Title: A.T. v. Cohen
Citation: N/A
Docket Number: 
State: new-jersey
Issuer: new-jersey Supreme Court
Date: December 14, 2017

A.T. v. Cohen Annotate this Case Justia Opinion Summary T.T., individually and on behalf of her three-year-old daughter, A.T., filed this medical malpractice action seeking damages from a hospital and several medical professionals for injuries caused during the child’s birth.1 The trial court granted summary judgment to defendants and dismissed the action with prejudice because plaintiff failed to serve a timely affidavit of merit. The Appellate Division affirmed, rejecting plaintiff’s argument that the circumstances should have supported entry of a dismissal without prejudice under Rule 4:37-1(b). After review, the New Jersey Supreme Court reversed the grant of summary judgment to defendants and remanded for further proceedings. The Court determined that a combination of circumstances (not the least of which was the failure to schedule a pretrial conference to address the affidavit of merit requirement as New Jersey case law directed), warranted allowing the untimely affidavit to be filed. "The equities militate in favor of permitting a facially meritorious action to proceed here, particularly because any prejudice to defendants may be addressed through costs imposed by the trial court. We decline to approve recourse to a voluntary dismissal without prejudice under Rule 4:37-1(b) as an appropriate avenue for addressing failures to comply with the affidavit of merit requirement, including when a minor is involved. Rather, we will require modification of the Judiciary’s electronic filing and notification case management system to ensure that, going forward, necessary and expected conferences are scheduled to enhance parties’ compliance with requirements under the Affidavit of Merit Statute (AMS or the statute), N.J.S.A. 2A:53A-26 to -29, in furtherance of the statutory policy goals." Read more Want to stay in the know about new opinions from the Supreme Court of New Jersey? Sign up for free summaries delivered directly to your inbox. Learn More › You already receive new opinion summaries from Supreme Court of New Jersey. Did you know we offer summary newsletters for even more practice areas and jurisdictions? Explore them here . SYLLABUS(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 interest of brevity, portions of any opinion may not have been summarized.) A.T. v. M. Cohen, M.D. (A-12-16) (077821)Argued September 25, 2017 -- Decided December 14, 2017LaVECCHIA, J., writing for the Court. In this appeal as of right, R. 2:2-1(a)(2), the Court considers whether, under the circumstances of this case, the trial court properly dismissed the action with prejudice because plaintiff failed to serve a timely affidavit of merit. The Court also considers whether recourse to a voluntary dismissal without prejudice under Rule 4:37-1(b) is an appropriate avenue for addressing failures to comply with the affidavit of merit requirement. T.T. gave birth to A.T. at Newark Beth Israel Hospital (the Hospital) on May 19, 2011. At the Hospital, T.T. and A.T. (collectively, plaintiff) were under the care of Morris Cohen, M.D., Khalid Savaged, M.D., Cindy Galeota, C.N.M., Julio Caban, M.D., and Bauhuong Tran, M.D. (collectively, with the Hospital, defendants). In her amended complaint filed on September 25, 2013, plaintiff alleges that defendants’ treatment of T.T. and A.T. fell below the accepted standard of care and caused A.T.’s injury and birth defects. Plaintiff further alleges that defendants’ negligence caused T.T. the loss of A.T.’s society, companionship, and support. Defendants filed an answer on December 5, 2013, denying the allegations set forth in the amended complaint and demanding, among other things, that plaintiff produce an affidavit of merit (AOM) pursuant to the Affidavit of Merit Statute (AMS), N.J.S.A. 2A:53A-26 to -29. Under the statute, plaintiff had sixty days from that date -- or 120 with leave of the court -- to file an AOM with respect to each defendant. By February 3, 2014, sixty days had elapsed since defendants filed their answer, and plaintiff had not served defendants with an AOM. At no time prior to the sixty-day mark or at any time thereafter did any court personnel attempt to convene a Ferreira conference, and at no time was one requested or waived by counsel. On April 7, 2014, defendants filed a motion for summary judgment. In support, defendants relied on plaintiff’s failure to produce an AOM within the statutorily mandated time frame and claimed entitlement to dismissal with prejudice. Plaintiff opposed defendants’ motion and submitted an AOM dated May 22, 2014. Prior to argument on the underlying motion, plaintiff’s counsel made an oral application for a voluntary dismissal without prejudice pursuant to Rule 4:37-1(b). Counsel revealed, for the first time, that plaintiff’s failure to timely submit an AOM was due to counsel’s own oversight, which stemmed from plaintiff’s stipulation granting defendants extra time to file an answer. The court denied plaintiff’s motion for a voluntary dismissal, granted defendants’ motion for summary judgment, and dismissed the action with prejudice. Plaintiff appealed. A majority of the Appellate Division panel rejected the assertion that attorney oversight was sufficient reason to grant a voluntary dismissal under the circumstances. 445 N.J. Super. 300, 306-07 (App. Div. 2016). The panel affirmed the order granting summary judgment to defendants and dismissing the matter with prejudice. The dissent asserted that a finding of exceptional circumstances would have been appropriate here. Id. at 313. The dissent would have ordered entry of a dismissal without prejudice in light of A.T.’s minor status, her attorney’s mishandling of the AOM, and the relatively little prejudice defendants have suffered, and would have allowed the trial court the ability to impose conditions on the re-filing of plaintiff’s claims.HELD: The Court reverses the grant of summary judgment to defendants and remands the matter for further proceedings, finding that the equities militate in favor of permitting a facially meritorious action to proceed here. The Court declines to approve recourse to a voluntary dismissal without prejudice under Rule 4:37-1(b) as an appropriate avenue for addressing failures to comply with the affidavit of merit requirement, including when a minor is involved. Rather, the Court will require modification of the Judiciary’s electronic filing and notification case management system to ensure that, going forward, necessary and expected conferences are scheduled to enhance parties’ compliance with requirements under the Affidavit of Merit Statute, in furtherance of the statutory policy goals. 1 1. The failure to provide an AOM is “deemed a failure to state a cause of action,” N.J.S.A. 2A:53A-29, requiring dismissal with prejudice, Alan J. Cornblatt, P.A. v. Barow, 153 N.J. 218, 247 (1998). However, the Court has recognized equitable exceptions to “temper the draconian results of an inflexible application of the statute,” Ferreira v. Rancocas Orthopedic Assocs., 178 N.J. 144, 151 (2003), and has created mechanisms to draw attention to and facilitate satisfaction of this statutory obligation and its goals, id. at 154-55 (establishing discovery-stage case management conference to encourage and facilitate compliance with AMS requirements, to avoid dismissal of meritorious claims due to inadvertence, and to promote goal of weeding out insubstantial claims). (pp. 11-12)2. The Ferreira conference was designed to be the Judiciary’s key tool to promote satisfaction of the AMS’s salutary policy goals. The Court mandated the conference and imposed requirements on both courts and defendants to discover and address issues as to the sufficiency of a plaintiff’s AOM. Id. at 155. In 2010, the Court wrestled with the fact that mandatory Ferreira conferences were not being routinely conducted as expected. In Paragon Contractors, Inc. v. Peachtree Condominium Ass’n, 202 N.J. 415, 424 (2010), the Court clarified that, “[a]lthough Ferreira conferences should be held as a matter of course, they may be omitted [upon submission of a proposed consent order indicating that] 'the [AOM] has been provided by plaintiff and all defendants have waived any objections to its adequacy.’” The Court added that, “going forward, reliance on the scheduling of a Ferreira conference to avoid the strictures of the Affidavit of Merit statute is entirely unwarranted and will not serve to toll the statutory time frames.” Id. at 426. (pp. 12-15)3. The Court’s warning in Paragon that the failure to conduct a Ferreira conference would not routinely toll the time for submission of an AOM was not meant to foreclose the finding of extraordinary circumstances when a combination of events occurred. Here, just such circumstances occurred. While “attorney inadvertence” will not, standing alone, support a finding of extraordinary circumstances, in this case, the Judiciary failed to do what the Court expected, namely to act as a backstop. No Ferreira conference was scheduled, which would have assisted in keeping the parties focused on the timing of the necessary affidavit. Counsel here did secure an affidavit when defendants filed a motion for summary judgment. The Court presumes from plaintiff’s swift compliance upon the filing of the motion that it is dealing with a non-frivolous matter, not the type of case that the AMS intended to weed out. There is no prejudice to defendants that the equitable powers of our courts cannot address. The trial court has the discretion to require plaintiff to reimburse defendants for the costs incurred in the extra proceedings that took place as a result of the delayed compliance with the AMS, which can mitigate prejudice to defendants. Although this matter does not fit neatly into the factual scenarios of past extraordinary-circumstances cases, the Court is persuaded that equitable relief should be afforded to plaintiff. (pp. 15-18)4. Except in certain types of actions inapplicable here, “an action shall be dismissed at the plaintiff’s instance only by leave of court and upon such terms and conditions as the court deems appropriate.” R. 4:37-1(b). Reviewing courts of this state frown on the use of a dismissal without prejudice under Rule 4:37-1(b) as a mechanism for salvaging a case that has run aground on requirements established in statutes or in the Rules of Court. Cracking open the use of dismissals of actions without prejudice to allow more time whenever a plaintiff runs aground on the requirements of the AMS would prolong litigation and potentially eviscerate the AMS policy of weeding out, early on, non-meritorious malpractice cases. The Court declines to send the matter back for entry of a dismissal without prejudice and instead relies on the presence of extraordinary circumstances to reverse the dismissal entered below. The Court cautions courts to adhere to the spare use of dismissals without prejudice as prior case law instructs. See Shulas v. Estabrook, 385 N.J. Super. 91, 102-03 (App. Div. 2006). (pp. 18-22)5. Going forward, advancements in the automated case management system will permit electronic notification of (1) the AOM filing obligation and (2) the scheduling of a Ferreira conference. The electronic case management system will be updated to issue notices to counsel and accomplish those tasks. Further details concerning those improvements will be provided through the Administrative Office of the Courts. With the Court’s announcement of those improvements comes a cautionary note. Counsel are on notice that disregarding the scheduling of the conference, or waiving the conference, will not provide a basis for relief from AMS obligations. (pp. 22-23) The judgment of the Appellate Division is REVERSED. The matter is REMANDED to the trial court for further proceedings consistent with this opinion.CHIEF JUSTICE RABNER and JUSTICES ALBIN, PATTERSON, FERNANDEZ-VINA, SOLOMON, AND TIMPONE join in JUSTICE LaVECCHIA’s opinion. 2 SUPREME COURT OF NEW JERSEY A- 12 September Term 2016 077821A.T., an infant by her mother and natural guardian, T.T., and T.T., individually, Plaintiffs-Appellants, v.M. COHEN, M.D., KHALID SAVAGED, M.D., CINDY GALEOTA, C.N.M., JULIO CABAN, M.D., BAOHUONG TRAN, M.D., and NEWARK BETH ISRAEL MEDICAL CENTER, Defendants-Respondents. Argued September 25, 2017 – Decided December 14, 2017 On appeal from the Superior Court, Appellate Division, whose opinion is reported at 445 N.J. Super. 300 (App. Div. 2016). Alan W. Roth argued the cause for appellants (Bendit Weinstock, attorneys; Alan W. Roth and Nikhil S. Agharkar, on the briefs). Lauren M. Strollo argued the cause for respondents (Vasios, Kelly & Strollo, attorneys; Lauren M. Strollo, of counsel and on the briefs, and Douglas M. Singleterry, on the briefs). Thomas M. Comer argued the cause for amicus curiae New Jersey Association for Justice (Lomurro, Munson, Comer, Brown & Schottland, attorneys; Thomas M. Comer and Abbott S. Brown, of counsel and on the brief, and Christina Vassiliou Harvey, on the brief). 1 Eric S. Poe argued the cause for amicus curiae New Jersey Physicians United Reciprocal Exchange (Eric S. Poe, of counsel and on the brief, and Abbey True Harris, on the brief). JUSTICE LaVECCHIA delivered the opinion of the Court. T.T., individually and on behalf of her three-year-olddaughter, A.T., filed this medical malpractice action seekingdamages from a hospital and several medical professionals forinjuries caused during the child’s birth.1 The trial courtgranted summary judgment to defendants and dismissed the actionwith prejudice because plaintiff failed to serve a timelyaffidavit of merit. The Appellate Division affirmed, rejectingplaintiff’s argument that the circumstances should havesupported entry of a dismissal without prejudice under Rule4:37-1(b). A.T. ex rel. T.T. v. Cohen, 445 N.J. Super. 300, 303(App. Div. 2016). One panel member dissented, maintaining that a dismissalbased on a failure to comply with the affidavit of meritrequirement should not invariably be with prejudice whenappropriate circumstances are present. Id. at 310 (Fisher,P.J.A.D., dissenting). The dissent found appropriate1 The Court adopts the terminology used in the published Appellate Division opinion and refers to T.T. and A.T. collectively as “plaintiff,” notwithstanding their individual claims. 2 circumstances present in respect of the tort claims involvingthis minor child. We now reverse the grant of summary judgment to defendantsand remand the matter for further proceedings. A combination ofcircumstances, not the least of which was the failure toschedule a pretrial conference to address the affidavit of meritrequirement as our case law directed, warrants allowing theuntimely affidavit to be filed. The equities militate in favorof permitting a facially meritorious action to proceed here,particularly because any prejudice to defendants may beaddressed through costs imposed by the trial court. We decline to approve recourse to a voluntary dismissalwithout prejudice under Rule 4:37-1(b) as an appropriate avenuefor addressing failures to comply with the affidavit of meritrequirement, including when a minor is involved. Rather, wewill require modification of the Judiciary’s electronic filingand notification case management system to ensure that, goingforward, necessary and expected conferences are scheduled toenhance parties’ compliance with requirements under theAffidavit of Merit Statute (AMS or the statute), N.J.S.A.2A:53A-26 to -29, in furtherance of the statutory policy goals. I. As alleged in the complaint, T.T. gave birth to A.T. atNewark Beth Israel Hospital (the Hospital) on May 19, 2011. At 3 the Hospital, T.T. and A.T. were under the care of Morris Cohen,M.D., Khalid Savaged, M.D., Cindy Galeota, C.N.M., Julio Caban,M.D., and Bauhuong Tran, M.D. (collectively, with the Hospital,defendants). As a result of defendants’ care, A.T. suffered abirth injury known as Erb’s Palsy, also described as a rightbrachial plexus injury. In her amended complaint filed onSeptember 25, 2013, plaintiff alleges that defendants’ treatmentof T.T. and A.T. fell below the accepted standard of care andcaused A.T.’s injury and birth defects. Plaintiff furtheralleges that defendants’ negligence caused T.T. the loss ofA.T.’s society, companionship, and support. Defendants2 filed an answer on December 5, 2013, denying theallegations set forth in the amended complaint and demanding,among other things, that plaintiff produce an affidavit of merit(AOM) pursuant to the AMS.3 Under the statute, plaintiff hadsixty days from that date -- or 120 with leave of the court --to file an AOM with respect to each defendant. By February 3, 2014, sixty days had elapsed sincedefendants filed their answer, and plaintiff had not served2 Dr. Savaged was not included in the answer filed, and the record does not disclose any other pleading on his behalf.3 A filing complication with the answer was corrected by submission of confirmation that plaintiff had consented to additional time for the filing of defendants’ answer. 4 defendants with an AOM. In the interim, plaintiff never soughtleave of the trial court to extend the AOM deadline. At no timeprior to the sixty-day mark or at any time thereafter did anycourt personnel attempt to convene a Ferreira4 conference, and atno time was one requested or waived by counsel. This Court’sdirection that such a conference be conducted unless waived bythe parties, see Paragon Contractors, Inc. v. Peachtree Condo.Ass’n, 202 N.J. 415, 424 (2010), appears to have beenoverlooked. By April 4, 2014, 120 days had elapsed sincedefendants filed their answer, and plaintiff still had notsupplied defendants with an AOM. Three days later, on April 7, 2014, defendants filed amotion for summary judgment. In support, defendants relied onplaintiff’s failure to produce an AOM within the statutorilymandated time frame and claimed entitlement to dismissal withprejudice. Plaintiff opposed defendants’ motion. In oppositionpapers filed on May 30, 2014, plaintiff claimed that the need toobtain medical records, which she did not receive in full untilMay 5, 2014 according to attached emails, impeded her ability tosecure a timely AOM. With those papers, plaintiff submitted anAOM dated May 22, 2014.4 Ferreira v. Rancocas Orthopedic Assocs., 178 N.J. 144, 154-55 (2003) (directing that accelerated case management conference be held in malpractice actions to address discovery issues, including AOM requirements). 5 A hearing was held on defendants’ motion on June 20, 2014.Prior to argument on the underlying motion, plaintiff’s then-current counsel made an oral application for a voluntarydismissal without prejudice pursuant to Rule 4:37-1(b). Counselrevealed, for the first time, that plaintiff’s failure to timelysubmit an AOM was due to counsel’s own oversight, which stemmedfrom plaintiff’s stipulation granting defendants extra time tofile an answer. After a colloquy between counsel and the court,the court carried defendants’ summary judgment motion in orderto permit the engagement of a co-counsel, who was present butnot yet retained and who was experienced in handling medicalmalpractice matters involving New Jersey’s AMS requirements.Thereafter, present counsel, Alan Roth, Esq., entered anappearance for plaintiff and filed a written motion forvoluntary dismissal without prejudice. On July 25, 2014, the court heard argument on bothplaintiff’s motion for dismissal without prejudice to permit thematter to be refiled with an AOM and defendants’ motion forsummary judgment based on plaintiff’s failure to submit a timelyAOM. With regard to the former, plaintiff argued that thefailure to hold a Ferreira conference and the former attorney’soversight were extraordinary circumstances that would justifythe court’s use of its discretion to grant a voluntary dismissalwithout prejudice. Plaintiff also advanced a constitutional 6 argument, contending that the AMS constitutes a violation of theprinciple of separation of powers. In response, defendantsnoted that if the court were to permit voluntary dismissalwithout prejudice, the court would be enabling a circumventionof the AMS, which requires the court to dismiss with prejudicewhen a plaintiff has failed to timely submit an AOM. The court declined to rule on the constitutionality issueand denied plaintiff’s motion for a voluntary dismissal. Thecourt granted defendants’ motion for summary judgment anddismissed the action with prejudice. In explaining its finding that no extraordinarycircumstances excused the noncompliance in this matter, thecourt interpreted Paragon to foreclose the possibility thatfailure to conduct a Ferreira conference ever would amount to anextraordinary circumstance unless the circumstances of the casedemonstrated some substantial attempt at compliance with theAMS. Moreover, the court reasoned that neither an attorney’sadmitted confusion about the time requirements of the AMS northe minor status of plaintiff A.T. gave rise to an extraordinarycircumstance. Determining that there was no attempt to complysubstantially with the AMS, the court rejected the request for adismissal without prejudice: The plaintiff seeks a dismissal without prejudice, on terms that if [the case] gets re-filed then the [AOM] would be with it. 7 That’s basically . . . engaging in a fiction to make it look like I’d be doing something that was allowed, that really wasn’t allowed, which would be extending the time beyond the 120 days. And no matter how you dressed it up and no matter how many orders I put around it, that is essentially what I would be doing. . . . And so the [c]ourt believes that to grant the plaintiff’s motion of a dismissal without prejudice, would essentially be to engage in a fictional practice aimed at making it look like the [c]ourt was complying with the legislative directive, when in fact it was not. Plaintiff filed a motion for reconsideration, reiteratingthat a dismissal without prejudice was appropriate given A.T.’sminor status and suggesting that the court set conditions forre-filing in order to mitigate potential prejudice todefendants. The court rejected those arguments and againdeclined to reach plaintiff’s argument that the AMS isunconstitutional, noting the argument was not properly beforethe court. Plaintiff appealed, arguing that (1) the trial court erredin dismissing the case with prejudice; and (2) the AMS isunconstitutional. Plaintiff asserted that the trial courtshould have granted a dismissal without prejudice under Rule4:37-1(b) because there were many years remaining on the statuteof limitations for the minor’s claim and there had been noprejudice to defendants because they had expended no resourceson discovery. 8 A majority of the Appellate Division panel concluded that“permitting a voluntary dismissal in these circumstances wouldrender the AOM statute meaningless in the case of a minorplaintiff.” A.T., 445 N.J. Super. at 308. Seeing nosubstantial compliance or extraordinary circumstances, theAppellate Division rejected the assertion that attorneyoversight was sufficient reason to grant a voluntary dismissalunder the circumstances. Id. at 306-07. Moreover, the majorityfound it significant that the Legislature opted not to carve outan explicit exception for minors in the AOM time frames. Id. at309. Accordingly, the Appellate Division majority declined toaccept the proposition that A.T.’s minor status warrantedprotection from the AMS beyond the protections afforded by thetolling of the statute of limitations. Ibid. The panelaffirmed the order granting summary judgment to defendants anddismissing the matter with prejudice. Ibid.5 Judge Fisher dissented. The dissent took issue with themajority’s reliance on an earlier decision of the AppellateDivision that had addressed a failure to comply with the AMS ina similar factual setting. Id. at 311 (Fisher, P.J.A.D.,dissenting) (citing Kubiak v. Robert Wood Johnson Univ. Hosp.,5 The panel declined to address plaintiff’s argument concerning the constitutionality of the AMS because it was not properly raised before the trial court. Id. at 305. 9332 N.J. Super. 230, 238 (App. Div. 2000) (holding that failureto comply with AMS must result in dismissal with prejudice, evenwhere plaintiff is a minor)). The dissent viewed Kubiak’sholding as inconsistent with the protective care courts of thisstate have traditionally accorded the tort claims of minors.Id. at 310. The dissent disputed Kubiak’s premise that “[a]dismissal for failure to comply with the [AMS] is not anydifferent than a dismissal after plenary or summaryadjudication” because the purpose of the AMS is to requireplaintiffs merely to make a facial showing of a meritoriousclaim and not to demonstrate any likelihood of success on themerits. Id. at 311 (first alteration in original) (quotingKubiak, 332 N.J. Super. at 238). Moreover, the dissent asserted that a finding ofexceptional circumstances would have been appropriate here,notwithstanding plaintiff’s failure to advance that claim, andthat such a finding in this case would not be disproportionateto other cases in which courts have found extraordinarycircumstances. Id. at 313. The dissent compared the minor’sattorney’s “fumbling of the [AOM] requirement” here to theattorney’s failure in Paragon, and argued that it should havebeen within the trial court’s discretion to either findextraordinary circumstances on the facts of this case or to havegranted a dismissal without prejudice, particularly because 10 defendants have suffered little by way of prejudice. Id. at313-14. Thus, the dissent would have reversed the judgment ofthe trial court in order to “foster[] disposition of cases ontheir merits rather than on procedural missteps.” Id. at 314.In sum, the dissent would have ordered entry of a dismissalwithout prejudice in light of A.T.’s minor status, herattorney’s mishandling of the AOM, and the relatively littleprejudice defendants have suffered, and would have allowed thetrial court the ability to impose conditions on the re-filing ofplaintiff’s claims. This matter is now before us on an appeal as of right fromthe dissent. R. 2:2-1(a)(2). In this appeal, the partiesrepeat arguments they advanced below. We also granted amicuscuriae status to the New Jersey Association for Justice and theNew Jersey Physicians United Reciprocal Exchange. II. The AMS requires a plaintiff to serve an affidavit of meritwithin sixty days of the filing of defendant’s answer; anadditional sixty days may be granted by a court upon good causefound. N.J.S.A. 2A:53A-27. The affidavit was identified earlyon by this Court as a required “threshold showing” that amalpractice claim is not frivolous. In re Petition of Hall, 147 N.J. 379, 391 (1997). We have recognized the Legislature’sintent that the statute facilitate the weeding-out of frivolous 11 lawsuits. Galik v. Clara Maass Med. Ctr., 167 N.J. 341, 350(2001); accord Alan J. Cornblatt, P.A. v. Barow, 153 N.J. 218,242 (1998). The failure to provide the affidavit or its legalequivalent is “deemed a failure to state a cause of action,”N.J.S.A. 2A:53A-29, and, not long after the AMS was enacted,this Court construed the statute to require dismissal withprejudice for noncompliance, Cornblatt, 153 N.J. at 247.However, we have recognized equitable exceptions to “temper thedraconian results of an inflexible application of the statute,”Ferreira, 178 N.J. at 151 (acknowledging applicability ofdoctrine of substantial compliance and extraordinarycircumstances), and we have created mechanisms to draw attentionto and facilitate satisfaction of this statutory obligation andits goals, id. at 154-55 (establishing discovery-stage casemanagement conference to encourage and facilitate compliancewith AMS requirements, to avoid dismissal of meritorious claimsdue to inadvertence, and to promote AMS’s goal of weeding outinsubstantial claims). The Ferreira conference was designed to be the Judiciary’skey tool to promote satisfaction of the AMS’s salutary policygoals. We mandated the conference and imposed requirements onboth courts and defendants to discover and address issues as tothe sufficiency of a plaintiff’s AOM. Id. at 155. In the 12 companion case to Ferreira, we stressed that the Ferreiraconference is required and reiterated that defendants must raiseany objections to an AOM that has been served: Our decision in Ferreira requires that an accelerated case management conference be held within ninety days of the service of an answer in all malpractice actions. That conference will allow the courts to head off potential discovery problems before they become the stuff of motions. At the case management conference, the defendant will be obliged to bring to the plaintiff’s attention any deficiency in an affidavit of merit already served in order to give the plaintiff the opportunity to cure the defect within the 120- day period. In the event that the affidavit has not been served, the court will remind the parties of their respective obligations. We trust that early court intervention will make the circumstances of this case unlikely to recur. [Knorr v. Smeal, 178 N.J. 169, 182 (2003) (emphases added).]See also Saunders ex rel. Saunders v. Capital Health Sys. atMercer, 398 N.J. Super. 500, 510 (App. Div. 2008) (“Contrary todefendants’ contention and the motion judge’s decision, Ferreiramandates a case management conference within ninety days of thefiling of an answer in a professional malpractice case.”). All that said, in 2010, we wrestled with the fact thatmandatory Ferreira conferences were not being routinelyconducted as expected, which was thwarting the salutary purposeof the conference requirement. We had sought in Ferreira “[to]ensure that discovery related issues, such as compliance with 13 the [AMS], do not become sideshows to the primary purpose of thecivil justice system –- to shepherd legitimate claimsexpeditiously to trial.” Paragon, 202 N.J. at 423 (quotingFerreira, 178 N.J. at 154). The conference was designed toserve as reminder of the obligation and to facilitate earlyidentification of “any deficiency in [an] affidavit” alreadyserved by a plaintiff. Id. at 423-24 (quoting Ferreira, 178 N.J. at 155). In Paragon, we confronted competing decisions inthe Appellate Division and trial courts over whether the failureto conduct a Ferreira conference worked a tolling or abeyance ofthe time period for assessing the timeliness of a late AOM. Ferreira and Knorr indicated that the conferences weremandatory, but we clarified in Paragon that, “[a]lthoughFerreira conferences should be held as a matter of course, theymay be omitted [upon submission of a proposed consent orderindicating that] 'the Affidavit of Merit has been provided byplaintiff and all defendants have waived any objections to itsadequacy.’” Id. at 424 (emphasis added) (quoting Waiver ofAffidavit of Merit Conference, 176 N.J.L.J. 1006 (2004)).Explaining that it is not “a tolling device,” we acknowledgedthat the conference “was never intended, nor could it have been,as an overlay on the statute that would effectively extend thelegislatively prescribed filing period.” Id. at 419. Althoughextraordinary circumstances were found to exist in Paragon due 14 to confusion about the tolling role of the Ferreira conference,id. at 425, we offered counsel for the future. Our decisionadded that, “going forward, reliance on the scheduling of aFerreira conference to avoid the strictures of the Affidavit ofMerit statute is entirely unwarranted and will not serve to tollthe statutory time frames.” Id. at 426. III. A. No Ferreira conference was conducted in this matter, and,when defendants filed a motion for summary judgment at theconclusion of the 120-day period, plaintiff included an AOM withher response to the motion. Nevertheless, the trial court feltconstrained to dismiss with prejudice. That result worked a double frustration. The Judiciary’skey tool to promote satisfaction of the AMS’s salutary policygoals was not employed. And the pruning of plaintiff’s claimwas not the pruning that the AMS is intended to achieve. Thestatute’s intended objective -- to curtail insubstantial claimsthrough the claimant’s inability to present a supportiveaffidavit early on, before significant litigation time andexpense are incurred -- was not advanced. Although the failure to conduct a Ferreira conference alonemay not demonstrate extraordinary circumstances, a confluence offactors persuades us to recognize this case as sufficiently 15 extraordinary to allow the untimely affidavit to be accepted andto require that the matter proceed on its merits. Our warning in Paragon that the failure to conduct aFerreira conference would not routinely toll the time forsubmission of an AOM was not meant to foreclose the finding ofextraordinary circumstances when a combination of eventsoccurred. Here, just such circumstances occurred, as noted inthe dissent’s distillation of what took place in the earlystages of this proceeding. An inexperienced practitioner became confused by timelinesand was “not as assiduous as he could or should have been” insecuring an AOM on a minor’s tort claim, filed well before anystatute of limitations period was close to expiring. Paragon,202 N.J. at 425. While that type of “attorney inadvertence”will not, standing alone, support a finding of extraordinarycircumstances, see Palanque v. Lambert-Woolley, 168 N.J. 398,405 (2001) (citing Cornblatt, 153 N.J. at 247), in this case,the Judiciary failed to do what this Court expected, namely toact as a backstop. No Ferreira conference was scheduled, whichwould have assisted in keeping the parties focused on the timingof the necessary affidavit. Counsel here did secure anaffidavit when defendants filed a motion for summary judgmentthree days after the time frame for submission of the AOM hadexpired. We presume from plaintiff’s swift compliance upon the 16 filing of the motion that we are dealing with a non-frivolousmatter, not the type of case that the AMS intended to weed out. Yet, the harsh consequence of dismissal with prejudice wasmeted out in this matter despite the fact that there is noprejudice to defendants that the equitable powers of our courtscannot address. Defendants are aware of the claim, so allowingit to proceed should not impair their ability to mount asubstantive defense to the merits of this claim. Permitting theclaim to go forward now, as opposed to proceeding by way of avoluntary dismissal without prejudice, eliminates the problem ofthe future prospect of an action being filed again, at someindefinite point, before the child’s age of maturity plus theexpiration of the statute of limitation period. Amicus NewJersey Physicians United Reciprocal Exchange raised a concernabout the prospect of a minor’s claim, dismissed withoutprejudice, being re-raised in the future as posing a problem formedical professionals required to secure malpractice insuranceas a condition of licensure. See N.J.S.A. 45:9-19.17 (requiringall physicians who maintain medical practice in New Jersey toobtain medical malpractice liability insurance); N.J.A.C. 13:35-6.18 (providing minimum standards of either medical malpracticeliability insurance coverage or letters of credit for physicianspracticing in New Jersey). And again, the trial court has thediscretion to require plaintiff to reimburse defendants for the 17 costs incurred in the extra proceedings that took place as aresult of the delayed compliance with the AMS, which canmitigate prejudice to defendants. Although this matter does not fit neatly into the factualscenarios of past extraordinary-circumstances cases, we arepersuaded that equitable relief should be afforded to plaintiff.We regard the circumstances of this case as extraordinary,viewed in combination with the Judiciary’s failure here. Thelack of a scheduled Ferreira conference significantlycontributed to an almost perfect storm of injustice. Plaintiffshould not be denied the opportunity to have her facially validclaim move forward and be addressed on its merits. B. Notwithstanding our determination to reverse the order ofdismissal entered by the trial court and affirmed by theAppellate Division, we further determine not to resort to avoluntary dismissal without prejudice under Rule 4:37-1(b) as anappropriate avenue for addressing the circumstances presented. Except in certain types of actions inapplicable here, aplaintiff may dismiss voluntarily an action without obtaining acourt order provided that either the dismissal occurs before theadverse party has filed an answer or a motion for summaryjudgment, whichever occurs first, or the plaintiff files astipulation signed by all parties who have appeared in the 18 action. R. 4:37-1(a). Unless otherwise specified, thedismissal is without prejudice in such circumstances. Ibid.Otherwise, “an action shall be dismissed at the plaintiff’sinstance only by leave of court and upon such terms andconditions as the court deems appropriate.” R. 4:37-1(b).Dismissals under subsection (b) are without prejudice unlessdirected differently by the court. Ibid. Generally stated, a dismissal with prejudice is regarded as“on the merits” of the claim, but a dismissal “based on acourt’s procedural inability to consider a case” is enteredwithout prejudice. Watkins v. Resorts Int’l Hotel & Casino,Inc., 124 N.J. 398, 415-16 (1991); Tsibikas v. Morrof, 5 N.J.Super. 306, 310 (App. Div. 1949); cf. R. 4:37-2(d) (“Unless theorder of dismissal otherwise specifies, a[n involuntary]dismissal under R. 4:37-2(b) or (c) and any dismissal notspecifically provided for by R. 4:37, other than a dismissal forlack of jurisdiction, operates as an adjudication on themerits.”). A dismissal specifying that it is “with prejudiceconstitutes an adjudication on the merits 'as fully andcompletely as if the order had been entered after trial.’”Velasquez v. Franz, 123 N.J. 498, 507 (1991) (quoting Gambocz v.Yelencsics, 468 F.2d 837, 840 (3d Cir. 1972)). Reviewing courts of this state frown on the use of adismissal without prejudice under Rule 4:37-1(b) as a mechanism 19 for salvaging a case that has run aground on requirementsestablished in statutes or in the Rules of Court. In rejectinguse of Rule 4:37-1 in such a situation, the Appellate Divisionexplained the reasons for deterring such interference with theorderly and efficient administration of litigation: [When] plaintiff faced defendants’ motion for summary judgment, and moved for a voluntary dismissal in response, the discovery end date had passed. At that point, absent court order, plaintiff was prohibited from offering his late expert report in opposition to defendants’ motion for summary judgment and from offering expert testimony at the time of trial. Instead of confronting this difficulty directly -- by seeking an extension of discovery pursuant to Rule 4:24-1(c) -- plaintiff opted for a solution that, when granted, severely prejudiced defendants by guaranteeing the unnecessary duplication of past efforts. The permission given to plaintiff to pursue a new, identical complaint without consequence also served to minimalize the central purpose of our court rules: the fair and efficient administration of justice. See Ragusa v. Lau, 119 N.J. 276, 283 (1990); Handelman v. Handelman, 17 N.J. 1, 10 (1954). Were we to endorse the order in question, we would legitimize a gaping loophole in the “Best Practices” rule amendments, which were intended to “improve” and not frustrate “efficiency and expedition of the litigation process.” Pressler, Current N.J. Court Rules, cmt. on R. 1:1-2 (2006). The process authorized by Rule 4:37-1(b) cannot be the means of avoiding the requirements of Rule 4:24-1(c) or the means for creating a less efficient or an uneven method for adjudicating disputes. Our modern procedures could not have evolved to the present day only to prove 20 irrelevant and ineffectual when faced with an artifice such as plaintiff created here. Plaintiff’s claim to relief from his “logistics problem” should have been pursued directly, not disingenuously. Instead of resorting to the charade of a voluntary dismissal coupled with the unveiling of a new complaint waiting in the wings, plaintiff should have first been obligated to seek relief from the discovery end date. Because plaintiff opted not to pursue that proper course, we conclude that the trial judge erred in granting a voluntary dismissal without prejudice, which had the undesirable effect of unraveling all that had been accomplished in this litigation. [Shulas v. Estabrook, 385 N.J. Super. 91, 102- 03 (App. Div. 2006).]As Shulas makes evident, dismissal under Rule 4:37-1(b)’sprovisions -- requiring court order and on terms as appropriate-- serves to protect a defendant from being subjected toduplicate costs of litigation if forced to defend another actionbased on the same set of claims. See also Union Carbide Corp.v. Litton Precision Prods., Inc., 94 N.J. Super. 315, 317 (Ch.Div. 1967) (recognizing same policy goals). That said, westress that to the extent that Shulas seemed to suggest thepresence of bad faith, that concern is not present here. Cracking open the use of dismissals of actions withoutprejudice to allow more time whenever a plaintiff runs agroundon the requirements of the AMS would prolong litigation andpotentially eviscerate the AMS policy of weeding out, early on, 21 non-meritorious malpractice cases. While the dissent here didnot suggest such a broad use and emphasized the extraordinarycircumstances present, we decline to send the matter back forentry of a dismissal without prejudice and instead rely on thepresence of extraordinary circumstances to reverse the dismissalentered below. We caution courts to adhere to the spare use ofdismissals without prejudice as prior case law instructs. SeeShulas, 385 N.J. Super. at 102-03. C. In conclusion, this Court will take additionaladministrative steps to promote adherence to the AMS’s salutarygoal of promptly culling frivolous malpractice claims and topromote the effective use of court and attorney resources sothat meritorious cases may advance efficiently. We designed ourFerreira conference requirement to promote such purposes. Wemade the conference mandatory to underscore its importance. Weimposed the burden of complying with the conference requirementon both attorneys and the Judiciary. We created that failsafemechanism within our system of case management envisioning thatthe required conference would be held unless it were knowinglywaived. But systems can be imperfect, as this case reflects. The failure of the Judiciary’s current mechanisms to ensurethe scheduling of the required Ferreira conference will not be 22 permitted to work an injustice in this matter. More improvementin our mechanisms is necessary, however. Going forward, advancements in our automated casemanagement system will permit electronic notification of (1) theAOM filing obligation and (2) the scheduling of a Ferreiraconference. The electronic case management system will beupdated to issue notices to counsel and accomplish those tasks.Further details concerning those improvements will be providedthrough the Administrative Office of the Courts. With our announcement of those improvements comes acautionary note. Counsel are on notice that disregarding thescheduling of the conference, or waiving the conference, willnot provide a basis for relief from AMS obligations. IV. The judgment of the Appellate Division is reversed. Thematter is remanded to the trial court for further proceedingsconsistent with this opinion. CHIEF JUSTICE RABNER and JUSTICES ALBIN, PATTERSON, FERNANDEZ-VINA, SOLOMON, AND TIMPONE join in JUSTICE LaVECCHIA’s opinion. 23