SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
A-5661-00T3
ENEZ BALTHAZAR,
Plaintiff-Appellant,
v.
ATLANTIC CITY MEDICAL CENTER,
BARBARA HENDERSON, M.D., DRS.
DeSTEFANO, FELDMAN, KAUFMAN &
KORZENIOWSKI, P.A., JOSEPH
DeSTEFANO, M.D., ALLAN FELDMAN,
M.D., LARRY KAUFMAN, M.D.,
PHILLIP KORZENIOWSKI, M.D.,
RICHARD COOPER, M.D., UNIVERSITY
OF MEDICINE AND DENTISTRY OF NEW
JERSEY SCHOOL OF OSTEOPATHIC MEDICINE,
Defendants-Respondents,
and
ATLANTIC CITY MEDICAL CENTER
COMMUNITY HEALTH SERVICES,
Defendant.
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Argued January 27, 2003 - Decided March 5,
2003
Before Judges Havey, A. A. Rodríguez,
and Payne.
On appeal from Superior Court of New
Jersey, Law Division, Atlantic County,
L-4192-99.
Anne Pope Cataline argued the cause for
appellant (Frank D. Branella, attorney;
Ms. Cataline on the brief).
Peter M. Sarkos argued the cause for
respondent Atlantic City Medical Center
(Fox, Rothschild, O'Brien & Frankel
attorneys; Mr. Sarkos, of counsel and
on the brief).
Thomas F. Marshall argued the cause for
respondents Richard Cooper, D.O. and
University of Medicine and Dentistry of New
Jersey School of Osteopathic Medicine
Sharon K. Galpern argued the cause for
respondents Barbara Henderson, M.D.,
Drs. DeStefano, Feldman, Kaufman &
Korzeniowski, P.A., Joseph DeStefano, M.D.,
Allan Feldman, M.D., Larry Kaufman, M.D.,
Phillip Korzeniowski, M.D. (Stahl &
DeLaurentis attorneys; Ms. Galpern and John A.
Talvacchia on the brief).
The opinion of the court was delivered by
PAYNE, J.A.D.
Plaintiff Enez Balthazar appeals from an order of May 23,
2000 dismissing with prejudice her claims for medical malpractice
against defendants Barbara Henderson, M.D., Joseph DeStefano,
M.D., Allan Feldman, M.D., Larry Kaufman, M.D., and Phillip
Korzeniowski, M.D. (the Henderson defendants) as the result of
plaintiff's failure to comply with the requirements of the
affidavit of merit statute, N.J.S.A. 2A:53A-26 through -29.
Balthazar also appeals from an order of May 14, 2001 denying her
motion to amend her complaint to allege claims of battery and
fraudulent concealment.See footnote 11 We affirm.
On January 27, 1998, Plaintiff underwent an abdominal
hysterectomy at Atlantic City Medical Center (ACMC), performed by
Henderson, an employee of the medical group of DeStefano,
Feldman, Kaufman & Korzeniowski, P.A., with the assistance of
Korzeniowski. A resident named Richard Cooper was also present
in the operating room. During the surgery, sutures were
mistakenly placed in Balthazar's left ureter that blocked the
flow of urine, and the ureter may have been cut.See footnote 22 These acts
caused complications that resulted in a second laparotomy on
January 31, 1998, at which time the damage to the ureter was
discovered, the ureter was rejoined to the bladder at a new
location, and a stent was placed in it for a period of six weeks,
at which time it was surgically removed. Additional
complications arose of relevance to damages issues, but not to
this appeal.
On June 21, 1999, plaintiff filed suit against the Henderson
defendants, ACMC and others alleging injury to her ureter as the
result of defendants' negligence. The Henderson defendants
answered the complaint on October 5, 1999, and ACMC answered
within two additional days. Demands for service of an affidavit
of merit within sixty days were made in the answers of ACMC and
the Henderson defendants. However, plaintiff did not file her
affidavit until March 8, 2000 _ a date more than 120 days after
the answers of the relevant parties had been filed and after the
Henderson defendants and ACMC had movedSee footnote 33 for dismissal of
Balthazar's suit with prejudice as the result of her failure to
comply with the affidavit of merit act.See footnote 44
That act, enacted as a tort reform measure in 1995, requires
that plaintiffs seeking damages as the result of professional
negligence make a threshold showing that their claims are valid,
thereby permitting identification and dismissal of meritless
lawsuits at an early stage of litigation before large sums are
spent on defense. In re Petition of Hall,
147 N.J. 379, 391
(1997). See also, e.g., Galik v. Clara Maass Med. Ctr.,
167 N.J. 341 (2001); Fink v. Thompson,
167 N.J. 551, 559 (2001); Alan J.
Cornblatt, P.A. v. Barrow,
153 N.J. 218, 242 (1998).
N.J.S.A. 2A:53A-27, a key section of the statute, provides
in relevant part:
In any action for damages for personal injuries .
. . resulting from an alleged act of malpractice . . .
by a licensed person in his profession or occupation,
the plaintiff shall, within 60 days following the date
of filing of the answer to the complaint by the
defendant, provide each defendant with an affidavit of
an appropriate licensed person that there exists a
reasonable probability that the care, skill or
knowledge exercised or exhibited in the treatment,
practice or work that is the subject of the complaint,
fell outside acceptable professional . . . standards or
treatment practices. The court may grant no more than
one additional period, not to exceed 60 days, to file
the affidavit pursuant to this section, upon a finding
of good cause.
An escape from the statute's requirements is offered in
N.J.S.A. 2A:53A-28, which provides:
An affidavit shall not be required pursuant to
section 2 of this act [N.J.S.A. 2A:53A-27] if the
plaintiff provides a sworn statement in lieu of the
affidavit setting forth that: the defendant has failed
to provide plaintiff with medical records or other
records or information having a substantial bearing on
preparation of the affidavit; a written request
therefor along with, if necessary, a signed
authorization by the plaintiff for release of the
medical records . . . has been made by certified mail
or personal service; and at least 45 days have elapsed
since the defendant received the request.
That section of the act reflects a legislative recognition
that a plaintiff may be prevented from making a threshold showing
of merit if defendant fails to produce essential medical records.
Scaffidi v. Horvitz,
343 N.J. Super. 552, 558 (App. Div. 2001).
In this regard, we have observed that the purpose of the
affidavit of merit act is not to provide a sword to defendants
that can be used by them to fight off malpractice actions by
procrastinating in providing necessary records or information.
Barreiro v. Morais,
318 N.J. Super. 461, 470 (App. Div. 1999).
Nonetheless, to realize its tort reform goal, the act
provides a stiff penalty upon noncompliance with the act's
affidavit of merit or, alternatively, its escape provisions.
Failure to timely provide an affidavit pursuant to N.J.S.A.
2A:53A-27, or furnish a statement conforming to N.J.S.A. 2A:53A-
28 "shall be deemed a failure to state a cause of action."
N.J.S.A. 2A:53A-29. In this case, Balthazar's failure to submit
an affidavit of merit within the statutory time limit of 120
daysSee footnote 55 or to comply with the escape provisions of N.J.S.A. 2A:53A-
28 led to dismissal of her complaint with prejudice.
On appeal, Balthazar argues that her complaint should have
been preserved because of the allegedly fraudulent maintenance of
relevant records, her substantial compliance with statutory
directives, and the existence of extraordinary circumstances.
Balthazar also argues the unconstitutionality of the affidavit of
merit statute,See footnote 66 and claims error in the court's denial of her
motion to amend her complaint. We will address these arguments
in turn.
Even though appellant did provide an Affidavit of
Merit dated March 8, 2001, it is of no consequence. No
valid Affidavit can be prepared because there is no
valid medical record to serve as the basis for the
Affidavit. It is impossible to provide an Affidavit
when no authentic medical record exists.
We do not find patent the "fraud" that plaintiff claims to
exist, and find no other evidence that would suggest that it
occurred. Dr. Henderson presented a perfectly reasonable and
essentially uncontroverted explanation for the existence of the
two operative reports in Balthazar's hospital chart. Moreover,
the second report was clearly designated "REDICTATION," thereby
providing notice to anyone viewing the chart that another version
had been previously given by her to the transcriber. Neither
report contained overtly exculpatory or inculpatory material.
Both were dictated before damage to the ureter was discovered.
Thus, this is not a case in which there is evidence of deliberate
destruction or alteration of medical records in anticipation of
suit. Compare Rosenblit v. Zimmerman,
166 N.J. 391 (2001). Both
operative reports existed in the chart essentially from the
outset, and both were available to Balthazar for her analysis and
use.
Moreover, we note the fact that, aside from what appear to
have been dictation or transcription errors, the records are
essentially similar as they relate to Henderson's visualization
of Balthazar's ureters. The first report states the following:
Attention was then directed towards identifying the
left and right ureter. The retroperitoneal space was
entered posteriorly on the left side and on the right
side and the ureter was identified on the medial
ligament of the peritoneum. The ureter was identified
on the right side as well and the medial ligament.
The second report states:
Attention was then directed towards identifying the
left and right ureters. The retroperitoneal space was
entered posteriorly on the left side and the ureter was
identified along the medial ligament [handwritten:
broad ligament] of the peritoneum. The ureter was
identified in a similar fashion on the left side as
well.
Any "fraud" is thus inconsequential.
As a final matter, we again note that no reference in either
of Henderson's reports exists to suturing or transecting the left
ureter. That information appears elsewhere in the hospital chart
in documents whose accuracy and authenticity is uncontroverted.
Thus, even if we were to acknowledge fraud in what appears to us
to have been an innocent re-dictation, we can find no causal
relationship between that fraud and any inability on plaintiff's
part to determine the nature of her injury and prepare an
affidavit of merit. In this case, like many others, defendants
claim that the damage that was inflicted was unknown to them and
thus was unrepaired and unrecorded.See footnote 88 This asserted lack of
knowledge on defendants' part provides a factual foundation for
Balthazar's malpractice claim. It does not provide grounds for
avoidance of the requirements of the affidavit of merit.
We find the office records upon which Balthazar relies in
claiming extraordinary circumstances to have been non-essential
to her demonstration of malpractice.See footnote 1111 Plaintiff knew from the
time of her urologic surgery the basic outlines of her injury,
and at all relevant times she possessed those records that
supported her claim: the records of ACMC, including all operative
reports. Thus, we find that Balthazar had failed to demonstrate
circumstances that are sufficiently extraordinary to have
relieved her of her statutory obligations in this case.See footnote 1212 See
Davies v. Imbesi,
328 N.J. Super. 372, 378 (App. Div. 2000).
In Barreiro, we held that the 120-day period provided by
statute does not constitute a non-extendable barrier if
extraordinary circumstances warrant it. Id., 318 N.J. Super. at
472. Nonetheless, we have limited the situations in which such
circumstances can be found, and have rejected arguments that have
as their foundation carelessness, lack of circumspection, lack of
diligence, or ignorance of the law. Palanque v. Lambert-Wolley,
327 N.J. Super. 158, 164 (App. Div. 2000), rev'd on other
grounds,
168 N.J. 398 (2001); Hyman Zamft & Manard L.L.C. v.
Cornell,
309 N.J. Super. 586, 593 (App. Div. 1998). We class the
arguments in this matter to be among those that are insufficient
to warrant equitable relief.
Footnote: 1 1 We regard any arguments regarding the dismissal of claims
against the medical group of DeStefano, Feldman, Kaufman &
Korzeniowski, P.A., Atlantic City Medical Center, the University
of Medicine and Dentistry of New Jersey School of Osteopathic
Medicine and Richard Cooper, D.O. on motion for summary judgment
to have been abandoned, since the order dismissing claims against
them is not mentioned in Balthazar's notice of appeal, and no
legal argument with respect to that order appears. Fantis Foods
v. North River Ins. Co.,
332 N.J. Super. 250, 266-67 (App. Div.),
certif. denied,
165 N.J. 677 (2000); DeVane v. DeVane,
280 N.J.
Super. 488, 490 n.2 (App. Div. 1995); Pressler, Current N.J.
Court Rules, comment on Rule 2:6-2 (2003).
Footnote: 2 2 The record is unclear as to whether a transection
occurred. The operative report of the surgeon performing later
urological repairs stated:
At this time the dissection was brought along the
ureter down into the pelvis where there was identified
a stitch which was surrounding the ureter and tissue
around it. This was incised. It freed it, however the
ureter was still dilated. Upon further coming down
there was an area of inflammation. It was noted there
were other stitches involved with the distal portion of
the ureter. It was identified that the ureter then was
freed and was then separated from the underlying
tissue. The incised ureter was noted to have good
function with good urine coming out of the superior end
of the ureter.
In his deposition, Dr. Kimmel stated:
The initial suture that we ran into in the second
operation had the _ a distal portion of the ureter,
which was transected, so, yes, it was ligated, or cut,
and had a suture around it with some vascular
structures.
Balthazar asserts that she could not have known of the
transection of the ureter until Dr. Kimmel's deposition was taken
on November 3, 2000. After that deposition, Balthazar submitted
an additional expert report dated February 26, 2001 from Marvin
A. Krane, M.D. in which severance of the ureter was listed as an
additional act of malpractice. We agree with the trial court
that the late discovery that the ureter was severed did not serve
to extend the time for filing of an affidavit of merit, since
severance was merely another incident of the underlying damage
claimed to exist.
Footnote: 3 3 ACMC moved on February 16, 2000. The Henderson
defendants moved one day later.
Footnote: 4 4 The official name of the act is "An Act concerning tort
reform and the negligence or malpractice of certain licensed
persons and supplementing Title 2A of the New Jersey Statutes."
Footnote: 5 5 The Supreme Court has held that it is not necessary to
move within the initial 60-day period provided in N.J.S.A.
2A:53A-27 for an extension of the period for filing an affidavit
of merit to 120 days, if good cause for the extension is shown.
Burns v. Belafsky,
166 N.J. 466, 475 (2001). However, in this
case Balthazar did nothing until after the 120-day period had
ended.
Footnote: 6 6 We do not find the argument of unconstitutionality, which
does not appear to have been raised below, to have sufficient
merit to warrant further discussion in a written opinion. See R.
2:11-3(e)(1)(E). See also Cornblatt, 153 N.J. at 247-48;
Barreiro, supra, 318 N.J. Super. at 468-69.
Footnote: 7 7 The passage thus read: "The muscle that had been
partially transected was reapproximated using the overlying
fascia. Hemostasis was noted to be good on that dissected
portion."
Footnote: 8 8 Balthazar claims on appeal that defendants deliberately
sutured the left ureter to disguise the fact that it had been
severed and that they deliberately misled her into believing that
the sutures were accidently placed during closing. No support
for the claim of deliberate misinformation is provided, and we
find no evidence of such in the record.
Footnote: 9 9 In Palanque, a case in which the defendant acknowledged
that he had mistaken specimen identification numbers for lab
results on two occasions and therefore incorrectly reported that
plaintiff was pregnant, the Court nonetheless preserved
plaintiff's cause of action by finding that the existence of
malpractice in the circumstances could be determined through an
exercise of common knowledge. Palanque, supra, 168 N.J. at 407.
In the present case, in which damage to the left ureter was a
risk of surgery as the result of the proximity of the ureter to
the locus of that surgery, expert testimony is required as an aid
to the jury in resolving the negligence issue.
Footnote: 10 10 We do, however, recognize defendants' argument that the
records were not produced because Balthazar never paid
defendants' modest copying fee, despite a request that she do so.
Footnote: 11 11 We distinguish our decision in Aster ex rel. Garofalo v.
Shoreline Behavioral Health,
346 N.J. Super. 536 (App. Div. 2002)
in this regard. In Aster, plaintiff sought the records of the
institution in which the alleged malpractice occurred. In those
circumstances, we recognized a presumption that the records would
have a substantial bearing on the preparation of an affidavit of
merit, and held that the presumption had not been rebutted.
Here, the essential hospital records had been produced, and the
missing records were wholly collateral in nature. Thus, any
presumption that could arise in these circumstances has been
overcome. Moreover, in Aster, an affidavit was filed by the
plaintiff pursuant to N.J.S.A. 2A:53A-28, albeit late. In the
present case, no compliance with the act's escape provision
occurred.
Footnote: 12 12 Additionally, we note language in Cornblatt that
suggests that a showing of extraordinary circumstances would only
convert the dismissal of Balthazar's suit into a dismissal
without prejudice. Cornblatt, supra, 153 N.J. at 247. See also
Davies v. Imbesi,
328 N.J. Super. 372, 376 (App. Div. 2000);
Hyman Zamft & Manard L.L.C. v. Cornell,
309 N.J. Super. 586, 593
(App. Div. 1998). Such a dismissal would be of no benefit, since
the statute of limitations had expired by the time that dismissal
occurred.
Footnote: 13 13 The record on appeal does not contain Balthazar's motion
to amend her complaint or her proposed amended pleading. We
assume that the claim of battery arises out of the infliction of
damage by the Henderson defendants on Balthazar's left ureter.