Chapter 1: Duties of Health Care Providers……………………. 1
I DUTY OF CARE ………………………………………………………….. 1
1-1 The Generally Accepted Standard of Care …………………….. 1
1-1:1 Introduction ……………………………………………………… 1
1-1:2 “Generally Accepted” and “Reasonably Prudent”
Standards Distinguished …………………………………………….. 3
1-1:3 Not All Deviations From the Standard of Care
Constitute Malpractice ………………………………………………… 5
1-2 The Role of the Physician’s Judgment …………………………… 8
1-2:1 Physician’s Exercise of Reasonable Judgment
Is Not Malpractice ……………………………………………………….. 8
1-2:2 Evolution of the Judgment Charge ……………………………. 11
1-2:3 Limitations on Applicability
of the Judgment Charge ………………………………………………….16
1-2:4 Specific Cases Addressing the Judgment Charge ……………. 21
1-2:5 Need for Informed Consent Charge
When Judgment Charge Is Given …………………………………….. 30
1-3 Personal Standards Do Not Establish the Standard of Care… 30
1-4 Duties of Specific Medical Providers …………………………. 34
1-4:1 Duty of Examining or Consulting Physician
Acting for Third Party ……………………………………………… 34
1-4:1.1 General Duty of Care ………………………………………. 34
1-4:1.2 Duty to Report Findings to Patient ……………………. 39
1-4:1.2a Duty of Examining Physician ………………….………… 39
1-4:1.2b Duty of Consulting Physician
Not Examining Patient ………………………………………………….. 43
1-4:1.2c Duty of Third Party to Disclose Test Results ………..…. 45
1-4:1.3 Duty to Persons Other Than Patient …………………………46
1-4:2 Duty of a Specialist ………………………………………………. 46
1-4:3 Standard of Care for Hospital Resident Physician …………. 50
1-4:4 Duty of a Supervisor ……………………………………………… 52
1-4:5 Duty of a Supervisor of Nurses …………………………………. 56
1-4:6 The Scope of Chiropractic Care ………………………………… 58
1-4:7 Duty of Emergency Department ……………………………….. 62
1-4:8 Duty of Nursing Home …………………………………………… 62
1-4:9 Non-Delegable Duty of Jail or Prison …………………………. 66
1-5 Duties in Specific Circumstances …………………………………. 68
1-5:1 Duty Regarding Treatment of Body/Deceased …………….. 68
1-5:2 Duty to Elderly and Infirm Patient …………………………….69
1-5:3 Duty to Suicidal Patient …………………………………………. 70
1-6 Liability of Third Parties for Physician’s Breach
of Duty of Care …………………………………………………………….. 75
1-6:1 Duty of a Credentialer …………………………………………… 75
1-6:2 Duty of Employer/Respondeat Superior ……………………. 79
1-6:2.1 Employment Relationship Required ………………………79
1-6:2.2 Employee Need Not Be Party ……………………………….. 79
1-6:2.3 Employer Not Liable for Employee
Conduct Outside Scope of Employment …………………………….81
1-6:2.4 Limitation of Liability ……………………………………………83
1-6:3 Apparent Employment of Medical Professionals …………. 84
1-6:4 Liability of Referring Physician ………………………………… 89
1-6:5 Liability of Workers’ Compensation Carrier
for Examining Physician’s Negligence ……………………………….. 90
1-7 Termination of the Duty of Care ………………………………… 93
II OTHER RELATED DUTIES …………………………………………….. 94
1-8 The Duty of Confidentiality ……………………………………….. 94
1-8:1 Generally ………………………………………………………….. 94
1-8:2 Exceptions to/Waiver of Confidentiality ……………………. 96
1-8:2.1 Personal Injury Claim Waives Confidentiality …………..96
1-8:2.2 Use and Misuse of a Subpoena ……………………………. 99
1-8:3 Duty to Keep AIDS Diagnosis Confidential ………………….. 102
1-8:4 Duty to Keep Psychiatric Records Confidential …………….. 104
1-8:4.1 Privilege Akin to Attorney-ClientPrivilege ……………..… 104
1-8:4.2 Exceptions to Confidentiality
of Psychiatric Records …………………………………………….. 108
1-8:4.2a Defense to Crime/Mental
State at Issue/Best Interests of Children …………………………… 108
1-8:4.2b Persons at Risk of Harm ……………………………….. 109
1-8:4.3 Improper Use of Subpoena
for Psychiatric Records ………………………………………………. 111
1-9 The Duty to Provide Genetic Counseling …………………… 112
1-10 The Duty to Terminate Care …………………………………… 114
1-11 The Duty of Treating Physician to Testify or Provide
Litigation Support ……………………………………………………… 115
1-12 The Duty to Maintain Insurance …………………………….. 119
Chapter 2: Doctrines of Informed Consent and Refusal ………. 123
I Duty to obtain INFORMED
CONSENT or REFUSAL..................................................................123
2-1 The Fully Informed Patient …………………………………….123
2-1:1 Physician’s Common Law Duty to Provide
Information ………………………………………………………………. 123
2-1:2 Code Provisions Require Written
Informed Consent …………………………………………………………. 127
2-2 Actions for Breach of Duty to Obtain Informed
Consent or Refusal ………………………………………………………… 127
2-2:1 Elements of Cause of Action for Breach
of Duty to Obtain Informed Consent ………………………………… 127
2-2:2 Standard for Duty to Disclose ………………………………….. 128
2-2:2.1 Professional Standard Abandoned ……………………………128
2-2:2.2 Reasonable Patient Standard …………………………….. 129
2-2:2.3 Informed Consent Regarding Prescription Drugs ………..133
2-2:2.4 Only Material Risks Need Be Disclosed ………………………. 134
2-2:3 Duty to Disclose Applicable to Non-Invasive
Procedures or Non-Treatment ……………………………………………..142
2-2:4 Duty Regarding Informed Refusal …………………………………. 144
2-2:5 Duty to Inform of Available Diagnostic Testing ………………..145
2-2:6 The Relationship Between Medical
Judgment and Informed Consent ……………………………………….. 148
2-2:7 No Duty to Disclose Unavailable Options …………………….. 154
2-2:8 Distinguishing Negligent Treatment/Failure
to Diagnose from Failure to Disclose ……………………………….. 155
2-2:8.1 Negligent Treatment/Diagnosis ………………………… 155
2-2:8.2 Failure to Disclose Distinguished ………………………….. 160
2-2:9 Immunity/No Duty to Obtain Informed
Consent in Emergencies ………………………………………………. 163
2-2:10 Disclosure Regarding FDA Approvals ……………………. 166
2-2:11 Disclosures Regarding Physicians ………………………. 168
2-2:11.1 Duty to Disclose Physician’s HIV/AIDS …………………… 168
2-2:11.2 Duty Regarding Disclosure of Credentials …………..170
2-2:11.3 Duty to Identify Specific Physician
Performing Service ………………………………………………… 174
2-2:11.4 No Duty to Disclose Risks
of Treatment by Other Physicians ……………………………….. 175
2-2:12 Liability to Third Parties for Breach
of Duty to Obtain Informed Consent ……………………………… 177
2-2:12.1 Child’s Cause of Action for Breach
of Duty to Disclose Risks to Mother ……………………………….177
2-2:12.2 Duty to Advise of Test Results
Affecting Patient and Third Parties ……………………………. 182
II PROCEDURAL ISSUES........................................................187
2-3 Pleading Informed Consent …………………………………….. 187
2-4 A Directed Verdict May be Warranted Where
Defendant Concedes a Material Risk Was Not Disclosed …….. 189
2-5 Routine Disclosure As Evidence of Information
Disclosed to Patient …………………………………………………..191
2-6 Whether Patient Would Decline Treatment Is Issue
for the Jury …………………………………………………………… 192
2-7 Jury Interrogatories in Informed Consent Case …………. 194
III ASSAULT AND BATTERY DISTINGUISHED...................194
2-8 Introduction ………………………………………………………… 194
2-9 “Ghost Surgeries”: Patient Not Informed Who
Will Perform Services …………………………………………………… 194
2-10 Performing Different Surgery Than Described ……………… 196
2-11 No Proof of a Deviation from the Standard
of Care Required for Battery ………………………………………. 202
2-12 Exceeding Conditions of Consent Constitutes Battery ….. 203
Chapter 3: Other Causes of Action …………………………….. 207
I TORT CLAIMS......................................................................207
3-1 Strict Liability in Tort …………………………………………….. 207
3-2 Abandonment ……………………………………………………. 207
II FRAUD CLAIMS...................................................................210
3-3 Fraud ……………………………………………………………….. 210
3-3:1 Elements of Cause of Action …………………………………… 210
3-3:2 Benefits/Burdens of Pleading Fraudulent
Concealment …………………………………………………………….. 210
3-3:3 Consumer Fraud ……………………………………………….. 212
3-3:4 Misrepresentation of Credentials …………………………… 213
3-3:5 Misrepresentations Concerning Treatment …………….. 216
III CONTRACT AND OTHER CLAIMS ………………………………… 220
3-4 Breach of Contract ……………………………………………….. 220
3-5 False Imprisonment …………………………………………………222
3-6 The Mishandling of a Corpse …………………………………….. 223
3-7 Unauthorized Autopsy …………………………………………. 224
3-8 False Diagnosis of Disease ………………………………………… 225
3-9 Alteration or Destruction of Medical Records …………….. 225
3-10 Sexual Misconduct ………………………………………………230
Chapter 4: Proximate Causation ……………………………………. 233
I INTRODUCTION .................................................................233
4-1 Overview…………………………………………………………..233
4-2 Reasonable Degree of Medical Probability ………………………. 234
II PRE-EXISTING CONDITIONS......................................................240
4-3 Causation Issues Raised by Pre-Existing Conditions ……………… 240
4-3:1 Introduction ………………………………………………………….….. 240
4-3:2 Defining What Constitutes a Pre-Existing Condition ………………… 242
4-3:2.1 Condition That Could Evolve into
Ultimate Condition Absent Negligence …………………………….…… 242
4-3:2.2 Condition Being Treated to Delay Outcome ……………….. 242
4-3:2.3 Addiction as Pre-Existing Condition …………………………… 245
4-3:3 Defendant’s Burden to Apportion Damages
Caused by Pre-Existing Condition …………………………………………… 249
4-3:4 Evers, Scafidi and the “Increased
Risk/Substantial Factor” Test ……………………………………………….. 252
4-3:4.1 Development of “Increased Risk/Substantial Factor” Test ............ 252
4-3:4.2 Defining “Substantial Factor” ……………………………………….283
4-3:4.3 Retroactive Application of Scafidi ………………………………….. 285
4-3:4.4 Application of Scafidi to Specific Cases ………………………... 287
4-3:4.5 Explaining Limitation of Scafidi Charge ………………………….. 299
4-3:4.6 Issuing Ultimate Outcome Jury Charge with Scafidi Charge ….. 299
4-3:5 Failure to Perform Diagnostic Test Which
Would Have Disclosed Pre-Existing Condition ……………………….300
4-3:6 Apportionment of Pain and Suffering …………………………. 306
4-4 Loss of a Chance …………………………………………………….. 307
4-5 Aggravation of a Prior Independent Tort …………………….. 312
4-6 Pain and Suffering .……………………………………………….. 322
III AVOIDABLE CONSEQUENCES/COMPARATIVE
NEGLIGENCE......................................................................325
4-7 Effect of Avoidable Consequences/Comparative
Negligence on Proof of Causation ………………………………….. 325
4-7:1 Introduction ……………………………………………………….325
4-7:2 Distinction Between Patient’s Pre-Treatment
and Post-Treatment Conduct ………………………………………. 325
4-7:3 Distinguishing Avoidable Consequence
and Superseding Cause ………………………………………………….. 331
4-7:4 Cases Limiting Application of Avoidable
Consequence/Comparative Negligence …………………………….. 334
4-7:5 Applicability to Informed Consent Cases ………….335
IV CAUSATION IN INFORMED CONSENT CASES.............336
4-8 Proof of Proximate Causation in the Informed
Consent Case...........................................................................336
4-9 Failure to Warn Regarding Prescription Drug Risks................338
4-10 Failure to Fully Inform Patient Regarding
Procedure and Alternatives......................................................343
Chapter 5: Damages in Medical Malpractice Cases …………. 351
I TYPES OF DAMAGES..........................................................351
5-1 Introduction ………………………………………………………………….. 351
5-2 Damages for Delay in Treatment ………………………………………. 352
5-3 Pain and Suffering ……………………………………………………….. 356
5-4 Hedonic Damages ………………………………………………………….. 363
5-5 Disability ………………………………………………………………………. 366
5-6 Economic Loss ……………………………………………………………………. 367
5-7 Medical Bills …………………………………………………………………….. 373
5-8 Emotional Distress Damages ………………………………………………….379
5-8:1 Generally …………………………………………………………………….. 379
5-8:2 Emotional Distress of Relatives ……………………………………….. 383
5-8:2.1 Portee and Elements of Claim ………………………………………….. 383
5-8:2.2 Application of Portee in Malpractice Cases …………………………384
5-8:2.3 Claims for Mistreatment of Body/Corpse ……………………………… 389
5-8:2.4 Misdiagnosis Generally Does Not Satisfy Portee Factors ……………. 390
5-8:2.5 Emotional Distress of Parents for Loss of a Child ………….……..393
5-8:2.6 Relatives Must Connect Malpractice
to Injury to Recover Emotional Distress Damages …………………..….. 402
II DAMAGES IN CASES INVOLVING A FETUS OR CHILD......................406
5-9 Damages Involving a Fetus ……………………………………………….. 406
5-9:1 Injuries to a Fetus/Preconception Injuries ……………………………. 406
5-9:2 Loss of a Fetus ……………………………………………………………. 412
5-10 Injuries to a Child …………………………………………………………… 414
5-11 Effect of Settlement with Infant Without Judicial Approval ……….. 417
III WRONGFUL BIRTH/LIFE CLAIMS............................................................419
5-12 Wrongful Birth ……………………………………………………………. 419
5-12:1 Introduction …………………………………………………………….. 419
5-12:2 Distinguishing Wrongful Life Claims
in New Jersey …………………………………………………………….. 419
5-12:3 Development of Wrongful Birth Claim ……………………. 422
5-12:4 Measure of Damages for Wrongful Birth …………………….425
5-12:4.1 Emotional Distress of Parents ………………………….. 425
5-12:4.2 Damages for Extraordinary Costs of Care ……………….425
5-12:5 Distinguishing Wrongful Birth and Informed
Consent Claims: Medical Causation Not Required ………………… 428
5-12:6 Preconception Negligence ………………………………………….432
5-12:7 Superceding Cause/Avoidable Consequences
in Wrongful Birth Cases ……………………………………………………. 434
5-12:8 Emotional Distress Damages for Wrongful Birth …………... 438
5-12:9 Damages Not Reduced by Joy
of Raising Child …………………………………………………………….. 441
5-12:10 No Claim for Grandparents, Siblings ………………………………. 443
IV DAMAGES IN WRONGFUL DEATH CASES........................................445
5-13 Wrongful Death Claims...........................................................445
5-13:1 Generally …………………………………………………… 445
5-13:2 Wrongful Death of a Child ………………………………… 448
5-13:3 Wrongful Death After a Prior Medical
Malpractice Suit ……………………………………………… 453
V OTHER DAMAGES ISSUES................................................457
5-14 Punitive Damages....................................................................457
5-15 Per Quod …………………………………………………………. 462
5-16 Additur/Remittitur of Damages..............................................464
Chapter 6: Pre-Suit Investigation of Medical
Malpractice Claim …………………………………………………………471
I MEDICAL RECORDS ……………………………………………………… 471
6-1 The Duty to Maintain Accurate
and True Medical Records ……………………………………………….. 471
6-2 Statutory and Administrative Code Regulations
Regarding Medical Records ……………………………………………… 472
6-3 Legibility Requirements for Medical Records ……………….. 475
II INCIDENT, INVESTIGATION AND OTHER REPORTS ....…………476
6-4 Incident Reports ……………………………………………………. 476
6-5 The Patient Safety Act, N.J.S.A. 26:2H-12.23 ………………….. 476
6-6 Investigation of Serious Preventable Adverse Events …………. 488
6-7 Peer Review/Committee Reports …………………………………. 492
6-8 Sentinel Event Reports ………………………………………………..502
6-9 Interviews of Health Care Professionals ………………………….. 503
III DECLINING A MEDICAL MALPRACTICE CASE ………………….. 505
6-10 Advising the Client …………………………………………………… 505
Chapter 7: Expert Testimony and Learned Treatises ………………509
I EXPERT TESTIMONY IN MALPRACTICE CASES …………………….. 509
7-1 Introduction …………………………………………………………….509
7-2 Requirements for Expert Testimony ………………………………. 511
7-2:1 Expert Establishes Standard of Care
and Deviation Therefrom ……………………………………………….. 511
7-2:2 Content of Expert Testimony/Report ……………………….. 516
7-2:2.1 Introduction ……………………………………………………….. 516
7-2:2.2 Clear, Specific Opinions ………………………………………… 517
7-2:2.3 Reasonable Medical Probability ………………………………. 518
7-2:3 Importance of Expert Testimony ………………………………….. 521
II QUALIFICATION OF EXPERTS
AND THE PATIENTS FIRST ACT ………………………………………………………522
7-3 Qualification of Expert Witnesses ……………………………………… 522
7-3:1 Introduction …………………………………………………………… 522
7-3:2 Qualification of Expert Witnesses Prior to New
Jersey Medical Care Access and Responsibility and
Patients First Act …………………………………………………………………….. 523
7-3:2.1 Continuing Applicability of Pre-Act
Common Law for Cases Arising Prior to 2004 …………………….….. 523
7-3:2.2 Expert in Different Specialty May
Qualify in Pre-2004 Cases …………………………………………………….. 523
7-3:2.3 Examples of Qualified Experts in Pre-2004 Cases ……………………. 525
7-3:2.4 Examples of Experts Not Qualified in Pre-2004 Cases ...........…. 531
7-3:3 Qualification of Expert Witnesses After the
New Jersey Medical Care Access and Responsibility
and Patients First Act ……………………………………………………….…….. 534
7-3:3.1 Same Specialty Required for Expert …………………………………. 534
7-3:3.2 Applicability of Same Specialty Requirement ……………………. 535
7-3:3.3 The Specialties and Sub-specialties Recognized by the
American Board of Medical Specialties or the American
Osteopathic Association ………………………………………………..………. 537
7-3:3.3a Recognized Specialties ……………………………………………….. 537
7-3:3.3b ABMS Recognized Specialties …………………………………537
7-3:3.3c AOA Recognized Specialties ………………………………………… 542
7-3:3.3d Scope of Practice for Specialties …………………………..…… 545
7-3:3.3e Overlap Between Specialties ………………………………………. 546
7-3:3.4 Constitutionality Challenged ………………………………………….. 546
7-3:3.5 Amendment to Affidavit of Merit ………………………………………. 548
7-3:3.6 Equivalently Qualified ……………………………………………………. 549
7-3:3.7 Determining the Qualifications of Medical
Malpractice Liability Experts ………………………………………………………. 550
7-4 The Patients First Act’s Impact on Other Medical Malpractice Issues ………… 561
7-4:1 Introduction ……………………………………………………………………… 561
7-4:2 Statute of Limitations Amended ……………………………………………561
7-4:3 Affidavit of Noninvolvement …………………………………………………………… 562
7-4:4 Malpractice Premium Increases Barred
if Case Dismissed Within 180 Days ………………………………………………….. 562
7-4:5 Remittitur and Additur ……………………………………………………. 563
7-4:6 Good Samaritan Immunity …………………………………………………….. 563
7-4:7 Reimbursement of Non-Economic Damages ……………………………….. 563
7-4:8 Malpractice Insurance Policies ……………………………………………………..564
7-4:9 Applicability and Effective Date of The Patients First Act ……………….. 565
7-4:10 NJ Health Care Consumer Information Act …………………………………… 565
III THE AFFIDAVIT OF MERIT …………………………………………………………… 566
7-5 Overview ……………………………………………………………………………….. 566
7-5:1 Professions Covered…………………………………………………………………. 566
7-5:2 Statutory Requirements …………………………………………………………… 569
7-5:2.1 Time for Service …………………………………………………………………….. 569
7-5:2.2 Failure to Produce Necessary Records or Other Information ………… 569
7-5:2.3 Minimum Requirements ………………………………………………………….. 570
7-5:2.4 Qualifications of the Affiant ……………………………………………………. 570
7-6 Judicial Interpretation of Affidavit of Merit Statute ……………………………… 571
7-6:1 Constitutionality ………………………………………………………. 571
7-6:2 Supreme Court’s Initial Construction:
Hall and Cornblatt …………………………………………………………………573
7-6:2.1 In re Hall: Purpose of Affidavit of Merit Statute ……………………….. 573
7-6:2.2 Cornblatt v. Barow: Affidavit of Merit Not
Required for Malpractice Occurring Pre-Statute …………………….. 575
7-7 Application of the Affidavit of Merit Requirements ………………. 577
7-7:1 Introduction ………………………………………………………………… 577
7-7:2 Who is Entitled to an Affidavit of Merit? …………………………………. 579
7-7:2.1 Which Licensed Professionals are
Entitled to Affidavit of Merit? ………………………………………………… 579
7-7:2.2 Is an Affidavit of Merit Needed for
Professional Corporations? …………………………………………………….581
7-7:3 Who is Qualified to Render the Affidavit of Merit? …………….. 583
7-7:3.1 Same Specialty Requirement ……………………………………….. 583
7-7:3.2 Waiver of Same Specialty Requirement ……………………………… 586
7-7:4 What Information Must be Contained
in the Affidavit of Merit? ………………………………………………… 589
7-7:5 Does the Affidavit of Merit Statute Require Identification
of the Defendants Who Deviated from the Standard of Care? …….. 590
7-7:6 When Must the Affidavit of Merit be Filed? ………………………… 592
7-7:7 What Constitutes Substantial Compliance
with the Affidavit of Merit Statute? …………………………………… 596
7-7:7.1 Substantial Compliance Concept Explained ………….. 596
7-7:7.2 Applying the Substantial Compliance Concept ………………… 598
7-7:7.3 The Affidavit of Merit Statute Should
Not Be Mechanically Applied ……………………………………………….600
7-7:7.4 Dismissal with Prejudice Absent
Extraordinary Circumstances …………………………………………………. 603
7-7:7.5 Failure to Put Expert Under Oath
Renders Affidavit Non-Compliant …………………………………………. 606
7-7:8 Does the Doctrine of Waiver or Estoppel
Apply to the Affidavit of Merit Statute? ……………………………….. 607
7-7:8.1 Failure to Promptly Seek Dismissal
Estops Defendant……………………………………………………………. 607
7-7:8.2 The Ferreira Conference …………………………………….. 609
7-7:9 Does the Failure to Hold a Ferreira
Conference Extend the Time to Serve an Affidavit of Merit? ………….. 609
7-7:10 Can the Ferreira/Affidavit of Merit
Conference be Waived? …………………………………………………….. 610
7-7:11 Is the Affidavit of Merit Waived
if the Defendant Withholds Medical Records
Needed to Prepare the Affidavit? ……………………………………………. 610
7-7:11.1 Records Having Substantial Bearing
on Preparation of Affidavit of Merit ………………………………………… 610
7-7:11.2 Records Not Needed for Affidavit ……………………………… 614
7-7:12 Once Suit Is Filed, Is the Affidavit of Merit Statute Tolled
Due to the Minority of an Infant Plaintiff ? ……………………..…. 616
7-7:13 Is an Affidavit of Merit Required in Common
Knowledge or Res Ipsa Cases? ……………………………………………… 617
7-7:14 Is an Affidavit of Merit Required for
Informed Consent Cases? ……………………………………………………..620
7-7:15 Does the Affidavit of Merit Statute Apply
to Cross-claims or Counterclaims? ………………………………………. 621
7-7:15.1 Applicability to Cross-claims ……………………………………… 621
7-7:15.2 Applicability to Third-Party Malpractice Complaint ………………….. 622
7-7:15.3 Applicability to Counterclaim ……………………………. 624
7-7:16 Does the Affidavit of Merit Statute Apply to Non- Malpractice
Claims, Such as Contract or Assault and Battery Claims? …………………… 625
7-7:17 Is an Affidavit of Merit Needed to Establish Causation
or Damages? ……………………………………….. 627
7-7:18 Should the Affidavit of Merit Statute Ever
be Permitted to be Used to Defeat Meritorious Claims? ………………….. 628
IV PRESENTING EXPERT TESTIMONY AND REPORTS ……………….. 630
7-8 The Foundation for Expert Testimony ………………………… 630
7-8:1 Testimony Based on Knowledge, Training,
Experience or Education ……………………………………………..630
7-8:2 Theories Not Yet Generally Accepted …………………………. 633
7-8:3 Rule 104 Hearing on Admissibility …………………………….. 637
7-8:4 Use of Multiple Experts ……………………………………… 637
7-9 The Requirements of the Expert Report …………………….. 640
7-10 The Net Opinion Rule …………………………………………646
7-11 The Common Knowledge Doctrine ………………………….. 660
7-11:1 Doctrine Established in Cases of Foreign
Objects Left Behind in Surgery ……………………………………… 660
7-11:2 Cases in Which Common Knowledge Found ………………. 662
7-11:2.1 Generally ………………………………………………………………..662
7-11:2.2 An Extreme Application
of the Common Knowledge Doctrine ………………………………….. 670
7-11:2.3 Common Knowledge Regarding
Communication of Test Results ……………………………………………….672
7-11:3 Cases in Which Common Knowledge Doctrine Was Rejected …..…674
7-12 Res Ipsa Loquitur …………………………………………………….. 676
7-12:1 Required Elements ………………………………………………………. 676
7-12:2 Expert Testimony Still Required for Res Ipsa Loquitur ……………….. 678
7-12:3 Examples Where Res Ipsa Loquitur Applied ………………………… 681
7-12:4 Examples Where Res Ipsa Loquitur Not Applied …………………….. 684
7-12:5 Conditional Application of Res Ipsa Doctrine ………………………..687
7-13 Anderson v. Somberg and Collective Joint Responsibility………… 696
7-14 Expert Testimony in Informed Consent Cases …………………… 705
7-15 Compelling Expert Testimony ………………………………………… 716
V LEARNED TREATISES AND OTHER SOURCES …………………………….. 727
7-16 The Jacober Rule/Learned Treatises ……………………………………. 727
7-16:1 Treatises …………………………………………………………………. 727
7-16:2 Manufacturers’ Technical Guides and Package Inserts …………. 735
7-17 The Physicians’ Desk Reference and Package Inserts …………. 738
7-18 Hospital Protocols and Procedure Manuals …………………… 741
7-19 Recommendations of Professional Medical
Boards or Organizations ……………………………………………… 743
7-20 Recommendations of the American
Medical Association ……………………………………………………… 746
7-21 Statutes and Administrative Codes ……………………………….. 749
7-21:1 Generally ………………………………………………………….. 749
7-21:2 Statute as Evidence of Standard of ………………………………………. 750
7-21:3 Examples of Statute Held Not
Evidence of Standard ……………………………………………………….. 757
7-22 Discovery of Treatises to be Utilized as Evidence
of the Standard of Care …………………………………………………………758
VI REFUSAL OR INABILITY OF EXPERT TO TESTIFY …………………….….. 759
7-23 Remedies for Failure of Expert Witness to Testify ……………………….759
Chapter 8: Pleadings, Defenses and Voir Dire in Medical Malpractice
Cases …………………………………………………………………………………………763
I INTRODUCTION ………………………………………………………………763
8-1 Overview …………………………………………………………………….. 763
II PARTIES …………………………………………………………………………….. 763
8-2 Identifying All Claims as to All Parties …………………………………. 763
8-2:1 The Entire Controversy Doctrine ………………………………….. 763
8-2:2 Fictitious Defendant Rule …………………………………………….. 766
8-3 Service on Absent Defendants ………………………………………… 769
III DEFENSES ………………………………………………………………………… 770
8-4 Comparative Negligence and Avoidable Consequences …………. 770
8-5 Affidavit of Noninvolvement ……………………………………….777
8-6 Statute of Limitations ……………………………………………..779
8-6:1 Generally ……………………………………………………………. 779
8-6:2 The Discovery Rule ……………………………………………………..782
8-6:2.1 Development of the Discovery Rule ………………….….. 782
8-6:2.2 Filing within Two Years from the Date of Discovery ………………. 788
8-6:2.3 Discovery Rule Triggered by
Knowledge of Fault ……………………………………………………………………791
8-6:2.4 Fact of Injury, Not Injury’s Extent,
Triggers Statute of Limitations ………………………………………………………….. 799
8-6:2.5 Increased Risk of Harm, Latent Disease, Cancer Recurrence: Statute
of Limitations Begins to Run Only After Harm Occurs …………………………….…. 801
8-6:2.6 Discovery of Proper Defendant …………….………………… 804
8-6:2.6a Amended Complaint
Relates Back …………………………………………………………….. 804
8-6:2.6b Due Diligence Required …………………….…………………. 811
8-6:2.7 Application of Discovery Rule to Cases, Generally ……..…. 813
8-6:3 Statute of Limitations in Informed
Consent Cases ………………………………………………………….……831
8-6:4 Failure to Advise, Concealment of Malpractice
and the Statute of Limitations ………………………………………………… 834
8-6:5 Continuing Treatment and the Statute of Limitations .....……. 840
8-6:6 Incompetency/Insanity and the Statute of Limitations ……......841
8-6:7 Infancy/Parents’ Claim for Injuries to a
Child and the Statute of Limitations ……………………………..……… 842
8-6:8 Statute of Limitations for Wrongful Death……………………….. 846
8-7 Charitable and Other Immunities ……………………………….…. 857
8-7:1 Introduction …………………………………………………..………. 857
8-7:2 Hospitals and Charitable Immunity ……………………………. 857
8-7:2.1 Limitations on Hospital Liability ……………………………….. 857
8-7:2.2 Limitations on Hospital Liability Not
Applicable to Hospital Employees ………………………………………..859
8-7:2.3 Determining Whether Defendant is a
Charity Subject to Immunity …………………………………….. 860
8-7:2.4 Charitable Immunity Inapplicable
in Products Liability ……………………………………………………………862
8-7:2.5 Jury Charges on Charitable Immunity …………………….. 862
8-7:3 Immunity for Emergency Squads and Personnel …………. 865
8-7:4 Good Samaritan Act Immunity ………………………………..…… 870
8-8 Tort Claims Act and Public Entity Immunity ……………………… 872
8-8:1 Introduction …………………………………………………….. 872
8-8:2 The Notice of Tort Claim …………………………………… 872
8-8:3 Requirement of Notice of Tort Claim
for Public Employees …………………………………………….…….. 874
8-8:4 Time to Serve Notice of Claim in Malpractice Cases …….... 874
8-8:4.1 Eagan and Lowe Opinions ……………………………………. 874
8-8:4.1a Eagan v. Boyarsky: Public
Employee Status Unclear …………………………………………….…. 874
8-8:4.1b Lowe v. Zarghami:
Extraordinary Circumstances ………………………………………………. 877
8-8:4.2 Cases Applying Eagan and Lowe …………………………………….. 879
8-8:4.2a Ventola and Confusion about
Federal or State Status of Institution …………………………………….. 879
8-8:4.2b D.D. v. UMDNJ and Emotional
Distress as Extraordinary
Circumstances ……………………………………………….. 881
8-8:5 Application of Tort Claim Act Immunity ………………. 884
8-9 Workers’ Compensation Defenses …………………….. 886
8-10 Lack of Jurisdiction ……………………………………………. 891
IV MULTIPLE DEFENDANTS, DEFENSE
CLAIMS AGAINST OTHER PARTIES …………………………………. 893
8-11 Cross-claims ……………………………………………………… 893
8-12 Representation of Multiple Defendants ………………………902
8-13 Counterclaims by Defendants ………………………………… 912
V VOIR DIRE …………………………………………………………… 913
8-14 Voir Dire in Medical Malpractice Cases …………………. 913
8-14:1 Supreme Court Directive #4-07 ………………………. 913
8-14:2 Requirements of Voir Dire …………………………………..915
8-14:3 Use of Standard and Open-Ended Voir Dire……………….. 920
8-14:4 Peremptory Challenges ………………………………… 921
VI ARBITRATION ……………………………………………………… 926
8-15 Contractual Limitations Upon and Compelled
Arbitration of Malpractice Claims ………………………………….. 926
Chapter 9: Pretrial Discovery in Medical
Malpractice Cases ……………………………………………………. 935
I INTRODUCTION …………………………………………………………… 935
9-1 Overview ……………………………………………………………… 935
9-2 Priority of Discovery ……………………………………………………. 936
II MEDICAL RECORDS …………………………………………………………. 937
9-3 Obtaining Plaintiff’s Medical Records,
Interviewing Plaintiff’s Treating Physicians …………………………….. 937
9-4 Use of a Subpoena to Obtain Medical Records ………………. 942
III INTERROGATORIES ……………………………………………..944
9-5 Form Interrogatories ……………………………………………… 944
9-6 The Scope of Inquiry by Interrogatories ………………………………. 945
9-7 Discovery of Communications Between Plaintiff,
Counsel and Experts ……………………………………………………… 951
9-8 Penalty for Failure to Answer Interrogatories ……………………….. 952
9-9 Production of Expert Reports ………………………………………….953
IV USE OF ADVERSARY’S EXPERT …………………………………………. 958
9-10 Use of an Adversary’s Expert Generally Prohibited ………….958
V DEPOSITIONS …………………………………………………………….. 963
9-11 Depositions of Parties ………………………………………………963
9-11:1 Raising Objections During Depositions ………………………… 963
9-11:2 Scope of Deposition Questions …………………………………..964
9-11:3 Deposition Questions Concerning Opinions ……………………. 968
9-11:4 Deposition Testimony Supporting Learned Treatises ……. 972
9-12 Depositions of Experts ……………………………………………….. 973
9-13 Material Change in Testimony by a Witness …………………. 978
VI TREATING PHYSICIANS’ OPINIONS, REPORTS AND TESTIMONY ………… 983
9-14 Use of Treating Physicians’ Opinions …………………………….. 983
9-14:1 Value of Treating Physicians’ Testimony ……………………. 983
9-14:2 Discovery of Treating Physician’s Opinion ………………… 984
9-14:3 Use of Subsequent Treating Physician as Witness …… 985
9-14:3.1 Subsequent Treating Physician as
Witness Concerning Liability Issues …………………………….. 985
9-14:3.2 Subsequent Treating Physician as
Witness Regarding Causation …………………………………………… 989
9-14:4 Admissibility of Subsequent Treating Physician’s Reports ……. 995
9-14:5 Other Issues Concerning Treating
Physician’s Testimony …………………………………………………………… 997
9-15 Opinions of Psychiatrists or Mental Health Care Professionals …… 998
VII OTHER DISCOVERY ISSUES ……………………………………………………….. 1002
9-16 Opinions in Medical Records ……………………………………….. 1002
9-17 Medical Examiner’s/Autopsy Reports ……………………………………….. 1007
9-18 Records and Reports of Board of Health, Board of Medical Examiners ……… 1010
VIII CROSS-EXAMINATION OF EXPERTS ………………………………………. 1012
9-19 Scope of Cross-Examination of Expert Witnesses …………………….. 1012
9-19:1 Cross-Examination of Collateral Issues ……………………………….. 1012
9-19:2 Cross-Examination Regarding Prior Service as Expert Witness ……..1015
9-19:3 Use of Hypothetical Questions in Cross-Examination……………………… 1017
9-19:4 Questions Concerning Experts’ Financial
Arrangements …………………………………………………………………….1018
Appendix........................................................................................... 1021
Table of Cases …………………………………………………………………… 1023
Index …………………………………………………………………………….. 1049