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Williamson v. Waldman

July 21, 1997


On certification to the Superior Court, Appellate Division, whose opinion is reported at 291 N.J. Super. 600 (1996).

The opinion of the Court was delivered by Handler, J. Chief Justice Poritz and Justices Pollock, O'hern, Garibaldi, Stein and Coleman join in Justice HANDLER's opinion.

The opinion of the court was delivered by: Handler

(This syllabus is not part of the opinion of the Court. It has been prepared by the Office of the Clerk for the convenience of the reader. It has been neither reviewed nor approved by the Supreme Court. Please note that, in the interests of brevity, portions of any opinion may not have been summarized).

Karen Williamson, et al. v. Leonard Waldman, M.D., et al. (A-127/128/129-96)

Argued April 29, 1997 -- Decided July 21, 1997

HANDLER, J., writing for a unanimous Court.

In this appeal the Court considers the standard for establishing causation for emotional distress attributable to the fear of contracting AIDS through infection from the HIV virus.

On June 6, 1991, Karen Williamson was pricked with a lancet while she was cleaning a trash can in the examining room of the offices occupied by Leonard Waldman, M.D., Jeffrey Feldman, M.D., and Jacques Losman, M.D. A lancet is a surgical knife that is used to prick fingers to acquire blood samples. The lancet should have been disposed of in a medical waste receptacle, not a common trash can.

After becoming alarmed over the potential of contracting AIDS, Williamson visited her family physician, Dr. Jerome DeMasi on June 10, 1991. He recommended that she be tested for the HIV virus annually for a period of seven to ten years. Dr. DeMasi subsequently modified the time period for testing to a "year or two" but did not inform Williamson until November 1994. Dr. DeMasi told Williamson that the yearly test was the most decisive in determining whether she had been infected with HIV.

Since the incident, Williamson has been tested for HIV several times: in July 1992, in July 1993 and in July 1994. Each test has been negative for both HIV and hepatitis. After the 1994 test, Dr. DeMasi told Williamson that her chances of having contracted HIV from the finger prick were "slim or remote."

Williamson asserts that as a result of the incident, she has become depressed and has suffered "lifestyle changes," including the decision not to have another baby. In addition, she and her husband, James, have engaged in protected sex since the incident. On May 19, 1993, the Williamsons filed suit against Drs. Waldman, Losman and Feldman, alleging that the doctors breached their duty to use reasonable care to inspect and to make the premises reasonably safe. This breach of duty resulted in Williamson suffering severe personal injuries, great physical and mental pain, loss of enjoyment of life, loss of earning capacity, and the need for future medical treatments and/or hospitalizations. Williamson's husband makes a claim for the loss of his wife's services, support and consortium.

After the completion of discovery, the doctors filed motions for summary judgment, which the trial court granted, dismissing without prejudice Williamson's claim for negligent infliction of emotional distress. The court found that Williamson had failed to demonstrate that she was exposed to HIV; that, given her negative test results, her continued fear was "idiosyncratic;" and that, as a result, the doctors' acts were not the proximate cause of her emotional distress.

On appeal, the Appellate Division reversed and remanded, holding that Williamson was not required to demonstrate actual exposure to HIV but could recover based on the reasonableness of her fears, which requires determination by a jury.

The Supreme Court granted the petitions for certification filed by the defendant doctors.


A person claiming damages for emotional distress based on the fear of contracting AIDS must demonstrate that the defendant's negligence proximately caused his or her genuine and substantial emotional distress that would be experienced by a reasonable person of ordinary experience who has a level of knowledge that coincides with then-current, accurate and generally available public information about the causes and transmission of AIDS.

1. The majority of jurisdictions addressing this issue impose an objective standard for determining proximate cause of emotional distress arising from the fear of contracting AIDS. The courts applying this standard require, as a condition for establishing proximate causation, that the claimant demonstrate actual exposure and/or prove a medically sound channel of transmission of the HIV virus. In addition, some courts require that plaintiff show a probability that he or she will develop AIDS. (pp. 6-10)

2. Some jurisdictions have adopted a "reasonableness" standard of recovery for emotional-distress claims based on the fear of contracting AIDS. That standard allows a plaintiff to recover for emotional distress without demonstrating either actual exposure to the HIV virus or a viable channel of transmission of the virus. (pp. 10-12)

3. Policy considerations support the actual-exposure and/or channel-of-transmission objective standard in order to combat against speculative, unreliable and fraudulent claims. In addition, the objective standard would serve to counteract general ignorance about AIDS, which fosters hysteria and irrational fears about contracting the disease, as well as prejudice, stigmatization and discrimination directed at those who have AIDS. Nevertheless, several considerations support the adoption of the reasonableness standard. A test based on reasonableness encourages the use of reasonable care in preventing the exposure of another to HIV, can assure the genuineness of claims, and accommodates the policy of providing redress for harm suffered because of another. (pp. 12-15)

4. While the reasonableness standard can directly fulfill the basic goals of tort law in the context of claims based on the negligent infliction of emotional distress arising from the fear of contracting AIDS, it fails to adequately accommodate the serious public-policy concern about ignorance of AIDS and the resultant social consequences. Therefore, as a matter of sound public policy, the standard of proximate cause should require as an element of the test of causation a level of knowledge of the causes, transmission and risks of AIDS. Such an enhanced standard will serve to overcome and discourage ignorance about the disease and its resultant social ills. Thus, the reasonableness standard should be enhanced by the imputation to the victim of emotional distress based on the fear of contracting AIDS of that level of knowledge of the disease that is then-current, accurate, and generally available to the public. (pp. 15-20)

5. Emotional-distress damages must be based on the fears experienced by a reasonable and well-informed person and should be limited to the "window of anxiety" (the period after which such a reasonable and well-informed person no longer would experience continuing emotional distress). The window of anxiety in this type of case is in the range of six months to one year after exposure. Williamson's continued distress is "idiosyncratic" because it exceeds the emotional distress that would be experienced by a reasonable and well-informed person. Of course, the distress she suffered during the "window of anxiety" would be reasonable and could be compensable. (pp. 20-23)

6. The erroneous medical advice given to Williamson by Dr. DeMasi prolonged her reasonable fear of AIDS, thereby extending her window of anxiety beyond the six-month to one-year period. However, in the circumstances of this case, the defendant doctors should not be held responsible for subsequent incorrect advice that was not within the generally accepted medical evidence regarding the effectiveness of HIV testing and should not, as a matter of law, be deemed reasonably foreseeable by the defendant doctors. Thus, Williamson's emotional-distress damages arising from the fear of contracting AIDS, proximately caused by the defendant doctors' negligence as determined by the standard of enhanced reasonableness, does not include that emotional distress attributable to Dr. DeMasi. (pp. 23-26)

Judgment of the Appellate Division reversing summary judgment in favor of defendants is AFFIRMED. Judgment of the Appellate Division remanding this matter is MODIFIED in accordance with this opinion.


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