Court Opinion

ID: 9961221
Source: CourtListenerOpinion
Date Created: 2024-04-18 14:08:06.699586+00
Date Added: 2024-06-11T08:20:28.650482
License: Public Domain

NOT FOR PUBLICATION WITHOUT THE
               APPROVAL OF THE APPELLATE DIVISION

                                    SUPERIOR COURT OF NEW JERSEY
                                    APPELLATE DIVISION
                                    DOCKET NO. A-3847-22

EARNEKA WIGGINS and LYNDA
MYERS, as administratrixes of the
estate of APRIL CARDEN,
deceased,                                 APPROVED FOR PUBLICATION
                                                 April 18, 2024
      Plaintiffs-Respondents,
                                             APPELLATE DIVISION

v.

HACKENSACK MERIDIAN
HEALTH, d/b/a JFK UNIVERSITY
MEDICAL CENTER,

      Defendant-Respondent/
      Cross-Appellant,

and

ALOK GOYAL, M.D., and
SOUTH PLAINFIELD PRIMARY
CARE,

      Defendants-Appellants/
      Cross-Respondents.

            Argued January 24, 2024 – Decided April 18, 2024

            Before Judges Currier, Susswein and Vanek.

            On appeal from the Superior Court of New Jersey,
            Law Division, Union County, Docket No. L-0005-23.
            Richard J. Tamn, Jr., argued the cause for
            appellants/cross-respondents (Krompier & Tamn,
            LLC, attorneys; Richard J. Tamn, Jr., of counsel and
            on the brief; Jason Michael Altschul, on the brief).

            Katelyn E. Cutinello argued the cause for
            respondent/cross-appellant (Cocca & Cutinello, LLP,
            attorneys; Anthony Cocca and Katelyn E. Cutinello, of
            counsel and on the brief).

            Michael Scott Katz argued the cause for respondents
            Earneka Wiggins and Lynda Myers (Lopez McHugh,
            LLP, attorneys; Michael Scott Katz, on the brief).

      The opinion of the court was delivered by

CURRIER, P.J.A.D.

      On leave granted, in this medical negligence matter, we consider

whether N.J.S.A. 2A:53A-41(a) under the New Jersey Medical Care Access

and Responsibility and Patients First Act (Act), N.J.S.A. 2A:53A-37 to -42,

requires plaintiffs to serve an affidavit of merit (AOM) from a physician board

certified in both specialties if defendant physician is board certified in two

specialties, and the treatment claimed to be negligent involves both specialties.

Plaintiffs rely on Buck v. Henry, 207 N.J. 377 (2011), in asserting they need

only provide an AOM from a physician who specializes in either of the

defendant doctor's specialties. The trial court agreed and denied defendants'

motions for dismissal of the complaint and reconsideration.

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      Because the facts presented here are distinguishable from Buck and the

discrete ruling in Buck was not specific to this issue, and in considering the

purpose of the Act, we conclude plaintiffs must serve an AOM from a

physician board certified in each of defendant doctor's specialties. We are

guided by the kind-for-kind, credential equivalency requirement articulated in

N.J.S.A. 2A:53A-41(a) and the legislative purpose of the Act. Therefore, we

reverse the court's order denying reconsideration. However, because plaintiffs

raised the issue of a waiver from the AOM requirement, and the issue was

fully briefed and discussed during oral argument before the trial court, we

remand for the court to make a determination on the waiver issue.

                                      I.

      We derive our facts from the limited record before the trial court. In

December 2015, defendant Alok Goyal, M.D., prescribed tramadol to decedent

April Carden for pain associated with a medical condition.       Dr. Goyal is

employed by defendant South Plainfield Primary Care. 1       In January 2016,

another doctor prescribed allopurinol for Carden.     Plaintiffs allege Carden

1
   Dr. Goyal and South Plainfield Primary Care were represented by the same
attorney. All pleadings were filed on behalf of both the doctor and the entity.
We refer only to Dr. Goyal for the ease of the reader.

                                                                        A-3847-22
                                      3
suffered an allergic reaction from either medication or a combination of the

two and was treated for Stevens-Johnson Syndrome 2 in 2016.

      According to the complaint, Carden was treated for a blood clot at

defendant Hackensack Meridien Health d/b/a JFK University Medical Center

(JFK) in August 2020. She was discharged on September 3, 2020. Dr. Goyal

prescribed allopurinol which Carden took from September 4 to 8.            On

September 9, Carden was admitted to JFK and treated for Stevens-Johnson

Syndrome. She died on September 29, 2020, from cardiopulmonary arrest

attributed to "multiple organ failure, bacteremia, and Stevens[-]Johnson

Syndrome." Plaintiffs allege Carden's death was attributed to the usage of

allopurinol.

      Plaintiffs, as administratrices of Carden's estate, filed a complaint

against defendants alleging Dr. Goyal breached the applicable standard of care

and was negligent in his treatment of Carden, causing her injuries and death.

The complaint described Dr. Goyal as a physician "specializing in the field of

2
   Stevens-Johnson Syndrome is a rare disorder most commonly caused by an
adverse drug reaction; it "causes painful blisters and lesions on the skin and
mucous membranes and can cause severe eye problems." Esen Karamursel
Akpek, M.D., Stevens-Johnson Syndrome, Johns Hopkins Med.,
https://www.hopkinsmedicine.org/health/conditions-and-diseases/stevens-
johnson-syndrome (last visited Apr. 9, 2024).

                                                                       A-3847-22
                                      4
internal medicine and gastroenterology."       Plaintiffs asserted a claim of

vicarious liability against JFK.

      In answering the complaint, Dr. Goyal included a "specialty statement"

stating:   "At all relevant times, these defendants practiced the medical

specialties of [i]nternal [m]edicine and [g]astroenterology and their treatment

of plaintiffs' decedent involved the medical specialties of [i]nternal [m]edicine

and [g]astroenterology."

      Plaintiffs served an AOM against all defendants from Stella Jones

Fitzgibbons, M.D., FACP, FHM. 3 Dr. Fitzgibbons, licensed in Texas, certified

she was board certified in internal medicine, and practiced clinical internal

medicine for the majority of her professional time in the year before the events

leading to Carden's 2020 treatment and death. Dr. Fitzgibbons opined there

was a "reasonable probability" that defendants' treatment of Carden deviated

from "professional treatment standards."

      Defendants objected to the AOM. Dr. Goyal sent plaintiffs' counsel a

letter asserting that Dr. Fitzgibbons was not qualified to execute the AOM

because she was only board certified in internal medicine, and not in both of

Dr. Goyal's specialties. JFK objected to the AOM on the same grounds.

3
  FACP is Fellow of the American College of Physicians; FHM is Fellow in
Hospital Medicine.

                                                                          A-3847-22
                                       5
       The Essex County judge 4 conducted a Ferreira5 conference in late

November or early December 2022. There was no transcript of the hearing.

The judge did not issue an order.

                                       A.

       In December 2022, Dr. Goyal moved to dismiss the complaint, asserting

Dr. Fitzgibbons was not board certified in the same specialties as he was:

internal medicine and gastroenterology. Therefore, the AOM was deficient

under N.J.S.A. 2A:53A-41. Counsel certified plaintiffs had not requested a

sixty-day extension during the Ferreira conference, or thereafter, to file a new

AOM.

       The supporting documentation included a certification from Dr. Goyal

stating that he treated Carden as an internal medicine doctor and

gastroenterologist and he was board certified in both specialties. He also listed

specific medical conditions and treatment he provided or recommended to

Carden and included a portion of Carden's medical records detailing his

examinations and treatment from November 2016 to February 2020.

4
    The complaint was originally filed in Essex County.
5
    Ferreira v. Rancocas Orthopedic Assocs., 178 N.J. 144 (2003).

                                                                          A-3847-22
                                        6
      On December 22, 2022, an Essex County judge granted JFK's motion to

change venue and transferred the matter to Union County. Thereafter, JFK

cross-moved for dismissal on the grounds that the AOM was deficient.

      Plaintiffs opposed both motions and included a certification from Dr.

Fitzgibbons stating that Dr. Goyal's medical records reflected he had

prescribed allopurinol to Carden to treat high uric acid levels. Dr. Fitzgibbons

certified that "[h]igh uric acid levels can cause gout or kidney stones," but

those were not gastrointestinal conditions. The doctor stated she was unaware

of any "gastrointestinal condition that is treated by allopurinol."

      Plaintiffs also submitted a certification from Todd D. Eisner, M.D., a

licensed physician in Florida who specialized in the field of gastroenterology.

Dr. Eisner certified he "was asked to review this matter to see if the defendant

gastroenterologist was negligent in his practice of gastroenterology. . . . [He]

[was] familiar with the prescribing of allopurinol and [was] aware of no known

gastrointestinal condition that is treated by allopurinol."

                                        B.

      During oral arguments on the motions in March 2023, the court directed

plaintiffs' counsel to submit evidence of their efforts to acquire a

                                                                         A-3847-22
                                         7
gastroenterology expert. 6     Thereafter, plaintiffs' counsel submitted a

"supplemental memorandum in support of responses to motions to dismiss

complaint    and   counter   motion   for   relief."   Counsel   listed    twelve

gastroenterologists he "inquired upon" "to support" the case.

      Counsel stated only two physicians provided certifications—one of

which was from Dr. Eisner. A second gastroenterologist—Stuart I. Finkel,

M.D., stated he was asked to review the matter but "could not sign an [AOM]

because [he] d[id] not have experience in the diagnosis or management of the

conditions at issue, as there did not appear to be any [g]astrointestinal issues

for [him] to consider." 7

      The supplemental memorandum then asserted plaintiffs met the criteria

under N.J.S.A. 2A:53A-41(c) to obtain a waiver. Counsel stated he asked for

an exemption during oral argument and in a "counter-motion."              Counsel

asserted "[p]laintiffs continue to formally request an exemption pursuant to

[N.J.S.A.] 2A:53A-41(c), whether said request was found in their prior briefs,

6
  The record does not include the transcript of this oral argument. However,
the court referred to its request in its June 29, 2023 written statement of
reasons accompanying the order denying reconsideration of the denial of
defendants' dismissal motions.
7
     Counsel also represented he had communication from a third
gastroenterologist. There is no certification from this doctor. Therefore, we
cannot consider this hearsay evidence.

                                                                           A-3847-22
                                       8
or currently nunc pro tunc or by way of the instant document (formally titled a

counter[-]motion)."

      Plaintiffs' counsel contended the Essex County judge expressed her

opinion during the Ferreira conference "that Dr. Goyal was NOT acting as a

gastroenterologist at the time of treatment and that Dr. Goyal would have to

produce an affidavit to that end to prove otherwise." Therefore, counsel stated

he "followed the court's direction and . . . believed that this was not a case

involving a gastroenterologist." Counsel explained that was why he did not

file a formal motion requesting a waiver and asked the court to consider this

"[c]ounter-[m]otion."

      In April, the court requested additional briefing and held a second oral

argument.    We have not been apprised of the issues on which the court

requested briefs, and were not provided with the transcript of the argument.

                                        C.

      On May 9, 2023, the court denied defendants' motions to dismiss the

complaint. The court found that the Essex County judge "required Dr. Goyal

to provide a certification that he prescribed [a]llopurinol in his capacity as a

gastroenterologist." Therefore, plaintiffs "had a good faith belief to rely on

[their] understanding . . . that Dr. Goyal had to provide a [c]ertification that he

prescribed [a]llopurinol in his capacity as a gastroenterologist."

                                                                            A-3847-22
                                        9
       The court stated:

             [B]ased on all the circumstances, including the efforts
             by [p]laintiffs to identify a doctor who specialized as
             both a gastroenterologist and internist, taken together
             with [p]laintiffs' unrefuted position as to what
             transpired at the Ferreira conference, and in light of
             Dr. Goyal's 12/12/22 certification and its lack of
             specificity as to focusing on the treatment act of
             prescribing [a]llopurinol, . . . the "care and treatment
             at issue" was the prescribing of [a]llopurinol, and the
             "care or treatment at issue involves internal
             [medicine]."

             [(Last alteration   in   original)   (quoting   N.J.S.A.
             2A:53A-41).]

       The court then stated that "[a]lternatively," plaintiffs complied with the

Act as delineated by the Supreme Court in Buck, but the court was not making

a ruling on that basis. The trial court cited to two sentences from Buck: "A

physician may practice in more than one specialty, and the treatment involved

may fall within that physician's multiple specialty areas.      In that case, an

[AOM] from a physician specializing in either area will suffice." 207 N.J. at

391.   Therefore, the trial court advised that Dr. Fitzgibbons's [AOM] was

sufficient because she "specialize[d] in internal medicine—one of the two

fields of Dr. Goyal's expertise." The court did not rule on whether plaintiffs

demonstrated the requirements to establish a waiver of the requisite AOM.

However, the court stated "it accept[ed]" plaintiffs' counsel made "good faith

and honest" efforts to obtain an AOM from a gastroenterologist. The court

                                                                          A-3847-22
                                       10
also noted that plaintiffs only filed opposition to the dismissal motions and did

not file a cross-motion.

                                       D.

      Dr. Goyal moved for reconsideration.         The submission included a

certification from Meyer N. Solny, M.D., who was board certified in and

practiced internal medicine and gastroenterology. Dr. Solny stated allopurinol

was "not solely prescribed for internal medicine purposes." He certified "[t]he

use   of   [a]llopurinol   in   gastroenterology     [wa]s   well-known"      and

gastroenterologists regularly prescribe it in their practices. Dr. Solny advised

that "[a]ll treatment provided by a gastroenterologist necessarily involves

knowledge of both [gastroenterology] and internal medicine."           Therefore,

"only another gastroenterologist possesses the knowledge, skill[,] and

experience to identify the applicable standard of care of a gastroenterologist."

      Dr. Goyal's counsel also submitted a certification stating he attended the

Ferreira conference during which the Essex County judge "directed that the

dispute be resolved via motion and indicated that in determining the motion

she would want to see a [c]ertification from Dr. Goyal that his treatment

involved gastroenterology." Therefore, counsel prepared a certification for Dr.

Goyal's signature, "consistent with the [c]ertification requested by [the Essex

County judge]." However, the case was subsequently transferred to Union

                                                                           A-3847-22
                                       11
County, and the Essex County judge never considered the dismissal motions.

JFK cross-moved for reconsideration.

        On June 29, 2023, the court denied defendants' motions for

reconsideration. The court stated that the reference in Buck that "an [AOM]

from a physician specializing in either area will suffice" "remain[ed] good

law." The court explained it "made a finding that the care at issue in this case

was one that involved internal medicine such that a [c]ertification from a

gastroenterologist specialist is not needed." We granted defendants leave to

appeal.

                                        II.

        On appeal, defendants contend the trial court erred in denying the

motions for reconsideration because plaintiffs did not serve the required AOM

under     N.J.S.A.   2A:53A-41(a)(2).         Under   the   statute's   kind-for-kind

requirement, the physician executing the AOM must be qualified in the

specialties practiced by the defendant physician. Defendants further assert the

trial court erroneously made a factual determination that Dr. Goyal prescribed

allopurinol to Carden in his capacity as an internal medicine physician. In

addition, any statement the Essex County judge may have made to the parties

during the Ferreira conference was not a ruling on the merits and could not be

used by plaintiffs to support their argument they satisfied the AOM

                                                                              A-3847-22
                                        12
requirement.   Defendants contend the complaint must be dismissed with

prejudice.

      Our review of the court's order interpreting compliance with the Act is

de novo. Meehan v. Antonellis, 226 N.J. 216, 230 (2016). However, we

consider a trial court's denial of a motion for reconsideration under an abuse of

discretion standard. Branch v. Cream-O-Land Dairy, 244 N.J. 567, 582 (2021)

(citing Kornbleuth v. Westover, 241 N.J. 289, 301 (2020)). "An abuse of

discretion 'arises when a decision is "made without a rational explanation,

inexplicably departed from established policies, or rested on an impermissible

basis."'" Pitney Bowes Bank, Inc. v. ABC Caging Fulfillment, 440 N.J. Super.

378, 382 (App. Div. 2015) (quoting Flagg v. Essex Cnty. Prosecutor, 171 N.J.

561, 571 (2002)).

                                       A.

      Under N.J.S.A. 2A:53A-26 to -29 (the AOM statute), a plaintiff in a

medical malpractice action must "provide each defendant with an affidavit of

an appropriate licensed person that there exists a reasonable probability that

the care, skill or knowledge exercised or exhibited in the treatment, practice or

work that is the subject of the complaint, fell outside acceptable professional

or occupational standards or treatment practices." N.J.S.A. 2A:53A-27. The

AOM must be served within sixty days of the defendant's filed answer. Ibid.

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                                       13
The court may grant the plaintiff one sixty-day extension to file the AOM.

Ibid.

        The Act delineates the criteria required of the person executing the

AOM. N.J.S.A. 2A:53A-41(a) states that if the defendant

             is a specialist or subspecialist recognized by the
             American Board of Medical Specialties . . . and the
             care or treatment at issue involves that specialty or
             subspecialty recognized by the American Board of
             Medical Specialties . . . , the person providing the
             testimony shall have specialized at the time of the
             occurrence that is the basis for the action in the same
             specialty or subspecialty, recognized by the American
             Board of Medical Specialties . . . , as the [defendant].

If the defendant

             is board certified and the care or treatment at issue
             involves that board specialty or subspecialty
             recognized by the American Board of Medical
             Specialties . . . , the expert witness shall be:

                   (1) a physician credentialed by a hospital
                   to treat patients for the medical condition,
                   or to perform the procedure, that is the
                   basis for the claim or action; or

                   (2) a specialist or subspecialist recognized
                   by the American Board of Medical
                   Specialties . . . who is board certified in
                   the same specialty or subspecialty,
                   recognized by the American Board of
                   Medical Specialties . . . , and during the
                   year immediately preceding the date of
                   the occurrence that is the basis for the
                   claim or action, shall have devoted a
                   majority of his professional time to either:

                                                                        A-3847-22
                                       14
(a) the active clinical practice
of the same health care
profession in which the
defendant is licensed, and, if
the defendant is a specialist or
subspecialist recognized by
the American Board of
Medical Specialties . . . , the
active clinical practice of that
specialty    or    subspecialty
recognized by the American
Board of Medical Specialties
. . . ; or

(b) the instruction of students
in an accredited medical
school,     other    accredited
health professional school or
accredited     residency       or
clinical research program in
the     same     health      care
profession in which the
defendant is licensed, and, if
that party is a specialist or
subspecialist recognized by
the American Board of
Medical Specialties . . . , an
accredited medical school,
health professional school or
accredited     residency       or
clinical research program in
the    same      specialty     or
subspecialty recognized by
the American Board of
Medical Specialties . . . ; or

(c) both.

[Ibid.]

                                    A-3847-22
               15
N.J.S.A. 2A:53A:41(b) details the requirements for a general practitioner.

      In short, there are three categories of equivalency that satisfy the "kind -

for-kind" requirement of N.J.S.A. 2A:53A-41:

            (1) those who are specialists in a field recognized by
            the American Board of Medical Specialties . . . but
            who are not board certified in that specialty; (2) those
            who are specialists in a field recognized by the
            [American Board of Medical Specialties] and who are
            board certified in that specialty; and (3) those who are
            "general practitioners."

            [Buck, 207 N.J. at 389.]

The second category, N.J.S.A. 2A:53A-41(a)(2), is the applicable section to

the circumstances presented here.

      Our Supreme Court first considered the kind-for-kind requirement under

the Act as interpreted in Buck.         There, after the defendant physician

"diagnosed [the] plaintiff as suffering from . . . depression and insomnia," he

prescribed sleep medication and an anti-depressant. Buck, 207 N.J. at 383-84.

After taking the sleep medication, the "plaintiff fell asleep while inspecting a

gun" and was woken up by what he thought was a phone call. Id. at 384.

While reaching for his phone, he "somehow" put the gun into his mouth and

discharged it, suffering permanent injuries. Ibid.

      The plaintiff served an AOM executed by a licensed psychiatrist. Id. at

384-85. The defendant's counsel objected to the AOM, stating the defendant

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                                       16
was "engaged as a family practitioner." Id. at 385. The defendant's counsel

requested a Ferreira conference, but the trial court mistakenly failed to

schedule one. Ibid.

      After consulting the website of the New Jersey Division of Consumer

Affairs, the plaintiff learned the defendant was board certified in emergency

medicine. Id. at 385-86. The court granted the plaintiff a sixty-day extension

to obtain a new AOM. Id. at 385. Thereafter, the plaintiff served an AOM

from a doctor that specialized in emergency medicine. Id. at 386.

      The defendant moved for summary judgment, arguing the AOMs were

not from equivalent physicians as required under the statute. Id. at 386-87.

The defendant certified he practiced family medicine, and his care and

treatment of the plaintiff involved his specialty of family medicine. Id. at 387.

The trial court found the AOMs did not comply with the statute and dismissed

the complaint with prejudice. Ibid. We affirmed. Id. at 388.

      The Supreme Court reversed. Id. at 395-96. The Court reviewed the Act

and stated that "[t]he basic principle behind N.J.S.A. 2A:53A-41 is that 'the

challenging expert' who executes an [AOM] in a medical malpractice case,

generally, should 'be equivalently-qualified to the defendant' physician." Id. at

389 (italicization omitted) (quoting Ryan v. Renny, 203 N.J. 37, 52 (2010)).

The Court explained that N.J.S.A. 2A:53A-41 established "three distinct

                                                                          A-3847-22
                                       17
categories embodying this kind-for-kind rule." Ibid. If the defendant doctor

was a specialist, the court had to determine whether the treatment at issue

involved the doctor's specialty.    Id. at 391.   The Court stated, "When the

treatment 'involves' the physician's specialty the equivalency requirements

apply . . . ." Ibid.

      The Court continued, enunciating the sentences relied upon by plaintiffs

and the trial court in this matter: "A physician may practice in more than one

specialty, and the treatment involved may fall within that physician's multiple

specialty areas. In that case, an [AOM] from a physician specializing in either

area will suffice." Ibid. In support of this statement, the Court cited to the

language in the statute that referred to a "person" or "witness" executing an

affidavit in the singular. Ibid.

      The Court also noted a trial court could "waive the specialty

qualification requirements under specifically defined circumstances, but only

'upon motion by the party seeking a waiver.'" Id. at 390 (quoting N.J.S.A.

2A:53A-41(c)). The plaintiff had not made a waiver motion. Id. at 392-95.

And in fact, the Court stated this was "not a case of a desperate plaintiff unable

to find a physician willing to aver to a claim of malpractice." Id. at 395.

      The Court reversed the judgment of dismissal and remanded to the trial

court for a "case management conference and [to] decide anew the adequacy of

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                                       18
[the] plaintiff's [AOMs]." Ibid. The Court emphasized the importance of a

Ferreira conference, stating "had . . . [a] conference been conducted, [the]

plaintiff would have had at least thirty days to correct the deficiency by filing

a conforming affidavit." Ibid.

      The Court also established a new procedural requirement in a medical

malpractice action, resulting in a revised Rule 4:5-3. Id. at 396. The Rule now

provides that "[a] physician defending against a malpractice claim who admits

to treating the plaintiff must include in his or her answer the field of medicine

in which he or she specialized at that time . . . and whether his or her treatment

of the plaintiff involved that specialty." R. 4:5-3.

      Two years later, the Court again addressed the Act's kind-for-kind

requirement in Nicholas v. Mynster, 213 N.J. 463, 480-88 (2013). There, the

defendant Dr. Christopher Mynster, board certified in emergency medicine,

and the defendant Dr. Rekha Sehgal, board certified in family medicine,

treated the plaintiff Edward Nicholas for carbon monoxide poisoning. Id. at

468-69. After instituting suit against the defendant physicians (and others),

the plaintiffs submitted an AOM from (1) a doctor board certified in internal

medicine and preventive care with subspecialty certifications in pulmonary

disease, critical care, and undersea and hyperbaric medicine; and (2) a doctor

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                                        19
who was board certified in internal medicine and was on the staff of a

hospital's department of emergency medicine. Id. at 470-72.

      The plaintiffs only served an expert report from the first doctor. Id. at

472. The defendants moved to bar the expert's testimony because he did not

have the requisite credentials under N.J.S.A. 2A:53A-41 to attest "to the

standard of care applicable to board-certified physicians in emergency . . . and

family medicine." Id. at 473-74. The defendants also moved for summary

judgment, because without the expert's testimony, the plaintiffs could not

establish the applicable standard of care and could not sustain their claim. Id.

at 474.

      In considering N.J.S.A. 2A:53A-41(a), the Court cited to Buck and

stated, "When a physician is a specialist and the basis of the malpractice action

'involves' the physician's specialty, the challenging expert must practice in the

same specialty." Id. at 481-82. The Court added: "A medical expert must be

a specialist in the same field in which the defendant physician specializes;

there are no exceptions to that requirement other than the waiver provision of

N.J.S.A. 2A:53A-41(c) . . . ." Id. at 482.

      The Court rejected the plaintiffs' argument that a doctor credentialed to

treat patients for a condition at a hospital did not need to practice that specialty

and be board certified in it to meet the kind-for-kind requirement. Id. at 484.

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                                        20
The Court reiterated and concluded that "a physician specializing in internal

and preventive medicine" could not "serve as an expert witness against a

physician specializing in emergency or family medicine, even though each

wa[s] qualified to treat a patient for carbon monoxide poisoning." Ibid. The

Court cautioned that accepting the "plaintiffs' argument would lead back to the

days before passage of the . . . Act when . . . physician experts of different

medical specialties, but who treated similar maladies, could offer testimony

even though not equivalently credentialed to defendant physicians." Id. at 485.

      Most recently, in Pfannenstein ex rel. Est. of Pfannenstein v. Surrey, 475

N.J. Super. 83, 90-91 (App. Div.), certif. denied, 254 N.J. 517 (2023), this

court held that the kind-for-kind requirement was not satisfied when the person

who executed the AOM specialized in a subspecialty of the defendant

physician's specialty but was not board certified and did not specialize in the

defendant's specialty. We reasoned that the purpose behind the kind-for-kind

"requirement would be undermined if a physician with such specialized

training were permitted to opine regarding the standard of care applicable to a

physician practicing in the more generalized specialty because the

subspecialist no longer practices in the specialty." Id. at 102.

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                                        21
                                      B.

      Mindful of the legislative purpose of the Act and the applicable

principles of law espoused in Buck, Nicholas, and Pfannenstein, we conclude

the trial court erred in finding plaintiffs met the kind-for-kind specialty

requirement when they only served an AOM from an internal medicine

physician as to Dr. Goyal—a board-certified physician in two specialties.

      The problems highlighted in Buck leading to the revised Rule 4:5-3 and

a remand to the trial court are not present here. In answering the complaint,

Dr. Goyal complied with the Rule and informed plaintiffs he practiced in the

medical specialties of internal medicine and gastroenterology and his treatment

of Carden involved both specialties. 8      Unlike in Buck, plaintiffs were

immediately aware of Dr. Goyal's specialties. Nevertheless, plaintiffs only

served an AOM from a board-certified internal medicine physician.

Defendants instantly objected to the AOM.

      The court appropriately held a Ferreira conference which achieved its

designed purpose.   Plaintiffs were again apprised of defendants' continued

objections to the AOM and the reasons why. When the parties continued to

disagree, the court instructed defendants to file a dismissal motion. They did

8
  Plaintiffs were apparently already aware of Dr. Goyal's credentials since the
complaint describes him as "specializing in the field of internal medicine and
gastroenterology."

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so. Immediately thereafter, the matter was transferred to Union County. As a

result, the Essex County judge did not consider defendants' dismissal motions

and did not make any factual findings regarding the sufficiency of the AOM.

      Nevertheless, when the Union County judge considered the dismissal

motions, the judge made a finding that the Essex County judge directed Dr.

Goyal to certify that his prescription of allopurinol was in his capacity as a

gastroenterologist.    But there was no basis for the judge to make such a

finding. There was no transcript of the Ferreira conference, and the Essex

County judge did not issue an order.

      Any "direction" given by the Essex County judge was not a finding on

the merits as there was no pending motion before the judge at the time of the

conference.     In addition, counsel for the parties submitted differing

recollections of the Essex County judge's statements. Therefore, in ruling on

the dismissal motions, the Union County judge mistakenly made an

unsupported finding.

      In addition, the Union County judge found Dr. Goyal's prescribing of

allopurinol was "the 'care and treatment at issue' . . . and the 'care or treatment

at issue involves internal [medicine].'" (alteration in original). This finding

was also an error.

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      At the time of the court's ruling on the dismissal motions, the parties had

submitted multiple certifications. Dr. Goyal certified he treated Carden as an

internist and gastroenterologist. He produced medical records regarding his

treatment.

      In response, Dr. Fitzgibbons, an internist, certified that she was unaware

of the use of allopurinol for any gastrointestinal issue. Plaintiffs' counsel also

included a certification from Dr. Eisner which stated he was unaware of

allopurinol's use for any gastrointestinal condition.       After the first oral

argument, plaintiffs submitted a new affidavit, from a doctor stating there "did

not appear to be any [g]astrointestinal issues for [him] to consider." With this

myriad of conflicting certifications before it, the Union County judge could

not make a factual finding and erred in determining that Dr. Goyal only treated

Carden as an internist.

      This error could have been corrected by granting defendants' motion for

reconsideration. Rule 4:42-2(b) permitted the earlier interlocutory order to be

revised upon a showing of "sound discretion" and "in the interest of justice."

With the reconsideration motion, Dr. Goyal included a certification from Dr.

Solny who was board certified in internal medicine and gastroenterology. He

certified allopurinol's treatment of gastroenterology issues was "well -known"

and its prescription was "within the standard of care" of a gastroenterologist.

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Further, he stated that "[a]ll treatment provided by a gastroenterologist

necessarily involve[d] knowledge of both [gastroenterology] and internal

medicine." Therefore, it was impossible for him to "bif[ur]cate and segregate

[his] knowledge as a gastroenterologist from that as an internist."

      With the presentation of yet another conflicting certification, the court

could not support its factual findings as to what specialty Dr. Goyal was

practicing when he prescribed allopurinol for Carden. The court mistakenly

exercised its discretion when it denied the reconsideration motions.

                                         C.

      However, our analysis does not end there because the court made an

alternative ruling, relying on the language in Buck that plaintiffs needed to

only provide an AOM from an expert in one specialty even if defendant doctor

specialized in two practices. Our careful reading of Buck and its progeny

supports our conclusion that the language relied upon by plaintiffs and the trial

court was dicta and not controlling in the circumstances presented here.

Bandler v. Melillo, 443 N.J. Super. 203, 209-11 (App. Div. 2015). The central

issue in Buck did not involve what AOM a plaintiff needed to serve in a case

where a defendant physician specialized in two practice areas and was treating

the plaintiff in both of those capacities.

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                                         25
      If Dr. Fitzgibbons is permitted to be the only doctor serving an AOM,

she—a lesser-qualified doctor than Dr. Goyal—is criticizing a higher-qualified

physician's actions. That is not kind-for-kind credentialing as required under

the Act. As the Court stated in Nicholas, the Act is viewed "as a framework in

which only an equivalently credentialed specialist would be qualified to testify

against another specialist."   213 N.J. at 483.     Allowing plaintiffs to only

submit Dr. Fitzgibbons's AOM contravenes the purpose of the Act. See Buck,

207 N.J. at 391 n.8 ("A physician board certified in a specialty can offer an

[AOM] in a case involving a physician not board certified in that specialty .

But under the equivalency doctrine, the reverse is not permitted." (citing

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

      The Nicholas Court further explained:         "The apparent objective of

N.J.S.A. 2A:53A-41 is to ensure that, when a defendant physician is subject to

a medical-malpractice action for treating a patient's condition falling within his

[board-certified] specialty, a challenging plaintiff's expert, who is expounding

on the standard of care, must practice in the same specialty." 213 N.J. at 486.

In short, a plaintiff cannot choose the specialty that the defendant physician

was practicing when treating the patient; the plaintiff must respond to the

information provided by the doctor in the answer. As our role is to construe

the meaning of a statute and enforce it as intended by the legislature, see

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Wilson by Manzano v. City of Jersey City, 209 N.J. 558, 572 (2012), we

conclude plaintiffs' submission of only Dr. Fitzgibbons's AOM as an internist

did not comply with the underlying purpose of the Act and did not suffice to

support the continuation of the lawsuit.

                                       D.

      Because plaintiffs failed to present the statutorily required AOM and did

not request an extension of time to do so, the complaint should have been

dismissed with prejudice. However, plaintiffs contend they requested a waiver

of the AOM requirement pursuant to N.J.S.A. 2A:53A-41(c).               Defendants

assert plaintiffs did not follow the procedure articulated under the statute to

request a waiver and they cannot meet the statute's requirements for an

exemption.

      N.J.S.A. 2A:53A-41(c) provides that:

             A court may waive the same specialty or subspecialty
             . . . and . . . board certification requirements of this
             section, upon motion by the party seeking a waiver, if,
             after the moving party has demonstrated to the
             satisfaction of the court that a good faith effort has
             been made to identify an expert in the same specialty
             or subspecialty, the court determines that the expert
             possesses sufficient training, experience and
             knowledge to provide the testimony as a result of
             active involvement in, or full-time teaching of,
             medicine in the applicable area of practice or a related
             field of medicine.

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      To obtain a waiver, a plaintiff must file a motion seeking the relief.

Plaintiffs do not contend they requested a waiver during the Ferreira

conference. Nor did plaintiffs ever file a formal motion. Ordinarily, that

would end our discussion.

      However, it is clear the waiver issue was discussed during several

proceedings and in the parties' submissions. During oral arguments on the

dismissal motions in March 2023, the court apparently directed plaintiffs'

counsel to submit evidence of their efforts to acquire a gastroenterology

expert. This indicates the issue was raised and the court was giving the parties

the opportunity to formally address it. Thereafter, plaintiffs' counsel submitted

a "supplemental memorandum in support of responses to motions to dismiss

complaint and counter motion for relief."         In that submission, counsel

described efforts made to secure a new or second AOM and provided an

affidavit from a gastroenterologist. Plaintiffs asserted they met the criteria

under N.J.S.A. 2A:53A-41(c) to obtain a waiver.           Defendant disagreed,

arguing plaintiffs never made a formal motion for a waiver as required under

the statute.

      In its May 9, 2023 decision, the trial court acknowledged the waiver

argument but did not address it since the court found Dr. Fitzgibbons's AOM

satisfied the Act as discussed above. Although the waiver issue was raised

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again in the reconsideration motions, the court stated it was a "moot" issue

because of its ruling regarding the sufficiency of Dr. Fitzgibbons's AOM.

      It is clear plaintiffs did not make a formal motion for a waiver. But the

record reflects they raised the issue in opposition to the dismissal motions, and

during oral argument on the motions. In response to the discussion, the court

permitted supplemental briefing specifically as to plaintiffs' efforts "to acquire

a gastroenterology expert." Thereafter, plaintiffs submitted a supplemental

memorandum and a certification from an additional physician.

      We cannot put form over substance here when the parties and the court

discussed the waiver issue during two oral arguments, and the parties

presented additional submissions with accompanying documents at the court's

request. The issue was raised both during the consideration of the dismissal

motions and the reconsideration of those motions.          Although we do not

abrogate the requirement for a formal motion under the statute, 9 the waiver

issue was thoroughly addressed by the parties.         Therefore, it should be

considered on its merits.

9
    See Castello v. Wohler, 446 N.J. Super. 1, 11, 18-19 (App. Div. 2016)
(finding that a plaintiff who requested a waiver in its opposition to the
defendant's motion to disqualify an expert had not met the procedural
requirements of N.J.S.A. 2A:53A-41(c) because "[a] party seeking a waiver
must file a motion for that relief" and the plaintiff had only "informally asked"
for a waiver).

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                                       29
      We remand to the trial court to consider the parties' submissions on the

waiver issue that had been filed with the court at the time it decided the

reconsideration motions.     The court may entertain oral argument at its

discretion. The court shall consider the waiver statute and applicable caselaw,

including Ryan, 203 N.J. at 54-61, and Pfannenstein, 475 N.J. Super. at 103-

06, in making its determination. We do not opine on the merit of plaintiffs'

arguments, the sufficiency of the submitted certifications or the outcome of the

decision.

      Reversed and remanded for further proceedings in accordance with this

opinion. We do not retain jurisdiction.

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