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Estate of Frederick Hetmanski v. Rahway Hospital; Martin P. Mayer

September 1, 2011

ESTATE OF FREDERICK HETMANSKI AND CATHERINE HETMANSKI, AS ADMINISTRATRIX AD PROSEQUENDUM FOR THE ESTATE OF FREDERICK HETMANSKI AND CATHERINE HETMANSKI, INDIVIDUALLY, PLAINTIFFS-APPELLANTS/ CROSS-RESPONDENTS,
v.
RAHWAY HOSPITAL; MARTIN P. MAYER, M.D.; HEASUN LEE; KAREN VARGAS; JANET KARANEVICH; JANET DORO; AND JANET DONOR*FN1 , DEFENDANTS-RESPONDENTS, AND MOTIVATED SECURITY SERVICES, DEFENDANT-RESPONDENT/ CROSS-APPELLANT, AND B. ESTRELLAS, M.D.; DR. SINHA, M.D.; DR. GUERRERO, M.D.; JANET DIPASQUALE AND GONZOLO MANNES, DEFENDANTS.



On appeal from the Superior Court of New Jersey, Law Division, Middlesex County, Docket No. L-6506-04.

Per curiam.

NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION

Argued May 4, 2011

Before Judges Axelrad, Lihotz and J. N. Harris.

Plaintiffs appeal from the jury verdict for defendants finding no cause of action in this wrongful death case, concluding defendant Rahway Hospital was negligent, but its conduct was not the proximate cause of the death of Frederick Hetmanski (decedent). Plaintiffs raise seven claims of error by the trial judge, challenging designated evidential determinations and the jury charge. We have considered each argument presented in light of the record and the applicable law. We affirm.

Additionally, defendant Motivated Security Services filed a defensive cross-appeal from the court's June 29, 2010 order. However, defendant Motivated Security Services failed to provide this court with a supporting brief regarding issues appealed, R. 2:6-2(d), and, therefore, did not advance any legal arguments in support of its cross-appeal as required by Rule 2:6-2(a)(5). Accordingly, the cross-appeal is dismissed.

Decedent sought emergency room (ER) treatment at defendant Rahway Hospital (Rahway) on September 5, 2002, complaining of depression, loss of appetite and an inability to sleep. Specifically, on September 5, 2002, decedent was admitted to the hospital, and, as a precautionary measure, held overnight for observation. Decedent was examined on the morning of September 6, 2002 by Martin P. Mayer, M.D., Chairman of the Department of Psychiatry at Rahway. Dr. Mayer diagnosed decedent with depressive disorder, not otherwise specified, with anxiety features. Dr. Mayer specifically noted decedent presented "no suicidality"; instead, decedent's insight and judgment were good. Dr. Mayer prescribed antidepressants Celexa and Remeron and advised decedent to locate a psychiatrist for follow-up treatment.

Decedent returned to the Rahway ER on September 7, 2002. Following a second examination on September 8, 2002, Dr. Mayer modified his diagnosis to "major depressive disorder." He specifically noted decedent "denied active suicidality, suicide plan or intent" and did not consider decedent to be an immediate or active suicide risk. The hospital records state decedent denied suicidal or homicidal ideations during his September 5 and 7 visits. Janet Karanevich-Dono, a psychiatric nurse involved in attending to decedent, recorded he was "very vague on thoughts of suicide - recent - denies plan." Decedent was prescribed Xanax for anxiety caused by depression and sleep medication. Dr. Mayer readmitted decedent to the hospital for further observation.

When plaintiff Catherine Hetmanski, decedent's wife, visited decedent the following morning on September 8 she spoke with Karanevich-Dono and expressed her concern for her husband's lack of improvement. Karanevich-Dono stated decedent could either be sent home or transferred to Newark Beth Israel Medical Center (Newark Beth Israel) for in-patient treatment. Decedent opted to go home and try to rest. Around 5:00 p.m., decedent's sister picked him up to go to her nearby home so he might escape the noise of his children and get some sleep. Decedent's sister phoned Catherine later that night and reported decedent was "starting to talk crazy" and she decided to take him to Rahway's ER. Decedent was readmitted to Rahway in the early morning hours of September 9, 2002.

Karanevich-Dono spoke to decedent upon his readmission and recorded these notes: "on 9/8 Pt very vague on thoughts of suicide, no plan - unable to even describe a thought." On the assessment check list, she marked "suicidal ideation." Dr. Mayer examined decedent on two occasions when he arrived that morning and recommended decedent be transported to Newark Beth Israel for in-patient psychiatric treatment. Decedent agreed to this proposal. Dr. Mayer viewed decedent's willingness to seek in-patient treatment as significant and "believe[d] the patient was cooperative with care[,] [] followed my recommendations, [] was going as a voluntary patient and wanted to get better."

At trial, Dr. Mayer discussed this further. He maintained that because "there were no specific suicide plans or thoughts," the nurses' notes as written represented a "very weak signal about any kind of suicide mentation." Dr. Mayer also explained there was no basis to detain decedent and he could have changed his mind about in-patient treatment at any time and he could have "simply left" Rahway. Also, had decedent been admitted to Newark Beth Israel, he could have left at any time.

Before decedent could be transferred to Newark Beth Israel, it was required that he be medically cleared by an ER physician and his insurance company had to issue approval for in-patient care. Decedent was waiting at the hospital pending these events. At 2 p.m., Nurse Vargas completed blood work and decedent was taken to the radiology department for a chest xray. When the x-ray was completed, decedent was left unattended. Decedent was observed by Heasun Lee, an ER nurse, as he stood about three steps outside of the radiology department waiting room; his hospital gown was not tied in the back. She tied the gown and instructed decedent to walk back to the radiology department waiting room. Lee was aware decedent was a psychiatric patient who was scheduled to be transferred to an in-patient facility. She stated he seemed alert, oriented and cooperative and followed her instructions.

Decedent was next seen on the fifth floor roof by another Rahway patient. Nurse DiPasquale, accompanied by two maintenance workers, reported to the fifth floor roof. Seeing decedent, DiPasquale yelled "hey." Decedent jumped off the roof's edge, landing on the adjacent third floor roof. He died shortly thereafter of injuries sustained in the fall.

During trial, Peter Semler, Rahway's chief maintenance mechanic, testified that someone seeking to reach the roof would have to be very determined to do so. If someone wanted to reach the fifth floor, the roof was accessible only by first climbing a ladder, opening a hatch and climbing through to reach the water storage tank room. Thereafter, in order to reach the roof one had to step onto pipes, climb a second ladder, crawl on top of a water tank and push open a second hatch directly above the tank. Semler acknowledged that on the day of decedent's death, the hospital did not utilize key restrictions on elevators traveling to the fifth floor, as the floor was used only for storage and as a sleeping area for ...


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