Court Opinion

ID: 9963003
Source: CourtListenerOpinion
Date Created: 2024-04-24 14:07:05.096729+00
Date Added: 2024-06-11T08:20:44.998304
License: Public Domain

NOT FOR PUBLICATION WITHOUT THE
                               APPROVAL OF THE APPELLATE DIVISION
        This opinion shall not "constitute precedent or be binding upon any court ." Although it is posted on the
     internet, this opinion is binding only on the parties in the case and its use in other cases is limited. R. 1:36-3.

                                                        SUPERIOR COURT OF NEW JERSEY
                                                        APPELLATE DIVISION
                                                        DOCKET NO. A-0508-22

ROBIN NEWSOME,

          Plaintiff-Appellant,

v.

INSPIRA HEALTH NETWORK,
INC.,1

          Defendant-Respondent,

and

GLOUCESTER COUNTY
EMERGENCY MEDICAL
SERVICE,

     Defendant.
_____________________________

                   Submitted March 5, 2024 – Decided April 24, 2024

                   Before Judges Natali and Puglisi.

                   On appeal from the Superior Court of New Jersey, Law
                   Division, Gloucester County, Docket No. L-1462-19.

1
     Improperly plead as Inspira Health Network.
               Jarve Granato Starr, LLC, attorneys for appellant
               (Adam M. Starr and Michael D. O'Leary, on the briefs).

               Parker McCay, PA, attorneys for respondent (Marykay
               Wysocki, of counsel and on the brief).

PER CURIAM

         Plaintiff Robin Newsome appeals from the trial court's September 23,

2022 order granting summary judgment to defendant, Inspira Health Network,

Inc., and dismissing her complaint with prejudice. Because we agree with the

trial court's determination defendant was entitled to immunity, we affirm.

         Plaintiff's complaint alleged defendant's employees were negligent in

their provision of care during emergency response. The following facts were

adduced during discovery. Plaintiff has diabetes and, in the few years prior to

the incident at issue here, had multiple episodes of hypoglycemia (low blood

sugar). On January 1, 2018, plaintiff's family found her unresponsive and called

9-1-1.     Defendant's employees, paramedics Christopher Taylor and James

Thompson, responded to the call and found plaintiff unconscious and

unresponsive.

         Taylor was the "primary caregiver," responsible for obtaining information

from the patient, family and any other paramedic on the scene, completing the

patient record, and providing additional care if needed. Thompson was the

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"other caregiver," responsible for administering care to the patient. Plaintiff's

family members told Thompson and Taylor that they measured her blood sugar

multiple times on a home glucose meter, and it consistently read "Lo," indicating

a critically low blood sugar level.2

      Taylor testified to three methods of treating a hypoglycemic patient. The

patient can be given sugar, which was not possible here because plaintiff was

unconscious. A paramedic can also administer glucagon to the patient, either

intramuscularly or intranasally, which required a paramedic to call medical

command for approval.

      After assessing plaintiff's situation, Thompson opted to initiate an

intravenous (IV) line to administer dextrose, also known as D50. Thompson

described administering the dextrose in a carefully controlled manner, where he

observed the IV site to ensure there were no problems with it. After Thompson

started the IV line, he administered half the dextrose dose, but plaintiff's skin

was diaphoretic, meaning sweaty, so the IV adhesive did not stick to her skin

and the IV line came out of her arm. Three minutes later, Thompson removed

2
  According to defendant's expert, a normal blood sugar reading is between 80
and 120. Home glucose meters read "Lo" when glucose is less than 20
millimoles per liter (mmol/L), but sugar readings of less than 70 mmol/L are a
medical emergency when the patient's consciousness is altered, as plaintiff's
was.
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the IV line but could not find another suitable vein, so he and Taylor decided to

move plaintiff to the ambulance and transport her to the hospital. On the way,

Taylor obtained approval to administer glucagon, which he administered

intranasally. Plaintiff's blood sugar level registered twenty-one but she was still

unconscious, so Taylor administered a second dose intramuscularly.

      Once at the hospital and conscious, plaintiff began to complain of pain in

her left arm where Thompson had administered the IV. She required emergency

surgery to fix the compartment syndrome in her arm, which she alleged was

caused by the dextrose.

      Plaintiff's husband testified he told "every single human being that was in

that bedroom surrounding [his] wife" that she was allergic to dextrose, but

Taylor's notation in the record indicated he had confirmed plaintiff had no

known drug allergies. Taylor did not recall confirming plaintiff's allergies but

stated it was common practice to confirm allergies before administering any

medication. Thompson also did not recall having any conversations with Taylor

or plaintiff's family members on the scene because he was responsible for

plaintiff's care and was focused on the IV. While they were on the scene, the

paramedics did not have access to plaintiff's Inspira medical records.

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      Plaintiff's expert, Dr. Michael T. McEvoy, concluded defendant's

employees were negligent in plaintiff's care, but also opined that plaintiff was

not allergic to dextrose because it is a carbohydrate found in every human being,

which made an allergy highly unlikely. Dr. McEvoy also testified he thought

the paramedics acted in good faith and "reasonabl[y]."

      Defendant's expert, Dr. Rich Maenza, concluded Thompson and Taylor

"comported entirely with the standard of care" when treating plaintiff because

her life-threatening hypoglycemic condition required the use of dextrose rather

than glucagon. Dr. Maenza opined dextrose was "the most appropriate therapy

for patients with life-threatening hypoglycemia such as those with [an] altered

level of consciousness," in part because glucagon "works relatively slowly in

the context of life-threatening hypoglycemia."

      Dr. Maenza also noted Thompson had responded to a prior call for

plaintiff's hypoglycemia in July 2014, during which plaintiff's husband informed

Thompson of her adverse reaction to dextrose, and he administered glucagon

instead. Dr. Maenza pointed out plaintiff had been given dextrose without any

adverse reaction in October 2014, September 2015 and December 2016. Dr.

Maenza found the "standard of care [did] not require knowledge of, or utilization

of, any prior documentation in the management of a patient in the field with an

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acute medical crisis," nor did it require Thompson to recall patient details from

an encounter four years prior.

        The trial court granted defendant's motion for summary judgment and

dismissed plaintiff's complaint, finding defendant had good faith immunity from

suit.   The court determined defendant's employees acted in good faith by

administering dextrose because it was an objectively reasonable treatment

option in light of the emergency circumstances. The court further found the

alleged negligent communication about plaintiff's purported allergy was "part

and parcel" of providing intermediate and advanced life support services ;

therefore, defendant was entitled to qualified immunity pursuant to N.J.S.A.

26:2K-14.

        Plaintiff appeals, raising the following issues for our consideration:

              POINT I

              RESPONDENT DID NOT ACT IN "GOOD FAITH"
              AND THEREFORE THE TRIAL COURT ERRED IN
              FINDING THAT THE IMMUNITIES OF N.J.S.A.
              26:2K-14 WERE APPLICABLE.

              POINT II

              THE HARM TO RESPONDENT OCCURRED PRIOR
              TO RESPONDENT RENDERING "ADVANCED
              LIFE SUPPORT" SERVICES, AND THEREFORE
              THE IMMUNITIES OF N.J.S.A. 26:2K-14 ARE NOT
              APPLICABLE.

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      We review a trial court's grant or denial of a motion for summary judgment

de novo, applying the same standard used by the trial court. Samolyk v. Berthe,

251 N.J. 73, 78 (2022). Rule 4:46-2(c) provides that a motion for summary

judgment must be granted "if the pleadings, depositions, answers to

interrogatories and admissions on file, together with the affidavits, if any, show

that there is no genuine issue as to any material fact challenged and that the

moving party is entitled to a judgment or order as a matter of law." The court

must "consider whether the competent evidential materials presented, when

viewed in the light most favorable to the non-moving party, are sufficient to

permit a rational factfinder to resolve the alleged disputed issue in favor of the

non-moving party." Brill v. Guardian Life Ins. Co. of Am., 142 N.J. 520, 540

(1995).

      The Legislature has afforded immunity to certain emergency medical

providers:

             No . . . mobile intensive care paramedic, . . . first aid,
             ambulance or rescue squad, . . . or officers and members
             of a . . . rescue squad shall be liable for any civil
             damages as the result of an act or the omission of an act
             committed while in training for or in the rendering
             of . . . advanced life support services in good faith and
             in accordance with this act.

             [N.J.S.A. 26:2K-14.]

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      Advanced life support services are

            an advanced level of pre-hospital, inter-facility or
            emergency medical care that includes basic life support
            functions, cardiac monitoring, cardiac defibrillation,
            telemetered electrocardiography, administration of
            anti-arrhythmic      agents,    intravenous      therapy,
            administration of specific medications, drugs and
            solutions, utilization of adjunctive ventilation devices,
            trauma care and other techniques and procedures
            authorized in writing by the Commission[.]

            [N.J.S.A. 26:2K-7(a) (Jan. 2022)3.]

      There is no dispute defendant's employees are paramedics covered in

N.J.S.A. 26:2K-14, and IV therapy is an advanced life support service. The

question is whether the paramedics' actions or inactions complained of are

considered advanced life support services and, if so, whether they were acting

in good faith.

      Here, plaintiff claims that the alleged negligence occurred before the

paramedics began rendering advanced life support services, and therefore

defendant is not entitled to immunity. Defendant counters that the paramedics'

collection of patient allergy information is "part and parcel" of rendering

medical care and therefore the immunity applies.

3
   Although the Legislature amended the definition of advanced life support
services in 2022, see L. 2022, c. 118 (Oct. 2022), we consider the definition in
effect at the time of the incident.
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      In support of her argument, plaintiff cites De Tarquino v. City of Jersey

City, 352 N.J. Super. 450 (App. Div. 2002). In that case, a patient died of a

hematoma after being discharged from the emergency room. Id. at 453. The

ensuing complaint alleged the ambulance service was negligent for failing to

note on the run sheet 4 that the patient had vomited while being treated. Id. at

452. We determined that completing a run sheet was not in the scope of

intermediate life support services because it did not require the same level of

skill as administering medical care, was not related to the paramedics' treatment

plan, and was intended for the hospital staff's use in administering care. Ibid.

Because the statute was not intended to give such broad protection to medical

professionals, we held the paramedics were not entitled to immunity for

negligence in completing a run sheet. Id. at 456.

      Here, the paramedics testified that the first step in rendering medical

services was to obtain patient information before administering medications on

the scene. Unlike De Tarquino, where the negligence occurred in preparing a

report for continued care, here the alleged miscommunication and resulting

administration of dextrose occurred during the course of treatment on the scene.

4
  A run sheet "is a report of observations and treatment of an emergency patient,
to the emergency room staff." Id. at 452.
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Therefore, we agree with the trial court's determination the initial

communication, or miscommunication, was in the scope of rendering life

support services, and thus conduct the Legislature intended to afford the shield

of immunity.

      The paramedics' conduct must then be measured against the good faith

standard, not negligence. Generally, "good faith" exists where there is "honesty

of purpose and integrity of conduct without knowledge, either actual or

sufficient to demand inquiry, that the conduct is wrong." Frields v. St. Joseph's

Hosp., 305 N.J. Super. 244, 248 (App. Div. 1997) (quoting Marley v. Borough

of Palmyra, 193 N.J. Super. 271, 294 (Law Div. 1983)). While the issue of good

faith is often determined in a plenary hearing, summary judgment is proper

where the defendant demonstrates that the actions "were objectively reasonable

or that they performed them with subjective good faith." Canico v. Hurtado,

144 N.J. 361, 365 (1996). "This test recognizes that even a person who acted

negligently is entitled to a qualified immunity, if he acted in an objectively

reasonable manner." Frields, 305 N.J. Super. at 248 (citing id. at 366).

      In Frields, the plaintiff claimed that paramedics used excessive force when

putting his son on an ambulance, which caused a brain hemorrhage that resulted

in his death. Ibid. The plaintiff argued the paramedics should have administered

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a chemical sedative rather than use physical restraint. Ibid. We held that, while

the plaintiff proffered evidence of a possible negligence claim against the

paramedics, he failed to present any evidence that created a genuine issue of fact

that defendants' employees did not act in an objectively reasonable manner. Id.

at 249. Because the paramedics acted in good faith, they were entitled to

immunity under N.J.S.A. 26:2K-14. Ibid.

      As in Frields, the paramedics' alleged negligence will not vitiate qualified

immunity under N.J.S.A. 26:2K-14, as long as they acted in good faith. Under

the circumstances of plaintiff's medical emergency, we are convinced it was

objectively reasonable for Thompson to treat her with dextrose instead of

glucagon, which would have taken additional time to obtain approval and for

the drug to take effect. Given the fact that plaintiff was unconscious and her

blood sugar was dangerously low, she presented the paramedics with a medical

emergency requiring immediate intervention. After administering only half a

dose, Thompson quickly discontinued the dextrose when he observed plaintiff's

sweaty skin and instead decided to transport plaintiff to the hospital. The gravity

and urgency of the situation was borne out by the record, as the time from the

paramedics' arrival to the time they administered the intranasal glucagon en

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route to the hospital was only nineteen minutes. We also note plaintiff's own

expert found the paramedics acted in good faith.

      Even if plaintiff could establish a claim of negligence, that is not the

standard here.    Considering all the facts taken together, we are persuaded

defendant's employees acted in good faith in treating plaintiff and defendant is

therefore entitled to immunity.

      Affirmed.

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