Title: Mary Berberian v. Diane Lynn, et al., and The Estate of Edmund Gernannt
Citation: N/A
Docket Number: a-71-02
State: new-jersey
Issuer: new-jersey Supreme Court
Date: April 6, 2004

(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). On October 3, 1997, Edmund Gernannt, now deceased, was involuntarily committed to Bergen Pines County Hospital with a diagnosis of senile dementia, Alzheimer s type. On October 13, 1997, he was transferred from the long-term care unit to the acute geriatric psychiatric unit because he became increasingly agitated and assaultive towards the staff. On November 5, 1997, Gernannt was transferred to the eighth floor, where a number of other Alzheimer s and dementia patients were housed. On November 11, 1997, Gernannt attempted to leave the unit by way of the fire exit and set off the alarm. Mary Berberian, the head nurse at the facility, attempted to redirect Gernannt, but he pushed her, causing her to fall and fracture her right leg. Berberian ultimately sued The Estate of Gernannt and others. At the conclusion of Berberian s presentation of evidence, Gernannt s estate moved for an involuntary dismissal. The trial court denied that motion. After the close of the evidence portion of the trial, Berberian requested a reasonable man standard instruction. The trial court denied the request and charged the jury, in part, to measure his actions as you would a reasonably prudent person who has Alzheimer s dementia. The jury found in favor of The Estate of Gernannt. . Berberian appealed. The Appellate Division affirmed. In a concurring opinion, Judge Lintner concluded that Gernannt had no duty of care and that the trial court should have granted the motion for involuntary dismissal filed by The Estate of Gernannt. HELD: Mentally incompetent patients owe no duty of care to protect paid caregivers from injuries suffered while caring for those patients. 1. Generally, the reasonable person standard applies to a mentally deficient person. Restatement (Second) of Torts 283B (1965). The Restatement identifies a reasonable person as a person exercising those qualities of attention, knowledge, intelligence, and judgment which society requires of its members for the protection of their own interests and the interests of others. Id. at 283 comment b. However, the Restatement limits the distinction with respect to the standards of care governing the tort liability of children and physically disabled persons, but not mentally disabled persons. (Pp. 6-9) 2. The issue on appeal is one of first impression in New Jersey. In Cowan v. Doering, 215 N.J. Super 484 (1987), and Tobia v. Cooper Hosp. Univ. Med. Ctr., 136 N.J. 335 (1994), this Court addressed the issues of self-care and self-damaging conduct in the context of a mentally disturbed plaintiff who jumped out a window of a hospital and an elderly patient who was injured when she fell from an emergency room stretcher, respectively. In each case, the Court found that defendant breached its duty of care, a duty to prevent the very same act engaged in by plaintiff, and that as a result defendant could not assert comparative negligence. (Pp. 9-11) 3. While Cowan and Tobia tangentially inform this case, decisions from other jurisdictions with fact patterns closer to the present case are also instructive. The holdings in those out-of-state cases appear to have a common thread, namely, that no duty of care arises between an institutionalized person who has no control over his actions and a paid caregiver. In addition, courts have found the fireman s rule analogous and have determined that resulting injuries are compensable via workers compensation. (Pp. 12-16) 4. Several legal commentators favor the use of a no-duty rule in the relationship between the mentally disabled patient and his or her caregiver. (Pp. 17-18) 5. Persuaded by the reasoning of Judge Lintner, the out-of-state authorities, and the fireman s rule analogy, we hold that a mentally disabled patient, who does not have the capacity to control his conduct, does not owe his or her caregiver a duty of care. It would not be fair, under the circumstances, to impose a duty of care on Gernannt to his professional caregiver when the caregiver s job duties included preventing Gernannt from injuring himself and others. Moreover, Berberian has the benefit of worker s compensation for her work-related injuries. The trial court should have granted the estate s motion for an involuntary dismissal. (Pp. 18-20) As modified, the judgment of the Appellate Division is AFFIRMED. CHIEF JUSTICE PORITZ and JUSTICES LONG, VERNIERO, LAVECCHIA, ZAZZALI and ALBIN join in Justice WALLACE s opinion. Plaintiffs-Appellants, v. DIANA LYNN, AS GUARDIAN OF THE INCOMPETENT EDMUND GERNANNT, EDMUND GERNANNT, individually, DR. M.H. RAMAY, M.D., and JOHN DOE, INC., a fictitious entity, jointly, severally and in the alternative, Defendants, and THE ESTATE OF EDMUND GERNANNT, Defendant-Respondent. Argued November 3, 2003 Decided April 6, 2004 On certification to the Superior Court, Appellate Division, whose opinion is reported at 355 N.J. Super. 210 (2002). Michael J. Breslin, Jr., argued the cause for appellants (Waters, McPherson, McNeill, attorneys; James J. Seaman, on the briefs). Kevin P. Harrington argued the cause for respondent (Harrington and Lombardi, attorneys). JUSTICE WALLACE delivered the opinion of the Court. Plaintiffs, See footnote 1 Mary Berberian, the head nurse in a long-term care facility, and her husband, Emmanuel Berberian, sued defendant Edmund Gernannt, an institutionalized patient with Alzheimer s dementia, his estate (defendant)See footnote 2, Diane Lynn, in her capacity as Gernannt s guardian, and M.H. Rainey, M.D., to recover damages for personal injuries she sustained when Gernannt pushed her. After closing arguments, the trial court instructed the jury that the applicable standard of negligence was that of a reasonably prudent person who has Alzheimer s dementia. The jury found in favor of defendant. On appeal, plaintiffs argued that the trial court should have applied an objective reasonable person standard without taking into account Gernannt s mental disability. The Appellate Division disagreed with plaintiffs and affirmed the trial court. Berberian v. Lynn, 355 N.J. Super. 210 (2002). We granted certification, 175 N.J. 549 (2003), and now affirm the judgment of the Appellate Division on different grounds. We hold that mentally incompetent patients owe no duty of care to protect paid caregivers from injuries suffered while caring for those patients. 2. The unsatisfactory character of the evidence of mental deficiency in many cases, together with the ease with which it can be feigned, the difficulties which the triers of fact must encounter in determining its existence, nature, degree, and effect; and some fear of introducing into the law of torts the confusion which has surrounded such a defense in the criminal law. Although this factor may be of decreasing importance with the continued development of medical and psychiatric science, it remains at the present time a major obstacle to any allowance for mental deficiency. 3. The feeling that if mental defectives are to live in the world they should pay for the damage they do, and that it is better that their wealth, if any, should be used to compensate innocent victims than that it should remain in their hands. 4. The belief that their liability will mean that those who have charge of them or their estates will be stimulated to look after them, keep them in order, and see that they do not do harm. [Ibid.] The Restatement identifies a reasonable person as a person exercising those qualities of attention, knowledge, intelligence, and judgment which society requires of its members for the protection of their own interests and the interests of others. Id. at 283 comment b. Further, it recognizes that allowances must be made for some of the differences between individuals, the risk apparent to the actor, his capacity to meet it, and the circumstances under which he must act. Id. at 283 comment c. However, the Restatement limits the distinction with respect to the standards of care governing the tort liability of children and physically disabled persons, but not mentally disabled persons. See id. at 283A (providing that a child must conform his or her conduct to that of a reasonable person of like age, intelligence, and experience under like circumstances ); see also id. at 283C (providing that a physically disabled individual must conform his or her conduct to that of a reasonable man under like disability ). [Ibid. (quoting Krauth v. Geller, 31 N.J. 270, 273-74 (1960)).] Second, the Florida court noted the existence of workers compensation for the injured plaintiff. Ibid. Third, while analyzing the defendant s condition, the court opined that it would be unjust to impose liability on a defendant, who has no control over his actions and is thus innocent in any wrongdoing in the most basic sense of the term. Ibid. Finally, the court recognized that the defendant, his relatives, and society did as much as they could to protect others from the defendant s violence by confining him in the most restricted area of a restricted institution. Ibid.; see also Mujica v. Turner, 582 So. 2d 24, 25 (Fla. Dist. Ct. App.), review denied, 592 So. 2d 681 (Fla. 1991) (following Anicet to conclude that no liability attaches when the incompetent has been institutionalized . . . because of her mental incompetency and injures one of her caretakers while in such institution. ) In Gould v. American Family Mut. Ins. Co., 543 N.W.2d 282, 283 (Wis. 1996), the Supreme Court of Wisconsin addressed whether an institutionalized individual who has a mental disability and who does not have the capacity to control or appreciate his or her conduct can be liable for injuries caused to his or her paid caretaker. There, the plaintiff was the head nurse at a health center s dementia unit and took care of the defendant, an Alzheimer s patient. Ibid. The center s records indicated that the defendant was often disoriented, resistant to care, and occasionally combative. Ibid. On one occasion, the plaintiff attempted to redirect the defendant to his own room by touching him on the elbow. Ibid. In response, he knocked her to the floor, causing the plaintiff to suffer personal injuries. Ibid. The plaintiff sued the defendant s insurer. Id. at 284. At trial, the court instructed the jury to disregard any evidence related to the defendant s mental condition and to determine his negligence under the objective, reasonable person standard. Ibid. On interlocutory appeal, the appellate court reversed the judgment, holding that a person may not be held civilly liable where a mental condition deprives that person of the ability to control his or her conduct. Gould v. American Family Mut. Ins. Co., 523 N.W.2d 295, 296 (Wis. Ct. App. 1994). The Supreme Court of Wisconsin affirmed and held that an individual institutionalized . . . with a mental disability, and who does not have the capacity to control or appreciate his or her conduct cannot be liable for injuries caused to caretakers who are employed for financial compensation. Gould, supra, 543 N.W.2d at 283. First, the court reasoned that [the plaintiff], as head nurse of the secured dementia unit and [the defendant s] caretaker, had express knowledge of the potential danger inherent in dealing with Alzheimer s patients in general and [the defendant] in particular. Id. at 287. Second, the court declared that it would be unfair to find the defendant negligent under those circumstances because his disorientation and potential for violence were the very reasons he was institutionalized. Ibid. Third, the court noted that the defendant s relatives should not be held responsible because they did everything they could to restrain him when they placed him in a secured dementia unit of a restricted health care center. Ibid. Lastly, the court rejected the argument that the Restatement s objective standard of care should be applied to prevent tortfeasors from simulat[ing] or pretend[ing] insanity to defend their wrongful acts . . . . Ibid. (quoting German Mut. Fire Ins. Soc y v. Meyer, 261 N.W. 211, 215 (1935) (internal quotation marks omitted)). The court explained that the notion of a person simulating the symptoms of Alzheimer s disease over a period of years in order to avoid future liability was simply not believable. Ibid. Recently, the Supreme Court of Indiana held that no duty of care exists between a mentally disabled individual residing in a nursing home and a professional health care worker employed by the nursing home. Creasy v. Rusk, 730 N.E.2d 659 (Ind. 2000). There, the plaintiff, a certified nursing assistant, sued the defendant, a patient with Alzheimer s disease, for personal injuries that resulted when he kicked her while she was trying to put him to bed. Id. at 660-61. The plaintiff knew the defendant had Alzheimer s disease and was aware of his combative and resistant behavior resulting from the disease. Id. at 661. The court held that, due to the relationship between the parties and public policy concerns, the defendant owed no duty of care to the plaintiff. Id. at 667. The court further found the fireman s rule to be an analogous situation. Id. at 668; see also Herrle v. Estate of Marshall, 53 Cal. Rptr. 2d 713, 719 (Cal. Ct. App. 1996) (holding mentally incompetent patients should not owe a legal duty to protect caregivers from injuries suffered in attending to them ); Colman v. Notre Dame Convalescent Home, Inc., 968 F. Supp. 809, 814 (D. Conn. 1997) (observing that although a mentally disabled adult ordinarily is responsible for the injuries resulting from her negligence, no such duty of care arises between an institutionalized patient and her paid caregiver ). MARY BERBERIAN and EMANUEL BERBERIAN, Plaintiffs-Appellants, v. DIANA LYNN, AS GUARDIAN OF THE INCOMPETENT EDMUND GERNANNT, et al., Defendants, and THE ESTATE OF EDMUND GERNANNT, Defendant-Respondent. DECIDED April 6, 2004 Chief Justice Poritz PRESIDING OPINION BY Justice Wallace CONCURRING/DISSENTING OPINIONS BY DISSENTING OPINION BY