230 A.3d 265
N.J.2020Background
- Linda Cowley was hospitalized after surgery; a physician ordered placement of a nasogastric (NG) tube, which was inserted.
- Overnight Cowley removed the NG tube and refused reinsertion; nurses allegedly did not reinsert it or otherwise act.
- Cowleys sued Virtua and two nurses for malpractice, claiming complications resulted from the tube’s dislodgement and non-reinsertion.
- Defendants demanded an affidavit of merit under N.J.S.A. 2A:53A-26 to -29; plaintiffs did not file one and invoked the "common knowledge" exception.
- Trial court dismissed with prejudice for failure to provide an affidavit; the Appellate Division reversed; the Supreme Court granted certification.
- Supreme Court held the common knowledge exception did not apply because assessing a nurse’s duties after a patient refuses reinsertion—balanced with patient autonomy—requires expert proof; affirmed dismissal with prejudice for noncompliance.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the common knowledge exception to the Affidavit of Merit Statute relieves plaintiffs of the affidavit requirement when a patient removes an NG tube and refuses reinsertion | Cowley: nurses did nothing despite a continuing physician's order; a lay jury can see negligence without expert opinion | Virtua: standard of care after a patient refuses treatment is technical, involves protocols and patient-autonomy considerations, and requires expert testimony | Exception does not apply; affidavit of merit required because expert opinion is needed to define standard of care |
| Remedy where no affidavit is filed and no exception applies | Cowley: exception applies so affidavit unnecessary | Virtua: statutory failure requires dismissal with prejudice under N.J.S.A. 2A:53A-29 | Dismissal with prejudice required for failure to file affidavit when no exception applies |
Key Cases Cited
- Rosenberg v. Cahill, 99 N.J. 318 (N.J. 1985) (articulates the "common knowledge" exception where negligence is readily apparent)
- Hubbard v. Reed, 168 N.J. 387 (N.J. 2001) (construes exception narrowly; jury may decide simple, obvious physician errors)
- Cornblatt v. Barow, 153 N.J. 218 (N.J. 1998) (Affidavit of Merit Statute’s purpose is to show threshold merit)
- Ferreira v. Rancocas Orthopedic Assocs., 178 N.J. 144 (N.J. 2003) (discusses mechanisms and equitable exceptions to affidavit requirement)
- Estate of Chin v. Saint Barnabas Med. Ctr., 160 N.J. 454 (N.J. 1999) (common-knowledge negligence where an obvious hook-up error caused death)
- Sanzari v. Rosenfeld, 34 N.J. 128 (N.J. 1961) (early articulation of when jurors may assess professional negligence without experts)
- Palanque v. Lambert-Woolley, 168 N.J. 398 (N.J. 2001) (example where careless acts were obvious so expert testimony unnecessary)
- Schueler v. Strelinger, 43 N.J. 330 (N.J. 1964) (a jury cannot be permitted to speculate about professional standards)
- Butler v. Acme Mkts., Inc., 89 N.J. 270 (N.J. 1982) (test for when expert testimony is required versus jurors' common judgment)
- A.T. v. Cohen, 231 N.J. 337 (N.J. 2017) (confirms dismissal with prejudice for noncompliance with affidavit requirement)