Court Opinion

ID: 9755790
Source: CourtListenerOpinion
Date Created: 2023-08-28 20:50:48.771542+00
Date Added: 2024-06-11T07:28:11.358805
License: Public Domain

O’HERN, J.,
dissenting.
Despite evidence that Mary Ann Campo’s breast cancer had not been promptly diagnosed and that she would, to a reasonable degree of medical probability, suffer a recurrence of the cancer, and die from its effect, the trial court refused to treat such probable recurrence as an issue in the case and incorrectly instructed the jury that a separate action could be brought later if the cancer recurred. In addition, although no doctor could safely say, in circumstances such as this, following a treatment of breast cancer through mastectomy, that the cancer had been cured, the trial court expressly told this jury that the cancer “does not now exist.”
That statement was medically incorrect. The Court also concedes that the trial court erred in handling the recurrence issue. Nevertheless, the Court denies plaintiffs a new trial because it finds one phrase in the jury instructions that the Court believes adequately impressed on the jury the understanding that it was evaluating a physician’s conduct to see whether it had contributed to cause an otherwise-preventable spread of cancer.
Like other members of the Court, Frame v. Kothari, 115 N.J. 638, 651, 560 A.2d 675 (1989) (Wilentz, C.J., and Garibaldi, J., concurring), I share a concern about the ever-increasing complexity of medical reparations. I would hope that these doctor-patient disputes might be resolved in some way other than through our civil trial system. That system is expensive, unpredictable, and burdensome to both patient and physician. But so long as we have the system, we cannot add to its vicissitudes that a patient should suffer, in addition to medical malpractice, judicial error in her trial. The Court concedes that such judicial error exists:
Dr. Glover had testified that because of the delay in diagnosis, Mrs. Campo would probably suffer a recurrence of cancer. That testimony entitled Mrs. Campo *137to a jury determination on the probability of a recurrence and future medical costs. If future damage is reasonably probable, plaintiffs may recover for it at present. The trial court should have allowed Dr. Glover to testify before the jury regarding her estimate of the costs that would occur if Mrs. Campo were to suffer a recurrence of cancer.
[Ante at 131-132, 627 A.2d at 139 (citations omitted).]
Plaintiffs’ claim is not just about an “estimate of the costs that would occur if Mrs. Campo suffered a recurrence of cancer.” It is about dying from cancer; it is about a life that will, in medical probability, be lost or shortened due to the cancer, in part because of the delay in diagnosis.
The issues were complex indeed, requiring the jury to evaluate the extent to which Dr. Tama’s failure promptly to order a biopsy or aspiration of the breast mass in 1985 might have contributed to the spread of Mrs. Campo’s cancer. Plaintiffs’ expert witness, Dr. Donna Glover, was prepared to testify concerning the cost of future medical expenses related to a recurrence of cancer when, in ruling on a defense objection, the court first stated in the presence of the jury:
In the event of recurrence * * *, those events [presumably the cost of future treatment and attendant discomfort due to chemotherapy and failure of other bodily functions], there is an appropriate remedy in the nature of what we have termed a survival action as well as a wrongful death action which would be appropriate.
Plaintiffs’ counsel repeatedly requested the court to correct this misunderstanding. In a sidebar colloquy with counsel, presumably not heard by the jury, the court explained that it would allow jury consideration of fear of cancer, “[b]ut until cancer develops there is no right to bring an action for cancer and that action accrues when the cancer occurs.” The court nevertheless agreed to hear Dr. Glover’s testimony in a Rule 8 proceeding before making a final admissibility determination.
At the hearing, Dr. Glover explained that because of the delayed diagnosis Mrs. Campo had a “high probability of recurrence, certainly above 50%,” and that if the cancer recurred Mrs. Campo would “die * * * within a matter of less than a few years.” Dr. Glover explained that
*138the majority of patients who die with metastatic breast cancer have diffuse involvement of multiple organs usually involving lung, bone, often skin, occasionally liver, brain. If they have that type of diffuse involvement, they usually have several in-patient hospital admissions prior to their death [ ] [a]nd often require chemotherapy for prolonged periods of time.
The jury, of course, heard none of this testimony. Defense counsel, after agreeing with the trial court that our law “doesn’t preclude someone from bringing an action if something occurs in the future,” insisted that the proffered evidence “does not rise to that level of reliability that is required for damages.” The court agreed to keep the evidence from the jury, reasoning that it would be “more prudent under all of the circumstances to follow what has been established in the asbestos eases.” The court was referring to Mauro v. Raymark Industries, Inc., 116 N.J. 126, 561 A.2d 257 (1989), in which this Court held that exposure to asbestos did not warrant present recovery for the increased risk of cancer, absent proof that it is more probable than not that the plaintiff will develop the disease. But this is not an asbestosis case in which the risk of contracting cancér is uncertain. This is a case in which there was evidence that the plaintiff would probably die from cancer.
I do not see how the following assumption is fair or reasonable: that a jury that has been told a patient has no cancer will be evaluating the care provider’s conduct to determine whether the conduct had caused cancer. Negligence is always related to risk. For example, the jury in this case was evaluating, in part, the damages attributable to the need for radical mastectomy, reconstructive surgery, and chemotherapy. The jury may well have concluded that no matter how prompt the intervention, a need for those procedures might have existed. Defense counsel had hammered this point home in his cross-examination of Dr. Glover, asking her to review an answer she gave previously in depositions, “that it probably would be a good idea to * * * have done a mastectomy” on Mrs. Campo. In other words, no matter how early the diagnosis, Mrs. Campo probably would have needed the breast surgery and some type of definite therapy. Nevertheless, the risk that such procedures might be needed is simply not the *139same as the risk that one will, die or suffer a shortened life due to a non-diagnosed cancer. Paradoxically, the trial court had permitted Dr. Glover to testify in front of the jury that Mrs. Campo’s life expectancy would be shortened and that if the recurrence developed, which was medically probable, she would die within a few years after the recurrence. But the jury could have only been confused by the court’s statement that a “wrongful death action” or a “survival action” would provide an adequate remedy in the event of a recurrence. I am not confident that one phrase in a forty-four page jury charge explained to the jury that it was evaluating that risk, especially when the court had specifically told the jury that, “Should cancer develop, then the plaintiff may then bring a separate action for the cancer.” Nor is the risk of fear of developing cancer, something that we all share to a greater or lesser degree, the same as the risk of getting cancer. There was evidence in this case that Mrs. Campo had, as a result of earlier development of fibroid cysts, become increasingly fearful of developing cancer.
It has taken year’s for this Court to digest the doctrines of enhanced risk and preexisting causation in medical-negligence cases. See Olah v. Slobodian, 119 N.J. 119, 574 A.2d 411 (1990); Evers v. Dollinger, 95 N.J. 399, 471 A.2d 405 (1984). To assume that this jury fully grasped the significance of these words in the court’s charge asks too much:
But since [cancer] does not now exist, the court has ruled that there cannot be any such claim and no award is to be made by you with regard to that, your determination with regard to negligence and whether there was the increased risk of harm as I have delineated to you. If that determination is no, either as to one or the other so that you have found no liability, [it] will also apply to any future action.
I suspect that jurors would not draw the fine line that the Court does in parsing those phrases in the charge. The Court assumes that the jury fully understood that its evaluation of negligence was related to the recurrence of cancer, as though we expect jurors to say to themselves: “This case is not about cancer, I have been told that there is no cancer, but I am to evaluate the neglect as though there were a medical probability of cancer.” On this record, the Court expects too much.
*140As Justice Handler recently reminded us: “Common sense would dictate that a single excerpt, ripped from its setting within the entire charge, cannot possibly determine whether the charge as a whole correctly conveyed the relevant law.” Feldman v. Lederle Laboratories, 132 N.J. 339, 364, 625 A.2d 1066 (1993) (Handler, J., dissenting); see also Walter W. Steele, Jr. .and Elizabeth G. Thornburg, Jury Instructions: A Persistent Failure to Communicate, 67 N.C.L.Rev. 77, 78 (1988) (noting that “[r]ecent social science research has demonstrated empirically that juror comprehension of instructions is appallingly low”). We have always emphasized that juries must understand the import of their findings. Thus, in comparative negligence eases juries should be given an ultimate outcome charge that explains how their numerical findings will determine the outcome of the ease. See Buckley v. Pirolo, 101 N.J. 68, 500 A.2d 703 (1985); Roman v. Mitchell, 82 N.J. 336, 413 A.2d 322 (1980). In a case such as this, if the jury’s findings were to be given conclusive effect on the recurrence issue the jury should have been explicitly instructed as follows:
We are reserving the issue of damages due to any recurrence of cancer for a future trial. However, if you find in this case that there was no deviation from accepted medical standards, plaintiff will be at the end of the line for any future possible recovery should cancer recur.
Only vaguely did the trial court refer to that effect. The jury may have remembered that in the earlier discussion of Dr. Glover’s offer of testimony on future damages the court had said there could be a “survival action” or a “wrongful death action.”
For jurors, the judge is an imposing authority figure. This judge had reinforced his status in opening remarks to the jury by stating that he was “supreme in [his] sphere,” which included “presiding over the trial and, of course, seeing to it that it was conducted in accordance with the principles and rules of law.” Jurors “crave” guidance from the court “because they do not get it anywhere else.” Symposium Issue on the Selection and Function of the Modem Jury, Panel One: What Empirical Research Tells Us, and What We Need to Know About Juries and the Quest for Impartiality,” 40 Am.U.L.Rev. 547, 556 (1991). The court was *141wrong on the law (and perhaps understandably so because of the extreme complexity of the subject) and wrong on the facts (that plaintiff was free of cancer, a point that even defense counsel recognized — “there is a risk she may have it,” albeit “unquantifiable”). We ought not compound those errors now by expecting jurors to understand and grasp the nuances in his charge.
I repeat, no one expects physicians to do the impossible. Sometimes disease is untreatable and incurable. Most patients expect, however, that physicians will not fall short of acceptable medical standards in treating them. Some patients believe that they have a legal right to vindicate those expectations through the civil-justice system. We have an obligation to administer that system under acceptable legal principles.
I would grant plaintiffs a new trial.
HANDLER and STEIN, JJ., join in this opinion.
For affirmance — Chief Justice WILENTZ, and Justices CLIFFORD, POLLOCK and GARIBALDI — 4.
For reversal and remandment — Justices HANDLER, O’HERN and STEIN — 3.