Cottle v. Mankin

CourtSupreme Court of North Carolina
DecidedDecember 12, 2025
Docket173PA24
StatusPublished

This text of Cottle v. Mankin (Cottle v. Mankin) is published on Counsel Stack Legal Research, covering Supreme Court of North Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cottle v. Mankin, (N.C. 2025).

Opinion

IN THE SUPREME COURT OF NORTH CAROLINA

No. 173PA24

Filed 12 December 2025

BRITTANY JEANNE COTTLE, TERRY ALAN COTTLE, and CYNTHIA BALKCUM COTTLE

v. KEITH PINKNEY MANKIN, MD; JEANNE HALL, RN, MSN, FNP-C; BRADLEY K. VAUGHN, MD; WALLACE F. ANDREW JR., MD; KARL STEIN; JOSEPH U. BARKER, MD; MARK R. MIKLES, MD; RALEIGH ORTHOPAEDIC CLINIC, P.A.; and RALEIGH ORTHOPAEDIC RESEARCH FOUNDATION

On discretionary review pursuant to N.C.G.S. § 7A-31(c) of a unanimous

decision of the Court of Appeals, 294 N.C. App. 20 (2024), affirming in part and

reversing in part summary judgment entered on 16 March 2022 by Judge William R.

Pittman in Superior Court, Wake County. On 21 March 2025, the Supreme Court

allowed plaintiffs’ cross-petition for discretionary review. Heard in the Supreme

Court on 17 September 2025.

Mast, Johnson, Wright, Booker & Van Patten, P.A., by Charles Mast, Nichole G. Booker, and Caroline Parrish, for plaintiff-appellees.

Robinson, Bradshaw & Hinson, P.A., by Matthew W. Sawchak, Erik R. Zimmerman, Garrett A. Steadman, and Zachary A. Johnson; Huff, Powell & Bailey, LLC, by Pankaj Shere and Beth S. Reeves, pro hac vice, for Raleigh Orthopaedic Clinic, P.A., and Raleigh Orthopaedic Research Foundation, defendant-appellants.

Brown Moore & Associates, PLLC, by Jon R. Moore; Ward and Smith, P.A., by Christopher S. Edwards; and Tatum & Atkinson, PLLC, by Jon Ward, for North Carolina Advocates for Justice, amicus curiae. COTTLE V. MANKIN

Opinion of the Court

Roberts & Stevens, PA, by David C. Hawisher, for North Carolina Association of Defense Attorneys, amicus curiae.

Sarah Motley Stone, for North Carolina Healthcare Association, Carolinas Medical Group Management Association, North Carolina Medical Society, and North Carolina Independent Physician Practice Association, amici curiae.

BARRINGER, Justice.

Informed by the text of the controlling statute, our rules of statutory

construction, and the relevant caselaw, we hold plaintiffs’ negligent retention claim

against a corporate medical practice is a “medical malpractice action” as defined by

N.C.G.S. § 90-21.11 (2023). Accordingly, plaintiffs’ negligent retention claim is barred

by the statute of repose. N.C.G.S. § 1-15(c) (2023).

I. Background

On behalf of their daughter, Brittany Cottle, plaintiffs Terry Cottle and

Cynthia Cottle commenced this action against defendants for the alleged substandard

medical care provided to Brittany during her time as a patient at Raleigh Orthopaedic

Clinic (ROC).

A. Factual Background

Plaintiffs’ complaint alleges the following events: In 2010, when Brittany was

fourteen years old, she saw Dr. Keith Mankin, an orthopedist at ROC, seeking relief

from her back pain. Dr. Mankin ordered an X-ray of Brittany’s spine and diagnosed

her with spinal stenosis and mild scoliosis. Three months later, an MRI indicated

that Brittany did not suffer from spinal stenosis, but rather only minimal disc

desiccation. Nevertheless, Dr. Mankin performed surgery on Brittany, removing a

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portion of her vertebra to relieve pressure ostensibly caused by spinal stenosis and

fusing a portion of her spine in place.

Sometime in 2011, a father of one of Dr. Mankin’s surgical patients made a

complaint to Dr. Wallace Andrew, an orthopedist at ROC, and Karl Stein, the

executive director of ROC. He claimed that Dr. Mankin had never actually performed

a fusion surgery he claimed to have performed and that the patient never needed

surgery in the first place. Despite this disturbing report, ROC took no formal action.

In early 2011, ROC hired Dr. Neil Vining as a pediatric orthopedic surgeon.

Almost immediately upon joining the practice group, Dr. Vining recognized that ROC

employees generally understood Dr. Mankin to be a substandard physician.

Dr. Mankin’s substandard care was so severe that Dr. Vining even noticed ROC

doctors referring pediatric cases to outside practice groups, like UNC or Duke, in an

attempt to steer those patients away from Dr. Mankin. Dr. Vining quickly became

worried about how Dr. Mankin treated his patients.

By the end of the year, Dr. Vining’s mounting concerns hit a breaking point.

He arranged a meeting with Mr. Stein, Dr. Andrew, and an insurance representative.

At the meeting, Dr. Vining presented three pediatric cases in which Dr. Mankin

provided negligent medical care. He conveyed his opinion to the group that

Dr. Mankin presented a significant risk to his patients and urged that corrective

measures be implemented. Yet, still no action was taken—Dr. Mankin remained

employed by ROC.

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In July 2012, Brittany returned to Dr. Mankin with continuing back pain.

Upon evaluation, Dr. Mankin diagnosed Brittany with an unstable sacroiliac joint

and recommended that Brittany undergo a second surgery. Approximately four

months later, Dr. Mankin performed that second surgery, attempting a left sacroiliac

fusion and stabilization fixation with three screws. Dr. Mankin wrote in his operative

report that the screws were properly affixed. However, the operating room imaging

showed that two of the three screws were, in fact, not fixed to bone at all.

Concerns over Dr. Mankin reached a turning point in early 2013. In January

of that year, Dr. Edmund Campion, a pediatric orthopedist at UNC School of

Medicine, sent an email to Dr. Jeffrey Kobs, an orthopedist at ROC. The email

included a letter detailing widely held concerns regarding Dr. Mankin’s “pattern of

incompetent, and even dangerous, care” provided to his patients. In that email,

Dr. Campion expressed his intent to share the letter with the chief medical officer at

WakeMed.1 By March, Dr. Mankin had resigned from ROC.

After Dr. Mankin’s resignation, Dr. Vining learned that Dr. Mankin was still

treating patients—now through his own solo practice in Raleigh, North Carolina.

Dr. Vining, troubled by the “highly dubious” and “consistently substandard”

techniques of Dr. Mankin, decided that it was time to alert authorities. Dr. Vining

wrote a letter to the North Carolina Medical Board. In that letter, Dr. Vining

1 ROC physicians, including Dr. Mankin, relied upon WakeMed for its surgical facilities to execute their surgeries.

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encouraged the North Carolina Medical Board to independently contact various

pediatric orthopedists who were familiar with Dr. Mankin’s care and to entertain the

possibility of sanctions against him.

The Board opened an investigation into the quality of Dr. Mankin’s care. At

the conclusion of the investigation, Dr. Mankin entered a non-disciplinary consent

order. In that order, Dr. Mankin voluntarily agreed to place his medical license on

inactive status and move out of North Carolina to pursue non-medical interests. By

12 December 2015, Dr. Mankin officially ceased all practice of medicine in the State

of North Carolina.

In 2016, Brittany’s back pain returned. She called ROC to schedule an

appointment. This time, she was seen by Dr. Mark Mikles, another orthopedist at

ROC. Dr. Mikles saw Brittany for two visits before referring her to Dr. Joseph Barker,

a hip specialist at ROC.

Following her visit with Dr. Barker, Brittany determined it was time to seek a

second opinion. She visited Dr. William Richardson, an orthopedist at Duke. During

her visit with Dr.

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