On appeal from the Superior Court of New Jersey, Law Division, Civil Part, Burlington County, L-3100-01.
NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION
Argued: September 24, 2007
Before Judges A.A. Rodríguez and C.L. Miniman.
This is a medical malpractice action filed by plaintiff Betty J. Hutchins as the Executrix of the Estate of her daughter, Regina T. Hutchins. Plaintiff seeks compensatory damages for herself and on behalf of Regina's Estate. The matter was tried to a conclusion and the jury returned a verdict in favor of defendants Maria C. Carta-Mangione and Neurological Regional Associates.*fn1 On appeal, plaintiff challenges an evidence ruling, the sufficiency of a curative instruction to the jury and the judge's refusal to give a Scafidi*fn2 charge. We affirm.
In 1999 Regina Hutchins was a twenty-year-old junior at George Washington University (GWU). On November 2, 1999, she went to the emergency department at GWU Hospital complaining of acute frontal headache associated with nausea and vomiting. The staff noted on her chart that she had a history of migraine headaches. She was diagnosed with a migraine and instructed to follow up with the Student Health Center at GWU and return to the emergency room if she experienced severe headaches, blurred vision, flashing lights or intractable vomiting.
Two days later Regina went to the Student Health Center to follow up on her emergency room visit. She told the student health staff that she had not had a recent evaluation for migraines, but that the headache she had recently was "more severe" than past headaches. She admitted to an increase in stress and was instructed to follow up with her primary care physician for evaluation or referral to a neurologist.
On November 24, 1999, while home for the Thanksgiving holiday, Regina went to her primary care physician, Dr. Friedman, who referred her to a neurologist. She did not, however, pursue the referral at that time. Instead, Regina returned to college. On December 9, 1999, she returned to the GWU Hospital emergency room complaining of a right-sided "typical throbbing" migraine with nausea and photophobia. The emergency room medical staff gave her Compazine, which eased the nausea. She was diagnosed with a migraine and instructed to follow up with a neurologist in five to seven days.
On December 15, 1999, defendant saw Regina for a neurological evaluation. At that time Regina reported "rather subacute onset of pounding right-sided head pain while walking on the street last month which was associated with nausea but no dizziness, blurriness of vision, or focal, motor or sensory disturbance." She also told defendant about her prior evaluations at the GWU Hospital emergency room and said that she had experienced similar symptoms approximately two to three times a week, which worsened with exertion.
Defendant performed a physical examination on Regina. At that time, Regina was not suffering from a headache or any residual symptoms of a headache. Defendant found that Regina had equal pupils and intact visual fields and fundi. At trial, defendant explained that intact visual fields and fundi were important because "patients who have had any kind of aneurysm or bleed can have pupil size abnormalities and they also can have hemorrhages in the back of their eyes." The doctor administered a motor examination, which was normal and revealed no neck or nuchal rigidity. This was significant because, as the doctor testified, bleeding or hemorrhage in the subarachnoid space would cause irritation of the meninges, which would cause neck stiffness in all but the rarest of cases. Defendant diagnosed Regina with a migraine. She ordered an MRI, EEG and bloodwork; she also prescribed Maxalt to use for symptoms of a migraine.
On December 20, 1999, Regina had an MRI performed, which was normal. If there had been any blood in Regina's brain, defendant testified that the "MRI [would] light up like a Christmas tree" because "[y]ou can't miss [blood]." An MRI will show aneurysms that are greater than five millimeters in size, which are generally the type that rupture and bleed.
On December 21, 1999, Regina went to LabCorp for the blood work ordered by defendant. Later that day Regina complained to plaintiff that she had another headache. Regina had not taken her prescribed medication but proceeded to do so at her mother's behest. Plaintiff testified that after Regina took her medicine, she told her mother that she felt better.
Later that evening, between 7:30 p.m. and 8:00 p.m., Regina called her mother at work complaining of another headache. Plaintiff returned home to find Hutchins on the bathroom floor with the water running. Regina had vomited. Plaintiff immediately called 9-1-1 and Hutchins was taken to Rancocas Valley Hospital where a CT scan of her head revealed evidence of a subarachnoid bleed on the right side, "presumably from rupture of an aneurysm." Regina was transferred to Willis Eye Hospital in Philadelphia and admitted to the Neurosurgical Intensive Care Unit where she was declared brain dead. A CT scan of the head was performed which confirmed a diffuse subarachnoid hemorrhage but "no definite aneurysm" was seen. Regina was pronounced dead at 10:40 a.m. on December 22, 1999.
The matter was reached for trial on April 25, 2006, and began with the testimony of plaintiff and one of Regina's classmates. Daniel Rosenbaum, M.D., a neurologist, testified on behalf of plaintiff. He opined that defendant deviated from accepted standards of medical care by not ordering appropriate diagnostic tests to determine the cause of Regina's headaches. Specifically, he opined that defendant should have ordered a lumbar puncture or a Magnetic Resonance Angiogram ("MRA") to determine if Regina had an aneurysm or other malformation in the brain.
He also opined that the two headache episodes that brought Regina to the emergency room were actually sentinel bleeds, or a small rupture of an aneurysm. He opined that, had defendant performed a lumbar puncture and MRA, blood would have been discovered in the subarachnoid space and there would be evidence of an aneurysm. Finally, he opined that had Regina's ...