ESTATE OF ANNETTE JACOBS VS. PRINCETON MEDICAL CENTER (L-0914-16, MERCER COUNTY AND STATEWIDE)
A-5092-18
| N.J. Super. Ct. App. Div. | Oct 18, 2021Background
- Decedent Annette Jacobs developed a small sacral pressure ulcer during a May–June 2014 admission at Princeton Medical Center and later heel ulcers at other facilities; she had multiple admissions for serious GI disease and died April 11, 2015 of complications of Crohn’s disease.
- Plaintiff (executrix Tamara Jacobs) sued Princeton Medical Center (and others), alleging nursing negligence allowed her sacral ulcer to worsen, causing pain and contributing to her death; most co-defendants were later dismissed or resolved.
- Nurse expert Barbara Darlington, R.N., opined on the applicable nursing standard and identified deviations (e.g., inadequate turning, monitoring, nutrition, incontinence care) but, as a nurse, did not provide causation opinions.
- Plaintiff’s medical expert, Dr. Adam Karp, offered causation opinions attributing pain and contribution to death to the ulcers but admitted he had not reviewed Nurse Darlington’s reports before forming his opinions and made general statements that pressure ulcers result from poor care; his deposition and Rule 104 testimony conceded key facts undermining causation (heel ulcers acquired elsewhere, lack of charted pain or infection, ulcers showing granulation at Lenox Hill, treating physicians attributing death to Crohn’s complications).
- Trial court held a Rule 104 (Kemp) hearing, excluded Dr. Karp’s causation testimony as an inadmissible net opinion lacking factual support under N.J.R.E. 703, and granted summary judgment for Princeton; the Appellate Division affirmed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Admissibility of Dr. Karp’s causation opinion under N.J.R.E. 703 / net-opinion rule | Dr. Karp’s testimony that the ulcers caused pain and contributed to death creates a triable causation issue | Dr. Karp’s opinion is a net opinion unsupported by factual data in the record and thus inadmissible | Excluded: opinion was a net opinion lacking record support; inadmissible under N.J.R.E. 703; summary judgment proper |
| Whether a nurse expert may testify about causation | Plaintiff suggested nurse testimony could establish causation (citing unpublished authority) | Nursing statute and precedent limit nurse testimony to nursing standard; medical causation is for physicians | Nurse may testify to standard and deviations but not to medical causation; trial court correctly refused to treat nurse as causation witness |
| Whether the trial court improperly weighed evidence or denied adequate factfinding (Kemp/Rule 104 hearing) | Court weighed credibility and should have left causation to the jury; further clarification should have been allowed | Court properly conducted a Rule 104 inquiry and evaluated whether opinion had factual basis | No abuse of discretion: Rule 104 hearing was held, and weighing the factual record for admissibility was appropriate; testimony remained insufficient |
| Whether plaintiff established proximate cause to avoid summary judgment | Nurse’s deviations plus Dr. Karp’s opinions suffice to create triable issue on causation | Plaintiff failed to link specific deviations to pain or death; record contradicted causation theory | Plaintiff failed to prove proximate cause; summary judgment affirmed |
Key Cases Cited
- Nicholas v. Mynster, 213 N.J. 463 (2013) (elements of a prima facie medical‑malpractice claim require expert proof of standard, breach, and proximate cause)
- Townsend v. Pierre, 221 N.J. 36 (2015) (discussing N.J.R.E. 703 and the requirement that expert opinion be grounded in facts or data)
- State v. Townsend, 186 N.J. 473 (2006) (describing the net‑opinion rule prohibiting conclusory expert opinions unsupported by facts)
- One Marlin Rifle, 319 N.J. Super. 359 (App. Div. 1999) (nurse testimony that amounted to a medical diagnosis was impermissible)
- Ryan v. Renny, 203 N.J. 37 (2010) (trial court discretion in evaluating expert qualifications under N.J.R.E. 702 and statutory limits)
- Kemp ex rel. Wright v. State, 174 N.J. 412 (2002) (Rule 104/Kemp hearing as tool to assess expert reliability)
- Estate of Hanges v. Metro. Prop. & Cas. Ins. Co., 202 N.J. 369 (2010) (trial courts should address evidentiary admissibility issues first on summary judgment)
- Stanley Co. of Am. v. Hercules Powder Co., 16 N.J. 295 (1954) (expert opinion must be grounded in admitted or proved facts)
- Polzo v. County of Essex, 196 N.J. 569 (2008) (defining permissible bases for expert opinion under N.J.R.E. 703)