SUPERIOR COURT OF NEW JERSEY 

 APPELLATE DIVISION 

 DOCKET NO. A-2577-22 

 A-3261-22

BONNIE MARIE COTTRELL, 

and CHRISTOPHER DANIEL 

LETRENT, Co-Executors 

of the Estate of MARYANN 

COTTRELL, deceased, 

 Plaintiffs-Respondents, 

v. 

NATHAN HOLTZBERG, M.D., 

and ORTHOPAEDIC INSTITUTE 

OF CENTRAL JERSEY, P.A., 

Defendants-Appellants, 

and 

KIMBALL MEDICAL CENTER, 

INC., MONMOUTH MEDICAL 

CENTER SOUTHERN CAMPUS 

FOUNDATION, INC., BARRY 

GORDON, M.D., OCEAN COUNTY 

INTERNAL MEDICINE ASSOCIATES, 

P.C., BHARAT PATEL, M.D., ALEX 

LANGMAN, M.D., MEDICAL 

RADIOLOGY GROUP, P.A., 

BRUCE MONASTERSKY, M.D., 

NOT FOR PUBLICATION WITHOUT THE 

APPROVAL OF THE APPELLATE DIVISION 

This opinion shall not "constitute precedent or be binding upon any court." Although it is posted on the 

internet, this opinion is binding only on the parties in the case and its use in other cases is limited. R. 1:36-3.
2 A-2577-22

NEUROLOGICAL ASSOCIATES 

OF OCEAN COUNTY, P.A., 

FOUNTAIN VIEW CARE CENTER, 

SHORE HEALTH CARE CENTER, 

INC., SATUYENDRA SINGH, M.D., 

NORTH ATLANTIC MEDICAL 

ASSOCIATES, ST. BARNABAS 

MEDICAL CENTER, ST. BARNABAS 

CORPORATION, BARNABAS 

HEALTH, INC., HARHPAL SINGH, 

M.D., NORTH JERSEY BRAIN & 

SPINE CENTER, SAIKIRAN MURTHY, 

D.O., OTAKAR HUBSCHMANN, M.D., 

1351 OLD FREEHOLD ROAD 

OPERATIONS, LLC d/b/a BEY LEA 

VILLAGE CARE CENTER; SOMC 

MEDICAL GROUP, P.C., d/b/a 

OCEAN COUNTY FAMILY CARE; 

COMPLETE CARE AT BEY LEA 

LLC; SUSAN BELTRAN, R.N.; and 

ELIZABETH NOLLER, R.N., 

 Defendants-Respondents, 

and 

RAHUL PAWAR, M.D., 

ALEXANDER B. KING, M.D., 

ROY J. FERTAKOS, M.D., and 

IMAGING CONSULTANTS OF 

ESSEX, P.A., 

Defendants. 

________________________________

BONNIE MARIE COTTRELL, 

and CHRISTOPHER DANIEL 

LETRENT, Co-Executors 
3 A-2577-22

of the Estate of MARYANN 

COTTRELL, deceased, 

 Plaintiffs-Respondents, 

v. 

NATHAN HOLTZBERG, M.D., 

ORTHOPAEDIC INSTITUTE OF 

CENTRAL JERSEY, P.A., 

KIMBALL MEDICAL CENTER, 

INC., BHARAT PATEL, M.D., 

ALEX LANGMAN, M.D., MEDICAL 

RADIOLOGY GROUP, P.A., 

BRUCE MONASTERSKY, M.D., 

NEUROLOGICAL ASSOCIATES 

OF OCEAN COUNTY, P.A., 

FOUNTAIN VIEW CARE CENTER, 

SHORE HEALTH CARE CENTER, 

INC., SATUYENDRA SINGH, M.D., 

HARSHPAL SINGH, M.D., 

NORTH JERSEY BRAIN & SPINE 

CENTER, and OTAKAR 

HUBSCHMANN, M.D., 

 Defendants-Respondents, 

and 

BARRY GORDON, M.D., and 

OCEAN COUNTY INTERNAL 

MEDICINE ASSOCIATES, P.C., 

 Defendants-Appellants, 

and 

MONMOUTH MEDICAL 
4 A-2577-22

CENTER SOUTHERN CAMPUS 

FOUNDATION, INC., NORTH 

ATLANTIC MEDICAL ASSOCIATES, 

ST. BARNABAS MEDICAL CENTER, 

ST. BARNABAS CORPORATION, 

BARNABAS HEALTH, INC., RAHUL 

PAWAR, M.D., ALEXANDER B. 

KING, M.D., ROY J. FERTAKOS, 

M.D., IMAGING CONSULTANTS 

OF ESSEX, P.A., SAIKIRAN 

MURTHY, D.O., ELIZABETH 

NOLLER, R.N.; and SUSAN 

BELTRAN, R.N. 1, 

Defendants. 

________________________________

Submitted January 23, 2024 – Decided July 1, 2024 

Before Judges Sumners and Smith. 

On appeal from interlocutory orders of the Superior

Court of New Jersey, Law Division, Middlesex County, 

Docket No. L-5557-16.

Buckley Theroux Kline & Cooley, LLC, attorneys for 

appellants in A-2577-22 (Tess Jennifer Kline and 

Michael Paul Opacki, on the briefs). 

Schenck, Price, Smith & King, LLP, attorneys for 

appellants in A-3261-22 (William Buckley and Evan B. 

Magnone, on the briefs). 

Messa & Associates, PC, attorneys for respondents 

Bonnie Marie Cottrell and Christopher Daniel LeTrent 

1

 Improperly pled as Susan Beltra, R.N. 
5 A-2577-22

in A-2577-22 (Irene M. McLafferty and Alaina A. 

Gregorio, on the brief). 

Messa & Associates, PC, attorneys for respondents 

Bonnie Marie Cottrell and Christopher Daniel LeTrent 

in A-3261-22 (Irene M. McLafferty and Alaina A. 

Gregorio, on the brief). 

PER CURIAM 

On leave granted in these back-to-back appeals, we consider whether the 

motion court correctly applied the same-specialty requirement of the New Jersey 

Medical Care Access and Responsibility and Patients First Act (PFA), N.J.S.A. 

2A:53A-37 to -42. Plaintiffs Bonnie Marie Cottrell (Bonnie)2 and Christopher 

Daniel LeTrent, Co-Executors of the Estate of Maryann Cottrell (Cottrell), 

deceased, allege defendants Nathan Holtzberg, M.D., a pain management 

specialist, and Orthopaedic Institute of Central Jersey, P.A. (collectively Dr. 

Holtzberg) violated the standard of care in reviewing Cottrell's magnetic 

resonance imaging (MRI) scans which led to a failure to diagnose her medical 

condition. Plaintiffs allege that Barry Gordon, M.D., an internist, and Ocean 

County Internal Medicine Associates, P.C. (collectively Dr. Gordon), violated 

the standard of care in reviewing Cottrell's MRI scans which led to a failure to 

2

 We refer to Bonnie Marie Cottrell by her first name to avoid confusion because 

she has the same last name as the deceased. We mean no disrespect. 
6 A-2577-22

diagnose her medical condition and prematurely release her from the hospital 

without diagnosing the cause of her severe pain. In support of their claims 

against both doctors, plaintiffs rely upon the expert opinion of Terrance Baker, 

M.D, who specializes in family and emergency medicine. 

In Docket No. A-2577-22, the court denied Dr. Holtzberg's request to bar 

Dr. Baker's opinion that Dr. Holtzberg was negligent. We affirm because we 

agree with the court's finding the PFA's same-specialty requirement did not 

apply to Dr. Baker's opinion of Dr. Holtzberg because the opinion was not 

tethered to Dr. Holtzberg's standard of care as a pain medicine specialist but 

generally as a medical doctor. 

In Docket No. A-3261-22, the court denied Dr. Gordon's request to bar 

Dr. Baker's opinion that Dr. Gordon was negligent. We reverse because under 

the PFA, Dr. Baker is not a board-certified internist, and he cannot opine that 

Dr. Gordon deviated from the standard of care of an internist. 

I.

 The motion record provides the following relevant allegations, facts, and 

procedural history. 

Cottrell's Medical Treatment and Death 
7 A-2577-22

On August 30, 2014, an emergency room physician admitted Cottrell into 

Kimball Medical Center due to her "acute bilateral leg pain" whenever she 

moved her legs. Two days later, Dr. Gordon, a board-certified internist with 

extensive practice experience in internal and emergency medicine, examined 

Cottrell for a possible fungal infection but found none. Cottrell was diagnosed 

with rhabdomyolysis, a muscle injury that released chemicals into her 

bloodstream. 

An MRI of Cottrell's lumbar spine was taken on September 2. Dr. 

Holtzberg, Cottrell's longtime pain management doctor who completed an 

anesthesiology residency and pain management fellowship, reviewed the MRI 

scans, as did other doctors. Dr. Holtzberg found the scans showed "significant 

artifact" but "no obvious abnormal masses or lesions" on Cottrell's spine. In 

examining Cottrell, he "noted difficulty in testing her motor strength due to 

significant pain with movement." Despite "acknowledg[ing] the motion artifact 

existing on the [poor-quality] MRI," he concluded the MRI results were 

inconsistent with Cottrell's previous symptoms and "recommended additional 

pain medication and acute rehabilitation." After Cottrell was hospitalized for 

six days, Dr. Gordon discharged her to a rehabilitation center. 
8 A-2577-22

Over the next four years, Cottrell's suffered numerous medical 

complications resulting in frequent hospital and nursing home stays. She died 

on November 8, 2018. 

 Cottrell's Lawsuit 

 In September 2016, prior to her passing, Cottrell filed a medical 

malpractice complaint raising negligence and corporate negligence claims 

against Drs. Holtzberg and Gordon as well as several other healthcare providers 

not involved in this appeal. After Cottrell's passing, her children Bonnie and 

LeTrent filed an amended complaint, suing as the co-executors of her estate. 

Cottrell v. Holtzberg, 468 N.J. Super. 59, 66 (App. Div. 2021). 

As to the doctors, it is essentially alleged that they breached their 

respective duties of care by not taking the appropriate action upon viewing 

Cottrell's inadequate MRI scans leading to misdiagnosis of her medical 

condition contributing to paralysis and other medical conditions. Dr. Baker, 

board certified in family practice, emergency medicine, and forensic medicine, 

rendered expert reports asserting Cottrell's healthcare providers negligently 

cared for her at the rehabilitation center she entered after her August-September 

2014 emergency room visit and hospitalization without mentioning Drs. 

Holtzberg and Gordon. At his deposition, Dr. Baker opined Cottrell's 
9 A-2577-22

debilitating leg pain was a "true medical emergency." He stated the MRI of her 

lumbar spine was "limited due to motion artifacts," making it "an unusable 

study," and "[t]he standard of care required . . . a specific focus [CAT scan], or 

myelogram be performed." Without rescanning Cottrell's spine, according to 

Dr. Baker, her physicians could not have properly determined if there was "a 

structural basis of the spine . . . explain[ing] [her] . . . disproportionate pain 

symptoms associated with changes in motor function and sensation of both 

lower legs." Dr. Baker did not specifically identify Dr. Holtzberg, but he stated 

Dr. Gordon discharged Cottrell to the rehabilitation center from the hospital 

without a conclusive diagnosis of the severe back pain preventing her from 

walking. 

Drs. Holtzberg and Gordon filed separate motions to bar Dr. Baker from 

offering standard of care opinions.3 Dr. Holtzberg argued the PFA barred Dr. 

Baker's opinion regarding his care of Cottrell because Dr. Baker, a family and 

emergency medicine physician, and Dr. Holtzberg, a pain medicine specialist, 

did not share specialties. Dr. Gordon also argued Baker did not share specialties 

with him, an internist, and, moreover, his role during Cottrell's 2014 

3

 Other defendants filed similar motions, but we do not discuss them as they are 

not relevant to these appeals. 
10 A-2577-22

hospitalization "was [as] the attendant for [her], after she was admitted to the 

hospital" and as the doctor who signed off on her discharge from the hospital. 

The court, without citing any law, rejected these contentions and entered orders 

denying the motions for reasons explained in a single oral decision. The court 

found that Baker's lack of similar specialty with Drs. Holtzberg and Gordon was 

insignificant, reasoning "[i]f you have an MRI that's unclear, you should have 

another MRI done. So you have a clear MRI. . . . [I]t's common sense" and 

"[e]very doctor[ is] taught that in medical school," like learning when "you have 

to take somebody's blood pressure again." 

II. 

"To prove medical malpractice . . . 'a plaintiff must present expert 

testimony establishing (1) the applicable standard of care; (2) a deviation from 

that standard of care; and (3) that the deviation proximately caused the 

injury.'" Haviland v. Lourdes Med. Ctr. of Burlington Cty., Inc., 250 N.J. 368, 

384 (2022) (quoting Nicholas v. Mynster, 213 N.J. 463, 478 (2013)). The PFA 

sets forth the required qualifications for a medical-malpractice plaintiff's 

testifying expert. For cases involving a defendant doctor who practiced and 

rendered treatment within a recognized specialty, N.J.S.A. 2A:53A-41(a) 

provides: 
11 A-2577-22

If the party against whom or on whose behalf the 

testimony is offered is a specialist or subspecialist 

recognized by the American Board of Medical 

Specialties [(ABMS)] or the American Osteopathic 

Association and the care or treatment at issue involves 

that specialty or subspecialty recognized by the 

[ABMS] or the American Osteopathic Association, the

person providing the testimony shall have specialized 

at the time of the occurrence that is the basis for the 

action in the same specialty or subspecialty . . . as the 

party against whom or on whose behalf the testimony

is offered . . . . 

In the seminal case of Nicholas v. Mynster, our high court found "[t]he 

apparent objective of N.J.S.A. 2A:53A-41 is to ensure that, when a defendant 

physician is subject to a medical-malpractice action for treating a patient's 

condition falling within his ABMS specialty, a challenging plaintiff's expert, 

who is expounding on the standard of care, must practice in the same specialty." 

213 N.J. at 486. Thus, under N.J.S.A. 2A:53A-41(a), "[w]hen a physician is a 

specialist and the basis of the malpractice action 'involves' the physician's 

specialty, the challenging expert must practice in the same specialty," id. at 481-

82, and a plaintiff "cannot establish the standard of care through an expert who 

does not practice in the same medical specialties as defendant physicians," id. at 
12 A-2577-22

468.4 Nevertheless, the standard of medical care only involves a physician's 

specialty when the physician "rendered treatment within" the specialty. Id. at 

487. Thus, "[w]here the treatment at issue . . . is provided by a specialist but 

does not involve the physician's specialty, the requirements for the qualification 

of an expert to testify against a general practitioner," not the same-specialty 

requirement, apply. Nicholas v. Hackensack Univ. Med. Ctr., 456 N.J. Super. 

110, 119 n.6 (App. Div. 2018). 

III. 

Dr. Holtzberg argues the care he provided to Cottrell solely concerned his 

pain medicine specialty, which is not Dr. Baker's specialty. He posits an MRI 

scan "of poor quality to one physician may be perfectly acceptable to another." 

As a pain medicine specialist, he asserts he interpreted Cottrell's MRI scans 

differently from a physician with different credentials, as "[e]very specialty 

reads imaging differently" based on "what the specific physician is looking for" 

in the scans. He contends Dr. Baker lacks the qualifications to know "how a 

[p]ain [m]anagement physician would review" MRI scans or what a pain 

medicine specialist would have looked for in them. 

4

 The Court determined "there are no exceptions to that requirement other than 

the waiver provision of N.J.S.A. 2A:53A-41(c)." Nicholas, 213 N.J. at 482. 
13 A-2577-22

Based on our de novo review of the court's order denying Dr. Holtzberg's 

motion to bar Dr. Baker's testimony under the PFA, we are unpersuaded by Dr. 

Holtzberg's arguments. See Pfannenstein v. Surrey, 475 N.J. Super. 83, 95 (App. 

Div.) (holding we review de novo a trial court decision regarding "compliance 

with the same-specialty requirement of the PFA"), certif. denied, 254 N.J. 517 

(2023). The PFA same-specialty requirement did not apply to Dr. Holtzberg's 

care of Cottrell when he failed to order new MRI scans. Dr. Holtzberg offers 

no support for his "bare conclusory assertion[]" that as a pain medicine 

specialist, he views scans differently from other physicians. See Brae Asset 

Fund, L.P. v. Newman, 327 N.J. Super. 129, 134 (App. Div. 1999). Dr. Baker 

did not opine that based on a pain medicine specialist's standard of care, Dr. 

Holtzberg misinterpreted Cottrell's MRI scans or overlooked clues that a more 

thorough review of the scans would have revealed. He merely stated Dr. 

Holtzberg, like the other physicians who noticed the artifact in her scans, should 

have ordered a new MRI, or a CAT scan or myelogram be performed, instead of 

relying upon the inadequate MRI scans. In Dr. Baker's opinion, Dr. Holtzberg 

needed nothing more than standard medical training to know whether the scans 

were clear enough to properly diagnose Cottrell's complaints of pain. Assessing 

image clarity does not "go[] to the heart of" pain medicine. The pain medicine 
14 A-2577-22

specialty focuses on "diagnos[ing] and treat[ing] patients experiencing problems 

with acute or chronic pain . . . and coordinat[ing] care needs with other 

specialists." American Board of Anesthesiology, Am. Bd. of Med. Specialties, 

https://www.abms.org/board/american-board-of-anesthesiology/#aba-pm (last 

visited June 19, 2024). Because Dr. Holtzberg's failure to order new scans did 

not fall within his specialty, the PFA's same-specialty requirement is 

inapplicable to Dr. Baker's evaluation of Dr. Holtzberg. Cf. Nicholas, 213 N.J. 

at 487. Accordingly, we affirm the court's order denying Dr. Holtzberg's motion 

to bar Dr. Baker's expert opinion that Dr. Holtzberg was negligent in caring for 

Cottrell during her emergency room visit and hospitalization in September 2014. 

IV. 

Dr. Gordon argues Dr. Baker cannot offer standard of care testimony 

against him because Dr. Baker does not share his board certification of internal 

medicine. He cites Nicholas for its principle that the same-specialty requirement 

bars a doctor board-certified in internal medicine from testifying against doctors 

who are board-certified in emergency medicine or family medicine, even though 

physicians trained in any of those areas may have sufficient training to treat the 

plaintiff. 213 N.J. at 487-88. Dr. Gordon adds that Dr. Baker's deposition 

testimony addressed the standard of care Dr. Gordon should have exercised both 
15 A-2577-22

during Cottrell's hospital stay, including but not limited to Cottrell's MRI, and 

when he discharged her from the hospital. Even though Dr. Baker did not name 

Dr. Gordon when describing the conduct of the physicians who treated Cottrell 

in the hospital, he opined Cottrell should not have been discharged to the 

rehabilitation center before the physicians identified the cause of her leg pain. 

Viewing Dr. Gordon's arguments through the same lens that we 

considered Dr. Holtzman's arguments, we conclude the motion court should not 

have denied Dr Gordon's motion to bar Dr. Baker's expert opinion. Unlike with 

Dr. Holtzberg, the record is not clear if Dr. Gordon ever saw, much less 

analyzed, Cottrell's MRI scans. Hence, there is no basis for plaintiffs to claim 

Dr. Gordon should have ordered further testing due to the inadequate MRI scans. 

Dr. Gordon's interactions with Cottrell appear to have all occurred either before 

or after the MRI was ordered. He examined Cottrell shortly after she was first 

admitted and signed off on her discharge to the rehabilitation center. Relevantly, 

plaintiffs contend Dr. Gordon: (1) observed "Cottrell would scream with pain 

at attempts to minimally lift her legs or bend her knees" but did not do enough 

to quickly find out why; and (2) discharged her before anyone determined the 

source of Cottrell's leg pain. 
16 A-2577-22

Dr. Gordon's interactions with Cottrell fall squarely within the broad 

scope of internal medicine. Internal medicine "incorporates an understanding 

of disease prevention, wellness, substance abuse, mental health and effective 

treatment of common problems" involving many body parts, with an aim to 

"provide[] long-term, comprehensive care[,] . . . managing both common and 

complex illnesses of adolescents, adults and the elderly." American Board of 

Internal Medicine, Am. Bd. of Med. Specialties, 

https://www.abms.org/board/american-board-of-internal-medicine/#abim-im 

(last visited June 20, 2024). Dr. Gordon was in the same position as the second 

doctor in Nicholas, providing follow-up care to a patient with emergent 

symptoms once the patient was admitted into the hospital. 231 N.J. at 470, 487. 

He persuasively argues plaintiffs can only obtain standard of care testimony 

against him from another board-certified internist. See Pfannenstein, 475 N.J. 

Super. at 102-03. Because Dr. Baker is not a board-certified internist, he cannot 

opine that Dr. Holtzberg deviated from the standard of care of an internist. 

N.J.S.A. 2A:53A-41(a). 

Before the motion court, plaintiffs briefly alluded to the fact that Drs. 

Baker and Gordon share an emergency medicine specialty. Under the PFA's 

plain language, Dr. Baker could provide standard of care opinions against Dr. 
17 A-2577-22

Gordon if Dr. Gordon was acting as an emergency medicine physician rather 

than an internist. See DiProspero v. Penn, 183 N.J. 477, 492 (2005). However, 

given neither party briefed this issue on appeal, it is waived, and plaintiffs 

cannot in the future seek to offer Dr. Baker's testimony against Dr. Gordon on 

this basis. See N.J. Dep't of Env't Prot. v. Alloway Township, 438 N.J. Super. 

501, 505 n.2 (App. Div. 2015) (noting "[a]n issue that is not briefed is deemed 

waived"). 

Accordingly, we reverse the court's order denying Dr. Gordon's motion to 

bar Dr. Baker's expert opinion that Dr. Gordon was negligent in caring for 

Cottrell during her emergency room visit and hospitalization in AugustSeptember 2014. 

Affirmed in part and reversed in part. We do not retain jurisdiction.