Court Opinion

ID: 9702202
Source: CourtListenerOpinion
Date Created: 2023-08-25 23:00:28.725075+00
Date Added: 2024-06-11T15:10:32.576356
License: Public Domain

Justice ZAZZALI
concurring in part, and dissenting in part.
Since we embraced the seemingly straightforward discovery rule over forty years ago, our jurisprudence has applied that equitable doctrine to accommodate varied and complex factual circumstances. That precedent should enable us, in this appeal, to determine the appropriate formulation of the discovery rule in the context of a complicated medical malpractice case.
*287Although I agree with the concurrence in its decision to remand as to Somerset Medical Center, I respectfully disagree with its conclusion that plaintiff exceeded the statute of limitations in the Harborside matter.
I.
The per curiam opinion fairly sets forth the relevant facts in this appeal. I emphasize only the following.
On April 15, 1999, plaintiff visited his friend, Eugene Burns, at Harborside Nursing Home. During his visit of approximately two hours, plaintiff understood that Burns was afraid and dissatisfied with the care he was receiving. Plaintiff spent the rest of that day trying to locate alternative care for Bums. However, the next morning plaintiff received word that Burns was straggling to breathe and that Harborside had transferred him to Somerset Medical Center. The next day, a doctor from Somerset informed plaintiff that Burns had died of heart failure.
Two to three weeks later, plaintiff contacted an attorney who advised him to obtain the decedent’s medical records. Plaintiff certified that “upon obtaining those records [he] realized that [his] suspicions concerning the cause of [Mr. Burns’s] death might rest at the hands of Harborside.” Plaintiff filed a complaint on April 26, 2001.
The experts’ reports indicate the following medical history of decedent. In 1999, doctors discovered that Burns had an ascending aortic aneurysm during a pre-operation medical exam relating to reconstructive knee surgery. On February 5, 1999, doctors at Robert Wood Johnson University Hospital operated on Burns and replaced the aortic valve. The same day, they operated for tamponade (the restriction of the heart due to an accumulation of fluid). Post-operation, Burns failed to breathe adequately and was reintubated. Because he could not be taken off of a ventilator, Bums required a tracheotomy. While at Robert Wood Johnson, Bums suffered from pneumonia and colitis. On April 13, 1999, Robert Wood Johnson transferred Burns to Harborside for *288continued full-time care. Bums died on April 17,1999, at Somerset Hospital.
The defense expert stated that the cause of Burns’s death was “overwhelming septic shock as a result of severe pseudomembraneous colitis complicated by fecal impaction and massive cecal distention with probable syndrome of toxic megacolon.” The plaintiffs expert asserted that “the combined respiratory arrest with hypoxia and later development of coma and respiratory acidosis ... cause[d] the untimely death of’ Burns.
II.
Under the equitable doctrine of the discovery rule, “a cause of action will be held not to accrue until the injured party discovers, or by an exercise of reasonable diligence and intelligence should have discovered[,] that he may have a basis for an actionable claim.” Lopez v. Swyer, 62 N.J. 267, 272, 300 A.2d 563 (1973). This equitable doctrine tempers the harshness of statutes of limitations, which are “designed to stimulate litigants to pursue their actions diligently.” Mancuso v. Neckles, 163 N.J. 26, 29, 747 A.2d 255 (2000). The discovery rule requires that a plaintiff have “knowledge not only of the injury but also that another is at fault” to start the statutory period. Guichardo v. DeLisi, 177 N.J. 45, 51, 826 A.2d 700 (2003) (internal quotation marks and citation omitted).
However, in cases of complex medical causation, such as the present matter, “it is not at all self-evident that the cause of the injury [is] ... the fault of ... a third party.” Mancuso, supra, 163 N.J. at 34, 747 A.2d 255 (internal quotation marks and citation omitted). Because fault is not readily ascertainable in such situations, we apply a specialized formulation of the discovery rule and “require[ ] [more] than mere speculation or an uninformed guess” to start the statutory period. Ibid. A plaintiff must have “some reasonable medical support that there was a causal connection between [the plaintiffs] condition and [the defendant’s] conduct” before we will deem him or her to have the requisite knowledge of *289the facts that trigger the statutory period. Ibid, (emphasis added) (internal quotation marks omitted); see also Guichardo, supra, 177 N.J. at 51, 826 A.2d 700; cf. Vispisiano v. Ashland Chem. Co., 107 N.J. 416, 437, 527 A.2d 66 (1987) (recognizing toxic tort plaintiffs must have some reasonable medical support to trigger statute of limitations in discovery rule context).
III.
Because the concurrence deems plaintiff to have had sufficient knowledge of Harborside’s fault based solely on his personal observations, rather than reasonable medical support, I dissent on that issue.
A.
As Burns’s medical history demonstrates, this appeal presents a case of complex medical causation. The cause of Burns’s death is so unclear that the medical experts did not articulate the same cause of death. The defense expert stated that the theory that the allegedly inadequate suctioning at Harborside led to Burns’s death “is a totally unsubstantiated conclusion and [is] ignorant of the obvious cause of death in this case,” i.e., septic shock. Plaintiff’s expert stated the opposite. Additionally, in the two and one-half months preceding his death, Burns did not suffer from just one ailment. Rather, he endured a series of medical conditions including an aortic aneurysm, an inability to breathe on his own, pneumonia, and colitis. Moreover, the Harborside nurse’s statement that the doctor’s orders prohibited her from suctioning Burns, other than at specified intervals, further masked the cause of Burns’s death because a layperson would not be able to determine if such an order was medically inappropriate. Finally, at oral argument defense counsel agreed with the principle “that without the medical records there is no conceivable way that anyone would have a reasonable basis on which to conclude that there was an actionable claim.” It is for this type of malpractice *290case that we have developed the complex medical causation formulation of the discovery rule.
B.
I believe that plaintiff satisfied the statute of limitations period because he filed his complaint within two years of obtaining “some reasonable medical support” demonstrating a causal connection between Burns’s death and Harborside’s conduct. See Mancuso, supra, 163 N.J. at 34, 747 A.2d 255.
The concurrence’s conclusion that plaintiff discovered Harbor-side’s negligence at the time of Burns’s death hinges on language in Martinez v. Cooper Hospital-University Medical Ctr., 163 N.J. 45, 52, 747 A.2d 266 (2000): “The question is whether the facts presented would alert a reasonable person ... that he or she was injured due to the fault of another ... whether plaintiff knew or should have known of sufficient facts to start the statute of limitations running.” (Internal quotation marks and citation omitted). However, in Mancuso, supra, decided the same day as Martinez, we further modified “knowledge of fault” in the unique circumstances of complex medical causation cases. 163 N.J. at 34, 747 A.2d 255. In such situations, the statute of limitations will not start until plaintiff has “some reasonable medical support” for his suspicions. Ibid.
Under that formulation of the discovery rule, plaintiff first discovered Harborside’s malpractice when he received Burns’s medical records — some time after plaintiff consulted with his attorney two to three weeks after Burns’s death. As the concurrence notes, those records “evidenced that the medical care Bums received at Harborside contributed to his death.” Ante 182 N.J. at 279, 865 A.2d at 639. Until that point, as defense counsel conceded at oral argument, plaintiff could only “speculate” or make an “uninformed guess” that Harborside had been negligent. The contradictory conclusions of the medical experts demonstrate the problematic causal nexus in this case. It is unfair to demand that plaintiff — a former police officer and gas station owner — be *291able to identify a causal connection between Burns’s death and Harborside’s refusal to suction Burns. Indeed, this Court, in our unanimous per curiam opinion, does not expect laypersons to understand fully the medical significance of suctioning, given the inclusion of a footnote explaining the technical process and function of suctioning. Ante 182 N.J. at 278, 865 A.2d at 638. Nonetheless, the concurrence requires this plaintiff to recognize the causal nexus between Harborside’s conduct and Burns’s death without the aid of some reasonable medical support.
In complex medical causation cases like the present matter, it is not enough for statute of limitation purposes that plaintiff knew that Burns was dissatisfied with the care he received. Rather, Mancuso, Vispisiano, and Guichardo instruct that plaintiff must have some reasonable medical support for his belief that defendant committed medical malpractice. The heart-wrenching pleadings of a frightened and sick man do not constitute medical support, even if the patient’s fears are later realized. To hold otherwise is to encourage plaintiffs to file medical malpractice claims, even in the unique circumstances of complex medical causation, whenever they are dissatisfied with their treatment without first obtaining some reasonable medical support for their claims. That approach invites frivolous litigation and is inconsistent with our decision in Martinez, supra, 163 N.J. at 58, 747 A.2d 266, on which the concurrence depends. There, we held:
It is not necessary every time a person dies in a hospital for his or her relatives to immediately suspect malpractice. People die in hospitals in the absence of wrongdoing (for example, those gravely injured in accidents and the infirm elderly). Many times complications arise even if a procedure is performed perfectly. [Ibid, (citing Newmark v. Gimbel’s Inc., 54 N.J. 585, 596-97, 258 A.2d 697 (1969)).]
As in Martinez, supra, we should not expect the lay plaintiff here to immediately suspect that Harborside’s refusal to suction Burns contributed to his friend’s death. Indeed, as one of Burns’s nurses later testified at her deposition, the decision not to suction serves a legitimate medical purpose: “to train [patients’ bodies] to [cough] up the secretions by themselves,” which prevents them from becoming dependent on suctioning. Moreover, Burns’s need *292of a tracheotomy and twenty-four hour care evidences the gravity of his condition in the days and weeks before his death. A reasonable person easily could have believed that Burns simply suffered complications from his illnesses. Ibid. Indeed, given Burns’s recent medical history, that was the sensible inference to be drawn at the time. Unlike situations of obvious medical malpractice — such as the amputation of the wrong leg — this appeal involves a complicated series of events that ultimately caused Burns’s death.
Moreover, this matter presents a less obvious case of third party fault than did Guichardo, supra, where we applied the discovery rule and allowed plaintiff to assert a claim against defendant eight months after obtaining an expert’s opinion that defendant’s negligence contributed to plaintiffs injury and almost four years after the negligence occurred. 177 N.J. at 55, 826 A.2d 700. There, the defendant physician admitted to plaintiff that “something went wrong with” the procedure two days after he negligently failed to diagnose plaintiffs condition. Id. at 48, 826 A.2d 700. In contrast, here, plaintiff did not have the benefit of an admission by Harborside. Yet, plaintiff was still able to assert his claim only two years and eleven days after the negligence occurred. Thus, the facts supporting application of the discovery rule in this matter are even more compelling than in Guichardo.
In sum, consistent with our decisional law, I would not require plaintiff to differentiate between a case of medical malpractice and one of unavoidable death without the benefit of some reasonable medical support. To insist on that expertise, even when the plaintiff observes defendant’s negligent behavior, in effect requires that a layperson understand the medical consequences of a health care professional’s decisions. Although such a requirement may be appropriate in general medical malpractice cases, that expectation is inconsistent with the equitable nature of the discovery rule when applied in the context of complex medical causation.
Accordingly, I would hold that the statute of limitations began to run when plaintiff obtained Burns’s medical records. As de*293fense counsel conceded at oral argument, plaintiff had no reasonable basis for concluding that he had an actionable claim against Harborside until he obtained those records. She also acknowledged that without those records there was no conceivable way that anyone would have a reasonable basis to conclude that there was an actionable claim. It is my view, as well, that plaintiff initially discovered or should have discovered that he might “have a basis for an actionable claim” against Harborside when he received those records. Lopez, supra, 62 N.J. at 272, 300 A.2d 563. Although the exact date is unclear, it is certain that plaintiff did not receive those records before May of 1999. Under that construct, the statute of limitations expired no earlier than May of 2001. Because plaintiff filed his complaint on April 26, 2001, he did so within the two-year statute of limitations.
IV.
The concurrence states that the approach I support would delay the start of the limitation period “until the whimsical date” when the plaintiff receives the medical records. Ante, 182 N.J. at 286, 865 A.2d at 643. As a result, that methodology would extend the limitations period “in almost every medical malpractice case.” Ante, 182 N.J. at 286, 865 A.2d at 643.
Respectfully, that fear is groundless. The methodology that I describe is neither whimsy nor whim. It is the established procedure that is rooted in the Mancuso, Vispisiano, and Guichardo trilogy. Far more important, the spectre that the concurrence imagines — that this procedure would extend the statute of limitations in “almost every medical malpractice case” — is, like all spectres, an illusion. As a general rule, it is not in a plaintiffs interest to delay the commencement of litigation. More to the point, even if a plaintiff does protract matters, the fear of an open-ended process is misplaced. Less than two years ago, when we applied the discovery rule in Gmchardo, supra, we also stated that “nothing in our jurisprudence ... would bar the application of other equitable principles such as unclean hands or laches to avoid *294undue prejudice to a potential defendant.” 177 N.J. at 55-56, 826 A.2d 700. The laches defense applies when plaintiff “delay[s] for a length of time which, unexplained and unexeused, is unreasonable under the circumstances and has been prejudicial to the other party.” Mancini v. Twp. of Teaneck, 179 N.J. 425, 437, 846 A.2d 596 (2004) (internal quotation marks and citation omitted) (recognizing applicability of laches in context of continuing violation of Law Against Discrimination).
In some instances of complex medical causation, an unknowing plaintiff may not have any reason to suspect medical malpractice until the statutory period has passed. See, e.g., Mancuso, supra; ante at 182 N.J. 285, 865 A.2d at 642. In such circumstances, the defense of laches may or may not be convincing. In other complex medical causation cases, like the present one, a plaintiff may have the “mere suspicion” of medical malpractice but lack reasonable medical support for that belief. If such a plaintiff unreasonably delays in obtaining reasonable medical support, a defendant could invoke a laches argument and likely avoid application of the discovery rule. Thus, my approach appropriately recognizes the purpose of statutes of limitations — to encourage potential plaintiffs to diligently pursue their claims.
Quite apart from exactly when plaintiff obtained the medical records, it appears, as defense counsel conceded at oral argument, that plaintiff acted diligently for discovery rule purposes. Cf. Guichardo, supra, 177 N.J. at 49, 826 A.2d 700 (applying discovery rule where plaintiff obtained expert opinion implicating defendant nearly four years after negligence occurred); Mancuso, supra, 163 N.J. at 30, 747 A.2d 255 (applying discovery rule where plaintiff obtained expert opinion implicating defendant seven years after negligence occurred). Nonetheless, as a matter of fairness, I would remand to the trial court to allow Harborside the opportunity to assert its laches argument. Indeed, each party would be permitted to make equity-based arguments on remand. The trial court would then determine whether it is fair to allow plaintiff to proceed with his claim.
*295V.
As for the concurrence’s reasonable person test, I recognize that plaintiff read Burns’s note, was confused by the nursing staffs contradictory statements regarding Burns’s treatment, knew that the decedent had trouble breathing, and knew of the cause of death. However, I do not believe that those facts would cause a reasonable person to recognize that Harborside may have committed medical malpractice.
First, the fears of a gravely ill, seventy-eight year old man, who was dissatisfied with the care and attentiveness he received from the staff, do not necessarily indicate that medical malpractice occurred. This is true even though those same facts spurred plaintiff to make Burns more comfortable by seeking care for him elsewhere. Second, the nurse’s statement concerning the suctioning orders does not indicate that plaintiff knew or should have known of Harborside’s negligence because a reasonable layperson would not understand all of the medical consequences of a decision not to suction, or to suction at particular intervals, especially in light of the confusing and contradictory information with which plaintiff was presented that day. Finally, the causal connection between Burns’s difficulty breathing, Harborside’s refusal to suction, and Burns’s ultimate death is technical and not at all obvious to a non-medically trained layperson. Indeed, considering that Burns began struggling to breathe after his surgery, plaintiff may not have immediately assumed that a lack of suctioning caused Burns’s continued struggle to do so while at Harborside. Moreover, the Somerset doctor who informed plaintiff of Burns’s death explained, and plaintiff understood, the cause as “heart failure” — a cause that does not, of itself, suggest a connection to suctioning.
Thus, even applying the test of the concurrence, I would hold that plaintiff did not have sufficient information at the time of Burns’s death to begin the statute of limitations. Because I believe that plaintiff should receive the benefit of the discovery rule, I respectfully dissent with respect to defendant Harborside. As noted, however, I would remand to allow both sides to present *296their equity arguments more fully. That approach fairly balances the interests of the parties.
Justices LONG and ALBIN join in this opinion.
For affirmance as to Harborside — Chief Justice PORITZ and Justices WALLACE and RIVERA-SOTO — 3.
For reversal as to Harborside — Justices LONG, ZAZZALI and ALBIN — 3.
For reversal and remandment as to Somerset — Chief Justice PORITZ and Justices LONG, ZAZZALI, ALBIN, WALLACE and RIVERA-SOTO — 6.