On appeal from the Superior Court of New Jersey, Law Division, Monmouth County, Docket No. L-2189-05.
NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION
Before Judges Lisa and Baxter.
In this medical malpractice action, plaintiff Irene Baldassano appeals from a November 12, 2008 order that granted the motion of defendant Peter Litwin, M.D., for involuntary dismissal of plaintiff's complaint, due to the inadequacy of plaintiff's proofs at trial on the issue of causation. We reject plaintiff's argument that she presented sufficient evidence to withstand defendant's motion, and affirm.*fn1
In March 2004, plaintiff consulted her primary care physician because she was "extremely stressed and overwhelmed," and requested medication to "take the edge off" the anxiety that she was experiencing. After several months, plaintiff reported that the medication was causing drowsiness without improving the anxiety she was experiencing. As a result her doctor prescribed a different medication, Klonopin. Plaintiff took the Klonopin as prescribed for four days, but on the fifth day, November 8, 2004, swallowed the fifty pills that remained in the bottle. When plaintiff's husband returned home from work that night, he found his wife semi-conscious. He drove her to Riverview Medical Center, where the medical staff began treatment for the overdose. During a brief period while plaintiff was unattended, she attempted to wrap an IV cord around her neck. Shortly thereafter, in the early morning hours of November 9, 2004, plaintiff was admitted to the psychiatric unit at Riverview, where defendant Peter Litwin, M.D., was assigned as her attending psychiatrist. At the time of her admission to the psychiatric unit, a psychiatrist other than defendant issued an order placing plaintiff on close observation, which required nursing staff to visually observe her every fifteen minutes. Within a few hours of plaintiff's admission to the psychiatric unit, defendant, after examining plaintiff, reduced the frequency of observations of plaintiff to every thirty minutes.
In the early afternoon of the next day, November 10, 2004, plaintiff was discovered, during one of the thirty-minute checks, hanging from a sheet that she had tied to a curtain rod. Although unconscious, plaintiff still had a pulse. She was admitted to the intensive care unit where she was placed on a ventilator. Plaintiff sustained no lasting physical effects from the temporary loss of oxygen to her brain.
Dr. Kenneth Weiss, a psychiatrist, testified on behalf of plaintiff, opining that defendant deviated from accepted standards of psychiatric care by decreasing the frequency of observation of plaintiff from once every fifteen minutes to once every thirty minutes so quickly after plaintiff's admission to the psychiatric unit. In particular, Weiss testified that when defendant relaxed the interval between visual observations to every thirty minutes, he "didn't take into account that the patient had just taken a huge amount of Klonopin, and that when [the Klonopin] wore off she was going to go right back to the state she was in before, which would be within the first day or two." Weiss opined that "by relaxing the checks from every fifteen minutes to every thirty minutes, [defendant] should have known . . . that [plaintiff] would again be at high risk for becoming agitated. And after she stopped getting those relaxing effects from the Klonopin, that she would go back to being distraught."
Weiss described the consequences of defendant's deviation from the standard of care in the following terms:
There is no reason to think that a patient this intent on hurting herself would change simply in the matter of a few hours, and no longer be a threat to herself.
And by disregarding that clinical picture, which I believe any psychiatrist on an in-patient unit would be alert to, [defendant] by relaxing the frequency of the checks put the patient at risk by giving her an opportunity, and the time frame in which to formulate and carry out another attempt, which is indeed, what happened.
The effect of the relaxation [of the frequency of the checks] was simply to permit this patient . . . to again fall victim to her illness. That is, any time you increase the amount ...