On appeal from the Superior Court of New Jersey, Law Division, Middlesex County, Docket No. L-8148-03.
NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION
Before Judges Reisner, Simonelli and Hayden.
Plaintiffs Jessica Santana, the proposed guardian for John Stanford, and John Stanford (Stanford), a patient who suffered severe neurological injuries as the result of alleged malpractice, appeal from several trial court orders. For the reasons stated in this opinion, we decide the following: (a) we affirm the trial court's July 24, 2009 order granting a new trial with respect to Dr. Imran Chaudri; (b) we reverse the trial court's September 25, 2009 order, denying plaintiffs' motion for reconsideration of the court's mid-trial decision to grant a motion filed by Robert Wood Johnson University Hospital at Hamilton (the hospital) for involuntary dismissal at the close of plaintiffs' evidence; and (c) we remand the case for a new trial against the hospital.*fn1 For the parties' guidance on remand, we also confirm that the hospital's potential liability is limited to $250,000 under the Charitable Immunity Act, N.J.S.A. 2A:53A-7 to -11.
This was the most pertinent trial evidence.
The hospital is a nonprofit corporation organized for
hospital purposes. On November 16, 2001, Stanford, a forty-year-old
man, arrived at the hospital's emergency room (ER) with complaints of
headache and neck pain. He was seen by Dr. Chaudri, a board-certified
Dr. Chaudri was not a hospital employee; he was employed by Emergency Physician Associates, which had a contract with the hospital to staff the emergency room. Dr. Chaudri had never met Stanford before seeing him in the ER on November 16, and there was no way for Stanford to select the doctor who saw him in the ER. The only indication that Dr. Chaudri was not an employee of the hospital was a sign in the registration area stating that patients would receive a bill from Emergency Physician Associates for the physician's services; Dr. Chaudri did not tell Stanford of his independent-contractor status.
Dr. Chaudri ordered a CT scan for Stanford, which the radiologist reported as showing a nine-millimeter hyperdense rounded lesion, possibly a colloid cyst. The radiologist suggested that a follow-up MRI be performed. Dr. Chaudri testified that he told Stanford to obtain an outpatient MRI, but that instruction was not reflected in Stanford's chart. Dr. Chaudri diagnosed Stanford as suffering from a tension headache and sent him home with a prescription for narcotic painkillers.
Stanford was brought in the next day by ambulance, complaining of worsening headache, an inability to move his right arm, and weakness in his right leg. He was seen again by Dr. Chaudri, who requested a consultation with the on-call neurologist, Dr. Vergara. Like Dr. Chaudri, Dr. Vergara was not a hospital employee. He was an employee of Lawrenceville Neurology Center, a private-practice group. Dr. Vergara had never met Stanford before, did not tell Stanford that he was an independent contractor, and admitted that he had no contact with Stanford that would let Stanford know that he was "there for any reason other than the [that] hospital" wanted him to be there. As Dr. Vergara explained it, Dr. Chaudri looked up the attending neurologist on call and paged him. Stanford had no choice in the doctor that came to see him.
Dr. Vergara diagnosed Stanford with conversion disorder - that is, that there was no organic basis for the symptoms he was experiencing. He did recommend an MRI on either an inpatient or outpatient basis, but he did not believe there was any need to have Stanford admitted for an inpatient MRI. Based on Dr. Vergara's consultation, Dr. Chaudri decided to discharge Stanford with instructions to follow-up with a family doctor the following Monday for an MRI. Like Dr. Vergara, Dr. Chaudri did not believe that an immediate MRI was required.
The next day, November 18, Stanford returned to the emergency room by ambulance and was admitted to the hospital by Dr. Omah, the attending emergency-room physician. An MRI was performed on November 19, which revealed a cerebral aneurysm. Stanford was transferred to Robert Wood Johnson University Hospital in New Brunswick for neurosurgery, but by then he had suffered bleeding from the aneurysm and further damage to the blood vessel, which made the surgery more risky and difficult. Due to complications that developed during and after the surgery, he was left a quadriplegic.
At trial, the issues relevant to this appeal were: (a) whether the
various settling-defendant doctors, as well as the non-settling
defendants, Drs. Chaudri and Omah, deviated from
the standard of care by not promptly ordering an MRI,*fn2
(b) to what degree Stanford's permanent injuries were
attributable to the aneurysm, a pre-existing condition, as opposed to
being attributable to the defendant doctors' negligence, and (c) the
hospital's vicarious liability for the doctors' negligence.
Stanford's emergency-medicine expert testified that the standard of care called for Dr. Chaudri to order an MRI on November 16, the first time that Stanford came to the emergency room. She further opined that if the hospital did not have an MRI machine available, Dr. Chaudri should have arranged for an immediate transfer to a facility with an available MRI. She also testified that, if the hospital's policies did not allow Dr. Chaudri to order an MRI himself, he should have immediately obtained a neurological consultation and asked the neurologist to help him order an MRI.
Dr. Chaudri's emergency-medicine expert, however, testified that Dr. Chaudri met the standard of care on November 16, because he appropriately referred Stanford for a follow-up MRI. He also opined that an emergency MRI was not needed, based on the evidence Dr. Chaudri had available to him at the time. That expert also opined that Dr. Chaudri met the standard of care on November 17, because he reasonably relied on Dr. Vergara's opinion that the MRI could be done on an outpatient basis.
Stanford's expert neurologist testified that if Stanford's aneurysm had been discovered on November 16, there would have been a three percent risk of complication from an aneurysm-repair surgery. By the time the aneurysm was discovered and operated on, that risk had risen to forty percent.
Before the case was submitted to the jury, several of the defendant doctors settled with plaintiffs, and only Drs. Omah and Chaudri remained as defendants. The jury found that Dr. Chaudri was liable for Stanford's injuries but returned a no cause verdict in favor of Dr. Omah. The jury found that Drs. Vergara and Williams, who had settled, were negligent, and that Dr. Guarino, whom plaintiff had voluntarily dismissed from the case, was not negligent. The jury apportioned responsibility for Stanford's injuries as follows: 5.68 percent to Stanford's pre-existing condition; 33.88 percent to Dr. Chaudri; 42.56 percent to Dr. Vergara; and 17.88 percent to Dr. Williams. It awarded Stanford $18.33 million in non-economic damages and $6.67 million for his future medical expenses.
However, by order dated July 24, 2009, the trial court set aside the verdict, granting Dr. Chaudri's motion for a new trial. In a written opinion dated August 17, 2009, the trial judge explained that he was granting a new trial for three reasons. First, in his summation, plaintiffs' counsel made a statistical argument -- that the doctors' negligence had increased Stanford's risk of harm by more than 1000 percent --that had the capacity to mislead the jury. The judge also reasoned that the court's later curative instructions were insufficient. Second, he found that plaintiffs' counsel's argument, that Dr. Chaudri refrained from ordering an emergent MRI because it cost too ...