Title: Stephen Szczuvelek v. Harborside Healthcare Woods Edge et als.

State: new-jersey

Issuer: New Jersey Supreme Court

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). In February 1999, Eugene Burns was admitted to Robert Wood Johnson Hospital (RWJH) in New Brunswick for treatment of an ascending aortic aneurysm. During surgery, a tracheotomy tube was inserted into Burns throat. He was unable to speak and communicated by writing on a note pad. After two months of treatment at RWJH, Burns was transferred on April 13, 1999 to Harborside for rehabilitation. The medical order issued by RWJH directed that Burns trachea-bronchial secretions be suctioned every four hours. Harborside issued its own order on April 14, 1999, requiring healthcare personnel to suction once per shift, three shifts per day and as needed. Stephen Szczuvelek, a close friend of Burns, visited him at Harborside on April 15, 1999. During this visit, Burns wrote Szczuvelek a note stating, Steve, you have to get me out of here. They re going to kill me. They left me in my own waste for three hours. They won t suction me. Please get me out of here. And I need to be suctioned now. Szczuvelek tried to get a nurse to help. Eventually, he found a nurse who took him to a conference room to speak to a social worker. After Szczuvelek gave Burns note to the nurse and the social worker, he was assured that someone would help Burns. When he returned to Burns room, Szczuvelek asked the nurse to suction Burns. She responded that she had just done it but Burns shook his head that she had not. Szczuvelek confronted the nurse who responded that it was the doctor s orders that Burns not be suctioned. After continued prodding from Szczuvelek to suction Burns, the nurse left the room. Szczuvelek left Harborside that evening concerned for Burns health and determined to find an alternative placement for him. The following day, Burns was rushed to Somerset because he was unresponsive. Szczuvelek visited Burns in the emergency room, saw his poor condition and observed that Burns seemed terrified, lapsing in and out of consciousness. On April 17, 1999, Burns suffered a heart attack brought on by respiratory complications and died a short while later. Burns was buried on April 20, 1999. About three weeks after the funeral, Szczuvelek consulted with David Alperts, Esq. because he suspected that something had gone wrong with Burns medical treatment. Alperts told Szczuvelek to obtain Burns medical records from Harborside and Somerset, which he did. The records showed that the medical care Burns received at Harborside contributed to his death. Approximately three months later, Szczuvelek contacted a State agency to file a complaint against Harborside and urged an investigation into the events of April 15, 1999. The status of that complaint and investigation is unknown. On August 31, 2000, Szczuvelek consulted another attorney, Larry Leifer, Esq., and filed suit against Harborside and Somerset on April 26, 2001, two years and nine days after Burns death. The complaint, filed pursuant to the Survivor Act, N.J.S.A. 2A:15-3, alleged medical malpractice. On June 24, 2001, Szczuvelek received a report from Dr. Warren Widmann, a medical expert, who concluded that Burns had lapsed into a coma and died as a result of inadequate medical care by Harborside and Somerset. Szczuvelek filed an amended complaint on July 9, 2002, alleging a cause of action pursuant to the New Jersey Nursing Home Responsibilities and Rights of Residence Act, N.J.S.A. 30:13-5(J), and the Nursing Home Reform Act, 42 U.S.C. 483.25 et seq., including provisions contained in 42 C.F.R. 488.410 and 42 C.F.R. 488.301. Harborside and Somerset each moved for summary judgment dismissing the complaint, contending that the complaint was filed beyond the two-year statute of limitations period. In response, Szczuvelek argued that his complaint was timely because it was not until three weeks after Burns funeral on April 20, 1999 that he contacted an attorney and thereafter became aware or should have become aware of Harborside s negligence, and even later for Somerset. The trial court granted both Harborside s and Somerset s motion. The trial court concluded that, based on Burns April 15th note and Szczuvelek s observations that same day, along with the cause of Burns death (respiratory complications), Szczuvelek knew or should have known that Harborside s actions or lack thereof were actionable at that time. The court s letter opinion of October 4, 2003 directly addressed only the circumstances involving Harborside. The Appellate Division affirmed the decision of the trial court substantially for the reasons expressed in the trial court s opinion. The Supreme Court granted certification. HELD: The Court being equally divided on the issue of the timeliness of the filing of the complaint against Harborside, the judgment of the Appellate Division is affirmed in respect of Harborside. The Court unanimously finds that the trial court erred in entering judgment dismissing the complaint against Somerset and remands the matter to the trial court for further consideration. 1. In a medical malpractice action, a complaint must be filed within two years of the accrual date, which is generally the date of the negligent act or omission. To avoid the harsh effects of a mechanical application of that rule, the Court adopted the discovery rule, which provides that in an appropriate case, a cause of action will be held not to accrue until the injured party discovers, or by an exercise of reasonable diligence and intelligence should have discovered, that he or she may have a basis for an actionable claim. The standard is generally whether the claimant knew or should have known of sufficient facts to start the running of the statute of limitations. (Pp. 7-8) 2. Unlike the claim against Harborside, the trial court failed to discuss the application of the discovery rule to Somerset and to determine when Szczuvelek should have reasonably known of facts supporting a cause of action against Somerset that would have started the running of the statute of limitations. Because the record is incomplete, a remand is necessary for the trial court to determine the application of the discovery rule as to Somerset and when the cause of action arose against Somerset. However, the members of the Court being equally divided on the issue of the timeliness of the filing of the complaint against Harborside, the judgment of the Appellate Division dismissing the complaint against Harborside is unanimously affirmed. (Pp. 8-10) Judgment of the Appellate Division is AFFIRMED IN PART and REVERSED IN PART and the matter is REMANDED to the trial court for further proceedings on the complaint against Somerset only. CHIEF JUSTICE PORITZ and JUSTICES WALLACE AND RIVERA-SOTO, concurring, would affirm the judgment of the Appellate Division granting summary judgment in favor of Harborside based on their concurrence with the trial court s conclusion that Szczuvelek exceeded the statute of limitations time period for filing his complaint against Harborside. Szczuvelek provided no adequate basis for the application of the discovery rule. At the time of Burns death, Szczuvelek knew or should have known of sufficient facts to alert a reasonable person exercising ordinary diligence that Harborside s conduct may have caused or contributed to Burns death. JUSTICE ZAZZALI, concurring in part and dissenting in part, in which JUSTICES LONG and ALBIN join, agrees with the remand as to Somerset but dissents from the conclusion that Szczuvelek exceeded the statute of limitations as to Harborside. Justice Zazzali considers this a complex medical causation case, requiring the application of the discovery rule. Burns suffered from many complications in the two months after his aneurysm and his cause of death is so unclear that the medical experts did not agree on the same cause of death. According to the defense expert, the obvious cause of death was septic shock, while Szczuvelek s expert found that the failure to suction contributed to Burns death. Szczuvelek satisfied the statute of limitations period because he filed his complaint within two years of obtaining some reasonable medical support demonstrating a causal connection between Burns death and Harborside s care. Justice Zazzali would not require Szczuvelek to differentiate between a case of medical malpractice and one of unavoidable death without the benefit of some reasonable medical support. Accordingly, Justice Zazzali would hold that the statute of limitations began to run when Szczuvelek obtained Burns medical records. CHIEF JUSTICE PORITZ and JUSTICES WALLACE and RIVERA-SOTO join in the PER CURIAM opinion in its entirety. JUSTICES LONG, ZAZZALI and ALBIN join only in that part of the opinion relating to the issue of the timeliness of the complaint against Somerset. CHIEF JUSTICE PORITZ and JUSTICES WALLACE and RIVERA-SOTO also filed a separate concurring opinion. JUSTICE ZAZZALI filed a separate opinion concurring in part and dissenting in part, in which JUSTICES LONG and ALBIN join. JUSTICE LaVECCHIA did not participate. Plaintiff-Appellant, v. HARBORSIDE HEALTHCARE WOODS EDGE, t/a HARBORSIDE NURSING HOME and SOMERSET MEDICAL CENTER, a duly incorporated private hospital facility, Defendants-Respondents, and BARRY FREEMAN, M.D., JOHN DOE, fictitious name and ROBERT ROE, fictitious name, Defendants. Argued September 13, 2004 Decided January 24, 2005 On certification to the Superior Court, Appellate Division. George W. Conk argued the cause for appellant (Tulipan & Conk and Larry L. Leifer, attorneys). Raymond J. Fleming argued the cause for respondent Somerset Medical Center (Sachs, Maitlin, Fleming & Greene, attorneys). Francine M. Chillemi argued the cause for respondent HHCI Limited Partnership d/b/a Harborside Healthcare-Woods Edge improperly pled as Harborside Healthcare Woods Edge t/a Harborside Nursing Home (Monte, Sachs & Borowsky, attorneys). PER CURIAM The members of the Court being equally divided on the issue of the timeliness of the filing of plaintiff s complaint against Harborside Healthcare Woods Edge t/a Harborside Nursing Home (Harborside), the judgment of the Appellate Division is affirmed in respect of that defendant. The Court is unanimous that it was error to enter judgment dismissing the complaint against Somerset Medical Center (Somerset) and remands the matter to the trial court for further consideration. [Id. at 275.] Thus, it is necessary to identify the equitable claims of each party and evaluate and weigh those claims in determining whether it is appropriate to apply the discovery rule. The crucial inquiry is whether the facts presented would alert a reasonable person exercising ordinary diligence that he or she was injured due to the fault of another. The standard is basically an objective one whether plaintiff knew or should have known of sufficient facts to start the statute of limitations running. Martinez, supra, 163 N.J. at 52. Plaintiff-Appellant, v. HARBORSIDE HEALTHCARE WOODS EDGE, t/a HARBORSIDE NURSING HOME and SOMERSET MEDICAL CENTER, a duly incorporated private hospital facility, Defendants-Respondents, and BARRY FREEMAN, M.D., JOHN DOE, fictitious name and ROBERT ROE, fictitious name, Defendants. PORITZ, C.J., WALLACE, J., and RIVERA-SOTO, J., concurring. We would affirm the judgment of the Appellate Division granting summary judgment in favor of Harborside based on our concurrence with the trial court s conclusion that plaintiff exceeded the statute of limitations time period for filing his complaint against Harborside. We agree with the trial court and the Appellate Division that applying the objective standard of what a reasonable person knew or should have known from the surrounding facts, Martinez v. Cooper Hosp., 163 N.J. 45, 52 (2000), plaintiff provided no adequate basis for the application of the discovery rule to save his complaint against Harborside. In rendering its decision, the trial court stated: Here, Burns had trouble breathing on April 15, 1999, possibly stemming from the tracheotomy tube and it not being suctioned. This was told to plaintiff and plaintiff read Burns note and made his own observations. Plaintiff knew of defendant s cause of death, heart attack brought on by respiratory complications. Plaintiff knew or should have known that Harborside s actions or lack thereof was actionable at that time. Clearly, plaintiff s claim that he did not know a cause of action accrued until he talked to David Alperts or his present counsel is insufficient as a matter of law to toll the statute of limitations. Before us, plaintiff also urges that he was misled by the nursing staff at Harborside on April 15, 1999, when he was told that Burns was receiving respiratory care as often as permitted by the physician s orders. We would reject that claim. In his deposition, plaintiff stated that prior to that conversation, plaintiff asked the nurse on duty if she would suction Burns and the nurse replied, I just did. After Burns shook his head, plaintiff challenged the nurse s comment. It was then that the nurse changed her view and claimed it was the doctor s orders that Burns was not to be suctioned. We are satisfied that a reasonable person in plaintiff s position would have been concerned whether Burns received proper care and whether Harborside s treatment, or lack thereof, contributed to Burns death. According to plaintiff, the nurse s assertion that she was following the doctor s orders not to suction Burns contradicted her prior statement that she had just suctioned Burns. That glaring contradiction, standing alone would make any reasonable person suspicious. Indeed, the conduct of the nurses and their treatment of Burns prompted plaintiff to immediately seek to transfer his friend to another facility. Unfortunately, time was not on his side because Burns was rushed to the hospital the next morning. In any event, the nurse s advice did not assuage plaintiff s concern. Within three weeks of the funeral, plaintiff consulted counsel concerning the treatment Burns received at Harborside. Our dissenting colleagues invoke Mancuso v. Neckles, 163 N.J. 26 (2000), to reach a contrary conclusion. They postulate that this is a complex medical malpractice case and therefore the statute of limitations should not begin to run until plaintiff received Burns medical records. In Mancuso, plaintiff, a breast cancer victim, began mammography diagnosis in 1988, when she was thirty-seven years old. Id. at 30. She was diagnosed with breast cancer in July 1992, and underwent bone marrow transplant and debilitating radiation therapy. Ibid. In December 1992, plaintiff learned that her 1991-mammography films showed abnormalities. Id. at 31. She consulted an attorney in June 1993, and in July 1994, she filed a medical malpractice action against Dr. Neckles, the physician identified by her expert as the physician whose fault allowed cancer to spread. Id. at 32. During discovery, plaintiff learned from Dr. Neckles expert that in 1989, Dr. Bernart may have failed to read the mammography correctly. Ibid. After obtaining a new expert who opined that Dr. Bernart deviated from accepted standards of care, she filed an amended complaint in July 1999. Ibid. Based on the running of the statute of limitations, the trial court dismissed plaintiff s complaint against Dr. Bernart and the Appellate Division affirmed. Id. at 33. In reinstating the complaint against Dr. Bernart, we concluded that when a patient has relied on competent expert advice that one or more of her treating physicians did not contribute to the patient s injuries, later assertions to the contrary by a competent expert would then provide the basis for an actionable claim. Id. at 37 (citation omitted). In reaching that conclusion, we explained that in cases of complex medical causation, [n]ot only is the nature of the injury generally unclear, its very existence is frequently masked. Id. at 34 (citation omitted). Unlike in Mancuso, this case is not about a complex medical causation issue. Rather it is a simple case where a plaintiff is aware of facts that suggest the fault of a third party may have caused or contributed to the death of the victim, but further investigation is needed. The plaintiff need not have knowledge of the basis for legal liability or even that he is able to prove a cause of action. All that is required is that the facts suggest to a reasonable person that a third party s conduct, here Harborside, contributed to the injury. Under those circumstances, there is no need to apply the discovery rule because plaintiff has ample time to investigate and file a timely complaint. In the vast majority of cases, and this is one of those cases, plaintiff will have sufficient knowledge that a wrong has occurred to prompt an investigation. The main consideration behind statutes of limitations is one of fairness to the defendant. Lopez v. Swyer, 62 N.J. 267, 274 (1973). The dissent would disregard that principle and delay the start of the running of the statute of limitations until the whimsical date plaintiff decided to review the medical records. That methodology would extend the statute of limitations in almost every medical malpractice case. In short, [t]he linchpin of the discovery rule is the unfairness of barring claims of unknowing parties. Mancuso, supra, 163 N.J. at 29. At the time of Burns death, plaintiff was not an unknowing party. He knew or should have known of sufficient facts to alert a reasonable person exercising ordinary diligence, that Harborside s conduct may have caused or contributed to Burns death. Martinez, supra, 163 N.J. at 52. In this case, we find no justification to apply the discovery rule to plaintiff s cause of action against Harborside. Plaintiff-Appellant, v. HARBORSIDE HEALTHCARE WOODS EDGE, t/a HARBORSIDE NURSING HOME and SOMERSET MEDICAL CENTER, a duly incorporated private hospital facility, Defendants-Respondents, and BARRY FREEMAN, M.D., JOHN DOE, fictitious name and ROBERT ROE, fictitious name, Defendants. JUSTICE ZAZZALI concurring in part, and dissenting in part. Since we embraced the seemingly straightforward discovery rule over forty years ago, our jurisprudence has applied that equitable doctrine to accommodate varied and complex factual circumstances. That precedent should enable us, in this appeal, to determine the appropriate formulation of the discovery rule in the context of a complicated medical malpractice case. Although I agree with the concurrence in its decision to remand as to Somerset Medical Center, I respectfully disagree with its conclusion that plaintiff exceeded the statute of limitations in the Harborside matter. [Ibid. (citing Newmark v. Gimbel s Inc., 54 N.J. 585, 596-97 (1969)).] As in Martinez, supra, we should not expect the lay plaintiff here to immediately suspect that Harborside s refusal to suction Burns contributed to his friend s death. Indeed, as one of Burns s nurses later testified at her deposition, the decision not to suction serves a legitimate medical purpose: to train [patients bodies] to [cough] up the secretions by themselves, which prevents them from becoming dependent on suctioning. Moreover, Burns s need of a tracheotomy and twenty-four hour care evidences the gravity of his condition in the days and weeks before his death. A reasonable person easily could have believed that Burns simply suffered complications from his illnesses. Ibid. Indeed, given Burns s recent medical history, that was the sensible inference to be drawn at the time. Unlike situations of obvious medical malpractice -- such as the amputation of the wrong leg -- this appeal involves a complicated series of events that ultimately caused Burns s death. Moreover, this matter presents a less obvious case of third party fault than did Guichardo, supra, where we applied the discovery rule and allowed plaintiff to assert a claim against defendant eight months after obtaining an expert s opinion that defendant s negligence contributed to plaintiff s injury and almost four years after the negligence occurred. 177 N.J. at 55. There, the defendant physician admitted to plaintiff that something went wrong with the procedure two days after he negligently failed to diagnose plaintiff s condition. Id. at 48. In contrast, here, plaintiff did not have the benefit of an admission by Harborside. Yet, plaintiff was still able to assert his claim only two years and eleven days after the negligence occurred. Thus, the facts supporting application of the discovery rule in this matter are even more compelling than in Guichardo. In sum, consistent with our decisional law, I would not require plaintiff to differentiate between a case of medical malpractice and one of unavoidable death without the benefit of some reasonable medical support. To insist on that expertise, even when the plaintiff observes defendant s negligent behavior, in effect requires that a layperson understand the medical consequences of a health care professional s decisions. Although such a requirement may be appropriate in general medical malpractice cases, that expectation is inconsistent with the equitable nature of the discovery rule when applied in the context of complex medical causation. Accordingly, I would hold that the statute of limitations began to run when plaintiff obtained Burns s medical records. As defense counsel conceded at oral argument, plaintiff had no reasonable basis for concluding that he had an actionable claim against Harborside until he obtained those records. She also acknowledged that without those records there was no conceivable way that anyone would have a reasonable basis to conclude that there was an actionable claim. It is my view, as well, that plaintiff initially discovered or should have discovered that he might have a basis for an actionable claim against Harborside when he received those records. Lopez, supra, 62 N.J. at 272. Although the exact date is unclear, it is certain that plaintiff did not receive those records before May of 1999. Under that construct, the statute of limitations expired no earlier than May of 2001. Because plaintiff filed his complaint on April 26, 2001, he did so within the two-year statute of limitations. STEPHEN SZCZUVELEK, General Administrator of the Estate Of Eugene Burns, Plaintiff-Appellant, v. HARBORSIDE HEALTHCARE WOODS EDGE, t/a HARBORSIDE NURSING HOME and SOMERSET MEDICAL CENTER, a duly incorporated Private hospital facility, Defendants-Respondents. DECIDED January 24, 2005 Chief Justice Poritz PRESIDING OPINION BY Per Curiam CONCURRING/DISSENTING OPINION BY Justice Zazzali CONCURRING OPINION BY Chief Justice Poritz, and JJ. Wallace and Rivera-Soto