical judgments.  Rather, these types of acts or omissions are measured from a standard of ordinary judgment.  In other words, the inquiry is whether the typical, reasonable person have acted in that manner under the same or similar circumstances.

The Court went on to explain that in the case of a patient falling off an operating table, the dispositive factor in determining whether the case falls under medical malpractice or ordinary negligence is “whether the decisions leading up to the fall required clinical judgment and intellectual skill.” Thus, if evidence shows the fall occurred because physicians failed to properly use restraints, the claim sounds in medical malpractice.  On the other hand, if the evidence shows the patient fell off a gurney because the physicians did not remain in close proximity to the patient or stepped away from the patient, leaving her unattended, the claim would be based in ordinary negligence.  In the first instance, only a person possessing specialized medical knowledge would know the proper use of restraints.  In the second instance, however, the reasonable, ordinary person would know to never leave a patient unattended while minimally conscious or unconscious.

In the instant case, the Court determined the plaintiff’s claim fell into the category of ordinary negligence rather than medical malpractice.  The factual allegation that the plaintiff fell off the operating table while unconscious, open, and with surgical tools in her body was not the type of accident that would result from an action requiring specialized medical knowledge, skill, or judgment.  Rather, it was avoidable by the use of ordinary care, in particular, properly monitoring and controlling the plaintiff’s body during surgery, and properly supervising nurses and other staff throughout the process.  Even though the plaintiff’s complaint employed language that appeared related to a medical malpractice claim, the Court concluded the underlying facts pointed to ordinary negligence – namely, that the defendants failed to “use good judgment, reasonable skill, and diligence in the treatment of [the] Plaintiff.”

For the Court’s full opinion, click here.

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