Title: Estate of Savino v. Charlotte-Mecklenburg Hospital Authority

State: north-carolina

Issuer: North Carolina Supreme Court

Document:

IN THE SUPREME COURT OF NORTH CAROLINA 
No. 18PA19 
Filed 25 September 2020 
THE ESTATE OF ANTHONY LAWRENCE SAVINO 
 
 
v. 
THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY, a North Carolina 
Hospital Authority, d/b/a CAROLINAS HEALTHCARE SYSTEM and CMC-
NORTHEAST. 
 
On discretionary review pursuant to N.C.G.S. § 7A-31 of the unanimous 
decision of the Court of Appeals, 262 N.C. App. 526, 822 S.E.2d 565 (2018), reversing 
in part, and vacating in part, a judgment entered 8 December 2016 and orders entered 
19 January 2017 by Judge Julia Lynn Gullett in Superior Court, Cabarrus County. 
On 9 May 2019 the Supreme Court allowed both plaintiff’s petition for discretionary 
review and defendant’s conditional petition for discretionary review. Heard in the 
Supreme Court on 7 January 2020.  
 
Zaytoun Law Firm, PLLC, by Matthew D. Ballew, Robert E. Zaytoun and John 
R. Taylor; and Brown Moore & Associates, PLLC, by R. Kent Brown, John R. 
Moore, Paige L. Pahlke, for plaintiff. 
 
Bradley Arant Boult Cummings, LLP, by Robert R. Marcus, Brian Rowlson and 
Jonathan Schulz; and Horack Talley Pharr & Lowndes, PA, by Kimberly 
Sullivan, for defendant. 
 
HUDSON, Justice.  
 
 
Pursuant to plaintiff’s petition for discretionary review, we address whether 
the Court of Appeals erred by reversing the trial court’s denial of defendant’s motion 
for a directed verdict on pain and suffering damages. We also allowed review of 
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plaintiff’s additional issue per North Carolina Rule of Appellate Procedure 15(d): 
whether the Court of Appeals erred in holding that plaintiff failed to properly plead 
administrative negligence under N.C.G.S. § 90-21.11(2)(b). In addition, we allowed 
defendant’s conditional petition for discretionary review of two issues: (1) whether 
defendant was entitled to a new trial because it was prejudiced by the intertwining 
of plaintiff’s evidence and the trial court’s instruction to the jury on medical 
negligence and administrative negligence; and (2) whether the trial court erred by 
granting plaintiff’s motion for a directed verdict on contributory negligence.  
We modify and affirm in part, and reverse in part, the decision of the Court of 
Appeals because we conclude that (1) the trial court did not err by denying 
defendant’s motion for a directed verdict on pain and suffering damages; (2) plaintiff 
was not required to plead a claim for administrative negligence separate from medical 
negligence; (3) defendant is not entitled to a new trial; and (4) the trial court did not 
err by granting plaintiff’s motion for a directed verdict on contributory negligence.  
Factual and Procedural Background 
 
Just after 1:30 p.m. on 30 April 2012, Cabarrus County EMS was dispatched 
to the residence of Anthony Lawrence Savino. When EMS arrived, Mr. Savino was 
complaining of chest pain that was radiating down both of his arms and causing 
tingling and numbness. EMS checked his blood pressure and other vital signs in his 
residence before taking him into the ambulance. In the ambulance, EMS personnel 
performed an electrocardiogram which showed a normal sinus rhythm; this indicated 
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that Mr. Savino was not currently having a heart attack. EMS gave him an I.V., four 
baby aspirin, and sublingual nitroglycerin, and notified CMC-Northeast that they 
were bringing him in as a chest pain patient.  
On the way to the hospital, EMT Kimberly Allred prepared a document called 
an “EMS snapshot,” which provides a quick summary of the care that EMS provided 
to a patient; the snapshot is usually left with the intake nurse at the hospital. In the 
snapshot, EMT Allred included Mr. Savino’s demographics, vitals, and a description 
of the care provided to Mr. Savino en route to the hospital, including the medications 
he was given. Plaintiff alleges that this snapshot and the information it contained 
was never given nor communicated to his treating physician. 
A few hours after arriving in the emergency room, Mr. Savino was discharged. 
Later that evening, his wife found him unresponsive in their home after he suffered 
a heart attack. Mr. Savino could not be resuscitated by EMS and was pronounced 
dead on the scene.  
On 23 April 2014, Mr. Savino’s Estate (plaintiff) filed a Complaint for Medical 
Negligence (the 2014 Complaint) against The Charlotte-Mecklenburg Hospital 
Authority, Carolinas Healthcare System, CMC-Northeast, the attending emergency 
physician, and the attending physician’s practice. Defendants responded by filing an 
answer to the complaint. Then, on 2 January 2016, plaintiff filed a motion for leave 
to amend the 2014 Complaint in light of documents produced by defendant and 
depositions taken after the production of the documents. Plaintiff asserted that the 
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2014 Complaint provided defendants with sufficient notice of its negligence 
allegations and that plaintiff was seeking to file an Amended Complaint “out of an 
abundance of caution.” But on 12 January 2016, plaintiff withdrew the motion for 
leave to amend the complaint. On 19 January 2016, plaintiff filed a notice of 
voluntary dismissal of all claims against all parties, but without prejudice to re-file 
against defendants.  
Plaintiff filed another “Complaint for Medical Negligence,” (the 2016 
Complaint) naming only The Charlotte-Mecklenburg Hospital Authority, Carolinas 
Healthcare System, and CMC-Northeast (collectively, “defendant”), on 1 February 
2016. Defendant filed its answer on 5 April 2016.  
During a hearing on pre-trial motions, plaintiff and defendant disputed 
whether the case involved two theories of medical negligence or two separate claims 
of medical and administrative negligence. Plaintiff argued that the 2016 Complaint 
contained both allegations that defendant did not meet the standard of care in “the 
delivery and provision of medical care” and allegations that defendant “failed to 
comply with its corporate duty or administrative duty.” Plaintiff argued that both of 
these theories were part of the same medical negligence claim under N.C.G.S. § 90-
21.11(2) (2011). Defendant argued, however, that only the first theory of medical 
negligence was alleged in the 2016 Complaint and then proceeded to object 
throughout the trial that plaintiff had not pled a separate administrative negligence 
claim.  
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The case was tried to the jury from 24 October 2016 through 15 November 
2016. Plaintiff’s theory of negligence at trial rested on the “hand-off” between EMS 
and CMC-Northeast which resulted in neither the EMS snapshot, nor the 
information contained within it—including Mr. Savino’s chief complaint of chest pain 
and the fact that he was treated with aspirin and nitroglycerin—being given or 
communicated to his treating physician.  
At the close of plaintiff’s evidence, defendant moved for a directed verdict on 
two grounds: (1) the evidence was insufficient to support plaintiff’s medical 
negligence claims; and (2) plaintiff failed to properly plead its claim that defendant 
was negligent in its monitoring and supervision.1 The trial court denied the motion. 
Defendant renewed the motion for a directed verdict at the close of all evidence, and 
the trial court again denied it.  
On 15 November 2016, the jury returned verdicts finding that decedent’s death 
was caused by defendant’s (1) negligence; and (2) negligent performance of 
administrative duties. The jury awarded plaintiff $6,130,000 in total damages: 
$680,000 in economic damages and $5,500,000 in non-economic damages. The trial 
court entered judgment in these amounts. Following the entry of judgment, the trial 
court entered another order determining that plaintiff was entitled to recover (1) 
                                            
1 In the alternative, defendant argued that even if plaintiff had properly pled the 
negligent monitoring and supervision claim, that claim was time-barred because that 
allegation was not in the original 2014 Complaint.  
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$15,571.53 from defendant in costs; and (2) $417,847.15 in pre- and post-judgment 
interest.  
On 16 December 2016, defendant filed a motion for either judgment 
notwithstanding the verdict (JNOV) or for a new trial. The trial court denied the 
motions in orders filed on 19 January 2017. Defendant appealed.  
The Court of Appeals reversed in part and vacated in part the orders of the 
trial court; it also granted a new trial in part. Estate of Savino v. Charlotte-
Mecklenburg Hosp. Auth., 262 N.C. App. 526, 822 S.E.2d 565 (2018). First, the Court 
of Appeals held that the testimony of plaintiff’s expert was insufficient to support the 
jury’s award for pain and suffering. Id. at 557, 822 S.E.2d at 586. As a result—and 
because the jury’s verdict did not allow the court to determine which portion of the 
non-economic damages consisted of the pain and suffering damages—the Court of 
Appeals remanded for a new trial on non-economic damages. Second, the Court of 
Appeals held that plaintiff did not sufficiently plead “administrative negligence.” Id. 
at 534, 822 S.E.2d at 572. Specifically, it concluded that the allegations in the 2016 
Complaint “were not sufficient to put defendant on notice of a claim of administrative 
negligence” and thus, “the trial court erred in allowing plaintiff to proceed on an 
administrative negligence theory in the medical malpractice action.” Id. at 541, 822 
S.E.2d at 576. However, the Court of Appeals held that the jury’s verdict was not 
tainted by plaintiff being allowed to proceed on the administrative negligence theory, 
and thus that no new trial was required on this issue. Id. at 549–50, 822 S.E.2d at 
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581. Finally, the Court of Appeals held that the trial court did not err in granting a 
directed verdict to plaintiff on the issue of contributory negligence because Mr. Savino 
did not have “an affirmative duty to report that EMS gave him medication in the 
ambulance.” Id. at 558–559, 822 S.E.2d at 586. 
For the reasons discussed herein, we modify and affirm in part, and reverse in 
part, the decision of the Court of Appeals. 
Analysis 
 
On the issues presented by plaintiff, we conclude that (1) the Court of Appeals 
erred by reversing the trial court’s denial of defendant’s motion for a directed verdict 
on pain and suffering damages; and (2) plaintiff properly pled a medical negligence 
claim, but did not allege a separate claim for administrative negligence. On the issues 
presented by defendant, we conclude that (1) defendant is not entitled to a new trial; 
and (2) the trial court did not err by granting plaintiff’s motion for a directed verdict 
on contributory negligence.  
I. 
Standard of Review 
The standard of review for a motion for directed verdict and a motion for 
judgment notwithstanding the verdict (JNOV) is the same. Green v. Freeman, 367 
N.C. 136, 140, 749 S.E.2d 262, 267 (2013) (citing Davis v. Dennis Lilly Co., 330 N.C. 
314, 323, 411 S.E.2d 133, 138 (1991)). Accordingly, we must determine “whether the 
evidence, taken in the light most favorable to the non-moving party, is sufficient as a 
matter of law to be submitted to the jury.” Id. at 140, 749 S.E.2d at 267 (quoting 
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Davis, 330 N.C. at 322, 411 S.E.2d at 138). “If ‘there is evidence to support each 
element of the nonmoving party's cause of action, then the motion for directed verdict 
and any subsequent motion for [JNOV] should be denied.’ ” Id. at 140–41, 749 S.E.2d 
at 267 (quoting Abels v. Renfro Corp., 335 N.C. 209, 215, 436 S.E.2d 822, 825 (1993)). 
Because the question of whether a party is entitled to a motion for directed verdict or 
JNOV is one of law, our review is de novo. Id. at 141,749 S.E.2d at 267 (citing N.C. 
Farm Bureau Mut. Ins. Co. v. Cully's Motorcross Park, Inc., 366 N.C. 505, 512, 742 
S.E.2d 781, 786 (2013); Scarborough v. Dillard's, Inc., 363 N.C. 715, 720, 693 S.E.2d 
640, 643 (2009)).  
II. 
Pain and Suffering Damages 
First, we address the single issue raised in plaintiff’s petition for discretionary 
review: the Court of Appeals’ reversal of the trial court order denying defendant’s 
motion for a directed verdict on pain and suffering damages. Because we conclude 
that plaintiff’s expert’s testimony presented sufficient evidence of pain and suffering, 
we hold the trial court did not err, and we reverse the Court of Appeals.  
The legal standard for proof of damages is well-established. “Damages must be 
proved to a reasonable level of certainty, and may not be based on pure conjecture.” 
DiDonato v. Wortman, 320 N.C. 423, 431, 358 S.E.2d 489, 493 (1987) (citing Norwood 
v. Carter, 242 N.C. 152, 156, 87 S.E.2d 2, 5 (1955)). 
At trial, plaintiff offered testimony from several experts. Dr. Selwyn, an expert 
cardiologist, testified about Mr. Savino’s pain and suffering earlier in the day of 30 
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April 2012 prior to his death as follows: “[H]e presented with a fairly typical picture 
of chest pain radiating to the stomach, up into the neck, to the hands, which went 
away with nitroglycerin.” Dr. Selwyn then testified that Mr. Savino “more likely than 
not . . . would have got chest pain again” before his death.  
This expert opinion, based on an analysis of decedent’s symptoms and medical 
records, is precisely the kind of opinion that triers of fact rely on to help them 
“understand the evidence or to determine a fact in issue.” N.C.R.E. 702(a) (2019). This 
review of decedent’s symptoms was not “based on pure conjecture” but provided 
evidence of decedent’s pain and suffering “to a reasonable level of certainty” for the 
jury to consider. DiDonato, 320 N.C. at 431, 358 S.E.2d at 493.  
Although the Court of Appeals acknowledged that “testimony that something 
‘is more likely than not’ is generally sufficient proof that something occurred,” it 
concluded that such testimony was not sufficient here. Savino, 262 N.C. App. at 557, 
822 S.E.2d at 585. This conclusion was in error. Although the Court of Appeals 
correctly noted that “it [wa]s not [its] job to reweigh the evidence,” it nonetheless 
proceeded to reweigh the evidence by concluding that the testimony of plaintiff’s 
expert “standing alone” was insufficient to prove damages because (1) there was 
“ample other evidence . . . that plaintiff may not have experienced any further chest 
pain”; and (2) plaintiff’s expert “testified that there was ‘no direct evidence’ of chest 
pain following decedent’s discharge from the emergency department.” Id.  
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The Court of Appeals’ reasoning was erroneous for two reasons. First, its 
weighing of plaintiff’s expert’s testimony against other evidence that decedent may 
not have experienced further chest pain contradicts our well-established standard of 
review of trial court decisions on directed verdicts, which requires appellate courts to 
disregard contradictory evidence. See Bowen v. Gardner, 275 N.C. 363, 366, 168 
S.E.2d 47, 49 (1969) (requiring the movant's contradictory evidence to be disregarded 
when considering a motion for nonsuit); see also Northern Nat. Life Ins. Co. v. Lacy 
J. Miller Mach. Co., Inc., 311 N.C. 62, 69, 316 S.E.2d 256, 261 (1984) ("A verdict may 
never be directed when there is conflicting evidence on contested issues of fact.").  
Second, the Court of Appeals erred in apparently requiring plaintiff’s expert to 
present “direct evidence” of chest pain. Savino, 262 N.C. App. at 557, 822 S.E.2d at 
585. The evidentiary standard for damages requires only proof “to a reasonable level 
of certainty.” DiDonato, 320 N.C. at 431, 358 S.E.2d at 493 (citing Norwood, 242 N.C. 
at 156, 87 S.E.2d at 5). Competent opinion testimony, like Dr. Selwyn’s, that “more 
likely than not” Mr. Savino would have experienced pain before his death, satisfies 
that standard. Furthermore, direct evidence is not required because circumstantial 
evidence can satisfy the reasonable probability standard. See Snow v. Duke Power 
Co., 297 N.C. 591, 597, 256 S.E.2d 227, 231–32 (1979) ("[C]ircumstantial evidence 
[may be] sufficient to take the case out of the realm of conjecture and into the field of 
legitimate inference from established facts.").  
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Accordingly, we conclude that the trial court did not err in denying defendant’s 
motion for a directed verdict on plaintiff’s pain and suffering damages. As a result, 
we reverse the Court of Appeals’ holding on this issue, and we reverse its decision to 
remand this case to the trial court for a new trial on non-economic damages.  
III. 
Administrative Negligence 
Next, we consider defendant’s argument that administrative negligence 
constituted a separate claim that plaintiff failed to properly plead.  
Defendant contends that plaintiff was required to plead administrative 
negligence as a separate claim from medical negligence because in a 2011 amendment 
to N.C.G.S. § 90-21.11, “the legislature created a distinct cause of action for 
administrative negligence that must be separately and specifically pled.” Defendant 
argues that because plaintiff “failed to plead a claim for administrative negligence,” 
it was error for the trial court to deny defendant’s motion for JNOV. Because we 
conclude that the 2011 amendment to N.C.G.S. § 90-21.11 did not create a new cause 
of action or a new pleading requirement for a medical negligence claim like this one, 
we do not agree that plaintiff was required to plead a separate claim for 
administrative negligence here. We further conclude that plaintiff did properly plead 
breaches of administrative duties as a theory underlying the overall claim of medical 
negligence. 
In 2011, the General Assembly amended N.C.G.S. § 90-21.11 to broaden the 
definition of “medical malpractice action” to include breaches of “administrative or 
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corporate duties to the patient” that arise from the same set of facts as a traditional 
“professional services” medical malpractice claim. Act of July 25, 2011, S.L. 2011-400 
§ 5, 2011 N.C. Sess. Laws, 1712, 1714. Specifically, the amendment added the 
following subsection to the definition of “Medical malpractice action” in N.C.G.S. § 
90-21.11(2): 
(b) A civil action against a hospital, a nursing home 
licensed under Chapter 131E of the General Statutes, or an 
adult care home licensed under Chapter 131D of the 
General Statutes for damages for personal injury or death, 
when the civil action (i) alleges a breach of administrative 
or corporate duties to the patient, including, but not limited 
to, allegations of negligent credentialing or negligent 
monitoring and supervision and (ii) arises from the same 
facts or circumstances as a claim under sub-subdivision a. 
of this subdivision. 
 
It appears from contemporaneous committee reports and session laws, as well 
as subsequent analysis by the UNC School of Government, that the purpose of this 
specific part of a more comprehensive medical liability reform bill was to require that 
lawsuits which seek recovery for negligence in operating a hospital, nursing home, or 
adult care home, be treated as “medical malpractice” claims rather than ordinary 
negligence claims. See UNC School of Government, Bill Summaries: S33 (2011-2012 
Session), 
Summary 
date: 
Apr 
19 
2011, 
Legislative 
Reporting 
Service, 
https://lrs.sog.unc.edu/bill-summaries-lookup/S/33/2011-2012%20Session/S33 (“Adds 
a section amending GS 90-21.11 to clarify definitions for health care provider and 
medical malpractice action; applies to causes of action arising on or after October 1, 
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2011.”); Act of July 25, 2011, S.L. 2011-400 § 5 (providing the overall context of the 
reform legislation); Ann M. Anderson, Rule 9(j) of the Rules of Civil Procedure: Special 
Pleading in Medical Malpractice Claims, North Carolina Superior Court Judges’ 
Benchbook (March 2014) (discussing how the amendment recategorizes some 
administrative negligence claims arising out of the same facts and circumstances as 
a medical negligence claim). Prior to this amendment, such administrative or 
corporate negligence claims were often treated as ordinary negligence claims. 
Anderson, at 4 (citing Estate of Ray v. Forgy, 227 N.C. App. 24, 31, 744 S.E.2d 468, 
472 (2013) (claim against hospital for failure to monitor and oversee credentialing of 
physician treated as ordinary negligence); Estate of Waters v. Jarman, 144 N.C. App. 
98, 103, 547 S.E.2d 142, 145 (2011) (common law corporate negligence claim against 
a hospital treated as ordinary negligence)). Since the 2011 amendment, claims of 
administrative negligence against hospitals, nursing homes, or adult care homes that 
arise from the same facts and circumstances as a claim for furnishing or failing to 
furnish professional health services have been classified as medical malpractice suits, 
and thus are required to adhere to the much more detailed requirements of North 
Carolina Civil Procedure Rule 9(j) than claims for ordinary negligence.2 Thus, we 
agree with the Court of Appeals that the legislature did not “intend[] to create a new 
                                            
2 Claims of administrative negligence against hospitals, nursing homes, or adult care 
homes that do not arise from the same facts and circumstances as a claim for furnishing or 
failing to furnish professional health services may still be subject to the common law 
requirements of ordinary negligence. 
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cause of action by the 2011 amendment, but rather intended to re-classify 
administrative negligence claims against a hospital as a medical malpractice action 
so that they must meet the pleading requirements of a medical malpractice action 
rather than under a general negligence theory.” Savino, 262 N.C. App. at 536, 822 
S.E.2d at 573. 
Therefore, to the extent that defendant’s arguments presuppose that plaintiff 
was required to separately allege a claim for administrative negligence, we do not 
agree. Plaintiff brought suit against defendant alleging medical negligence, and the 
2011 amendment to N.C.G.S. § 90-21.11 had no effect on medical negligence claims 
like plaintiff’s. 
In general, a complaint is required to contain “[a] short and plain statement of 
the claim sufficiently particular to give the court and the parties notice of the 
transactions, occurrences, or series of transactions or occurrences, intended to be 
proved showing that the pleader is entitled to relief.” N.C. R. Civ. P. 8. (2019). We 
have interpreted this language as establishing a “notice pleading” standard. U.S. 
Bank Nat’l Ass’n v. Pinkey, 369 N.C. 723, 728, 800 S.E.2d 412, 416 (2017). 
Accordingly, “the complaint ‘is adequate if it gives sufficient notice of the claim 
asserted “to enable the [defendant] to answer and prepare for trial . . . and to show 
the type of case brought.” ’ ” Id. at 728, 800 S.E.2d at 416 (quoting Sutton v. Duke, 
277 N.C. 94, 102, 176 S.E.2d 161, 165 (1970)). “While the concept of notice pleading 
is liberal in nature, a complaint must nonetheless state enough to give the 
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substantive elements of a legally recognized claim . . . .” Raritan River Steel Co. v. 
Cherry, Bekaert & Holland, 322 N.C. 200, 205, 367 S.E.2d 609, 612 (1988) (citing 
Stanback v. Stanback, 297 N.C. 181, 204, 254 S.E.2d 611, 626 (1979)).  
 
The action began with plaintiff’s filing of the 2016 Complaint after it 
voluntarily dismissed its 2014 Complaint. In the 2016 Complaint, titled “Complaint 
for Medical Negligence,” plaintiff alleged that defendant was negligent in its failure 
to 
a. [T]imely and adequately assess, diagnose, monitor, and 
treat the conditions of Plaintiff’s Decedent so as to 
render appropriate medical diagnosis and treatment of 
his symptoms; 
 
b. [P]roperly advise Plaintiff’s Decedent of additional 
medical and 
pharmaceutical 
courses 
that 
were 
appropriate and should have been considered, utilized, 
and employed to treat Plaintiff’s Decedent’s medical 
condition prior to discharge; 
 
c. [T]imely obtain, utilize and employ proper, complete 
and thorough diagnostic procedures in the delivery of 
appropriate medical care to Plaintiff’s Decedent; 
 
d. [E]xercise due care, caution and circumspection in the 
diagnosis of the problems presented by Plaintiff’s 
Decedent; 
 
e. [E]xercise due care, caution and circumspection in the 
delivery of medical and nursing care to Plaintiff’s 
Decedent; 
 
f. [A]dequately 
evaluate 
Plaintiff’s 
Decedent 
response/lack of response to treatment and report 
findings; 
 
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g. [F]ollow accepted standards of medical care in the 
delivery of care to Plaintiff’s Decedent; 
 
h. [U]se their best judgment in the care and treatment of 
Plaintiff’s Decedent; 
 
i. [E]xercise reasonable care and diligence in the 
application of his/her/their knowledge and skill to 
Plaintiff’s Decedent care; 
 
j. [R]ecognize, appreciate and/or react to the medical 
status of Plaintiff’s Decedent and to initiate timely and 
appropriate intervention, including but not limited to 
medical 
testing, 
physical 
examination 
and/or 
appropriate medical consultation; 
 
k.  . . . 
 
l. [P]rovide health care in accordance with the standards 
of practice among members of the same health care 
professions with similar training and experience 
situated in the same or similar communities at the time 
the health care was rendered to Plaintiff’s Decedent. 
 
These alleged acts of negligence in the 2016 Complaint all relate to the “performance 
of medical . . . or other health care” by “health care provider[s]” working in CMC-
Northeast. N.C.G.S. § 90-21.11(2)(a) (2011). As a result, the allegations state a claim 
for medical negligence.  
As part of its case to prove medical negligence, plaintiff presented evidence at 
trial on the applicable standard of care. This evidence included documents defendant 
had previously submitted as part of an application to gain accreditation as a Chest 
Pain Center. Plaintiff also offered expert testimony that the policies and protocols 
within the Chest Pain Center application documents were consistent with the 
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standard of care applicable to Mr. Savino’s clinical care in defendant’s emergency 
department. To the extent plaintiff argued that the hospital violated the applicable 
standard of care by failing to implement or follow appropriate health care policies and 
protocols as outlined in these documents, we agree with the Court of Appeals that 
this argument was directly relevant to the medical negligence claim. Savino, 262 N.C. 
App. at 554, 822 S.E.2d at 583 (“[E]vidence of the defendant’s policies and protocols, 
or its purported policies and protocols, is certainly relevant and properly considered 
alongside expert testimony to establish the standard of care for medical negligence.”). 
Furthermore, the complaint provided defendant with sufficient notice of the 
fact that plaintiff intended to use the policies and protocols from the Chest Pain 
Center application documents as part of its claim for medical negligence. Specifically, 
plaintiff alleged in the 2016 Complaint that defendant had submitted an application 
for “accreditation as a Chest Pain Center and was approved for such accreditation at 
the time of the events complained of.” The complaint also included allegations that 
as part of the Chest Pain Center application, defendant attested that “it employed 
certain protocols, clinical practice guidelines, and procedures in the care of patients 
presenting with chest pain complaints” replicating “the existing standards of practice 
for medical providers and hospitals in the same care profession with similar training 
and experience situated in similar communities with similar resources at the time of 
the events giving rise to this cause of action.” Plaintiff then alleged that defendant 
failed to “[p]rovide health care in accordance with the standards of practice among 
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members of the same health care professions with similar training and experience 
situated in the same or similar communities at the time the health care was rendered 
to Plaintiff’s Decedent.” These allegations were “sufficiently particular to give the 
court and the parties notice of the transactions, occurrences, or series of transactions 
or occurrences, intended to be proved showing that the pleader is entitled to relief.” 
N.C. R. Civ. P. 8(a)(1). 
 
We agree with the Court of Appeals that plaintiff did not plead a separate claim 
for administrative negligence.3 See 262 N.C. App. at 534, 822 S.E.2d at 572. But 
plaintiff was not required to do so. Rather, plaintiff used multiple theories, including 
some administrative failures, to argue a single cause of action: medical negligence. 
Therefore, the trial court did not err by denying defendant’s motion for JNOV and 
defendant is not entitled to a new trial.4 We modify and affirm the decision of the 
Court of Appeals as to this issue. 
IV. 
Contributory Negligence 
Finally, we address the issue of contributory negligence raised in defendant’s 
conditional petition for discretional review. We conclude that the trial court did not 
                                            
3 Because we conclude that plaintiff was not required to plead a separate 
administrative negligence claim under N.C.G.S. § 90-21.11(2), we need not address 
defendant’s argument that such a claim was time-barred.  
4 We do not address the Court of Appeals’ holding about the effect of the intertwining 
of medical and administrative negligence because we conclude the trial court did not err in 
denying defendant’s motion for JNOV, and therefore do not reach the issue of prejudice. 
However, we do note that section (2)(b) requires that to be classified as medical malpractice, 
alleged administrative shortcomings must arise from the same facts or circumstances 
underpinning the medical negligence. 
SAVINO V. THE CHARLOTTE-MECKLENBURG HOSP. AUTH. 
 
Opinion of the Court 
 
 
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err in granting plaintiff’s motion for a directed verdict on defendant’s claim of 
contributory negligence.  
As we have previously explained, “gross negligence is a higher degree of 
negligence than ordinary negligence, and [ ] wilful and wanton and reckless conduct 
is still a higher degree of negligence or a greater degree of negligence than the 
negligence of gross negligence, so much so that in the wilful, wanton, and reckless 
conduct, the matter of contributory negligence, which might otherwise be interposed 
as a defense, is wiped out.” Crow v. Ballard, 263 N.C. 475, 477, 139 S.E.2d 624, 626 
(1965).  
Here, the jury found that defendant’s conduct in providing medical care to Mr. 
Savino was “in reckless disregard of the rights and safety of others.” Defendant did 
not challenge this finding. Accordingly, defendant’s “reckless conduct . . . wipe[s] out” 
any alleged defense of contributory negligence. Crow, 263 N.C. at 477, 139 S.E.2d at 
626.  
Conclusion  
We modify and affirm in part, and reverse in part, the decision of the Court of 
Appeals because we conclude that (1) the trial court did not err by denying 
defendant’s motion for a directed verdict on pain and suffering damages; (2) plaintiff 
was not required to plead a separate claim for administrative negligence; (3) 
defendant is not entitled to a new trial; and (4) the trial court did not err by granting 
plaintiff’s motion for a directed verdict on contributory negligence. Because we 
SAVINO V. THE CHARLOTTE-MECKLENBURG HOSP. AUTH. 
 
Opinion of the Court 
 
 
-20- 
reverse the Court of Appeals, and thereby uphold the trial court, on the issue of 
damages for pain and suffering we need not remand to the trial court for a new trial 
on non-economic damages.  
MODIFIED AND AFFIRMED IN PART; REVERSED IN PART. 
 
 
Justice DAVIS did not participate in the consideration or decision of this case. 
 
 
 
 
 
Justice NEWBY dissenting. 
 
This medical malpractice action involved a three-and-a-half-week trial. During 
trial, plaintiff pursued two negligence claims, one for medical negligence and one for 
administrative negligence. The trial court allowed evidence of and gave jury 
instructions on both distinct claims of negligence. Both claims were explicitly 
presented to the jury on the jury verdict form. The administrative negligence claim 
was neither pled nor properly presented to the jury. Because the trial court admitted 
a significant amount of extraneous evidence and comingled the jury instructions on 
medical negligence and administrative negligence, and because the jury clearly found 
that defendant was guilty of administrative negligence, defendant was prejudiced by 
the process and should be granted a new trial.  
To avoid having to concede that the administrative negligence claim was not 
properly pled here, the majority judicially restructures medical negligence claims, 
asserting that administrative negligence is merely a theory underlying medical care 
negligence. It holds that a plaintiff need not plead a separate claim for administrative 
negligence. The majority altogether ignores the relevant statutory text and the intent 
of the General Assembly. In amending the medical malpractice statute in 2011, the 
General Assembly did not intend to combine these two distinct types of negligence 
but simply meant to subject both medical care and administrative negligence claims 
to the same heightened pleading requirement. The majority allows all the evidence 
SAVINO V. CHARLOTTE-MECKLENBURG HOSP. AUTH. 
 
Newby, J., dissenting 
 
 
-2- 
relating to the administrative negligence claim to be considered by the jury to 
determine if medical care negligence occurred here. Because evidence of 
administrative negligence and the corresponding jury instructions irredeemably 
tainted the jury verdict, a new trial is warranted.1 I respectfully dissent.  
Defendant in this case does not dispute that plaintiff properly pled a claim for 
medical care negligence. In defendant’s view, the only claim for medical care 
negligence actually pled and pursued at trial was whether the admitting nurse failed 
to relay to the doctor that decedent received nitroglycerin from the EMTs, and, if so, 
whether that failure to relay the information violated the applicable standard of care. 
Ultimately, because the doctor allegedly did not know that the decedent had received 
nitroglycerin and his lab work was normal, the decedent was released but died later 
that evening.  
On 23 April 2014, plaintiff filed an initial “Complaint for Medical Negligence” 
(2014 Complaint). On 6 January 2016, plaintiff moved for leave to amend the 2014 
complaint. In the motion, plaintiff contemplated adding a claim for administrative 
negligence, citing, inter alia, defendant’s failure to train, monitor, and supervise 
employees as well as failure to implement or enforce protocol, policies, and 
procedures. Nonetheless, plaintiff withdrew the motion and, on 19 January 2016, 
                                            
1 Because I would conclude that a new trial is warranted, both issues of pain and 
suffering and contributory negligence would be dependent on the evidence presented at that 
new trial. Therefore, I do not address those issues in this dissenting opinion.  
SAVINO V. CHARLOTTE-MECKLENBURG HOSP. AUTH. 
 
Newby, J., dissenting 
 
 
-3- 
filed a notice of voluntary dismissal without prejudice to refile against defendant 
only. Thereafter, on 1 February 2016, plaintiff refiled a “Complaint for Medical 
Negligence” against defendant (2016 Complaint). In the 2016 Complaint, plaintiff did 
not include the administrative negligence allegations it asserted in its earlier motion; 
it simply added a few factual allegations about defendant’s status as a Chest Pain 
Center and its application for accreditation.2  
Before trial, defendant objected to the administrative negligence claim being 
presented, noting that the complaint alleged only medical care negligence. The trial 
court denied defendant’s motion in limine to exclude evidence related to 
administrative negligence.  
The case proceeded to trial, which occurred over a three-and-a-half-week 
period. Plaintiff presented evidence of defendant’s alleged medical care negligence, 
highlighting the nurse’s purported failure to communicate that the decedent had 
received nitroglycerin in the ambulance. Plaintiff also presented a significant amount 
of evidence related to defendant’s alleged administrative negligence. This evidence 
focused on defendant’s failure to properly train medical providers and to implement 
                                            
2 The majority states that it need not address defendant’s arguments that such a claim 
was time barred since under its reasoning, plaintiff did not need to plead a separate claim 
for administrative negligence. In its analysis, however, the majority relies on the 2016 
Complaint, which cites evidence of Chest Pain Management Center protocols and procedures, 
which plaintiff presented for the first time in the 2016 Complaint. Even if administrative 
negligence were merely a theory underlying medical negligence, as the majority proposes, it 
seems the statute of limitations would be implicated to bar that theory since the theory and 
the allegations were raised for the first time in the 2016 Complaint.  
SAVINO V. CHARLOTTE-MECKLENBURG HOSP. AUTH. 
 
Newby, J., dissenting 
 
 
-4- 
certain policies, procedures, and protocols that, in plaintiff’s view, would have 
ensured that the proper information was communicated to the ER Physician. In doing 
so, plaintiff introduced evidence about the credentials required for defendant to 
become a licensed Chest Pain Center, the application requirements and what the 
hospital had submitted in its application, and the policies to be implemented. On 
several occasions, plaintiff highlighted defendant’s failure to implement and ensure 
that the hospital was abiding by Chest Pain Center protocols stated in the 
application. Plaintiff presented this as amounting to negligence in the application 
process. Moreover, plaintiff’s evidence reiterated that hospital employees were 
unaware of the risk stratification protocol set forth in the Chest Pain Center 
application. Under part of plaintiff’s theory at trial, had defendant implemented and 
abided by these protocols, defendant could have saved the decedent’s life.  
Numerous 
times 
during 
the 
proceeding, 
defendant 
objected 
that 
administrative negligence was not properly before the jury since it was not pled in 
the original 2014 Complaint, nor could it be considered based on the 2016 Complaint 
because it was time barred. The trial court denied defendant’s motions.  
During the jury charge conference, defendant objected to the jury instructions, 
arguing that they improperly presented claims for administrative negligence and 
comingled administrative negligence with medical care negligence. Nonetheless, the 
trial court instructed the jury that it could find defendant liable if it found, inter alia, 
that any of the contentions below were true: 
SAVINO V. CHARLOTTE-MECKLENBURG HOSP. AUTH. 
 
Newby, J., dissenting 
 
 
-5- 
With respect to the first issue in this case, the 
plaintiff contends and the defendant denies that the 
defendant was negligent in one or more of the following 
ways. The first contention is that the hospital did not use 
its best judgment in the treatment and care of its patient 
in that the defendant did not adequately implement 
[emphasis added] and/or follow protocols, processes, 
procedures and/or policies for the evaluation and 
management of chest pain patients in the emergency room 
on April 30th of 2012, in accordance with the standard of 
care.  
 
. . . . 
 
The third contention is that the hospital did not use 
reasonable care and diligence in the application of its 
knowledge and skill to its patient’s care in that Carolinas 
Healthcare 
System 
did 
not 
adequately 
implement 
[emphasis added] and/or follow the protocols, processes, 
procedures and/or policies for the evaluation and 
management of chest pain patients in the emergency room 
or emergency department on April 30th of 2012. 
 
. . . .  
 
The fifth contention is that the hospital did not 
provide health care in accordance with the standards of 
practice among similar health care providers situated in 
the same or similar communities under the same or similar 
circumstances at the time the health care was rendered, 
and that the defendant did not adequately implement 
[emphasis added] and/or follow the protocols, processes, 
procedures and/or policies in place in the emergency 
department on April 30th of 2012. 
 
Despite the trial court’s failure to separate administrative negligence from 
medical negligence in its instructions, the jury verdict sheet recognized medical and 
administrative negligence as two separate issues, first asking the jury whether 
SAVINO V. CHARLOTTE-MECKLENBURG HOSP. AUTH. 
 
Newby, J., dissenting 
 
 
-6- 
decedent’s “death [was] caused by the negligence of defendant,” and then asking 
whether decedent’s “death [was] caused by the defendant’s negligent performance of 
administrative duties.” On 15 November 2016, the jury returned its verdict finding 
defendant liable for both administrative and medical negligence. The jury awarded 
$680,000 in economic damages and $5,500,000 in non-economic damages, amounting 
to a single sum of $6,130,000 in total damages.  
Defendant moved for judgment notwithstanding the verdict or for a new trial. 
In its motion, defendant argued in part that the trial court erroneously comingled the 
jury instructions on administrative and medical negligence, which ultimately 
confused the jury and unfairly prejudiced defendant. The trial court denied 
defendant’s motion.  
The determinative issue should be whether plaintiff properly pled a claim for 
administrative negligence, which should be answered in the negative. Based on this 
answer, the question then becomes what the appropriate remedy is when, in the 
course of an almost four week trial, evidence of an improperly pled claim is admitted, 
the jury charge is inaccurate because it comingles both negligence claims, and the 
jury verdict sheet is wrong because it asks in part whether defendant was liable for 
administrative negligence. In short, this Court should ask whether the comingling 
and intertwining of administrative negligence throughout the trial impacted the jury 
verdict so as to prejudice defendant and entitle defendant to a new trial. Because 
administrative and medical negligence were inextricably intertwined in the evidence 
SAVINO V. CHARLOTTE-MECKLENBURG HOSP. AUTH. 
 
Newby, J., dissenting 
 
 
-7- 
and instructions here, defendant was prejudiced and there should be a new trial 
untainted by the evidence of administrative negligence and the accompanying 
improper jury instruction. 
In its analysis, the majority fails to follow the intent of the legislature in 
amending the statute in 2011. Instead, the majority collapses administrative and 
medical care negligence into a single negligence claim. This reasoning turns on its 
head the intent of the General Assembly, which was not to combine the two types of 
negligence, but to require the same heightened pleading standard for an 
administrative negligence claim that previously existed for a medical care negligence 
claim. 
Prior to 2011, a claimant with an allegation of medical negligence in the 
rendering of care for medical services and an allegation of medical negligence arising 
from administrative negligence had two separate pleading standards. While medical 
care negligence was subject to the heightened pleading requirements of Rule 9(j) of 
the North Carolina Rules of Civil Procedure, a claim for medical administrative 
negligence was subject to the ordinary, non-heightened pleading requirements. Thus, 
prior to 2011, a medical malpractice action was defined only as a medical care 
negligence claim, i.e., “a civil action for damages for personal injury or death arising 
out of the furnishing or failure to furnish professional services in the performance of 
medical, dental, or other health care by a health care provider.” N.C.G.S. § 90-21.11 
(2009).  
SAVINO V. CHARLOTTE-MECKLENBURG HOSP. AUTH. 
 
Newby, J., dissenting 
 
 
-8- 
In 2011, however, while keeping a separate claim for medical care negligence, 
the North Carolina General Assembly changed the definition of “medical malpractice” 
to also include a claim for administrative negligence. See Act of July 25, 2011, S.L. 
2011-400 § 5, 2011 N.C. Sess. Laws, 1712, 1714. The legislature did not intend to 
combine or blend medical and administrative negligence claims into one claim but 
simply meant to subject claims of both types of negligence to the same stringent 9(j) 
pleading standard. Thus, under the current statute, a claim of medical malpractice 
can arise from medical care or administrative responsibilities: 
a. A civil action for damages for personal injury or 
death arising out of the furnishing or failure to furnish 
professional services in the performance of medical, dental, 
or other health care by a health care provider. 
b. A civil action against a hospital, a [licensed] 
nursing home . . . , or a[ licensed] adult care home . . . for 
damages for personal injury or death, when the civil action 
(i) alleges a breach of administrative or corporate duties to 
the patient, including, but not limited to, allegations of 
negligent credentialing or negligent monitoring and 
supervision and (ii) arises from the same facts or 
circumstances as a claim under sub-subdivision a. of this 
subdivision. 
 
N.C.G.S. § 90-21.11(2) (2019).  
Consistent with the way the legislature framed both separate claims as 
recognized in section 90-21.11(2), case law has recognized that there are “two kinds 
of [corporate hospital negligence] claims: (1) those relating to negligence in clinical 
care provided by the hospital directly to the patient, and (2) those relating to the 
negligence in the administration or management of the hospital.” Estate of Ray ex rel. 
SAVINO V. CHARLOTTE-MECKLENBURG HOSP. AUTH. 
 
Newby, J., dissenting 
 
 
-9- 
Ray v. Forgy, 227 N.C. App. 24, 29, 744 S.E.2d 468, 471 (2013) (quoting Estate of 
Waters v. Jarman, 144 N.C. App. 98, 101, 547 S.E.2d 142, 144, disc. rev. denied, 354 
N.C. 68, 533 S.E.2d 213 (2001)).  
Plaintiff failed to plead administrative negligence in its 2014 Complaint and 
its 2016 Complaint, despite plaintiff’s seeming intent to add a claim for 
administrative negligence when it filed its motion to amend on 6 January 2016. 
Notably, because medical and administrative negligence are two separate claims, 
they must be pled separately and proved independently. Because plaintiff failed to 
plead administrative negligence here, evidence of administrative negligence should 
not have been admitted at trial and the jury should not have been instructed on the 
claim.  
Because administrative negligence was not properly pled, the question 
becomes whether evidence of the improperly considered administrative negligence 
claim, and the corresponding instructions from the trial court, tainted the jury verdict 
in a way that prejudiced defendant, warranting a new trial. Here a new trial is 
warranted because it appears the jury based its decision to find defendant liable for 
medical care negligence on the improperly admitted evidence pertaining to 
administrative negligence. Further, the instructions blended the two claims.  
Error in the jury instructions or uncertainty in the jury verdict warrants a new 
trial in several situations. When it is unclear “upon what theory or under which part 
of the [jury] charge the verdict was based, and therefore error in any one of the 
SAVINO V. CHARLOTTE-MECKLENBURG HOSP. AUTH. 
 
Newby, J., dissenting 
 
 
-10- 
instructions . . . may have influenced the jury,” defendant is entitled to a new trial. 
Morrow v. Southern Ry. Co., 147 N.C. 623, 629, 61 S.E. 621, 623 (1908). Also, when a 
“trial judge inadvertently omit[s] . . . sufficiently definite instructions to guide the[ 
jury] to an intelligent determination of the question,” a new trial is warranted. Kee v. 
Dillingham, 229 N.C. 262, 266, 49 S.E.2d 510, 512 (1948); see also Robertson v. 
Stanley, 285 N.C. 561, 569, 206 S.E.2d 190, 196 (1974) (stating that where issues are 
“inextricably interwoven” within the case, suggesting that the jury awarded damages 
on an improper ground, a new trial on all issues should be granted); Hoaglin v. 
Western Union Telegraph Co., 161 N.C. 390, 398–99, 77 S.E. 417, 421 (1913) (“If we 
could separate the two [jury instructions], because we knew with certainty that the 
jury were not influenced by the error, we would do so, but it is impossible, as the 
correct and incorrect instructions have together passed into the verdict which is 
indivisible. A new trial is the only remedy for the error.”). 
Therefore, when an appellate court is reviewing a claim  
[o]n appeal, this Court considers a jury charge contextually 
and in its entirety. The charge will be held to be sufficient 
if “it presents the law of the case in such manner as to leave 
no reasonable cause to believe the jury was misled or 
misinformed . . . .” The party asserting error bears the 
burden of showing that the jury was misled or that the 
verdict was affected by an omitted instruction. “Under such 
a standard of review, it is not enough for the appealing 
party to show that error occurred in the jury instructions; 
rather, it must be demonstrated that such error was likely, 
in light of the entire charge, to mislead the jury.” 
 
SAVINO V. CHARLOTTE-MECKLENBURG HOSP. AUTH. 
 
Newby, J., dissenting 
 
 
-11- 
Boykin v. Kim, 174 N.C. App 278, 286, 620 S.E.2d 707, 713 (2005) (first citing and 
then quoting Jones v. Satterfield Dev. Co., 16 N.C. App. 80, 86–87, 191 S.E.2d 435, 
439, 440, cert. denied, 282 N.C. 304, 192 S.E.2d 194 (1972); then citing and then 
quoting Robinson v. Seaboard Sys. R.R., 87 N.C. App. 512, 524, 361 S.E.2d 909, 917, 
disc. rev. denied, 321 N.C. 474, 364 S.E.2d 924 (1988)).  
 
Defendant submits that the medical negligence claim properly before this 
Court asked whether the admitting nurse failed to communicate that decedent 
received nitroglycerin in the ambulance, and if so, whether that failure to 
communicate this information constituted a violation of the applicable standard of 
care. The administrative negligence claim presented at trial, however, focused on 
whether proper procedural safeguards were designed and implemented to prevent 
this type of communication failure.  
 
The trial court admitted evidence of the admitting nurse’s failure to 
communicate the applicable information, which would relate to plaintiff’s properly 
pled medical negligence claim. The trial court also allowed into evidence testimony 
and exhibits related to plaintiff’s administrative negligence claim, however. At trial, 
plaintiff introduced a significant amount of evidence about the credentials required 
for defendant to become a licensed Chest Pain Center, the application requirements, 
and the policies to be set forth by the hospital in compliance with the Chest Pain 
Center application requirements. Plaintiff’s evidence highlighted defendant’s failure 
to ensure that the hospital was implementing Chest Pain Center protocols and the 
SAVINO V. CHARLOTTE-MECKLENBURG HOSP. AUTH. 
 
Newby, J., dissenting 
 
 
-12- 
representations defendant made in its application. Moreover, testimony about 
individuals who were unaware of the risk stratification protocol stated in the Chest 
Pain Center application documents was repeated multiple times throughout trial.  
Despite the differences in these claims, the evidence at trial was not separated 
in a way that the jury could discern which evidence pertained to defendant’s alleged 
liability for medical negligence and which evidence pertained to defendant’s alleged 
liability for administrative negligence. Therefore, the jury was led to believe that it 
could find decedent’s death was caused by either or both medical and administrative 
negligence, regardless of which evidence supported which claim. Certainly plaintiff’s 
closing argument asserted both kinds of negligence.  
Moreover, the jury instructions failed to distinguish between the two different 
types of negligence. Despite asking the jury on the verdict sheet to separately answer 
whether defendant was liable for medical negligence and administrative negligence, 
the trial court’s instructions wholly failed to distinguish between the two types of 
negligence. Instead, the jury instructions inextricably comingled medical and 
administrative negligence so the jury likely believed it could find defendant liable for 
medical negligence based on evidence of administrative negligence. Thus, the 
evidence related to administrative negligence and the trial court’s failure to separate 
out the claims in the instructions together created a Gordian Knot, rendering it 
impossible to determine on which evidence or instruction the jury found defendant 
liable. Given the uncertainty about the premise of the jury’s verdict, defendant has 
SAVINO V. CHARLOTTE-MECKLENBURG HOSP. AUTH. 
 
Newby, J., dissenting 
 
 
-13- 
met its burden to show that the improper evidence and resulting comingled 
instructions likely misled the jury. Under our precedent, certainly it was unclear 
“upon what theory or under which part of the [jury] charge the verdict was based,” 
meaning defendant is entitled to a new trial. Morrow, 147 N.C. at 629, 61 S.E. at 623.  
The majority ignores the question of whether plaintiff properly pled 
administrative negligence. Instead of asking whether evidence related to 
administrative negligence tainted the verdict, the majority asserts that plaintiff need 
not plead a separate claim for administrative negligence because all of plaintiff’s 
evidence about defendant’s breach of administrative duties amounted to “a theory 
underlying the overall claim of medical negligence.” It appears that the majority 
would not require a plaintiff to precisely plead either medical or administrative 
negligence; under the majority’s rationale, so long as a party pursuing a medical 
malpractice claim meets 9(j) pleading requirements generally and states that it is 
pursuing a medical malpractice claim, that party can present evidence of either or 
both medical or administrative negligence under its claim by asserting that the 
evidence relates to a “theory,” not a separate claim. 
In doing so, the majority ignores that the legislature chose to separate medical 
and administrative negligence claims when re-categorizing administrative 
negligence as a type of medical malpractice subject to heightened pleading 
requirements. See N.C.G.S. § 90-21.11 (stating that a medical malpractice action can 
be based on either type of negligence, one being medical negligence and the other 
SAVINO V. CHARLOTTE-MECKLENBURG HOSP. AUTH. 
 
Newby, J., dissenting 
 
 
-14- 
being administrative negligence). The legislature chose to require separate 9(j) 
certification and other heightened requirements for both medical and administrative 
negligence. Further, the majority’s decision to allow a plaintiff to proceed on either 
type of negligence without distinction undermines the concept of notice pleading. 
Notably, it is not the Court’s job to redefine medical negligence. Through its 
holding, the majority nonetheless acts as the legislature, ignores the express 
language of our General Statutes, and relegates a clearly defined cause of action for 
administrative negligence into only a theory supporting a claim of medical negligence. 
This rationale conflicts with the express language of N.C.G.S. § 90-21.11(2). It is 
certainly unclear how the majority would treat a separate claim for administrative 
negligence. 
Because administrative negligence was not properly pled, it was improper to 
allow evidence of it and to include it in the jury instructions and verdict sheet. 
Administrative negligence should not have been a part of the jury’s decision on 
whether to find defendant liable for medical negligence. The jury instructions failed 
to separate the claims for administrative and medical negligence, and the evidence 
at trial failed to distinguish between the claims. Therefore, because the issues are 
“inextricably interwoven” here, Robertson, 285 N.C. at 569, 206 S.E.2d at 196, 
defendant is entitled to a new trial excluding evidence or instruction on 
administrative negligence. I respectfully dissent.