On certification to the Superior Court, Appellate Division, whose opinion is reported at 355 N.J. Super. 210 (2002).
(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).
WALLACE, J., writing for a unanimous Court.
The issue in this appeal is whether a mentally disabled patient, who does not have the capacity to control his conduct, owes his or her caregiver a duty of care.
On October 3, 1997, Edmund Gernannt, now deceased, was involuntarily committed to Bergen Pines County Hospital with a diagnosis of senile dementia, Alzheimer's type. On October 13, 1997, he was transferred from the long-term care unit to the acute geriatric psychiatric unit because he became increasingly agitated and assaultive towards the staff. On November 5, 1997, Gernannt was transferred to the eighth floor, where a number of other Alzheimer's and dementia patients were housed. On November 11, 1997, Gernannt attempted to leave the unit by way of the fire exit and set off the alarm. Mary Berberian, the head nurse at the facility, attempted to redirect Gernannt, but he pushed her, causing her to fall and fracture her right leg.
Berberian ultimately sued The Estate of Gernannt and others. At the conclusion of Berberian's presentation of evidence, Gernannt's estate moved for an involuntary dismissal. The trial court denied that motion. After the close of the evidence portion of the trial, Berberian requested a "reasonable man" standard instruction. The trial court denied the request and charged the jury, in part, to "measure his actions as you would a reasonably prudent person who has Alzheimer's dementia." The jury found in favor of The Estate of Gernannt..
Berberian appealed. The Appellate Division affirmed. In a concurring opinion, Judge Lintner concluded that Gernannt had no duty of care and that the trial court should have granted the motion for involuntary dismissal filed by The Estate of Gernannt.
HELD Mentally incompetent patients owe no duty of care to protect paid caregivers from injuries suffered while caring for those patients.
1. Generally, the reasonable person standard applies to a mentally deficient person. Restatement (Second) of Torts §283B (1965). The Restatement identifies a "reasonable person" as "a person exercising those qualities of attention, knowledge, intelligence, and judgment which society requires of its members for the protection of their own interests and the interests of others." Id. at §283 comment b. However, the Restatement limits the distinction with respect to the standards of care governing the tort liability of children and physically disabled persons, but not mentally disabled persons. (Pp. 6-9)
2. The issue on appeal is one of first impression in New Jersey. In Cowan v. Doering, 215 N.J. Super 484 (1987), and Tobia v. Cooper Hosp. Univ. Med. Ctr., 136 N.J. 335 (1994), this Court addressed the issues of self-care and self-damaging conduct in the context of a mentally disturbed plaintiff who jumped out a window of a hospital and an elderly patient who was injured when she fell from an emergency room stretcher, respectively. In each case, the Court found that defendant breached its duty of care, a duty to prevent the very same act engaged in by plaintiff, and that as a result defendant could not assert comparative negligence. (Pp. 9-11)
3. While Cowan and Tobia tangentially inform this case, decisions from other jurisdictions with fact patterns closer to the present case are also instructive. The holdings in those out-of-state cases appear to have a common thread, namely, that no duty of care arises between an institutionalized person who has no control over his actions and a paid caregiver. In addition, courts have found the "fireman's rule" analogous and have determined that resulting injuries are compensable via workers' compensation. (Pp. 12-16)
4. Several legal commentators favor the use of a no-duty rule in the relationship between the mentally disabled patient and his or her caregiver. (Pp. 17-18)
5. Persuaded by the reasoning of Judge Lintner, the out-of-state authorities, and the fireman's rule analogy, we hold that a mentally disabled patient, who does not have the capacity to control his conduct, does not owe his or her caregiver a duty of care. It would not be fair, under the circumstances, to impose a duty of care on Gernannt to his professional caregiver when the caregiver's job duties included preventing Gernannt from injuring himself and others. Moreover, Berberian has the benefit of worker's compensation for her work-related injuries. The trial court should have granted the estate's motion for an involuntary dismissal. (Pp. 18-20)
As modified, the judgment of the Appellate Division is AFFIRMED.
CHIEF JUSTICE PORITZ and JUSTICES LONG, VERNIERO, LAVECCHIA, ZAZZALI and ALBIN join in Justice WALLACE's opinion.
The opinion of the court was delivered by: Justice Wallace
Plaintiffs,*fn1 Mary Berberian, the head nurse in a long-term care facility, and her husband, Emmanuel Berberian, sued defendant Edmund Gernannt, an institutionalized patient with Alzheimer's dementia, his estate (defendant)*fn2, Diane Lynn, in her capacity as Gernannt's guardian, and M.H. Rainey, M.D., to recover damages for personal injuries she sustained when Gernannt pushed her. After closing arguments, the trial court instructed the jury that the applicable standard of negligence was that of "a reasonably prudent person who has Alzheimer's dementia." The jury found in favor of defendant. On appeal, plaintiffs argued that the trial court should have applied an objective "reasonable person" standard without taking into account Gernannt's mental disability. The Appellate Division disagreed with plaintiffs and affirmed the trial court. Berberian v. Lynn, 355 N.J. Super. 210 (2002). We granted certification, 175 N.J. 549 (2003), and now affirm the judgment of the Appellate Division on different grounds. We hold that mentally incompetent patients owe no duty of care to protect paid caregivers from injuries suffered while caring for those patients.
On October 3, 1997, Gernannt, now deceased, was involuntarily committed to Bergen Pines County Hospital (Bergen Pines) with a diagnosis of senile dementia, Alzheimer's type. On October 13, 1997, he was transferred from the long-term care unit to the acute geriatric psychiatric unit because he became increasingly agitated and assaultive towards the staff. On November 5, 1997, Gernannt was transferred to the eighth floor, where a number of other Alzheimer's and dementia patients were housed.
Plaintiff first met Gernannt on November 8, 1997. At that time, she was a nurse supervisor in the long-term care unit and had over twenty years of experience working with Alzheimer's patients. She knew that Gernannt had dementia and a history of agitation, including prior acts of violence towards staff. With respect to that behavior, plaintiff reported in her notes that Gernannt "refused to go to bed [,]... was combative, agitated," and "[t]ried to hit staff." Plaintiff was also aware of the Bergen Pines standard patient aggression policy. That policy stated that if a patient with dementia is violent, aggressive, resistant or unredirectable, the nurse should retreat from the patient and call security for assistance.
On November 11, 1997, Gernannt attempted to leave the unit by way of the fire exit and set off the alarm. Nurse Christine Schell tried to redirect him, but he began hitting her. Schell backed away and walked down the hall to call security. Plaintiff then approached him and extended her hand to help him to his room. Gernannt grabbed plaintiff's hand, pulled her toward him and then pushed her back, causing her to fall and fracture her right leg.
On January 26, 1998, plaintiffs filed a complaint against Lynn, Gernannt, and a fictitious designee. The complaint was later amended to add Gernannt's estate after he died, and to substitute Dr. Rainey as a defendant in place of the fictitious designee. While not disputing that Gernannt was an adjudicated incompetent, plaintiffs alleged that he, "without provocation negligently, recklessly and carelessly" struck plaintiff, causing her injuries. Further, the complaint alleged that Lynn was negligent for allowing Gernannt's transfer from the psychiatric ward to the long-term care ...