No. 01-3449
Kevin W. Lynch (Argued), White & Williams LLP, Westmont, NJ, for Appellee.
Before AMBRO and STAPLETON, Circuit Judges, O‘NEILL,s District Judge.
OPINION OF THE COURT
AMBRO, Circuit Judge.
We decide two issues: whether New Jersey law required Daniel and Kathleen Natale (collectively, the “Natales“; in the singular, the reference is to Daniel Natale) to file an affidavit of merit in order to state a medical malpractice claim, and whether the Natales provided sufficient evidence of a governmental policy or custom for their claim under
We reverse and remand both rulings. Because the Natales’ malpractice claim falls within the “common knowledge” exception to the affidavit requirement, they did not need to submit the affidavit of a medical expert. In addition, the Natales produced sufficient evidence of a policy or custom at PHS that deprived Daniel Natale of his right to adequate medical care to survive a motion for summary judgment.
On the evening of November 23, 1997, Gloucester Township police arrested Dаniel Natale, an insulin-dependent diabetic. Before transporting him to the Camden County Correctional Facility (“CCCF“), the police took him to the emergency department of John F. Kennedy Memorial Hospital for a medical clearance prior to incarceration. The physician treating Natale at the hospital gave him a dose of insulin, and wrote a note stating that Natale “must have insulin” while incarcerated. The note did not, however, indicate how often the insulin should be administered.
At 3:30 a.m. on November 24, 1997, Natale arrived at CCCF, where, as part of his initial processing, employees of PHS, a private company that provides health services to CCCF inmates, performed a medical screening. Natale informed PHS employees that he was an insulin-dependent diabetic, and a PHS employee noted this fact on Natale‘s chart. There is no indication in the record that the PHS employee screening Natale ever asked him how often he needed insulin. Natale was then admitted to the general prison population.
At 12:30 a.m. on November 25, 1997, twenty-one hours after being admitted to CCCF, Natale received his first dose of insulin at that facility. He was released later the same day. Two days later, Natale suffered a stroke. Attributing this stroke to the failure of PHS to administer insulin during the first twenty-one hours of his incarceration, Natale and his wife, Kathleen Natale, filed suit in New Jersey state court on March 9, 1999, alleging medical malpractice and violations of
On July 26, 2000, the District Court ordered sua sponte that the Natales show cause why their medical malpractice claim should not be dismissed for failure to state a claim, citing the Natales’ failure to comply with
On July 24, 2001, the District Court issued an order dismissing the Natales’ medical malpractice claim for failure to state a claim as a result of their failure to file an affidavit of merit. On July 30, 2001, the District Court granted PHS‘s motion for summary judgment on the Natales’
II. Discussion
A. Dismissal of the Natales’ Medical Malpractice Claim
We review de novo the dismissal of the Natales’ New Jersey malpractice claim. Island Insteel Sys. Inc. v. Waters, 296 F.3d 200, 206 (3d Cir.2002). The Natales argue that because the issue of negligence in this case was one that could be resolved from the jury‘s common knowledge without expert testimony, there was no need for an affidavit of merit, citing to the Supreme Court of New Jersey‘s recent decision in Hubbard v. Reed, 168 N.J. 387, 774 A.2d 495, 499-500 (2001) (holding that no affidavit of merit need be filed in “common knowledge” malpractice cases).
A successful malpractice claim requires a plaintiff to show, inter alia, that a duty of care existed and that the defendant breached that duty.3 Rosenberg v. Cahill, 99 N.J. 318, 492 A.2d 371, 374 (1985). In the typical malpractice case, the duty of care, or “the standard of practice to which the defendant-practitioner failed to adhere[,] must be established by expert testimony.” Id. (quoting Sanzari v. Rosenfeld, 34 N.J. 128, 167 A.2d 625, 628 (1961)). But where “the jurors’ common knowledge as lay persons is sufficient to enable them, using ordinary understanding and experience, to determine a defendant‘s negligence without the benefit of the specialized knowledge of experts,” Estate of Chin v. Saint Barnabas Med. Ctr., 160 N.J. 454, 734 A.2d 778, 785 (1999), “the jury itself is allowed `to supply the applicable standard of сare and thus to obviate the necessity for expert testimony relative thereto.‘” Rosenberg, 492 A.2d at 374 (quoting Sanzari, 167 A.2d at 632). The factual predicate for a common knowledge case is one where “`the carelessness of the defendant is readily apparent to anyone of average intelligence and ordinary experience.‘” Estate of Chin, 734 A.2d at 785-86 (quoting Rosenberg, 492 A.2d at 375).
The New Jersey legislature enacted the affidavit of merit statute as part of a tort reform package “designed to strike a fair balance between preserving a pеrson‘s right to sue and controlling nuisance suits.” Palanque v. Lambert-Woolley, 168 N.J. 398, 774 A.2d 501, 505 (2001) (internal quotation marks omitted). The statute requires the plaintiff in a malpractice action to file “an affidavit of an appropriate licensed person [stating] that there exists a reasonable probability that the care, skill or knowledge exercised or exhibited in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional or occupational standards or treatment practices.”
We disagree. A reasonable jury could conclude that PHS personnel were negligent absent expert testimony. PHS personnel failed to call Natale‘s treating physician to determine how often he needed insulin to be administered. They didn‘t even ask Natale. When “defendant‘s careless acts are quite obvious,” Palanque, 774 A.2d at 506, no affidavit of merit is required. While laypersons are unlikely to know how often insulin-dependent diabetics need insulin, common sense — the judgment imparted by human experience — would tell a layperson that medical personnel charged with caring for an insulin-dependent diabetic should determine how often the diabetic needs insulin. No special expertise or expert testimony is needed to show, at the outset of a case, that the claim is not frivolous. The New Jersey Supreme Court‘s decision in Hubbard supports this view; thus no affidavit of merit need be filed. The District Court‘s decision to dismiss the Natales’ malpractiсe claim for failure to file such an affidavit was therefore erroneous, and we reverse.
B. Dismissal of the Natales’ 42 U.S.C. § 1983 Claim
The District Court granted summary judgment to PHS on the Natales’
Summary judgment is proper if, when viewed in the light most favorаble to the Natales, there is no genuine issue of material fact and the moving party is entitled to judgment as a matter of law. Fed. R.Civ.P. 56(c); Bailey v. United Airlines, 279 F.3d 194, 198 (3d Cir.2002). A factual dispute is material if it bears on an essential element of the plaintiff‘s claim, and is genuine if a reasonable jury could find in favor of the nonmoving party. Fakete v. Aetna, Inc., 308 F.3d 335, 337 (3d Cir. 2002) (quoting Cloverland-Green Spring Dairies, Inc. v. Pa. Milk Mktg. Bd., 298 F.3d 201, 210 (3d Cir.2002)). Because there is evidence from which a reasonable jury could conclude that PHS had a policy failing to address the immediate medication needs of CCCF inmates with serious medical conditions, we conсlude that the District Court erred in granting summary judgment in favor of PHS on the Natales’
To establish a claim under
When evaluating a claim brought under
As a threshold matter, we note that the District Court accepted the Natales’
In this context, the Natales should have pleaded their
We therefore evaluate the Natales’ Fourteenth Amendment claim for inadequate medical care under the standard used to evaluate similar claims brought under the Eighth Amendment, the standard used by the District Court to evaluate the Natales’ claim. In Estelle, the Supreme Court held that the Eighth Amendment proscribes deliberate indifference to prisoners’ serious medical needs. Estelle, 429 U.S. at 103-04. In order to establish a violation of Daniel Natale‘s constitutional right to adequate medical care, evidence must show (i) a serious medical need, and (ii) acts or omissions by prison officials that indicate deliberate indifference to that need. Rouse v. Plantier, 182 F.3d 192, 197 (3d Cir.1999).
Natale has established that he is an insulin-dependent diabetic. PHS does not dispute that this is a serious illness, and that Natale had a serious medical need. Because PHS is a state actor, employees of PHS are considered prison officials. The question, therefore, is whether PHS employees were deliberately indifferent to Natale‘s serious medical needs.6
Deliberate indifference is a “subjective standard of liability consistent with recklessness as that term is defined in criminal law.” Nicini, 212 F.3d at 811. In Farmer v. Brennan, 511 U.S. 825, 837 (1994), the Supreme Court held that finding a prison official liable for violating a prisoner‘s Eighth Amendment rights requires proof that the official “knows of and disregards an excessive risk to inmate health or safety.” Id. He must be “both [] aware of facts from which the inference could be drawn that a substantial risk of serious harm exists, and ... draw the inference.” Id. To survive a summary judgment motion on this issue, the Natales “must point to some evidence beyond [their] raw claim that [PHS employees] w[ere] deliberately indifferent,” or put another way, some evidence “that [PHS employees] knew or w[ere] aware of [the risk to Natale].” Singletary, 266 F.3d at 192 n. 2.
Sufficient evidence exists in the record that PHS employees were deliberately indifferent to Natale‘s serious mediсal needs to survive a summary judgment motion. First, as in Nicini, prison officials ignored the evidence of his need for insulin. Natale testified that he informed a PHS employee that he was an insulin-dependent diabetic, a PHS employee noted this fact on his chart, and he had a note from a physician indicating that he “must have insulin.” A reasonable jury could conclude that PHS employees knew that Natale was an insulin-dependent diabetic and that if insulin was not administered as required, he would suffer adverse health consequenсes. In addition, there is evidence that, as in Monmouth County, PHS employees delayed medical treatment for non-medical reasons — the PHS policy that failed to address the immediate medication needs of inmates with serious medical conditions. Nurse Lynda Sanferraro, a PHS employee, testified that PHS‘s “policy” was that a doctor would see inmates within 72 hours, but that there was no practice in place to accommodate inmates with more immediate medication needs.7 A reasonable jury could find thаt such a practice constituted the delay of medical treatment for non-medical reasons. The Natales have, therefore, provided sufficient evidence to survive a motion for summary judgment on the question of whether PHS employees violated Daniel Natale‘s Fourteenth Amendment right to adequate health care while detained.
2. Liability of PHS for Its Employees’ Violations of Natale‘s Constitutional Right
What remains to be determined is whether, for
There are three situations where acts of a government employee may be deemed to be the result of a policy or custom of the governmental entity for whom the employee works, thereby rendering the entity liable under
In this case, there is no evidence that PHS had an affirmative policy or custom that prevented its employees from inquiring into the frequency with which Natale required insulin. There is, however, evidence that PHS turned a blind eye to an obviously inadequate practice that was likely to result in the violation of constitutional rights.
The Natales allege that the failure to establish a policy to address the medication needs of inmates during the first 72 hours of their incarceration constitutes deliberate indifference to serious medical needs. We return to the testimony of PHS employee Lynda Sanferraro, and what a reasonable trier of fact could conclude from that testimony. According to Sanferraro, the policy at PHS for screening inmates was as follows: a medical assistant would inquire about an incoming inmate‘s medication needs, and write those needs in the inmate‘s medical records, but was not otherwise required to pass on that information. No one could provide an inmate with medication without having first obtained an order from a doctor. There was no requirement that а doctor see an inmate during the first 72 hours of incarceration and no one was charged with determining whether an inmate should be seen by a doctor earlier in the 72-hour period. As a result, there was no policy ensuring that an inmate having need of medication for a serious medical condition would be given that medication during the first 72 hours of his incarceration.
A reasonable jury could conclude that the failure to establish a policy to address the immediate medication needs of inmates with serious medical conditions creates a risk that is sufficiently obvious as to constitute deliberate indifference to those inmates’ medical needs. The failure to establish such a policy is a “particular[ly] glaring omission” in a program of medical care. Bryan County, 520 U.S. at 410-11. PHS “disregarded a known or obvious” consequence of its actions, i.e., the likelihood that the medical conditions of some inmates may require that medication be administered within the first 72 hours of their incarceration. Id. at 412. A reasonable jury could infer that “а system responsible for [assessing the medical needs of all incoming prisoners] would be the product of a decision maker‘s action or acquiescence.” See Berg, 219 F.3d at 275 (holding that a reasonable jury could infer from testimony of police officer about system for issuing warrants that system was the product of a decisionmaker). It could also infer that the failure to establish a more responsive policy caused the specific constitutional violation of which the Natales complain, i.e., the failurе to administer insulin to Daniel Natale in a timely fashion. See Bryan County, 520 U.S. at 404 (holding that plaintiff must demonstrate “a direct causal link between the municipal action and the deprivation of federal rights“); see also Kneipp, 95 F.3d at 1213 (holding that plaintiff must “establish that the government policy or custom was the proximate cause of the injuries suffered“).
III. Conclusion
For the reasons stated above, we reverse the District Court‘s order dismissing the Natales’ malpractice claim and its order granting summary judgment in favor of PHS on the Natales’
Notes
Nurse Sanferraro testified as follows:
Q: So that from what you‘re saying, if somebody came in with this form, the first page of Lynda-2, a doctor would still have to assess Mr. Natale to determine what medications, if any, should be administered?
A: Yes.
Q: Do you know how soon it would have been for there to have been a determination of when Mr. Natale should have been examined by a physician?
A: I know there was [a] policy of within 72 hours.
* * *
Q: Is there anybody to your knowledge in PHS back in November of 1997 who would have been made or been responsible to determine if an inmate needed to be medically examined by a doctor earlier in the 72 hour period versus later in the 72 hour period?
A: There was no real determination on that.
* * *
Q: So that for the first 72 hours they may not be seen by the doctor; is that a fair statement? I‘m talking about November of 1997.
A: In 72 hours they were seen by the doctor.
Q: Up until that point they‘re in Three South A?
A: Yes
Q: Unless they have obvious physical either a[sic] deformity or a problem with аmbulation or something of that nature?
A: Yes.
Q: Do you know whether or not the medical assistant was supposed to report to anyone else if the medical assistant was made aware of a chronic condition of an inmate such as diabetes?
A: Can you repeat that?
Q: Yes. When the medical assistant took the assessment interview receiving screening and was told that an inmate is diabetic, what was the medical assistant supposed to do with that knowledge?
A: Write it on this form.
Q: That‘s it?
A: Yes.