Case Name: MARIE C. BAPTISTA, ADMINISTRATRIX AD PROSEQUENDUM AND GENERAL ADMINISTRATRIX OF THE ESTATE OF LEOPOLDO A. BAPTISTA, DECEASED, PLAINTIFF-APPELLANT, v. SAINT BARNABAS MEDICAL CENTER, A CORPORATION OF THE STATE OF NEW JERSEY, DEFENDANT-RESPONDENT
Court: New Jersey Superior Court, Appellate Division
Jurisdiction: New Jersey
Decision Date: 1970-03-13
Citations: 109 N.J. Super. 217
Docket Number: 
Parties: MARIE C. BAPTISTA, ADMINISTRATRIX AD PROSEQUENDUM AND GENERAL ADMINISTRATRIX OF THE ESTATE OF LEOPOLDO A. BAPTISTA, DECEASED, PLAINTIFF-APPELLANT, v. SAINT BARNABAS MEDICAL CENTER, A CORPORATION OF THE STATE OF NEW JERSEY, DEFENDANT-RESPONDENT.
Judges: 
Reporter: New Jersey Superior Court Reports
Volume: 109
Pages: 217–230

Head Matter:
MARIE C. BAPTISTA, ADMINISTRATRIX AD PROSEQUENDUM AND GENERAL ADMINISTRATRIX OF THE ESTATE OF LEOPOLDO A. BAPTISTA, DECEASED, PLAINTIFF-APPELLANT, v. SAINT BARNABAS MEDICAL CENTER, A CORPORATION OF THE STATE OF NEW JERSEY, DEFENDANT-RESPONDENT.
Superior Court of New Jersey Appellate Division
Argued October 14, 1969—Supplemental Briefs Filed December 3, 1969
Decided March 13, 1970.
Before Judges Coneord, Collester and Kolovsky.
Mr. Gerald W. Conway argued the cause for appellant (Messrs. Schreiber and Lancaster, attorneys).
Mr. Wilbur A. Stevens argued the cause for respondent (Messrs. Stevens and Mathias, attorneys).

Opinion:
The opinion of the court was delivered by
Kolovsky, J. A. D.
During a period beginning some six months prior to May 1963 Leopoldo A. Baptista had been treated by Dr. Zins for hypertension. During the night of May 4, 1963 he became seriously ill and when Mrs. Baptista reported his symptons to Dr. Zins the next day, the doctor suggested immediate hospitalization. Leopoldo entered defendant hospital on Sunday, May 5, 1963.
Tests revealed a serious malfunctioning of Leopoldo's kidneys so that body poisons were being built up rather than eliminated. Dr. Zins decided that use of an artifical kidney would help carry his patient along, with the hope that in the meantime the patient's kidney condition would heal itself. He finally ascertained that there was an artificial kidney available for use at Poliak Hospital in Jersey City. Leopoldo was transferred to the latter hospital on May 10.
In the meantime, on May 9, pursuant to Dr. Zins' directions, defendant hospital had given Leopoldo a blood transfusion. Plaintiff contends that "incompatible" blood was used in the transfusion and that as a result Leopoldo's condition continued to grow worse, ending with his death on May 18, 1963 at Poliak Hospital. Plaintiff offers no criticism of the treatment, including four blood transfusions, which Leopoldo received while at Poliak.
In this action by plaintiff as administratrix ad pros, for damages under the Death Act, N. J. S. A. 2A:31-1 et seq., and as general administratrix to recover damages for Leopoldo's injuries, pain and suffering, plaintiff charged defendant Saint Barnabas Medical Center with (1) negligence and (2) breach of warranty.
At the close of all the evidence defendant moved for judgment in its favor. While the trial court denied the motion for judgment, it ruled that it would submit the case to the jury only with respect to the allegations of negligence. The verdict returned by the jury was, "We find the defendant not negligent." A subsequent motion by plaintiff for a new trial was denied. Plaintiff appeals.
Plaintiff's principal contention is that the court erred in refusing to submit the case to the jury on the pleaded theory of breach of warranty, and that "the doctrine of strict liability in tort should apply to the furnishing of blood by a hospital to a patient for transfusion purposes." Proper evaluation of these contentions requires a review of the proofs in this case with respect to the alleged incompatibility of the transfused blood.
To support her claim that a transfusion of incompatible blood was a contributing cause of Leopoldo's death, plaintiff relied on the opinion testimony of a Dr. Graubard, whom she called as an expert witness, and the statement to that effect in the death certificate signed by a Dr. Speckhart, then a resident physician at Poliak Hospital. Dr. Speckhart was on the service of Dr. Lasker, an associate professor of medicine of the New Jersey College of Medicine and the staff physician at Poliak Hospital who was in charge of Leopoldo's case.
The pertinent portion of the death certificate (with the misspellings therein corrected) reads as follows :
IT. CAUSE OE DEATH
Interval between Onset and Death
Part I. Death was caused by:
Immediate Cause (a) Acute Tubular Necrosis Due to (b) Chronic Glomerulonephritis 1 yr. 3 mos. Due to (c) Arteriolar Nephrosclerosis Conditions, if any, which gave rise to above cause (a), stating the exciting cause last.
Part II. Other significant Conditions Contributing to Death But Not Related to the Terminal Disease Condition Given in Part 1(a)
Transfusion of Incompatible Blood.
Dr. Graubard defined acute tubular necrosis as "the death of certain cells within the kidney so that there is no absorption of the waste products: they are allowed to accumulate in the blood." Nephritis is an inflammation of the kidney. Glomerulonephritis is a variety of nephritis characterized by inflammation of the capillary loops in the blood vessels of the kidney, Dorland's Medical Dictionary, 619 (24 ed. 1965), arteriolar nephrosclerosis is a form of nephritis characterized by a thickening of parts of the kidney. Ibid., at 990. According to Dr. Lasker, the last mentioned condition is "the type of kidney lesion which we see in patients with severe hypertension."
At the time of the trial Dr. Speekhart was in the Congo. However, Dr. Lasker testified that what was set forth by resident physician Dr. Speekhart in the death certificate represented his •— Dr. Lasker's — opinion at the time, an opinion which lie had since revised following his examination of the records of defendant hospital which indicate that "The blood was properly cross-matched prior to its administration." That being so, it was his opinion at the time of the trial that "it's unlikely that [Leopoldo's] demise was due to incompatible transfusion."
Dr. Zins and other physicians called as witnesses by defendant testified that there was no indication that the blood nsed was incompatible.
Dr. Graubard expressed a contrary opinion. In response to a hypothetical question embodying what was shown in the records of the two hospitals, his opinion was that "incompatible blood produced the tubular necrosis which led to the eventual death of Mr. Baptista." But he was unable to tell in what respect the blood was incompatible "other than the fact that it ultimately resulted in Mr. Baptista's death." He was certain, however, to quote from plaintiff's brief, that "there was no indication of serum hepatitis, syphilis or virus or infection in the blood nsed for transfusion."
While there may be some question as to the evidential value of Dr. Graubard's opinion in view of his inability to specify the nature of the alleged incompatibility, cf. Germann v. Matriss, 55 N. J. 193 (Jan. 19, 1970), we assume, for present purposes, that his opinion and that set forth in the death certificate would be sufficient to support a jury finding that the transfused blood was incompatible with that of decedent.
In view of plaintiff's concession that the blood used in the transfusion was wholesome and free from infection or other defect, the only explanations for the administration of the allegedly incompatible blood would be either (1) the failure of defendant to follow standard recognized procedures in receiving or storing the blood or in testing to insure that the blood of the donor and that of the patient were not ineom patible, or (3) the inadequacy of then existing recognized tests and procedures to disclose all possible kinds of incompatibility.
The first hypothesis appears to have been the gravamen of the contentions made by plaintiff in the pretrial order where her sole assertions were that :
The blood was furnished to plaintiff's decedent by St. Barnabas Medical Center, cross-matched, and typed inaccurately producing incompatible blood from, which plaintiff's decedent died. Plaintiff contends that the defendant St. Barnabas Medical Center impliedly and expressly warranted that the blood was fit and wholesome and that it was properly cross-matched and typed and compatible with plaintiff's decedent's blood. As a result of its breach of warranty and its negligence, plaintiff's decedent died. [Emphasis added]
The italicized language basically sounds in negligence. However, plaintiff offered no affirmative proof that in fact the blood was "cross-matched and typed inaccurately." No evidence was offered to contradict what appeared from the hospital records and from the testimony of the clinical pathologist who was the director of its laboratory that all standard procedures were followed in receiving and storing the blood; that the donor blood and that of the patient were subjected to all tests in use in 1963 to determine incompatibility (some other tests have been developed since), and that the tests showed that the two blood samples were compatible.
Dr. Graubard, plaintiff's expert witness, conceded that if the hospital had in fact followed the procedures and tests so testified to, then it had complied with established standards and could not be charged with malpractice. In this aspect the issue thus became one of the credibility of the hospital records and of the director of its laboratory — an issue which the jury resolved in defendant's favor by its verdict, "We find defendant not negligent."
The question of the scope of the liability of a hospital for the deleterious effects of a blood transfusion has heretofore arisen only in a case where the transfused blood contained viral hepatitis. The Law Division held that transaction was a "sale" and that the supplying blood hank and hospital should be held liable for the harm caused by the defective product or blood they "sold." Jackson v. Muhlenberg Hospital, 96 N. J. Super. 314 (Law Div. 1967). But the Supreme Court reversed, 53 N. J. 138 (1969), saying:
[T]he issue of whether a commercial blood bank and a hospital may be held accountable on the basis of implied warranty or strict liability where their furnishing of blood containing viral hepatitis has resulted in consequential injury to the complaining party. is a very important one involving highly significant policy considerations and obviously should not be decided on the wholly inadequate record before us. cf. Public Service Commission of Utah v. Wycoff Co., 344 U. S. 237, 2-43, 73 S. Ct. 236, 240, 97 L. Ed. 291, 296 (1952) : "A maximum of caution is necessary in the type of litigation that we have here, where a ruling is sought that would reach far beyond the particular case."
In the factual situation presented here, the plaintiffs' cause of action would traditionally be grounded on principles of negligence and accordingly tlieir complaint contained appropriate allegations that the defendants had failed to exercise due care with consequential injury to the plaintiffs, [at 141-142]
The court then reinstated negligence counts which plaintiffs had abandoned and remanded the matter for trial, directing that:
At the trial, a complete record should be made, including not only detailed testimony as to the nature of the defendants' operations, but also expert testimony as to the availability of any tests to ascertain the presence of viral hepatitis in blood, the respective incidences of hepatitis in blood received from commercial blood banks and other sources, and such other available testimony and materials as may be relevant to any of the questions presented by the parties, including such economic and other factors as may bear on the question of whether the doctrine of implied warranty or strict liability should apply io deliveries and transfusions of blood, [at 142-143]
Whatever may be the final policy decision to be reached in cases involving blood infected with viral hepatitis, we find no justification for extending the doctrine of strict liability to a case such as this where the blood is not infected or defective.
To accept plaintiff's contention would be to adopt a rule that a hospital is accountable on the basis of implied warranty or strict liability in tort for injuries resulting from a blood transfusion even though the article allegedly "sold" was wholesome and free from internal defect and even though the hospital followed standard recognized procedures in dealing with donor blood and in testing both the donor blood and the patient's blood for incompatibility.
To adopt such a rule would be to make a hospital an insurer of what are in essence medical services and opinions, the cross-matching and typing of blood. In our view, the same policy considerations which led the court in Newmark v. Gimbel's Incorporated, 54 N. J. 585, 596-597 (1969), to hold that the rules of strict liability in tort and implied warranty should not be imposed on dentists and doctors apply to the services rendered by defendant hospital in this case. The obligation of hospitals in cross-matching and typing blood in cases of blood transfusions should continue to be as it is now, grounded and expressed in a duty to exercise reasonable competence and care.
Plaintiff's only other contention is that the court's charge on the issue of proximate cause was erroneous. However, our reading of the court's charge as a whole satisfies us that although there was room for improvement in its explanation of "proximate cause," still the issue was adequately dealt with and the jury could not have been misled.
In any event, even if the charge be deemed erroneous, no prejudice appears since the jury's finding that defendant was not negligent — a finding which the evidence mandated if the jury believed the testimony of defendant's laboratory director and the hospital records — made it unnecessary for it to reach the issue of proximate cause.
The judgment is affirmed.
The records of the trial court in Jackson v. Muhlenberg Hospital (Docket L 21730-64) show that no further proceedings were taken following the remand by the Supreme Court. The only instrument thereafl.er filed was a stipulation dated June 29, 1969, signed by all counsel, reciting that the matters in difference had been amicably adjusted by and between the parties and dismissing the action with prejudice but without costs.