NOT FOR PUBLICATION WITHOUT THE
APPROVAL OF THE APPELLATE DIVISION
SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
A-229-97T1
MIRIAM BARREIRO and JOSE
BARREIRO, Administrators
ad prosequendum and General
Administrators of the Estate
of Jose Manuel Barreiro,
deceased,
Plaintiffs-Appellants,
v.
CHRISTOPHER N. MORAIS, FRANK
HOFFMAN, WAHID A. IBRAHIM,
and ST. JAMES HOSPITAL, a
hospital corporation,
Defendants-Respondents.
_________________________________________________________________
Argued November 17, 1998 - Decided February
23, 1999
Before Judges Muir, Jr., Keefe, and Coburn.
On appeal from the Superior Court of New
Jersey, Law Division, Hudson County.
Lewis Stein argued the cause for appellants
(Nusbaum, Stein, Goldstein & Bronstein,
attorneys; Mr. Stein, on the brief).
JoAnn B. Pietro argued the cause for
respondent Frank Hoffman, M.D. (Ruprecht, Hart
& Weeks, attorneys; David F. Soltero, on the
brief).
George J. Kenny argued the cause for
respondents St. James Hospital and Wahid A.
Ibrahim, M.D. (Connell, Foley & Geiser,
attorneys; Mr. Kenny, of counsel; Ernest W.
Schoellkopff, on the brief).
Paul J. Giblin, Jr., argued the cause for
respondent Christopher N. Morais, M.D. (Giblin
& Giblin, attorneys; Mr. Giblin, joins in the
brief of respondents St. James Hospital and
Wahid A. Ibrahim, M.D.).
PER CURIAM
Plaintiffs appeal from an order dismissing with prejudice
their medical malpractice complaint for failure to comply with the
Affidavit of Merit Statute, N.J.S.A. 2A:53A-27. The trial court's
order was entered after our opinion, but before the Supreme Court's
opinion, in Cornblatt v. Barow,
303 N.J. Super. 81 (App. Div.
1997), rev'd,
153 N.J. 218 (1998). Plaintiff raises the following
contentions:
POINT I
SINCE (1) THE PURPORTED BENEFIT OF EARLY
TERMINATION OF SUITS IS ILLUSORY, (2) THE
STATUTE IS ESSENTIALLY DIRECTED TOWARD
MEDICAL NEGLIGENCE AND HAS LITTLE
APPLICATION TO THE OTHER NAMED
PROFESSIONS AND (3) EFFECTS MAJOR CHANGES
IN THE PROOFS REQUIRED TO ESTABLISH A
CAUSE OF ACTION AT TRIAL, N.J.S.A.
2A:53A-
26 TO 29 IS UNCONSTITUTIONAL ON
SUBSTANTIVE DUE PROCESS AND EQUAL
PROTECTION GROUNDS UNDER THE NEW JERSEY
CONSTITUTION.
POINT II
THE CERTIFICATE OF MERIT STATUTE
CONTRAVENES THE DOCTRINE OF SEPARATION OF
POWERS AND IS IN CONFLICT, EITHER
DIRECTLY OR BY NECESSARY IMPLICATION WITH
THE RULES OF PROCEDURE PROMULGATED BY THE
SUPREME COURT PURSUANT TO THE AUTHORITY
DELEGATED TO IT UNDER THE CONSTITUTION.
POINT III
THE PROPER CONSTRUCTION OF N.J.S.A.
2A:53A-29 REQUIRES A FINDING THAT ANY
DISMISSAL BE "WITHOUT PREJUDICE."
We reject the contentions raised. Nonetheless, the
circumstances demonstrated in the record before us suggest
extraordinary circumstances, see Cornblatt, supra, 153 N.J. at 245,
which would have dictated a dismissal without prejudice before the
tort statute of limitations ran. Plaintiff did not have the
opportunity to present evidence on the issue of extraordinary
circumstances. Consequently, we vacate the order under appeal and
remand for a hearing on that issue. We rely on documents in the
record for the factual backdrop.
I
Jose Manuel Barreiro (Barreiro), plaintiffs' son, died
March 29, 1996. He was 20 years old. The cause of death was brain
stem herniation due to subarachnoid hemorrhage.
Barreiro's medical history prior to his death is reflected in
a University Hospital Discharge Summary. Defendant St. James
Hospital transferred Barreiro to University Hospital after he went
into a deep coma. During the two weeks prior to his admission to
St. James, Barreiro experienced flu-like symptoms, vomiting,
diarrhea, abdominal pain, and dizziness. Barreiro, three days
prior to admission, had trouble walking because he could not keep
his balance.
Two days prior to his admission to St. James, Barreiro saw
defendant Dr. Christopher N. Morais, his family doctor. Dr. Morais
gave a diagnosis of gallbladder infection. The doctor advised
hospital admission for abdominal ultrasound and prescribed
Compazine PO.
The next day, March 22, Barreiro experienced severe headache,
dizziness, vomiting, and inability to walk. He was taken to the
St. James emergency room. Defendant Dr. Wahid A. Ibrahim was the
emergency room doctor at the time. At 7:45 a.m., hospital
personnel conducted a gallbladder ultrasound. At 8:15 a.m., a CT
scan was taken. Clinical examinations were made. Hospital
personnel gave Barreiro intramuscular injections. As the result of
the CT scan, there was an assessment of obstructive hydrocephalus.
An MRI was recommended. When Barreiro vomited in the emergency
room, emergency room personnel gave him another intramuscular
injection.
At some point, Barreiro's father called the nurse to assess
his son due to shallow breathing and unresponsiveness. A code was
called. At 12:35 p.m., emergency room personnel intubated Barreiro
and transferred him to the Intensive Care Unit. The hospital
report afforded an extremely guarded prognosis.
On March 23, at 2:45 p.m., Barreiro's pupils were non-reactive. By 3 p.m., Barreiro was in a deep coma. A repeat CT
scan showed obstructive hydrocephalus with cerebral edema and a
small subarachnoid hemorrhage around the brain stem with brain stem
herniation.
On March 24, Barreiro was admitted to University Hospital. At
that time, there was no evidence of clinical brain stem function or
corticalis. University Hospital records disclosed the etiology of
the coma was "unclear" except to note the CT scan showed
hydrocephalus. At that point, surgical intervention was deemed
unnecessary. The University Hospital apparently kept Barreiro on
life support systems until 11:20 a.m. on March 29, when he was
pronounced dead.
Plaintiffs engaged counselSee footnote 1 on April 25, 1996. Counsel began
an investigation on May 1, 1996. He sent letters to St. James
requesting hospital records related to Barreiro's hospitalization.
The hospital responded on May 9 that it had "no listing in [its]
files for the dates being requested." Counsel sent further letters
on May 9 and May 24 requesting pertinent hospital records. On
June 10, counsel requested CT scan films from St. James.
That same day, plaintiffs' counsel forwarded the St. James
Hospital chart to Dr. Richard Defendini, Professor of
Neuropathology at Columbia Presbyterian College of Physicians and
Surgeons. It is not clear from the record when counsel received
the chart from St. James. Three days later, at Dr. Defendini's
request, counsel wrote to University Hospital asking it to give the
doctor an opportunity to examine certain physical evidence from
Barreiro's autopsy.
On June 27, counsel provided Dr. Defendini with plaintiffs'
historical statement and copies of the CT scans. In the same
letter, counsel noted he would forward the autopsy materials when
made available.
On June 28, 1996, plaintiffs filed the complaint in this
matter. On August 2, defendants St. James Hospital and Dr. Ibrahim
filed their answer. In the answer defendants reserved "the right
to move to dismiss the Complaint on the grounds that the cause of
action alleged therein is bound or proscribed by the provisions of
N.J.S.A. 2A:53A-7 & 8." Simultaneously, those defendants served
interrogatories, a notice to take depositions, and a demand for
production of documents.
The St. James Hospital records proved to be indecipherable.
Dr. Defendini sought clarification and explanation. On or about
August 21, 1996, counsel wrote to defense counsel for St. James
requesting the "translation" of the notes. On October 17, counsel,
in writing, reminded defense counsel of the need for translation.
Defense counsel forwarded the translation on December 16, which
counsel then forwarded to Dr. Defendini.
In the interim, several other relevant events occurred. On
September 10, counsel sent Dr. Defendini complete medical records
"recently received" from University Hospital. On September 30,
defendant Dr. Morais filed an answer and served interrogatories.
The answer made no reference to the Affidavit of Merit Statute. On
November 18, defendant Dr. Frank Hoffman served his answer, which
similarly made no reference to the Affidavit of Merit Statute. The
parties also exchanged discovery requests and discovery
information. In his discovery demand, Dr. Hoffman requested
plaintiff provide an Affidavit of Merit.
On January 28, 1997, Dr. Defendini found particular facets of
St. James Hospital records still indecipherable. As a result,
counsel wrote to St. James' defense counsel requesting "a
`transcription of handwriting' as soon as is reasonably possible."
The request related to admitting history, body system review, and
physical examination records.
It was not until March 11, 1997, that defense counsel for
St. James forwarded "Dr. Ibrahim's transcription of his own entries
in the chart and neuro & vital observation sheets with transcribed
names of the nurses who signed those sheets." In the same letter,
defense counsel requested answers to interrogatories and an
Affidavit of Merit within one week. Counsel forwarded the
transcriptions to Dr. Defendini on March 20, 1997. On the same
date, counsel advised St. James' defense counsel the plaintiffs'
expert's report was not anticipated until the end of April.
Defense counsel for St. James thereafter filed a motion to dismiss
for failure to answer interrogatories. An order dismissing the
complaint against St. James and Dr. Ibrahim ensued. The remaining
parties continued to schedule discovery.
On May 19, 1997, counsel forwarded Dr. Defendini's report and
his curriculum vitae to all defense counsel. The report, in
extensive detail, concluded the doctors who cared for Jose Manuel
Barreiro were professionally incompetent and negligent.
On May 21, 1997, plaintiffs received a motion of defendants
St. James Hospital and Dr. Ibrahim to dismiss for failure to comply
with
N.J.S.A. 2A:53A-27. On July 31, 1997, the trial court granted
the motion after oral argument based on papers filed, which
included certifications by counsel and by movants' defense counsel.
The ensuing order dismissed the entire complaint with prejudice.
Plaintiffs then filed this appeal.
II
We turn first to the constitutional objections to the statute.
Similar objections were raised for the first time before the
Supreme Court in
Cornblatt,
supra, 153
N.J. at 247-48. The Court
elected not to decide the issues. The Court did "note in passing"
that neither equal protection nor due process poses a substantial
threat to the statute's validity.
Ibid. The Court further
observed the separation of powers doctrine is not implicated by the
statute.
Id. at 248. We recognize these rulings are dictum.
Nonetheless, we consider ourselves bound by them.
Professor Wright has postulated criteria useful to evaluate
the dictum in
Cornblatt. "Much depends upon the character of the
dictum. Mere obiter may be entitled to little weight, while a
carefully considered statement . . . though technically dictum,
must carry great weight, and may even . . . be regarded as
conclusive." Charles A. Wright,
The Law of Federal Courts § 58 at
374 (4th ed. 1983). The
Cornblatt dictum, although expressed in
"passing" terms, was more than casually constructed. It has more
substance than mere obiter. It has the attributes of carefully
considered dictum.
As an intermediate appellate court, we consider ourselves
bound by
Cornblatt's carefully considered dictum in the same manner
as its outright holdings.
See State v. Rush,
46 N.J. 399, 416
(1966). To undergird that reasoning, we highlight the careful
analysis afforded and its very recent application to the same
statute. Consequently, relying on the
Cornblatt dictum and for the
reasons expressed by it, we reject the plaintiffs' claims the
statute is unconstitutional.
III
Cornblatt also disposes of plaintiffs' remaining contention
that any dismissal under the statute be without prejudice.
Generally, a dismissal for failure to timely file an Affidavit of
Merit is with prejudice.
Cornblatt,
supra, 153
N.J. at 242.
However,
Cornblatt creates an exception. The dismissal will be
without prejudice when extraordinary circumstances justify such a
disposition.
Id. at 247. It is this exception that requires the
remand.
Due to the fact this case arose between our decision in
Cornblatt and that of the Supreme Court, the extraordinary
circumstances issue was not raised in the trial court. Generally,
this court will not consider an issue if the record before the
court is not complete on the issue.
See Cornblatt,
supra, 153
N.J.
at 230. Here, although the trial court to some degree anticipated
that issue in its ruling, plaintiffs could not have foreseen the
need, and consequently did not have the opportunity, to present a
factual basis upon which a claim of extraordinary circumstances
could be considered. Therefore, we remand to afford that
opportunity consistent with this opinion.
The Affidavit of Merit Statute provides malpractice defendants
with a shield against meritless litigation. As the Supreme Court
noted in
In re Hall,
147 N.J. 379, 391 (1997), "[t]he legislative
history pertinent to the Affidavit of Merit Statute supports the
conclusion that its purpose was to require plaintiffs in
malpractice cases to make a threshold showing that their claim is
meritorious, in order that meritless lawsuits readily could be
identified at an early stage of litigation." Consonant with that
purpose, the statute requires a plaintiff to file an Affidavit of
Merit "within 60 days following the date of filing of the answer to
the complaint by the defendant."
N.J.S.A. 2A:53A-27. A plaintiff,
however, has a window of opportunity for an additional 60 days if
the court finds good cause for extension.
N.J.S.A. 2A:53A-27;
see
also Hall,
supra, 147
N.J. at 391-92. Consequently, the statute
allows a plaintiff a maximum of 120 days in which to file the
affidavit.
The purpose of the statute, however, is not to afford
malpractice defendants with a sword to fight off a malpractice
action by procrastinating in providing records and other relevant
materials that a competent, conscientious expert would have to
analyze before submitting an Affidavit of Merit. There can be no
dispute that licensed professionals envision malpractice litigation
as an anathema. Human nature being what it is, a malpractice
litigant would not enthusiastically furnish the records necessary
for expert review. Indeed, as the statutory clock ticks against a
plaintiff, procrastination, subtle or otherwise, could be used as
a sword to prevent a valid malpractice claim from reaching the
courtroom.
The Legislature, in part, recognized the potential for such
intransigency by the malpractice defendant when it created the in
lieu of affidavit procedure under
N.J.S.A. 2A:53A-28. That
procedure affords a plaintiff a vehicle to prevent a malpractice
defendant from defeating a malpractice claim prematurely by failing
to provide the data necessary for an expert to render an Affidavit
of Merit. If 45 days have passed after a plaintiff has submitted
a properly addressed request to defendant and "defendant has failed
to provide plaintiff with medical records or other records or
information having a substantial bearing on preparation of the
affidavit," plaintiffs are permitted to file a sworn statement in
lieu of the affidavit.
N.J.S.A. 2A:53A-28;
see also Hall,
supra,
147
N.J. at 390.
However, an educated malpractice defendant may, though subtly,
induce a plaintiff into believing there is no need to comply with
the "in lieu of" procedure. The defendant may agree to supply the
required information but simply fail to provide it in a diligent
and timely manner, thereby allowing the statutory clock to run out.
Consequently, the statute's time limits may become a sword in the
hand of a defendant so that a meritorious claim escapes exposure to
the litigation process. We view the extraordinary circumstances
exception, in part, as a means of preventing the shield from being
transformed to a sword.
The
Cornblatt Court, in effectuating the extraordinary
circumstances exception, imputed the legislative intent for its
implementation.
Cornblatt,
supra, 153
N.J. at 247. In doing so,
it relied upon the holdings of
Hartsfield v. Fantini,
149 N.J. 611
(1997), and its companion case,
Wallace v. JFK Hartwyck at Oak
Tree, Inc.,
149 N.J. 605 (1997). In
Hartsfield, despite statutory
language mandating statute-created causes of action be initiated
within fixed time limits, the Court permitted relaxation of the
time limits upon showing the failure to meet the time limits was
due to "`extraordinary circumstances.'"
Hartsfield,
supra, 149
N.J. at 618. The
Hartsfield Court noted, "[w]hat constitutes an
`extraordinary circumstance' will require a fact-sensitive
analysis. . . ."
Ibid.
Here, the trial court cited
Hartsfield when it found, on the
basis of the record before it, "no extraordinary circumstances
which would justify relaxing the time limits of the statute."
While that finding exhibited prescience on the court's part, we
conclude the finding cannot be controlling in this instance given
plaintiffs' lack of opportunity to present proofs as noted. While
Hartsfield identifies the standard, it does not afford an answer
whether such circumstances occurred here. Only a plenary hearing
on remand will resolve that issue.
Defendants St. James and Dr. Ibrahim nevertheless argue that
the expiration of the 120 days in this instance mandates the
dismissal with prejudice. Essentially, they argue the expiration
of 120 days is a bright line beyond which extraordinary
circumstances cannot apply. We reject that contention. Adoption
of the argument would make the exception meaningless. Beyond that,
it would provide malpractice defendants who are aware of the
statute, such as defendants here, with the ability to use the
statute improperly as a sword. We are satisfied the extraordinary
circumstances exception engrafted on the statute by the
Cornblatt
Court requires the remand for a hearing to prevent such an
occurrence.
At the remand hearing, the facts asserted in the record before
us must be explored. Those facts provide the structure for the
proofs to be taken. The record discloses plaintiffs requested
hospital records prior to the filing of the complaint but were
initially rebuffed. Thereafter, they made an August 21, 1996,
request for translation of the illegible or indecipherable records
the hospital had finally provided. Again, despite an October 17
reminder requesting the translations, the defendants did not
provide the translations until December 16, 1996, more than 130
days after they filed their answers. Even then, Dr. Defendini
needed further translations. What caused those delays which
ultimately made the statutory clock expire is not clear.
We note parenthetically, in a profession somewhat notorious
for its indecipherable handwriting, reason dictates hospitals
should require prompt typing of notes, particularly when the
patient dies during a hospitalization. Certainly, the protracted
delays and lack of prompt production of legible documents entitles
the fact finder to draw inferences consonant with the sword analogy
previously discussed.
At the hearing plaintiffs will have the opportunity to
establish the facts projected by the record before us. They will
be given the opportunity to present proofs that the hospital
records were indecipherable. Once that indecipherable nature is
established, Dr. Defendini will be afforded the opportunity to
prove the indecipherable documents had a substantial bearing on his
preparation of the affidavit and prevented him from doing so in a
timely fashion. Assuming the evidence presented demonstrates, by
its preponderance, such an obstacle to the submission of an
Affidavit of Merit, the trial court must determine whether the
delays asserted in the record before us did in fact occur. Those
proofs, and other relevant facts, must then be considered by the
court to determine whether extraordinary circumstances existed to
justify a dismissal without prejudice.
In the event the court concludes extraordinary circumstances
existed, plaintiffs shall be afforded such time, from the ensuing
order dismissing the complaint without prejudice, to file a new
complaint with an appropriate Affidavit of Merit as if the statute
of limitations had been tolled when the order under appeal was
entered. By our calculation, that would allow plaintiffs a little
over six months to file the properly authenticated complaint.
The order under appeal is reversed. The matter is remanded
for a hearing consistent with this opinion.
Reversed.
Footnote: 1"Counsel" hereafter refers to plaintiffs' attorney.
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