Share this article

What the NC Supreme Court Ruling Means for Nurses’ Civil Liability

Nina Chamlou
Updated September 15, 2022
    In August, the North Carolina Supreme Court overruled a long-standing precedent that shielded nurses from liability related to medical error when following doctors' orders. But what does this news mean for nurses in the state?
    Credit: Getty Images/Cavan Images RF
    • North Carolina nurses can be sued for medical error even when following doctors’ orders.
    • On Aug. 19, 2022, a North Carolina Supreme Court case resulted in a 3-2 ruling in favor of the patient’s family.
    • Though nurses historically have civil liability, the decision writes over a long-standing legal precedent that shielded nurses from prosecution in similar cases.

    Nurses in North Carolina can be sued for following physicians’ orders if these orders result in patient harm. A recent North Carolina Supreme Court decision overwrites a 90-year-old precedent, Byrd v. Marion General Hospital, which has partially shielded North Carolina nurses from liability when following doctors’ orders.

    Many nurses prickled at the ruling, worrying this could be a growing trend of court rulings being “against” nurses — especially after the recent RaDonda Vaught trial, in which a Tennessee nurse initially faced eight years of prison time for giving a patient the wrong medication.

    But the North Carolina ruling may not be as transformative to nurses’ liability as it seems at first glance.

    “Many have taken the headline and assumed that nurses previously did not have civil liability, which is not the case,” says Danielle Miller, RN, business advisor, and medical consultant.

    Nurses in North Carolina already had a legislated standard for medical malpractice suits to be brought if the care provided by the nurse did not meet what a similar peer would have done, Miller explains.

    Overturning Byrd v. Marion

    The new ruling was brought on by a 2010 incident in which a 3-year-old patient, Amaya Gullatte, visited Carolinas Medical Center (now Atrium Health) for an ablation procedure. An anesthetic administered by mask caused her to go into sudden cardiac arrest, resulting in brain damage, cerebral palsy, and developmental delays.

    The family’s initial attempt to sue the hospital, doctors, and the certified registered nurse anesthetist was unsuccessful. But in a more recent attempt to pursue legal action, in which the case was taken to the state’s Supreme Court, justices voted to overturn the 1932 Byrd v. Marion precedent.

    Justice Michael Morgan argues that now was an “opportune” time to revisit the 90-year-old Byrd precedent due to the “increased, influential roles which nurses occupy in medical diagnosis and treatment.”

    Morgan says the nursing profession has evolved, citing the “recognition of the increased specialization and independence of nurses” in the medical field.

    What This Means for Nurses

    According to Miller, the new ruling simply holds nurses to an already existing, appropriate standard of care. The court rules that even when a nurse is carrying out duties under a doctor’s orders, a nurse may be held liable for medical malpractice “in the event that the registered nurse is found to have breached the applicable professional standard of care,” says Miller.

    But this change doesn’t affect every nurse. Miller explains that as in other jurisdictions, the standard set by the NC Supreme Court ruling is already in effect.

    “This allows nurses in North Carolina to be held to the standard of their peers,” rather than being held to an old standard that was established prior to the advancement of the profession, Miller says.

    As Justice Morgan and Miller suggest, this ruling can be seen as a necessary step in line with the furthering authority of nurses and advanced practice nurses — as demonstrated in New York and Kansas granting nurse practitioners full-practice authority earlier this year.

    But in a field that is already struggling to attract and retain workers, the perception of increased risk of liability for medical errors may be seen as another reason for current and prospective nurses to leave the profession.

    “This ruling comes at a time when burnout, moral injury, staffing concerns, lack of raises, etc., are driving individuals to leave the profession,” Miller says.

    From working overtime throughout the pandemic without sufficient personal protective equipment to watching the emotional Vaught trial, nurses have endured increased stressors over the last few years.

    “The bottom line is they feel there is no one who is fighting for them,” Miller says. “They feel like they are always fighting for those they care for but no one is supporting them in doing the work that many of them feel they were called to do.”

    Because the decision was split narrowly at a 3-2 majority, it’s unclear if it will hold in future cases.

    “My advice to nurses would be to know and follow policies, document to tell the story, carry professional liability insurance, stay up to date on changes in standards of care, and speak up when you have questions or concerns,” Miller says.

    Meet Our Contributors

    Portrait of Danielle Miller, RN

    Danielle Miller, RN

    Danielle Miller has been an RN for over a decade with experience in pediatrics, cardiac, neurology, and abdominal surgery. She also has experience as a transplant coordinator and risk manager for Johns Hopkins Medicine. She is currently CEO of Stars and Stripes Consulting LLC, a medical consulting and business management advisory firm.



    CJ Staff. (2022). N.C. Supreme Court overrules 90-year-old precedent protecting nurses from legal liability. https://www.carolinajournal.com/n-c-supreme-court-overrules-90-year-old-precedent-protecting-nurses-from-legal-liability/

    Connette v. Charlotte-Mecklenburg hospital authority. (2020). https://casetext.com/case/connette-v-charlotte-mecklenburg-hosp-auth

    Kokai M. (2022). N.C. Supreme Court overrules 90-year-old precedent protecting nurses from legal liability. https://richmondobserver.com/local-news/n-c-supreme-court-overrules-90-year-old-precedent-protecting-nurses-from-legal-liability.html

    Fisher D. (2022). Nurses can be sued for following doctor’s orders, North Carolina court rules. https://legalnewsline.com/stories/630746499-nurses-can-be-sued-for-following-doctor-s-orders-north-carolina-court-rules