Case Title: The Estate of Angelina Chin v. St. Barnabas Medical Center

Citation: 

Docket Number: a-11-98

State: new-jersey

Court: New Jersey Supreme Court

Date: 1999-07-28T00:00:00Z

Document:
(This syllabus is not part of the opinion of the Court. It has been prepared by the Office of the Clerk for the convenience of the reader. It has been neither reviewed nor approved by the Supreme Court. Please note that, in the interests of brevity, portions of any opinion may not have been summarized). HANDLER, J., writing for a unanimous Court. This case requires the Court to consider the application of the principles set forth in Anderson v. Somberg. In that case, the Court held that where a blameless and unconscious patient suffers an injury, the medical professionals charged with malpractice or fault bear the burden of proving that they are not responsible for causing the patient's injury. The central issue posed in this appeal is to what extent the burden of proving liability should shift to the medical professionals rather than remain with the injured patient. The Court also addresses whether the doctrine of common knowledge, which allows the jury to determine the negligence of professionals without expert testimony concerning professional standards of care, is applicable to this case. Forty-five-year-old Angelina Chin died from a massive air embolism suffered during a diagnostic hysteroscopy performed by Dr. Herbert Goldfarb at St. Barnabas Medical Center. A hysteroscopy is a procedure used to determine uterine abnormalities. A hysteroscope, a wand-like instrument with a camera lens at one end, is used by the physician to view, through a television monitor, the walls of the uterus. During a hysteroscopy, a continuous flow of fluid is pumped into the uterus. Generally, this procedure has minimal risks. Unfortunately, in this case, nitrogen gas was inappropriately pumped into the uterus instead of fluid, causing the embolism and resulting death. The record clearly reflects that the embolism was the direct result of an incorrect hook-up of the hysteroscope, the Hystero-Flo Pump, manufactured by C.R. Bard, Inc. (Bard). Robert Chin, individually and as administrator of his wife's estate, brought a medical malpractice action against Dr. Goldfarb, Nurses Leib, Louis-Charles, and Hofsegang (the nurses assisting in the hysteroscopy), St. Barnabas Medical Center, and Bard for the death of his wife. During trial, the medical professionals presented conflicting testimony concerning which party or parties incorrectly hooked-up the hysteroscope. At the close of evidence, Bard's motion for a directed verdict dismissing it from the case was granted because there was no evidence presented that Bard had defectively manufactured the Hystero-Flo Pump. The trial judge charged the jury under the principles set forth in Anderson v. Somberg, informing the jurors that the entire burden of proof shifted to St. Barnabas, the nurses and Dr. Goldfarb to prove they were not at fault for the injury suffered by Angelina Chin. The court also instructed the jury that they were allowed to use their common knowledge as lay persons in deciding whether the nurses had breached their duty of care. No expert testimony had been presented at trial on the appropriate nursing standard of care. The jury found in favor of Robert Chin and awarded two million dollars in damages. The jury apportioned liability against the medical professionals as follows: Dr. Goldfarb, 20%; Nurse Leib, 20%; Nurse Hofsegang, 25%; and St. Barnabas Medical Center, 35%. The jury found no liability as to Nurse Louis-Charles. Thereafter, the trial court granted St. Barnabas' and the nurses' (the hospital defendants) motion for judgment notwithstanding the verdict, reasoning that the case was improperly submitted under both Anderson and the doctrine of common knowledge. The trial court then entered the amount of the entire verdict against Dr. Goldfarb. Dr. Goldfarb appealed and the Appellate Division reversed, ruling that the jury was properly instructed both under the doctrines of common knowledge and Anderson v. Somberg. The hospital defendants petitioned the Supreme Court for certification and Robert Chin cross-petitioned. The Supreme Court granted both the petition and cross-petition for certification. 2. The plaintiff must show three things in order to shift the burden of proof to the defendants: 1) the plaintiff must be entirely blameless; 2) the injury must be one that bespeaks negligence on the part of one or more of the defendants; and 3) all potential defendants who participated in the chain of events causing plaintiff's injury must be before the court. (pp. 11-12) 3. All three Anderson factors have been met in this case. Angelina Chin was unconscious and blameless at the time of her fatal injury. Her injury and resulting death bespeaks negligence on the part of one or more of the hospital defendants. Lastly, all defendants were before the court. The jury weighed the conflicting evidence and found various levels of liability among the hospital defendants. These findings are not irrational and are supported by sufficient evidence. Bard successfully met its burden of proving that it was not liable for Ms. Chin's fatal injury. (pp. 12-14) 4. The jury's finding that Nurse Louis-Charles was not liable for the injury to Ms. Chin was not against the weight of the evidence. As for the other hospital defendants, there was ample evidence to enable the jury to find that one or more of those parties was at fault. Thus, the trial court improperly granted judgment notwithstanding the jury's verdict. (pp. 14-17) 5. Generally, evidence of the deviation from accepted standards of medical care must be provided by competent and qualified medical experts. In exceptional circumstances, the common knowledge doctrine may be invoked, enabling the applicable standard of care to be demonstrated without the use of expert testimony. The doctrine of common knowledge applies to a case in which the experience possessed by lay persons, without the explanation of experts, would enable a jury to determine that the defendant acted without reasonable care. Expert testimony was not necessary for the jury to determine that the Hystero-Flo Pump was improperly connected, causing the embolism and eventual death of Ms. Chin. (pp. 17-21) Judgment of the Appellate Division is AFFIRMED and the matter is REMANDED for an entry of judgment in accordance with the jury's verdict . CHIEF JUSTICE PORITZ and JUSTICES POLLOCK, O'HERN, GARIBALDI, STEIN and COLEMAN join in JUSTICE HANDLER'S opinion. THE ESTATE OF ANGELINA A. CHIN by ROBERT CHIN as Administrator and Administrator Ad Prosequendum, and Robert Chin, individually, Plaintiff-Respondent and Cross-Appellant, v. ST. BARNABAS MEDICAL CENTER, TERESA LEIB and NANCY HOFGESANG, Defendants-Appellants and Cross-Respondents, and DR. HERBERT GOLDFARB, Defendant-Respondent and Cross-Respondent, and C.R. BARD INC., DRS. JOHN DOE 1-10 (fictitious names, real names presently unknown) and NURSES JANE DOE 1-10 (fictitious names, real names presently unknown) and XYZ CORPORATIONS 1 & 2 (fictitious names, real names presently unknown) and IMMACULA LOUIS CHARLES, Defendants. Argued February 16, 1999 -- Decided July 28, 1999 The opinion of the Court was delivered by HANDLER, J. This case requires the Court to consider the application of the doctrine first developed nearly twenty-five years ago in Anderson v. Somberg, 67 N.J. 291, cert. denied, 423 U.S. 929, 96 S. Ct. 279, 46 L. Ed. 2d 258 (1975). In that decision, a medical malpractice case, the Court held that where a blameless and unconscious patient suffers an injury, the defendants charged with malpractice or fault bear the burden of proving their non culpability for the plaintiff's injury. The case before the Court involves a patient who died from an air embolism when gas was introduced into her bloodstream during a surgical procedure. The nature of the fatal injury was such that it was certainly the result of the negligent use of a medical instrument, but it was unclear who was at fault. This medical malpractice suit was brought against all the defendants who had a possible role in the events leading to the patient's death: the doctor who performed the procedure; the nurses in the operating room; the hospital; and the manufacturer of the medical instrument used in the operation. The central issue posed in this appeal is to what extent the burden of proof in respect of liability should shift to defendants rather than remain with plaintiff. In addition, we are asked to consider whether the doctrine of common knowledge, which allows the jury to determine the negligence of professionals without expert testimony concerning professional standards of care, is applicable to this case. CHIEF JUSTICE PORITZ and JUSTICES POLLOCK, O'HERN, GARIBALDI, STEIN and COLEMAN join in JUSTICE HANDLER's opinion. NO. A-11/12 THE ESTATE OF ANGELINA A. CHIN, Plaintiff-Respondent and Cross-Appellant, v. ST. BARNABAS MEDICAL CENTER, et al., Defendants-Appellants and Cross-Respondents, and DR. HERBERT GOLDFARB, Defendant-Respondent and Cross-Respondent, and C.R. BARD, INC., et al., Defendants. DECIDED