234 N.C. App. 759
N.C. Ct. App.2014Background
- On July 8–9, 2005 Lakisha Wiggins was admitted for induced labor; nurses failed to perform a vaginal exam immediately before restarting Pitocin as required by protocol.
- A vaginal exam at 12:54 p.m. on July 9 revealed an umbilical cord prolapse; nurses called Dr. Gavigan and preparations began for an emergency C-section.
- It took 16 minutes to move Wiggins to the OR; Roy was delivered by C-section at 1:30 p.m. with initial APGARs 0/3/7 and was transferred for further care, including an attempted therapeutic cooling.
- Plaintiffs sued Chowan Hospital alleging negligent failure to perform timely C-section and other breaches of nursing protocol that caused Roy’s brain injury; experts testified the cord prolapse was a sudden, uncommon emergency and nurses breached standards.
- At trial the court gave the sudden emergency jury instruction (N.C.P.I.—Civ. 102.15) over plaintiffs’ objection; the jury returned a defense verdict and plaintiffs appealed arguing the instruction was improper and the court failed to instruct on liability for harmful subsequent treatment.
- The Court of Appeals held the sudden emergency doctrine is inapplicable to medical negligence actions because the healthcare professional standard already accounts for emergency circumstances; it reversed and remanded for a new trial.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the sudden emergency doctrine may be given in a medical negligence trial | Sudden emergency doctrine is inapplicable because the medical standard of care already contemplates emergencies; instruction misled the jury | Sudden emergency doctrine applies to medical cases as it does to ordinary negligence and was properly given here | The doctrine is unnecessary and inapplicable in medical negligence cases; giving it likely misled the jury — reversal and new trial |
| Whether the sudden emergency instruction should be framed by a layperson standard or a medical-professional standard | Instruction must not replace professional standard with "reasonable person" standard; medical standard already includes emergency context | Sudden emergency instruction is permissible and can lower the required care in emergencies | Even if doctrine applied, the court erred by using a "reasonable person" formulation rather than a reasonable healthcare professional standard, requiring a new trial |
Key Cases Cited
- Mosley & Mosley Builders, Inc. v. Landin Ltd., 87 N.C. App. 438 (clarifies trial court duty to instruct the jury on all substantial legal issues)
- Hammel v. USF Dugan, Inc., 178 N.C. App. 344 (charge reviewed contextually; error must be likely to mislead jury)
- Wall v. Stout, 310 N.C. 184 (healthcare standard of care is unitary and accounts for best judgment, reasonable care, and professional standards)
- Masciulli v. Tucker, 82 N.C. App. 200 (describes sudden emergency doctrine in ordinary negligence)
- O'Mara v. Wake Forest Univ. Health Servs., 184 N.C. App. 428 (applied healthcare professional standard in a birth-oxygen-deprivation case)
- Brawley v. Heymann, 16 N.C. App. 125 (assesses physician conduct in light of the specific factual circumstances)
- Olinger v. Univ. Med. Ctr., 269 S.W.3d 560 (Tenn. Ct. App.) (recognized limited application of sudden emergency doctrine in obstetric context but framed by physician standard)
- Ross v. Vanderbilt Univ. Med. Ctr., 27 S.W.3d 523 (Tenn. Ct. App.) (approved sudden emergency instruction for ER physician under appropriate facts)
- Sutherlin v. Fenenga, 810 P.2d 353 (N.M. Ct. App.) (authorized sudden emergency instruction in medical context)