Case Title: King v. Bryant

Citation: 

Docket Number: 294PA14

State: north-carolina

Court: North Carolina Supreme Court

Date: 2017-01-27T00:00:00Z

Document:
IN THE SUPREME COURT OF NORTH CAROLINA 
No. 294PA14  
Filed 27 January 2017 
ROBERT E. KING and wife, JO ANN O’NEAL 
 
 
v. 
MICHAEL S. BRYANT, M.D. and VILLAGE SURGICAL ASSOCIATES, P.A. 
 
On discretionary review pursuant to N.C.G.S. § 7A-31 of a unanimous decision 
of the Court of Appeals, 235 N.C. App. 218, 763 S.E.2d 338 (2014), affirming an order 
entered on 10 May 2013 by Judge Lucy N. Inman in Superior Court, Cumberland 
County.  After hearing oral argument on 18 May 2015 and receiving additional 
findings of fact following the entry of a remand order on 19 February 2016, the Court 
ordered the parties to submit supplemental briefs.  Additional issues raised in the 
supplemental briefs heard on 31 August 2016.  
Beaver, Courie, Sternlicht, Hearp & Broadfoot, P.A., by Mark A. Sternlicht, for 
plaintiff-appellees. 
Walker, Allen, Grice, Ammons & Foy, L.L.P., by Robert D. Walker, Jr., O. Drew 
Grice, Jr., and Alexandra L. Couch, for defendant-appellants. 
Zaytoun Law Firm, PLLC, by Matthew D. Ballew, and Patterson Harkavy LLP, 
by Burton Craige, for North Carolina Advocates for Justice, amicus curiae. 
 
ERVIN, Justice. 
 
This case arises out of a medical malpractice action that plaintiffs, Robert E. 
King and his wife, Jo Ann O’Neal, brought against defendants, Michael S. Bryant, 
M.D., and Village Surgical Associates, P.A.  According to the allegations contained in 
KING V. BRYANT  
 
Opinion of the Court 
 
 
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plaintiffs’ complaint, Mr. King was scheduled to undergo a bilateral inguinal hernia 
repair to be performed by Dr. Bryant at the Fayetteville Ambulatory Surgery Center 
on 14 May 2009.  At the time of his initial appointment with Dr. Bryant, Mr. King 
was presented with an Agreement to Alternative Dispute Resolution (arbitration 
agreement) that defendants routinely presented to new patients along with other 
documents prior to the first occasion on which a patient met with a physician.  The 
arbitration agreement provided that: 
In accordance with the terms of the Federal 
Arbitration Act, 9 USC 1-16, I agree that any dispute 
arising out of or related to the provision of 
healthcare services by me, by Village Surgical 
Associates, PA, or its employees, physician members, 
and agents shall be subject to final and binding 
resolution through private arbitration. 
 
The parties to this Agreement shall agree upon three 
Arbitrators and at least one arbitrator of the three shall be 
a physician licensed to practice medicine and shall be board 
certified in the same specialty as the physician party.  The 
remaining Arbitrators either shall be licensed to practice 
law in NC or licensed to practice medicine in NC.  The 
parties shall agree upon all rules that shall govern the 
arbitration, but may be guided by the Health Care Claim 
Settlement Procedures of the American Arbitration 
Association, a copy of which is available to me upon 
request.  I understand that this agreement includes all 
health care [sic] services which previously have been or will 
in the future be provided to me, and that this agreement is 
not restricted to those health care [sic] services rendered in 
connection with any particular treatment, office or hospital 
admission.  I understand that this agreement is also 
binding on any individual or entity and not a precondition 
to receiving health care [sic] services. 
 
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Opinion of the Court 
 
 
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Mr. King, a witness, and Dr. Bryant each signed the arbitration agreement on 29 
April 2009. 
According to the unchallenged findings of fact, a front desk employee at Village 
Surgical Associates provided Mr. King with several intake forms to complete and sign 
while he waited to meet Dr. Bryant.  The initial intake forms asked Mr. King to 
provide personal and medical history information and to sign the signature lines on 
all of the forms, including the arbitration agreement.  Mr. King stated in his affidavit 
that he was then provided with a second set of documents, which addressed insurance 
and payment-related issues, after he had met with Dr. Bryant.  Mr. King 
acknowledged that he did not read any of the documents that he signed after his 
initial meeting with Dr. Bryant and stated that he had believed them to be “just a 
formality.”  Mr. King denied having received a copy of the arbitration agreement on 
the day that it was signed and asserted that the contents of the agreement were not 
clear to him even after he had read it.  Mr. King contended that, “[i]f the agreement 
had been brought to my attention and I had been told signing it was optional, I would 
not have signed it.”1 
In the course of the performance of the hernia repair procedure, Dr. Bryant 
injured Mr. King’s distal abdominal aorta, resulting in abdominal bleeding.  Although 
                                            
1 Plaintiffs have not complained about, much less challenged the validity of, any of the 
other documents that Mr. King signed during his visit to the Village Surgical Center on 29 
April 2009.  The identity and contents of these documents are not clear from the record. 
KING V. BRYANT  
 
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Dr. Bryant was able to repair Mr. King’s injury, the necessary remedial procedures 
led to occlusion of an artery, a thromboembolism to Mr. King’s right lower leg, and 
acute ischemia in Mr. King’s right foot.  After undergoing the performance of an 
immediate revascularization at Cape Fear Valley Health Systems for the purpose of 
salvaging his right leg, Mr. King remained hospitalized until 26 May 2009.  At the 
time of his discharge, Mr. King continued to suffer from complications related to his 
abdominal aortic injury and needed additional treatment.  As a result of the injury 
that he sustained during the hernia repair procedure, Mr. King incurred unexpected 
medical expenses, abdominal scarring, lost wages, numbness, and a limited ability to 
use his right leg and foot. 
On 28 September 2011, plaintiffs filed a complaint against defendants in the 
Superior Court, Cumberland County, seeking damages for medical malpractice.  On 
7 November 2011, defendants filed a motion seeking to have further litigation in this 
action stayed and the arbitration agreement that had been entered into between Mr. 
King and defendants enforced and an answer in which defendants denied the 
material allegations of plaintiffs’ complaint.  Plaintiffs responded to defendants’ 
motion to stay and enforce the arbitration agreement by arguing that: 
[T]he purported agreement is not enforceable for reasons 
that include but are not limited to the undue, prohibitive 
financial burden that enforcement of the agreement would 
have on plaintiffs by requiring the hiring of three 
arbitrators, one who must be a board certified physician in 
the same specialty as the defendant, Michael S. Bryant, 
M.D., and two who must be attorneys or physicians 
KING V. BRYANT  
 
Opinion of the Court 
 
 
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licensed in North Carolina; the inherent unfairness of 
requiring one arbitrator be a member of the same 
profession and medical specialty as the defendant, . . . 
especially in light of the absence of any comparable 
requirement for an arbitrator to be similarly affiliated with 
the plaintiffs . . . .   
 
On 13 February 2012, defendants filed a motion seeking the entry of an order 
compelling arbitration.  On 23 March 2012, the trial court entered an order denying 
defendants’ motion to enforce the arbitration agreement on the basis of conclusions 
that: 
4.  
The 
Agreement 
to 
Alternative 
Dispute 
Resolution leaves material portions open to future 
agreements by providing, inter alia, that the parties shall 
agree upon three arbitrators and that the parties shall 
agree upon all rules that shall govern the arbitration. 
 
5.  
At most, the Agreement to Alternative 
Dispute Resolution is an “agreement to agree” that is 
indefinite and depends on one or more future agreements.  
Seawell v. Continental Cas. Co., 84 N.C. App. 277, 281, 352 
S.E.2d 263, 265 (1987). 
 
6.  
The 
Agreement 
to 
Alternative 
Dispute 
Resolution is not a binding contract and is not enforceable. 
 
Defendants noted an appeal to the Court of Appeals from the trial court’s order. 
On 5 February 2013, the Court of Appeals filed an opinion reversing the March 
2012 order and remanding this case for further proceedings, King v. Bryant, 225 N.C. 
App. 340, 737 S.E.2d 802 (2013) (King I), on the grounds “that the trial court erred in 
concluding the Agreement between the parties was too indefinite to be enforced,” id. 
at 345, 737 S.E.2d at 807.  According to the Court of Appeals, “there was clearly an 
KING V. BRYANT  
 
Opinion of the Court 
 
 
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offer to arbitrate any dispute which arose out of Defendants’ provision of medical care, 
as well as an acceptance of that offer by Mr. King.”  Id. at 346, 737 S.E.2d at 807.  
Although plaintiffs had argued before the trial court and the Court of Appeals that 
the arbitration agreement was unenforceable on unconscionability grounds, the 
Court of Appeals declined to address that issue given that the trial judge in the March 
2012 order had not made the necessary factual findings.  Id. at 347, 737 S.E.2d at 
808.  According to the Court of Appeals, “the trial court is the appropriate body to 
determine whether the agreement is unconscionable,” id. at 347-48, 737 S.E.2d at 808 
(citation omitted), with the needed unconscionability analysis to “be undertaken with 
an understanding of the unique nature of the physician/patient relationship,” id. at 
348, 737 S.E.2d at 808.  In addition, the Court of Appeals noted that, “[u]nder North 
Carolina law, fiduciary relationships create a rebuttable presumption that the 
plaintiff put his trust and confidence in the defendant as a matter of law.”  Id. at 349, 
737 S.E.2d at 809.  As a result, the Court of Appeals required that these issues be 
addressed on remand.  Id. at 350, 737 S.E.2d at 809. 
On 10 May 2013, the trial court entered an order on remand determining that, 
given the nature of the fiduciary relationship that existed between Mr. King and 
defendants, defendant Bryant “had a fiduciary duty to disclose to his patient all facts 
material to their transaction.”  More specifically, the trial court’s May 2013 order 
found as a fact that: 
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2.  
Mr. King, now 68, has no educational degree 
beyond high school and his job requires little reading.  He 
has minimal experience reading legal documents. 
 
3.  
Defendant Village Surgical Associates, P.A. 
(“Village Surgical”) has experience in managing patient 
complaints, responding to claims of medical negligence 
made by patients, and resolving disputes through 
arbitration. 
 
4.   
On 
April 
29, 
2009, 
Plaintiffs 
visited 
Defendant’s office for the first time to consult with 
Defendant Bryant about performing laparoscopic surgery 
on Plaintiff King to repair a hernia.  Plaintiff King had 
been referred to Defendants by his primary care physician. 
 
5.   
While Plaintiffs were waiting to meet 
Defendant Bryant and consult with him about performing 
surgery, Defendant’s receptionist provided Plaintiff King 
with several intake forms to complete and sign.  Plaintiff 
King considered the forms to be a formality. 
 
6.   
Neither the receptionist, nor Defendant 
Bryant, nor any agent of Defendants called to Plaintiff 
King’s attention the fact that one of the forms he was asked 
to sign, the Agreement, differed from all of the other forms 
because it did not concern medical information, insurance 
information, or payment for the surgery, all routine for a 
new patient.  Nor did anyone disclose to Plaintiff King that 
the Agreement sought to foreclose his access to the judicial 
process in the event that any dispute arose out of or related 
to the surgery to be performed by Defendant Bryant. 
 
. . . . 
 
8.   
The Agreement does not provide that by 
signing it, the patient waives his or her right to a trial.  The 
Agreement does not include the word “jury” or “judge” or 
“trial.”  The Agreement does not provide that the patient 
can consult an attorney before signing it. 
 
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9.   
There is no evidence that the physician or any 
agent of Defendants discussed with the patient, Plaintiff 
King, any provision of the Agreement. 
 
. . . . 
 
11.   At the time Plaintiff King signed the 
Agreement and provided his medical information on intake 
forms, even though he had not yet met Defendant Bryant, 
he was already placing his confidence and trust in 
Defendants, as demonstrated by his willingness to share 
his confidential medical information. 
 
. . . . 
 
14.  
The first, bold-faced paragraph of the 
Agreement is poorly drafted, confusing, and nonsensical.  
For example, it refers to the “provision of healthcare 
services by me,” suggesting that “me” refers to the 
physician rather than the patient. 
 
15.   The 
Agreement 
repeatedly 
refers 
to 
arbitration without defining the term.  The Agreement 
includes no mention whatsoever of the judicial process, a 
trial, or a jury.  The Agreement does not disclose 
Defendants’ intent for Plaintiff King to waive his rights to 
the judicial process, including his right to a jury trial, in 
the event of any claim arising from or related to the 
surgery.  A person of Plaintiff King’s education and 
experience should not reasonably have been expected to 
know from the language of the Agreement, or from any 
information provided to him by Defendants, that he had a 
right to a jury trial to resolve any potential dispute with 
his surgeon.  Nor should he have been expected to 
understand from the language of the Agreement or other 
information provided to him by Defendants that by signing 
the Agreement, he would waive his right to a jury trial. 
 
16.   The last sentence of the second paragraph in 
the Agreement starts with complex but complete clauses 
. . . and ends with an incomplete clause . . . .  A person of 
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Opinion of the Court 
 
 
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Plaintiff King’s education and experience should not 
reasonably be expected to understand the last, tacked on, 
incomplete clause to mean that he did not need to sign the 
Agreement in order for Defendant Bryant to perform the 
surgery. 
 
17.   Plaintiff King read the Agreement after a 
copy was provided to him by his attorney, and he still did 
not understand its contents or the intended consequence of 
signing it. 
 
18.   Unlike arbitration agreements which have 
been upheld and enforced in medical negligence cases, the 
Agreement 
includes 
no 
provision 
allowing 
or 
recommending that the patient consult with an attorney 
regarding the Agreement prior to signing it.   
 
19.  
Defendants sought Plaintiff’s signature on 
the Agreement to benefit themselves. 
 
20.  
The Agreement’s provision requiring at least 
one physician arbitrator, and its provision allowing all 
three arbitration panelists to be a physician, confers a 
benefit to Defendants and detriment to Plaintiffs. 
 
. . . . 
 
23.   Ms. Ramos, a receptionist at Defendant 
Village Surgical, states in a sworn affidavit that the form 
arbitration 
agreement 
is 
included 
in 
“registration 
paperwork” presented to each new patient when he or she 
visits the practice for an initial appointment, prior to 
meeting with a physician. . . .  It is reasonable to infer from 
Ms. Ramos’ sworn statement that, in fact, it is the practice 
of Defendants to obscure the form arbitration agreement 
by presenting it among a pile of other documents without 
pointing it out or explaining its contents. 
 
Based upon these findings of fact, the trial court concluded as a matter of law in the 
May 2013 order that: 
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3.  
Defendants were fiduciaries of Plaintiff King 
as the result of the physician-patient relationship. 
 
4.  
Defendant Bryant and other agents of 
Defendants breached their fiduciary duties to Plaintiff 
King by failing to disclose to him all material terms of the 
Agreement and failing to deal with him openly, fairly, 
honestly, and without imposition, oppression, or fraud in 
procuring his signature on the Agreement. 
 
. . . . 
 
6.   
The Agreement is the product of constructive 
fraud and is therefore unenforceable. 
 
7.  
The Agreement is unconscionable and is 
therefore unenforceable. 
 
Defendants noted an appeal to the Court of Appeals from the trial court’s May 2013 
remand order declining to enforce the arbitration agreement. 
On 15 July 2014, the Court of Appeals filed an unpublished opinion affirming 
the May 2013 remand order on unconscionability grounds.  King v. Bryant, 235 N.C. 
App. 218, 763 S.E.2d 338, 2014 WL 3510481 (2014) (unpublished) (King II).  Although 
defendants had argued on appeal that the arbitration agreement was “not a product 
of constructive fraud and not unconscionable” and that the trial court had “erred by 
denying their motion to compel arbitration,” King II, 2014 WL 3510481 at *2, the 
Court of Appeals noted that “[d]efendants do not argue that the trial court’s findings 
of fact are not based on competent evidence,” id. at *6, making the trial court’s 
findings “binding on appeal,” id. at *6 n.1.  In addition, the Court of Appeals declined 
to address defendants’ contention that “a fiduciary relationship did not exist at the 
KING V. BRYANT  
 
Opinion of the Court 
 
 
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time that Mr. King signed the arbitration agreement because [Dr. Bryant] had not 
yet accepted King as a patient,” id. at *6, given that the Court had already decided in 
King I “that a fiduciary relationship existed between the parties and directed the trial 
court to consider that fact on remand,” id. (citing N.C. Nat’l Bank v. Va. Carolina 
Builders, 307 N.C. 563, 567, 299 S.E.2d 629, 631 (1983) (concluding that, “once a 
panel of the Court of Appeals has decided a question in a given case that decision 
becomes the law of the case and governs other panels which may thereafter consider 
the case”)). 
Upon reaching the unconscionability issue, the Court of Appeals noted this 
Court’s holding in Tillman v. Commercial Credit Loans, Inc., to the effect that, 
although 
[a]rbitration is favored in North Carolina. . . . “equity may 
require invalidation of an arbitration agreement that is 
unconscionable.”  A court will find a contract to be 
unconscionable “only when the inequity of the bargain is so 
manifest as to shock the judgment of a person of common 
sense, and where the terms are so oppressive that no 
reasonable person would make them on the one hand, and 
no honest and fair person would accept them on the other.” 
 
362 N.C. 93, 101-02, 655 S.E.2d 362, 369-70 (2008) (internal citations omitted) 
(quoting Murray v. United Food & Commercial Workers Int’l Union, 289 F.3d 297, 
302 (4th Cir. 2002), and Brenner v. Little Red Sch. House Ltd., 302 N.C. 207, 213, 274 
S.E.2d 206, 210 (1981)).  “A party asserting that a contract is unconscionable must 
KING V. BRYANT  
 
Opinion of the Court 
 
 
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prove both procedural and substantive unconscionability.”  Id. at 102, 655 S.E.2d at 
370 (citations omitted).  However, 
[s]ince Tillman, the United States Supreme Court has 
issued two important opinions on the use of state law to set 
aside an arbitration agreement when that agreement is 
governed by the FAA: AT&T Mobility v. Concepcion, ___ 
U.S. ___, 179 L.Ed.2d 742 (2011) (determining that the 
FAA preempted California’s judicial rule prohibiting class 
waivers in consumer arbitration agreements contained 
within contracts of adhesion) and American Express Co. v. 
Italian Colors Rest., ___ U.S. ___, 186 L.Ed.2d 417 (2013) 
(holding that the FAA does not permit courts to invalidate 
an arbitration agreement on the grounds that it does not 
permit class arbitration). 
 
King II, 2014 WL 3510481, at *8.  The Court of Appeals had addressed the impact of 
Concepcion and Italian Colors on Tillman in Torrence v. Nationwide Budget Finance, 
232 N.C. App. 306, 753 S.E.2d 802, disc. rev. denied and cert. denied, 367 N.C. 505, 
759 S.E.2d 88 (2014), and stated that, “[w]hile both Concepcion and Italian Colors 
dealt with class action waivers, underlying those decisions was a broader theme that 
unconscionability attacks that are directed at the arbitration process itself will no 
longer be tolerated.”  Torrence, 232 N.C. App. at 321, 753 S.E.2d at 811 (citation 
omitted).  As a result, in Torrence, the Court of Appeals held that “(1) the 
‘prohibitively high’ cost factor is no longer applicable to an unconscionability analysis; 
(2) an agreement’s lack of mutuality, alone, is not sufficient to justify a finding of 
substantive unconscionability; and (3) the prohibition of joinder of claims and class 
KING V. BRYANT  
 
Opinion of the Court 
 
 
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actions does not render an arbitration agreement unconscionable.”  King II, 2014 WL 
3510481 *8 (citing Torrence, 232 N.C. App. at 322, 753 S.E.2d at 811-12). 
In spite of the limitations on the use of state law to preclude enforcement of 
arbitration agreements noted in Torrence, the Court of Appeals concluded that “the 
trial court correctly determined that the arbitration agreement here is 
unconscionable,” id., given defendant’s failure to take “any active steps, in accordance 
with their fiduciary duty, to make a full, open disclosure of material facts to King 
before he signed the arbitration agreement,” id. at *9 (internal quotations marks 
omitted).  The Court of Appeals concluded that the arbitration agreement is 
procedurally unconscionable because, 
[g]iven (1) the fact that we analyze the agreement here in 
the context of the fiduciary duty Defendants owed King, (2) 
the disparate levels of sophistication between the parties, 
(3) the nature of the delivery of the agreement, and 
(4) Defendants’ burden because of their fiduciary duty to 
King to provide full and open disclosure of the material 
facts surrounding the transaction between the parties, we 
hold that the arbitration agreement suffered from 
significant procedural unconscionability.  King did not 
have a meaningful choice between whether to sign the 
agreement or not.  Accordingly, Defendants’ argument is 
overruled. 
 
Id. at *10.  Similarly, the Court of Appeals found the arbitration agreement to be 
substantively unconscionable because it is “a harsh, one-sided and oppressive 
instrument.”  Id.  As a result, after concluding that “this agreement is unconscionable 
because of Defendants’ failure to properly prepare and present the arbitration 
KING V. BRYANT  
 
Opinion of the Court 
 
 
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agreement to King in the context of their confidential, physician-patient, fiduciary 
relationship,” id. at *11, the Court of Appeals affirmed the remand order, id. 
On 18 August 2014, defendants filed a petition for discretionary review 
requesting this Court to grant further review of the Court of Appeals’ decision in King 
II.  On 18 December 2014, this Court granted defendants’ discretionary review 
petition.  After briefing and oral argument, this Court entered an order on 21 August 
2015 remanding this case to the Superior Court, Cumberland County, for the making 
of further findings of fact relating to the issue of whether a physician-patient 
relationship existed at the time that Mr. King signed the arbitration agreement on 
the grounds that both the trial court’s May 2013 remand order and the Court of 
Appeals decision in King II had “assumed the existence of such a relationship” and 
that the record was devoid of sufficient findings to permit the proper resolution of 
this case in the absence of such findings.  
On 6 November 2015, Judge Mary Ann Tally entered an order on remand 
making the factual findings requested in this Court’s remand order.  In the November 
2015 order, the trial court found as fact that: 
5.   
When Mr. King completed the forms by 
providing his confidential medical history, symptoms, 
personal identifying information, and health insurance [ ] 
information, and signing the arbitration agreement, he 
trusted Dr. Bryant as his doctor, Dr. Bryant’s practice, and 
its employees, particularly because of the referral from his 
family doctor.  Mr. King would not have provided private 
and confidential information and signed the documents, 
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Opinion of the Court 
 
 
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including the arbitration agreement, if he had not 
considered Dr. Bryant to be his doctor and trusted him.   
 
6.   
Patient trust is fundamental to the physician-
patient 
relationship. 
 
The 
requirements 
of 
that 
relationship include adequate communication between the 
physician and patient; there be no conflict of interest 
between the patient and the physician; personal details of 
the patient[’]s life shared with the physician be held in 
confidence; there be respect for the patient’s autonomy; 
patient primacy; and selflessness.  These requirements are 
described in the North Carolina Medical Board Position 
Statement, The physician-patient relationship.  Each of 
these requirements applied to the relationship between 
defendants and Mr. King. 
 
7.   
Each of those requirements arose because a 
physician-patient relationship existed between defendants 
and Mr. King. . . .  [A] physician-patient relationship can 
exist before a physician meets a patient, particularly when 
the physician delegates to others certain duties that are 
involved in the relationship, even though this may “not fit 
traditional notions of the doctor-patient relationship.”  
Mozingo v. Pitt Cnty. Mem. Hosp., Inc., 331 N.C. 182, 188, 
415 S.E.2d 341, 344-45 (1992).  These cases support the fact 
that a physician-patient relationship can exist when a 
physician has fewer than all of the duties that attach to the 
relationship after the duty to treat arises or when a 
physician, in today’s modern health care environment, 
relies on others to participate in activities necessary for 
patient care. 
 
8.   
By analogy, the [a]ttorney-client privilege 
protects “not only the giving of professional advice to those 
who can act on it but also the giving of information to the 
lawyer to enable him to give sound and informed advice.”  
Upjohn Co. v. United States, 449 U.S. 383, 390, 394 (1981). 
 
9.   
The physician-patient relationship began 
before Mr. King signed the arbitration agreement and was 
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Opinion of the Court 
 
 
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in existence at the time he signed the arbitration 
agreement. 
 
After receiving these additional findings of fact concerning the physician-patient 
relationship issue, this Court ordered supplemental briefing and argument.  In their 
supplemental brief, defendants urge us to “disregard the findings of fact entered by 
the trial court, find that no physician-patient relationship existed at the time Mr. 
King signed the arbitration agreement, and reverse the decision of the Court of 
Appeals affirming the trial court’s order on the grounds that the arbitration 
agreement is unconscionable.”  Plaintiffs, on the other hand, argue that the findings 
contained in the November 2015 order establish that a physician-patient relationship 
existed when Mr. King signed the arbitration agreement, so that “this Court should 
affirm the holdings that the Agreement is unenforceable due to constructive fraud 
and unconscionability.” 
Although they have vigorously challenged the legal effect of the factual 
findings contained in the May 2013 and November 2015 orders, defendants have not 
challenged the sufficiency of the evidence to support any of those findings.  According 
to well-established North Carolina law, “[w]here no exception is taken to a finding of 
fact by the trial court, the finding is presumed to be supported by competent evidence 
and is binding on appeal.”  Koufman v. Koufman, 330 N.C. 93, 97, 408 S.E.2d 729, 
731 (1991) (citing, inter alia, Schloss v. Jamison, 258 N.C. 271, 275, 128 S.E.2d 590, 
593 (1962)).  However, defendants do argue that the findings of fact fail to support 
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Opinion of the Court 
 
 
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the conclusions of law to the effect that “[d]efendants were fiduciaries of Plaintiff King 
as the result of the physician-patient relationship” and that “[t]he Agreement is 
unconscionable and is therefore unenforceable.”  Unlike findings of fact, 
“[c]onclusions of law drawn by the trial court from its findings of fact are reviewable 
de novo on appeal.”  Carolina Power & Light Co. v. City of Asheville, 358 N.C. 512, 
517, 597 S.E.2d 717, 721 (2004) (citations omitted).  As a result, we will review 
defendants’ challenges to these conclusions of law using a de novo standard of review. 
After carefully considering the record and the briefs and arguments submitted 
by the parties, we believe that the proper resolution of this case hinges upon the 
nature of the relationship that existed between Mr. King and Dr. Bryant at the time 
that the arbitration agreement was signed.  Although the parties, especially in their 
supplemental briefs, have placed particular emphasis upon the issue of whether a 
physician-patient relationship could have existed between Mr. King and Dr. Bryant 
before Dr. Bryant met with and accepted Mr. King as a patient, we are not, after 
extensive reflection, convinced that this case is properly viewed through a physician-
patient relationship lens.  Instead, we believe that this case is most properly 
understood as revolving around the issue of whether a fiduciary relationship existed 
KING V. BRYANT  
 
Opinion of the Court 
 
 
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between Mr. King and Dr. Bryant independent of the existence of a physician-patient 
relationship at the time that Mr. King signed the arbitration agreement.2 
“For a breach of fiduciary duty to exist, there must first be a fiduciary 
relationship between the parties.”  Dalton v. Camp, 353 N.C. 647, 651, 548 S.E.2d 
704, 707 (2001) (citing Curl v. Key, 311 N.C. 259, 264, 316 S.E.2d 272, 275 (1984), and 
Link v. Link, 278 N.C. 181, 192, 179 S.E.2d 697, 704 (1971)).  “The courts generally 
have declined to define the term ‘fiduciary relation’ and thereby exclude from this 
broad term any relation that may exist between two or more persons with respect to 
the rights of persons or property of either.”  Abbitt v. Gregory, 201 N.C. 577, 598, 160 
S.E. 896, 906 (1931).  “In general terms, a fiduciary relation is said to exist [w]herever 
confidence on one side results in superiority and influence on the other side; where a 
special confidence is reposed in one who in equity and good conscience is bound to act 
in good faith and with due regard to the interests of the one reposing the confidence.”  
Vail v. Vail, 233 N.C. 109, 114, 63 S.E.2d 202, 206 (1951) (internal quotation marks 
omitted). 
A number of relationships have been held to be inherently fiduciary, including 
the relationships between spouses, attorney and client, trustee and beneficiary, 
members of a partnership, Dallaire v. Bank of America, N.A., 367 N.C. 363, 367, 760 
                                            
2 Defendants have never contended at any point in this litigation that the breach of 
fiduciary duty issue, which was clearly discussed in the trial court and raised before the Court 
of Appeals during the proceedings that led to King II, is not properly before the Court. 
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Opinion of the Court 
 
 
-19- 
S.E.2d 263 266, and physician and patient, Watts v. Cumberland County Hospital 
System Inc., 317 N.C. 110, 116, 343 S.E.2d 879, 884 (1986).  However, 
[t]he relation may exist under a variety of circumstances; 
it exists in all cases where there has been a special 
confidence reposed in one who in equity and good 
conscience is bound to act in good faith and with due regard 
to the interests of the one reposing confidence. . . . .  Courts 
of equity have carefully refrained from defining the 
particular instances of fiduciary relations in such a manner 
that other and perhaps new cases might be excluded.  It is 
settled by an overwhelming weight of authority that the 
principle extends to every possible case in which a fiduciary 
relation exists as a fact, in which there is confidence 
reposed on one side and the resulting superiority and 
influence on the other.  The relation and the duties 
involved in it need not be legal; it may be moral, social, 
domestic, or merely personal. 
 
Abbitt, 201 N.C. at 598, 160 S.E. at 906-07 (internal quotation marks omitted); see 
also Dallaire, 367 N.C. at 367, 760 S.E.2d at 266 (concluding that fiduciary 
relationships are characterized by “a heightened level of trust and the duty of the 
fiduciary to act in the best interests of the other party”).  
If a fiduciary relationship is found to exist, the fiduciary is “held to a standard 
‘stricter than the morals of the market place’ . . . ‘[n]ot honesty alone, but the punctilio 
of an honor the most sensitive, is [then] the standard of behavior.’ ”  Dallaire, 367 
N.C. at 367, 760 S.E.2d at 266 (second alteration in original) (quoting Meinhard v. 
Salmon, 249 N.Y. 458, 464, 164 N.E. 545, 546 (1928)).  Liability for breach of fiduciary 
duty “is based on [the taking advantage of] a confidential relationship rather than a 
specific misrepresentation.”  Barger v. McCoy Hillard Parks, 346 N.C. 650, 666, 488 
KING V. BRYANT  
 
Opinion of the Court 
 
 
-20- 
S.E.2d 215, 224 (1997) (quoting Terry v. Terry, 302 N.C. 77, 85, 273 S.E.2d 674, 678-
79 (1981)); Priddy v. Kernersville Lumber Co., 258 N.C., 653, 658, 129 S.E.2d 256, 261 
(1963) (stating that liability for breach of fiduciary duty “may exist without any 
fraudulent intent”).  As a result, “[w]here a relation of trust and confidence exists 
between the parties, there is a duty to disclose all material facts and failure to do so 
constitutes” a breach of fiduciary duty.  Vail, 233 N.C. at 114, 63 S.E.2d at 206 
(internal quotation marks omitted).3  However, before liability for breach of fiduciary 
duty can exist, it must be shown that the defendant sought to benefit himself at the 
expense of the other party.  Barger, 346 N.C. at 666-67, 488 S.E.2d at 224. 
The record evidence, as reflected in the factual findings contained in the May 
2013 and November 2015 orders, demonstrates that Mr. King was referred to Dr. 
Bryant by his family practitioner for the purpose of having a hernia repair procedure 
performed.  Individuals consult with surgeons, like they do with other physicians, 
because such persons possess “special knowledge and skill in diagnosing and treating 
diseases and injuries, which the patient lacks;” accordingly, “the patient has sought 
                                            
3 The elements of a claim for breach of fiduciary relationship are the same as those for 
constructive fraud.  See Link v. Link, 278 N.C. 181, 192, 179 S.E.2d 697, 704 (1971) (stating 
that, “[w]here a transferee of property stands in a confidential or fiduciary relationship to the 
transferor, it is the duty of the transferee to exercise the utmost good faith in the transaction 
and to disclose to the transferor all material facts relating thereto and his failure to do so 
constitutes fraud” (citing Vail, 233 N.C. 109, 63 S.E.2d 202));  Rhodes v. Jones, 232 N.C. 547, 
548, 61 S.E.2d 725, 726 (1950) (stating that “[c]onstructive fraud often exists where the 
parties to a transaction have a special confidential or fiduciary relation which affords the 
power and means to one to take undue advantage of, or exercise undue influence over the 
other.” (internal quotation marks omitted) (citing McNeill v. McNeill, 223 N.C. 178, 25 S.E.2d 
615 (1943)). 
KING V. BRYANT  
 
Opinion of the Court 
 
 
-21- 
and obtained the services of the physician because of such special knowledge and 
skill.”  Black v. Littlejohn, 312 N.C. 626, 646, 325 S.E.2d 469, 482 (1985) (internal 
quotation marks omitted).  Upon arrival at defendants’ office, Mr. King was presented 
with a collection of documents, including the arbitration agreement, and asked to 
complete them.  The majority of the documents that Mr. King was requested to 
complete and sign involved the provision of medical information, which is inherently 
sensitive and confidential in nature, for Dr. Bryant’s use in determining whether to 
accept Mr. King as a patient and in determining how he should be treated.  No one 
directed Mr. King’s attention to the arbitration agreement, which was only one of a 
number of documents presented to him on that occasion, or made any attempt to 
explain the ramifications that would result from any decision on his part to sign it.  
After Mr. King completed and signed these documents and met with Dr. Bryant, Dr. 
Bryant agreed to assume responsibility for providing Mr. King with medical care and 
treatment. 
A careful examination of the information contained in the findings of fact made 
in the May 2013 and November 2015 orders persuades us that, regardless of whether 
a physician-patient relationship existed between Mr. King and Dr. Bryant at the time 
that the arbitration agreement was signed, there was a confidential relationship 
between them at that point.  It is difficult for us to see how one could reach any 
conclusion other than that Mr. King reposed trust and confidence in Dr. Bryant, to 
whom he had been referred by his family physician for the purpose of receiving 
KING V. BRYANT  
 
Opinion of the Court 
 
 
-22- 
surgical treatment.  As we have already noted, the fact that Mr. King decided to 
consult Dr. Bryant constituted recognition on Mr. King’s part that Dr. Bryant 
possessed “special knowledge and skill in diagnosing and treating diseases and 
injuries, which the patient lacks.”  Black. 312 N.C. at 646, 325 S.E.2d at 482.  Before 
he even saw Dr. Bryant, Mr. King demonstrated sufficient trust and confidence in 
him to provide Dr. Bryant with confidential medical information.  Finally, unlike Dr. 
Bryant, Mr. King had received a limited education and had little to no experience 
interpreting legal documents.  As a result, we conclude that a fiduciary relationship 
existed between Mr. King and Dr. Bryant at the time that Mr. King signed the 
arbitration agreement. 
Similarly, we conclude that defendants violated their fiduciary duty to Mr. 
King by failing to make full disclosure of the nature and import of the arbitration 
agreement to him at or before the time that it was presented for his signature.  
Instead of specifically bringing this agreement, which substantially affected his legal 
rights in the event that an untoward event occurred during the course of the 
treatment that he received from defendants, to Mr. King’s attention and explaining 
it to him, defendants presented Mr. King with the arbitration agreement, which, at a 
minimum, could have been worded more clearly, in a collection of documents, thereby 
creating the understandable impression that the arbitration agreement was simply 
another routine document that Mr. King needed to sign in order to become a patient.  
Moreover, consistent with the unchallenged findings of fact, defendants benefitted 
KING V. BRYANT  
 
Opinion of the Court 
 
 
-23- 
from Mr. King’s action in signing the arbitration agreement by ensuring that any 
subsequent dispute between the parties would be resolved using the forum, 
procedures, and decision makers of their choice.  As a result, the findings of fact 
contained in the May 2013 and November 2015 orders establish that defendants 
failed to act consistently with their fiduciary duty to Mr. King by requesting that he 
sign a document with substantial legal ramifications and which they believed to be 
of benefit to themselves without making full disclosure to Mr. King.  
Aside from the fact that defendants have failed to clearly advance a federal 
preemption argument in reliance upon Concepcion and related decisions in the briefs 
that they filed before this Court, State v. Garcell, 363 N.C. 10, 41, 678 S.E.2d 618, 
638 (stating that, “[d]espite citing due process concerns to the trial court, defendant 
fails to adequately develop a constitutional claim on appeal and has thus abandoned 
any such argument”) (citing N.C. R. App. P. 28(a), (b)(6))), cert. denied, 558 U.S. 999, 
130 S. Ct. 510, 175 L. Ed. 2d 362 (2009), and the fact that defendants have made no 
attempt to show that the present arbitration agreement is subject to the Federal 
Arbitration Act,4 we do not believe that our decision in this case is in any way 
                                            
4 Any federal preemption claim advanced in this case pursuant to Concepcion and 
related decisions must rest upon 9 U.S.C. § 2, which applies to “contract[s] evidencing a 
transaction involving commerce.”  The necessary nexus between the relevant transaction and 
“interstate commerce” exists in the event that “the ‘transaction’ in fact ‘involv[e][s]’ interstate 
commerce, even if the parties did not contemplate an interstate commerce connection.”  
Allied—Bruce Terminix Cos. v. Dobson, 513 U.S. 265, 281, 115 S. Ct. 834, 843, 130 L. Ed. 2d 
753, 769 (1995) (first set of brackets in original).  Given that the present record contains no 
indication that the agreement between the parties constitutes a “transaction involving 
commerce,” 9 U.S.C. § 2 (2012), and given that the burden of demonstrating the applicability 
KING V. BRYANT  
 
Opinion of the Court 
 
 
-24- 
inconsistent with the federal preemption principles enunciated in Concepcion and 
related cases.  As those decisions clearly recognize, arbitration agreements are 
subject to invalidation based upon “ ‘generally applicable contract defenses, such as 
fraud,[5] duress, or unconscionability,’ but not by defenses that apply only to 
arbitration or that derive their meaning from the fact that an agreement to arbitrate 
is at issue.”6  Concepcion, 563 U.S. at 339, 131 S. Ct. at 1746, 179 L. Ed. 2d at 751 
(quoting Doctor’s Assocs., Inc. v. Casarotto, 517 U.S. 681, 687, 116 S. Ct. 1652, 1656, 
134 L. Ed. 2d 902, 909 (1996)) (other citations omitted).  A decision to refrain from 
enforcing the agreement on breach of fiduciary duty grounds does not rest upon the 
fact that it provides for the arbitration of medical negligence claims, does not treat 
arbitration agreements differently than other contracts, and does not make the 
enforcement of arbitration agreements more difficult than the enforcement of any 
other contract.  On the contrary, we would have reached the same result on these 
                                            
of the Federal Arbitration Act rests upon defendants, Sillins v. Ness, 164 N.C. App. 755, 760, 
596 S.E.2d 874, 877-78 (2004) (observing that “defendants were required to submit sufficient 
evidence in support of their motion to compel arbitration to establish that plaintiff’s contract 
evidenced a transaction involving interstate commerce” and reversing and remanding for 
additional findings an order denying arbitration, while noting that “defendants offered no 
evidence in support of their motion to compel arbitration apart from the employment 
agreement” itself), a necessary precondition to federal preemption under Concepcion and 
related cases simply does not appear to exist in this case. 
 
5 According to well-established North Carolina law, a breach of fiduciary duty 
“constitutes fraud.”  Link, 278 N.C. at 192, 179 S.E.2d at 704. 
 
6 As the language quoted in the text of this opinion clearly recognizes, a party is 
entitled to challenge the enforceability of an arbitration agreement on recognized state law 
grounds in addition to unconscionability. 
KING V. BRYANT  
 
Opinion of the Court 
 
 
-25- 
facts with respect to any agreement that substantially affected Mr. King’s 
substantive legal rights, such as an agreement absolving defendants from the 
necessity for compliance with otherwise applicable confidentiality requirements, 
providing for the transfer of items of real or personal property from Mr. King to 
defendants, or waiving any tort or contract-based claims that Mr. King might have 
had against either or both defendants.  Thus, since the breach of fiduciary duty 
defense to enforcement of the agreement that we uphold in this case does not apply 
“only to arbitration” or “derive [its] meaning from the fact that an agreement to 
arbitrate is at issue,” id. at 339, 131 S. Ct. at 1746, 179 L. Ed. 2d at 759, a refusal to 
enforce an arbitration agreement on that basis does not “stand[ ] as an obstacle to the 
accomplishment and execution of the full purposes and objectives of Congress,” id. at 
352, 131 S. Ct. at 1753, 179 L. Ed. 2d at 759 (quoting Hines v. Davidowitz, 312 U.S. 
52, 67, 61 S. Ct. 399, 404, 85 L. Ed. 2d 581, 587 (1941)).  Instead, consistently with 
Prima Paint Corp. v. Flood & Conklin Manufacturing. Co., 388 U.S. 395, 403-04, 87 
S. Ct. 1801, 1806, 18 L. Ed. 2d 1270, 1277 (1967), our decision simply recognizes that 
a “claim [of] fraud in the inducement of the arbitration [agreement] itself—an issue 
which goes to the ‘making’ of the agreement to arbitrate—[is one that a] court may 
proceed to adjudicate.”7  As a result, our decision to refrain from enforcing the 
                                            
7 Given that judicial consideration of fraud-based challenges to the enforceability of 
arbitration agreements is limited, by virtue of Prima Paint, to instances in which the 
arbitration agreement, rather than the entire contract between the parties, was induced by 
fraud, the fact that the “benefit” that defendants derived from the existence of the arbitration 
agreement in this case was the right to litigate any dispute between the parties in an arbitral 
KING V. BRYANT  
 
Opinion of the Court 
 
 
-26- 
arbitration agreement at issue in this case is not precluded by the doctrine of federal 
preemption. 
Thus, for all of these reasons, we hold that the arbitration agreement at issue 
in this case was obtained as a result of defendants’ breach of a fiduciary duty that 
they owed to Mr. King.8  In light of that determination, we hold that the Court of 
Appeals did not err by upholding the trial court’s decision to deny defendants’ motion 
to enforce the arbitration agreement.9  We do, however, wish to make clear that 
nothing in our decision in this case should be understood to cast any doubt upon the 
ability of physicians and patients, assuming that proper disclosure is made, to enter 
into appropriately drafted agreements providing for the arbitration of disputes like 
the one that underlies this case.  However, given our determination that Mr. King 
                                            
rather than a judicial forum has no bearing on a proper analysis of any federal preemption 
issue that might be before us in this case.  Any other result, given the limitations that Prima 
Paint places upon judicial challenges to the enforceability of arbitration agreements 
predicated on fraud or some similar defense, would effectively eliminate the ability of a party 
to assert such a defense despite Concepcion’s recognition of its continued viability. 
 
8 In view of our determination that the arbitration agreement is unenforceable on 
breach of fiduciary duty grounds, we need not address plaintiff’s unconscionability claim, 
Vail, 233 N.C. at 114, 63 S.E.2d 206 (stating that, in the event of a breach of fiduciary duty, 
“ ‘the transaction will be set aside even though it could not have been impeached had no such 
relation existed, whether the unconscionable advantage was obtained by misrepresentation, 
concealment or suppression of material facts, artifice, or undue’ advantage” (quoting 23 Am. 
Jur. Fraud and Deceit § 14 (1939))), even if there is no finding of unconscionability. 
 
9 The decision of the Court of Appeals in Westmoreland v. High Point Healthcare, Inc., 
218 N.C. App. 76, 721 S.E.2d 712 (2012), has no bearing upon the proper resolution of this 
case given the absence of a claim that the contract at issue in that case was allegedly procured 
as the result of a breach of fiduciary duty. 
KING V. BRYANT  
 
Opinion of the Court 
 
 
-27- 
had entered into a fiduciary relationship with Dr. Bryant at the time that the 
arbitration agreement was signed and the fact that defendants did not make full 
disclosure to Mr. King before presenting the agreement at issue in this case for his 
signature, we hold that the arbitration agreement was obtained as the result of a 
breach of fiduciary duty from which defendants benefitted and is, for that reason, 
unenforceable.  Thus, we modify and affirm the decision of the Court of Appeals in 
King II by holding the arbitration agreement unenforceable on breach of fiduciary 
duty, as opposed to unconscionability, grounds. 
 
MODIFIED AND AFFIRMED. 
 
Justice MORGAN did not participate in the consideration or decision of this 
case. 
 
 
Chief Justice MARTIN dissenting. 
 
In Tillman v. Commercial Credit Loans, Inc., this Court applied common law 
unconscionability doctrine to invalidate an arbitration clause in the plaintiffs’ loan 
agreements.  362 N.C. 93, 103-09, 655 S.E.2d 362, 370-74 (2008) (plurality opinion); 
id. at 110-11, 655 S.E.2d at 374-75 (Edmunds, J., concurring in result only).  Three 
years later, the Supreme Court of the United States decided AT&T Mobility LLC v. 
Concepcion, which clarified the scope of the Federal Arbitration Act’s preemptive 
effect when state law might otherwise make an arbitration agreement unenforceable.  
KING V. BRYANT 
 
MARTIN, C.J., dissenting 
 
 
-28- 
See 563 U.S. 333, 340, 352 (2011).  Because Concepcion’s rationale extends to a case 
like this one, in which a broadly applicable state law defense (constructive fraud) 
purportedly requires non-enforcement of an arbitration agreement specifically 
because it is an arbitration agreement, I respectfully dissent. 
Before I turn to the preemption issue, a few observations are in order about 
the majority’s parsing of state law fiduciary duty principles.  Because it asserts that 
Dr. Bryant committed constructive fraud by failing to adequately disclose certain 
contractual terms to Mr. King, the majority first has to find that a fiduciary 
relationship between Mr. King and Dr. Bryant existed when Mr. King filled out the 
paperwork that included the arbitration agreement—paperwork that Mr. King filled 
out at Dr. Bryant’s office before Dr. Bryant had met him or accepted him as a patient.  
As the majority correctly notes, certain relationships automatically “give[ ] rise to a 
fiduciary relationship as a matter of law.”  CommScope Credit Union v. Butler & 
Burke, LLP, ___ N.C. ___, ___, 790 S.E.2d 657, 660 (2016).  Curiously, though, the 
majority does not decide whether a physician-patient relationship had been formed 
by the time Mr. King signed the arbitration agreement.  The majority thus does not 
determine whether, as a matter of law, a fiduciary duty existed at that time.  Instead, 
the majority decides only that, at the time that Mr. King signed the arbitration 
agreement, Dr. Bryant owed Mr. King a fiduciary duty in fact.  
But, although the majority finds that a fiduciary relationship existed here only 
as a matter of fact, it effectively determines that a physician-patient relationship 
KING V. BRYANT 
 
MARTIN, C.J., dissenting 
 
 
-29- 
existed here in all but name.  A fiduciary relationship exists as a matter of fact 
“whenever ‘there is confidence reposed on one side, and resulting domination and 
influence on the other.’ ” Id. at ___, 790 S.E.2d at 661 (quoting Abbitt v. Gregory, 201 
N.C. 577, 598, 160 S.E. 896, 906 (1931)).  Pointing to specific findings of fact by the 
trial court, the majority maintains that a fiduciary relationship existed between Mr. 
King and Dr. Bryant primarily because Mr. King placed his trust in Dr. Bryant as a 
doctor.10  In addition, the majority quotes Black v. Littlejohn to suggest that Mr. King 
sought Dr. Bryant’s services because of Dr. Bryant’s “special knowledge and skill,” 
Black v. Littlejohn, 312 N.C. 626, 646, 325 S.E.2d 469, 482 (1985) (quoting 61 Am. 
Jur. 2d Physicians, Surgeons, and Other Healers § 167 (1981)), and later quotes Black 
to assert that Dr. Bryant possessed “special knowledge and skill in diagnosing and 
treating diseases and injuries, which the patient lacks,” id. (quoting 61 Am. Jur. 2d 
Physicians, Surgeons, and Other Healers § 167 (1981)).  Both of these quotes come 
from a passage in Black that discusses the characteristics of a fiduciary relationship 
that exists between a physician and his patient.  See id.  Thus, the majority 
determines, in effect, that the fiduciary relationship existed because Dr. Bryant was 
Mr. King’s doctor—even though the majority claims that its conclusion is reached 
                                            
10 On the other hand, the majority also finds a fiduciary duty here at least in part 
because Mr. King “provide[d] Dr. Bryant with confidential medical information,” which is not 
exactly based on Dr. Bryant’s status as a doctor.  (A patient may, for instance, provide 
confidential medical information to a health insurance company.)  But the majority’s 
reasoning confuses a duty of confidentiality—a more limited duty that can arise even when 
no fiduciary duty exists—with a full-fledged fiduciary duty. 
KING V. BRYANT 
 
MARTIN, C.J., dissenting 
 
 
-30- 
“independent of the existence of a physician-patient relationship.” 
So the majority tries to have its cake and eat it too.  It purports not to take a 
position on whether a physician-patient relationship exists, but then rests its analysis 
on the characteristics of the physician-patient relationship.  More particularly, the 
majority does not indicate whether a physician-patient relationship exists at the 
moment that a prospective patient fills out his preliminary paperwork, even when (as 
here) the doctor has never met the patient or accepted him as a patient.  Yet the 
majority uses the characteristics of a physician-patient relationship, and the things 
that a prospective patient thinks and does, to find a fiduciary relationship in fact.  By 
relying almost exclusively on aspects of a physician-patient relationship but then 
finding a fiduciary duty that is “independent” of that kind of relationship, the 
majority has muddied the waters in this area of the law.  This legal sleight of hand is 
especially troubling for our fiduciary duty jurisprudence and for doctors and patients, 
who necessarily rely on us to provide clear and predictable rules to guide their daily 
interactions.        
What’s more, the majority’s muddled parsing of state law, however 
well-intentioned, must yield to principles of federal preemption.  Section 2 of the 
Federal Arbitration Act (FAA) provides that an arbitration provision “shall be valid, 
irrevocable, and enforceable, save upon such grounds as exist at law or in equity for 
KING V. BRYANT 
 
MARTIN, C.J., dissenting 
 
 
-31- 
the revocation of any contract.”  9 U.S.C. § 2 (2012).11  In cases that it handed down 
before this Court decided Tillman, the Supreme Court of the United States held that 
Section 2 of the FAA preempted state law provisions that “set[ ] out a precise, 
arbitration-specific limitation.”  Doctor’s Assocs. v. Casarotto, 517 U.S. 681, 688 n.3 
(1996).  In Perry v. Thomas, for example, the Supreme Court held that Section 2 of 
the FAA preempted a California statute that allowed actions for the collection of 
wages to be maintained even in the face of a private arbitration agreement.  See 482 
U.S. 483, 484, 490-91 (1987).  And in Doctor’s Associates, Inc. v. Casarotto, the Court 
held that Section 2 preempted a Montana statute that imposed special notice 
requirements “specifically and solely” on “contracts ‘subject to arbitration.’ ”  517 U.S. 
                                            
11 The majority expresses considerable doubt that Section 2 of the FAA applies to the 
arbitration agreement at issue in this case.  But it is unclear why the majority thinks that 
this is such an uphill battle.  By its terms, Section 2 applies to any contract to arbitrate a 
transaction that is either specified in the contract or referred to by the contract, as long as 
the contract “evidenc[es] a transaction involving commerce.”  9 U.S.C. § 2.  Section 2’s phrase 
“involving commerce” has the same meaning as the phrase “affecting commerce,” Allied–
Bruce Terminix Cos. v. Dobson, 513 U.S. 265, 273-74 (1995), and Section 2’s reach thus 
“extend[s] . . . to the limits of Congress’ Commerce Clause power,” id. at 268.  The arbitration 
agreement that Mr. King signed pertained to “any dispute arising out of or related to the 
provision of healthcare services,” and clearly falls within both the commerce power and, by 
extension, the terms of Section 2.  The provision of healthcare services is a form of commerce, 
see Nat’l Fed’n of Indep. Bus. v. Sebelius, ___ U.S. ___, ___, 132 S. Ct. 2566, 2587-88 (2012) 
(opinion of Roberts, C.J.); id. at ___, ___, 132 S. Ct. at 2617, 2621 (Ginsburg, J., concurring in 
part and dissenting in part), and contracting for those services is an economic activity that, 
when aggregated with other economic activities of its kind, is bound to substantially affect 
interstate commerce, see Gonzales v. Raich, 545 U.S. 1, 22 (2005); see also Nat’l Fed’n of 
Indep. Bus., ___ U.S. at ___ n.7, 132 S. Ct. at 2622 n.7.  The only quirk in this case is that the 
arbitration agreement was made separately from any agreement to provide the services 
themselves.  But Section 2, which applies to “a contract . . . to settle by arbitration a 
controversy thereafter arising out of such contract or transaction,” 9 U.S.C. § 2 (emphasis 
added), clearly covers this scenario. 
KING V. BRYANT 
 
MARTIN, C.J., dissenting 
 
 
-32- 
at 683 (quoting Mont. Code Ann. § 27-5-114(4) (1995)); id. at 688.  Both of these cases 
addressed state statutory provisions that applied specifically to arbitration 
agreements, but did not apply to contracts that did not have arbitration agreements. 
After Tillman, however, the Supreme Court of the United States issued its 
decision in AT&T Mobility v. Concepcion.  In Concepcion, the Court squarely held 
that the use of even a doctrine like unconscionability—which can be applied to any 
contract, even one that does not contain an arbitration clause—can be preempted by 
Section 2 of the FAA when the doctrine “ha[s] been applied in a fashion that disfavors 
arbitration.”  563 U.S. at 341.  The Court reaffirmed its holding in Concepcion two 
years later.  See Am. Express Co. v. Italian Colors Rest., ___ U.S. ___, ___, 133 S. Ct. 
2304, 2312 (2013).  Concepcion’s holding and rationale apply directly to the majority’s 
approach and make the majority’s holding untenable.12 
The majority claims that, because Dr. Bryant owed a fiduciary duty to Mr. 
                                            
12 The majority asserts that “defendants have failed to clearly advance a federal 
preemption argument” but then proceeds to address that argument at length.  That is likely 
because defendants did cite to Concepcion.  Quoting Torrence v. Nationwide Budget Finance, 
a recent case from our Court of Appeals, defendants raised the fact that Concepcion 
“dismiss[ed] . . . the idea that an arbitration agreement, apart from any other form of contract, 
could be found substantively unconscionable based solely upon its adhesive nature.”  232 N.C. 
App. 306, 322, 753 S.E.2d 802, 812, disc. rev. denied and cert. denied, 367 N.C. 505, 759 
S.E.2d 88 (2014).  Although defendants’ reference to this sentence is not the clearest 
articulation of Concepcion’s preemption principle, it is notable that the very next sentence in 
Torrence states that the dismissal of this unconscionability argument “was an explicit part 
of the Supreme Court’s reasoning” in holding that the FAA preempted a state 
unconscionability rule.  Id. at 322, 753 S.E.2d at 812. 
 
KING V. BRYANT 
 
MARTIN, C.J., dissenting 
 
 
-33- 
King, Dr. Bryant committed constructive fraud “by failing to make full disclosure of 
the nature and import of the arbitration agreement to” Mr. King.  But this conclusion 
requires the majority to find that defendant sought to benefit himself at Mr. King’s 
expense.  See Barger v. McCoy Hillard & Parks, 346 N.C. 650, 666-67, 488 S.E.2d 
215, 224 (1997).  The majority does so by finding that the arbitration agreement 
“ensur[ed] that any subsequent dispute between the parties would be resolved using 
the forum, procedures, and decision[-] makers of their choice.”13  Of course, that is 
precisely what arbitration clauses in contracts of adhesion do.  And that gets to the 
heart of the matter: the majority takes issue with the arbitration agreement in this 
case because it is an arbitration agreement. 
In doing so, the majority runs headlong into the FAA's prohibition of state law 
defenses that specifically target arbitration agreements.  State law cannot address 
the concerns presented by contracts of adhesion in a way that “conflict[s] with the 
FAA or frustrate[s] its purpose to ensure that private arbitration agreements are 
enforced according to their terms.”  Concepcion, 563 U.S. at 347 n.6.  Nor can state 
courts apply a doctrine like constructive fraud “in a fashion that disfavors 
arbitration.”  Id. at 341.  Because the majority does exactly that, its holding is 
                                            
13 The majority refers to the trial court’s “unchallenged findings of fact” that Dr. 
Bryant benefitted from the arbitration agreement in this way.  But the majority is making a 
legal argument that the arbitration agreement benefitted Dr. Bryant, and that Dr. Bryant 
may therefore be liable for the breach of his purported fiduciary duty to Mr. King.  We review 
all conclusions of law de novo, even those that the trial court has characterized as findings of 
fact. 
KING V. BRYANT 
 
MARTIN, C.J., dissenting 
 
 
-34- 
preempted by Section 2 of the FAA. 
The majority maintains that its rationale does not single out arbitration 
agreements for negative treatment because the majority would treat “any agreement 
that substantially affected Mr. King’s substantive legal rights” in the same way.  The 
majority gives examples of other agreements that it thinks would substantially affect 
a person’s legal rights in ways that have nothing to do with arbitration.  But the fact 
that the majority might find other contractual provisions to be problematic for other 
reasons does not change the fact that the majority finds this arbitration agreement 
to be problematic because it is an arbitration agreement.14 
In sum, if a state court cannot say that an arbitration agreement is 
unconscionable for arbitration-specific reasons, it likewise cannot say that the same 
agreement gives rise to a constructive fraud claim for arbitration-specific reasons.  By 
declining to reach the unconscionability issue and focusing on constructive fraud 
instead, the majority artfully tries to evade federal preemption.  But in our 
post-Concepcion legal landscape, federal law cannot be so easily evaded.  Because the 
                                            
14 The majority quotes Prima Paint Corp. v. Flood & Conklin Manufacturing Co.’s 
statement that, “if [a] claim is fraud in the inducement of the arbitration clause itself,” then 
a “court may proceed to adjudicate it.”  388 U.S. 395, 403-04 (1967).  But this invocation of 
Prima Paint is a red herring because Prima Paint is not about preemption at all.  It is simply 
about whether a certain kind of claim arising under Section 2 of the FAA—namely, a “claim[ ] 
of fraud in the inducement of [a] contract generally,” id. at 404—should be resolved by an 
arbitrator or by a court, id. at 396-97.  Thus, Prima Paint’s holding that an arbitrator, not a 
court, should resolve this claim, see id. at 404—and its related assertion that a court may 
resolve a claim about fraud in the inducement of an arbitration clause specifically, see id. at 
403-04—does not provide any grist for the majority’s mill. 
KING V. BRYANT 
 
MARTIN, C.J., dissenting 
 
 
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majority has applied the constructive fraud doctrine in a way that disfavors 
arbitration, and because the FAA clearly prohibits applying that doctrine in that way, 
I respectfully dissent. 
 
 
Justice NEWBY dissenting. 
 
The United States Supreme Court has repeatedly held that arbitration 
agreements may not be invalidated by state-law defenses arising from the fact that 
an arbitration agreement is at issue.  Congress has explicitly indicated that 
arbitration is to be favored.  Despite these mandates, the majority invents a new 
defense to enforcement of an arbitration agreement, not raised by plaintiff below, to 
mask their disparate treatment of and continued hostility towards arbitration, 
thereby attempting to circumvent an unconscionability analysis.  Startlingly, without 
argument or findings, the majority baldly asserts that the Federal Arbitration Act 
(FAA) does not apply.  This jiggery-pokery is precisely the type of impermissible 
“rationalization” admonished by the United States Supreme Court.  Such a tortured 
attempt to obviate the FAA fails.  Because the arbitration agreement at issue here is 
not unconscionable and is otherwise enforceable at law, I respectfully dissent. 
KING V. BRYANT 
 
NEWBY, J., dissenting 
 
 
-36- 
 
The majority seeks to avoid an unconscionability analysis by fabricating a 
contract defense not raised by plaintiff, namely the breach of a fiduciary duty.15  
Based solely on the fact that the contract in question is an arbitration agreement, 
which the majority contends “substantially affected [plaintiff’s] legal rights,” the 
majority holds that “defendants violated their fiduciary duty to [plaintiff] by failing 
to make full disclosure of the nature and import of the arbitration agreement to him.”  
In their view, this breach of fiduciary duty would void the arbitration agreement ab 
initio.  The majority asserts that “defendants benefitted by [plaintiff’s] action in 
signing the arbitration agreement,” and states that the language “could have been 
worded more clearly” and was presented “in a collection of documents, thereby 
creating the [ ] impression that the arbitration agreement was simply another routine 
document.”  (Emphasis added.) 
 
Since 1925 Congress has established that arbitration agreements are “valid, 
irrevocable, and enforceable, save upon such grounds as exist at law or in equity for 
                                            
15 Though plaintiffs are Robert E. King and wife Jo Ann O’Neal, the record reflects 
Mr. King was the primary actor in the following events, and I refer to him in the singular as 
“plaintiff.” 
Plaintiff never raised a “breach of fiduciary duty” defense to enforcement of the 
agreement.  At the trial court, plaintiff opposed defendants’ motion to compel arbitration on 
three grounds: that the arbitration agreement was (1) “not a contract” but an unenforceable 
“agreement to agree,” (2) ineffective as to co-plaintiff’s consortium claim for lack of her 
signature, and (3) unconscionable.  The trial court denied defendants’ motion on the first 
ground.  Only on interlocutory appeal did the Court of Appeals, not plaintiff, mention 
“fiduciary relationship” as a procedural consideration for plaintiff’s burden of proof under his 
unconscionability defense on remand.  King v. Bryant, 225 N.C. App. 340, 349, 737 S.E.2d 
802, 809 (2013). 
KING V. BRYANT 
 
NEWBY, J., dissenting 
 
 
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the revocation of any contract.”  Federal Arbitration Act (FAA), ch. 213, § 2, 43 Stat. 
883, 883 (1925) (codified as amended at 9 U.S.C. § 2 (2012)).  The FAA “reverse[d] the 
longstanding judicial hostility to arbitration agreements . . . and place[s them] upon 
the same footing as other contracts.”  Gilmer v. Interstate/Johnson Lane Corp., 500 
U.S. 20, 24, 111 S. Ct. 1647, 1651, 114 L. Ed. 2d 26, 36 (1991).  The preemptive effect 
of the FAA may “extend even to grounds traditionally thought to exist ‘at law or in 
equity for the revocation of any contract.’ ” AT&T Mobility LLC v. Concepcion, 563 
U.S. 333, 341, 131 S. Ct. 1740, 1747, 179 L. Ed. 2d 742, 752 (2011) (quoting Perry v. 
Thomas, 482 U.S. 483, 492 n.9, 107 S. Ct. 2520, 2527 n.9, 96 L. Ed. 2d 426, 437 n.9 
(1987) (emphasis omitted)).   
Arbitration agreements may “be invalidated by ‘generally applicable contract 
defenses, such as fraud, duress, or unconscionability,’ but not by defenses that apply 
only to arbitration or that derive their meaning from the fact that an agreement to 
arbitrate is at issue.”  Id. at 339, 131 S. Ct. at 1746, 179 L. Ed. 2d at 751 (quoting 
Doctor’s Assocs. v. Casarotto, 517 U.S. 681, 687, 116 S. Ct. 1652, 1656, 134 L. Ed. 2d 
902, 909 (1996)).  A court may not “rely on the uniqueness of an agreement to 
arbitrate as a basis for a state-law holding that enforcement would be 
unconscionable.”  Perry, 482 U.S. at 493 n.9, 107 S. Ct. at 2527 n.9, 96 L. Ed. 2d at 
437 n.9.   
Contract defenses cannot be “applied in a fashion that disfavors arbitration.”  
Concepcion, 563 U.S. at 341, 131 S. Ct. at 1747, 179 L. Ed. 2d at 752.  Such an 
KING V. BRYANT 
 
NEWBY, J., dissenting 
 
 
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application is not justified by state-law “rationalizations,” even when the defense 
could apply to other contracts.  Id. at 342, 131 S. Ct. at 1747, 179 L. Ed. 2d at 752 (“In 
practice, of course, the [defense] would have a disproportionate impact on arbitration 
agreements; but it would presumably apply to [nonarbitration] contracts . . . as 
well.”); see also id. at 342, 131 S. Ct. at 1747, 179 L. Ed. 2d at 753 (“Such 
[rationalizations] are not fanciful, since the judicial hostility towards arbitration that 
prompted the FAA had manifested itself in ‘a great variety’ of ‘devices and formulas’ 
declaring arbitration against public policy.” (quoting Robert Lawrence Co. v. 
Devonshire Fabrics, Inc., 271 F.2d 402, 406 (2d Cir. 1959))).   
Contrary to well-settled law, the majority impermissibly targets arbitration 
agreements for disparate treatment, attempting to ignore plaintiff’s claim of 
unconscionability and cloaking their disfavor of arbitration under the guise of newly 
constructed fiduciary-relationship principles.  This sort of manufactured state-law 
justification is a facade and cannot displace the preemptive effect of the FAA. 
The purported breach of a fiduciary duty described by the majority is a 
procedural consideration in an unconscionability analysis.  As such, any concerns 
arising from the circumstances under which plaintiff signed the arbitration 
agreement are squarely contemplated by his assertion of unconscionability, yet the 
majority refuses to address this defense at all.  See Rite Color Chem. Co. v. Velvet 
Textile Co., 105 N.C. App. 14, 20, 411 S.E.2d 645, 648 (1992) (“Procedural 
unconscionability involves ‘bargaining naughtiness,’ ” which encompasses the use of 
KING V. BRYANT 
 
NEWBY, J., dissenting 
 
 
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sharp practices and unequal bargaining power. (citations omitted)).  Instead, the 
majority has taken the extraordinary step of crafting a new legal theory for plaintiff, 
attempting to bypass the obligation to address his unconscionability defense.  Though 
plaintiff “should not be allowed to change his position with respect to a material 
matter in the course of litigation,” Ussery v. Branch Banking & Tr. Co., 368 N.C. 325, 
340, 777 S.E.2d 272, 282 (2015) (quoting Whitacre P’ship v. Biosignia, Inc., 358 N.C. 
1, 26, 591 S.E.2d 870, 886 (2004)), and “[i]t is not the role of the appellate court[ ] . . . 
to create [his] appeal,” Viar v. N.C. Dep’t of Transp., 359 N.C. 400, 402, 610 S.E.2d 
360, 361 (2005) (per curiam), it seems this Court is more than willing to do so for him 
when arbitration is involved. 
Our case law is clear that a fiduciary relationship raises a procedural hurdle, 
not a requirement to void the transaction.  Only when a complainant alleges and 
establishes that a fiduciary relationship arose and that the offending party benefitted 
from the transaction to the detriment of the complainant, does the burden shift from 
the complainant to the offending party to prove that “no fraud was committed, and 
no undue influence or moral duress exerted.”  Wachovia Bank & Tr. Co. v. Johnston, 
269 N.C. 701, 711, 153 S.E.2d 449, 457 (1967) (emphasis omitted) (quoting McNeill v. 
McNeill, 223 N.C. 178, 181, 25 S.E.2d 615, 616-17 (1943)); see Watts v. Cumberland 
Cty. Hosp. Sys., Inc., 317 N.C. 110, 116, 343 S.E.2d 879, 884 (1986).  The majority 
fails to identify any such detriment to plaintiff and instead relies on the unlawful 
presumption that arbitration itself is harmful.  The majority’s speculation that 
KING V. BRYANT 
 
NEWBY, J., dissenting 
 
 
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“defendants benefitted from [plaintiff’s] action in signing the arbitration agreement 
by ensuring that any subsequent dispute between the parties would be resolved using 
the forum, procedures, and decision makers of their choice” falls well short of 
establishing the requisite benefit and harm.  Such a “state-law principle that takes 
its meaning precisely from the fact that a contract to arbitrate is at issue does not 
comport with” the FAA.  Perry, 482 U.S. at 493 n.9, 107 S. Ct. at 2527 n.9, 96 L. Ed. 
2d at 437 n.9.   
 
Assuming without deciding that the alleged breach of fiduciary duty results in 
procedural unconscionability, the agreement is plainly not substantively 
unconscionable, and plaintiff’s defense therefore fails.  The agreement contains none 
of the “harsh, oppressive, and ‘one-sided terms’ ” that are the hallmarks of 
substantive unconscionability, Rite Color Chem. Co., 105 N.C. App. at 20, 411 S.E.2d 
at 648-49 (citations omitted), and follows the “Health Care Claim Settlement 
Procedures of the American Arbitration Association,” governed by the FAA.  
Furthermore, this analysis comports with recent comprehensive appellate review of 
arbitration agreements.  See Westmoreland v. High Point Healthcare Inc., 218 N.C. 
App. 76, 77-78, 721 S.E.2d 712, 715 (2012) (concluding that an arbitration agreement 
was valid and not unconscionable when signed among a stack of other patient intake 
forms for a nursing home facility).  By skirting such an analysis, see id. at 79, 721 
KING V. BRYANT 
 
NEWBY, J., dissenting 
 
 
-41- 
S.E.2d at 716, the majority’s new breach of fiduciary duty defense seems without 
limit, deprived of the traditional constraints of the unconscionability doctrine.16 
Irrespective of whether a fiduciary relationship arose, the majority justifies 
handling plaintiff’s arbitration agreement differently than other “routine [contract] 
documents” because the agreement “substantially affected [plaintiff’s] legal rights.”  
Isolating arbitration agreements in this way plainly subjects them to impermissible 
scrutiny.  See Concepcion, 563 U.S. at 342, 131 S. Ct. at 1747, 179 L. Ed. 2d at 752.  
All contracts affect legal rights; the contract at issue here designates dispute 
resolution through arbitration.  See Am. Express Co. v. Italian Colors Rest., ___ U.S. 
___, ___, 133 S. Ct. 2304, 2309, 186 L. Ed. 2d 417, 424 (2013) (“[A]rbitration is a 
matter of contract” and “courts must ‘rigorously enforce’ arbitration agreements.” 
(citations omitted) (quoting Dean Witter Reynolds, Inc. v. Byrd, 470 U.S. 213, 221, 
105 S. Ct. 1238, 1242, 84 L. Ed. 2d 158, 165 (1985)); see also Ussery, 368 N.C. at 336, 
777 S.E.2d at 279 (“One who executes a written instrument is ordinarily charged with 
knowledge of its contents, . . . and he may not base his action on ignorance of the legal 
effect of its provisions in the absence of considerations such as fraud or mistake.” 
(citations omitted)); accord Westmoreland, 218 N.C. App. at 83, 721 S.E.2d at 718 
(citation omitted).  Either arbitration agreements are on equal footing with other 
                                            
16 For example, is there always a breach of fiduciary duty by a professional who does 
not adequately explain arbitration, and is the required result that the agreement is void ab 
initio? 
KING V. BRYANT 
 
NEWBY, J., dissenting 
 
 
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“routine” contracts or they are not.  The United States Supreme Court has directed 
that a court cannot construe arbitration “agreement[s] in a manner different from 
that in which it otherwise construes nonarbitration agreements.”  Perry, 482 U.S. at 
493 n.9, 107 S. Ct. at 2527 n.9, 96 L. Ed. 2d at 437 n.9. 
In a strained effort to add more window dressing, the majority brazenly claims 
that the FAA does not apply “[g]iven the record contains no indication that the 
agreement between the parties constitutes a ‘transaction involving commerce,’ 9 
U.S.C. § 2.”  Not only have the parties not argued this point, nor has the trial court 
made any accompanying findings, but the first line of plaintiff’s arbitration 
agreement expressly incorporates the FAA by stating: “In accordance with the terms 
of the Federal Arbitration Act, 9 USC 1-16 . . . .”  See Johnston County v. R.N. Rouse 
& Co., Inc., 331 N.C. 88, 92-93, 414 S.E.2d 30, 33 (1992) (discussing the incorporation 
of law into contracts); Pike v. Wachovia Bank & Tr. Co., 274 N.C. 1, 16, 161 S.E.2d 
453, 465 (1968) (“[L]aws in force at the time of the execution of a contract become a 
part of the contract.”); see also Perry, 482 U.S. at 490, 107 S. Ct. at 2526, 96 L. Ed. 2d 
at 436 (The FAA’s ambit is expansive and “embodies Congress’ intent to provide for 
the enforcement of arbitration agreements within the full reach of the Commerce 
Clause.”).  Moreover, such professional service contracts generally “involve 
commerce” under the broad purview of the FAA.17   
                                            
17 See, e.g., Morrison v. Colo. Permanente Med. Grp., 983 F. Supp. 937, 943-44 (D. Colo. 
1997) (finding a patient-physician “medical services agreement” evidenced a “transaction 
KING V. BRYANT 
 
NEWBY, J., dissenting 
 
 
-43- 
In sum, plaintiff raised his contract defenses and received the benefit of 
asserting them.18  The arbitration agreement is not substantively unconscionable, 
and plaintiff’s defense therefore fails.  Apparently unsatisfied with this result, the 
majority, once again, impermissibly targets arbitration agreements.  E.g., Tillman v. 
Commercial Credit Loans, Inc., 362 N.C. 93, 114, 655 S.E.2d 362, 377 (2008) (Newby, 
J., dissenting) (“The majority finds the agreement unconscionable based on provisions 
that would only exist in an arbitration agreement.” (emphasis added)); see also 
Torrence v. Nationwide Budget Fin., 232 N.C. App. 306, 321, 753 S.E.2d 802, 811 
(concluding that Tillman conflicts with United States Supreme Court precedent), 
disc. rev. denied and cert. denied, 367 N.C. 505, 759 S.E.2d 88 (2014).  Such a policy 
decision is not for this Court to determine.  See Perry, 482 U.S. at 493 n.9, 107 S. Ct. 
at 2527 n.9, 96 L. Ed. 2d at 437 n.9 (A court may not construe arbitration agreements 
differently or “rely on the[ir] uniqueness . . . as a basis” for a contract defense, “for 
this would enable the court to effect what . . . the state legislature cannot.”).  Instead 
of pursuing its relentless assault on the FAA, the majority should follow the 
principles clearly expressed by the United States Supreme Court.  Because the 
                                            
involving commerce”); Ex parte Lorance, 669 So. 2d 890, 892 (Ala. 1995) (finding a physician’s 
professional services contract “involve[es] commerce”); Vicksburg Partners, L.P. v. Stephens, 
911 So. 2d 507, 515-16 (Miss. 2005) (same for patient’s “nursing home admissions 
agreement”), overruled in part on other grounds by Covenant Health & Rehab., LP v. Estate 
of Moulds, 14 So. 3d 695, 706 (Miss. 2009). 
18 Plaintiff’s remaining contract defenses are not before the Court at this time. 
KING V. BRYANT 
 
NEWBY, J., dissenting 
 
 
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majority has concocted a new contract defense in a fashion that disfavors arbitration 
in contravention of the FAA and binding United States Supreme Court precedent, I 
respectfully dissent.