<b><i>Ptaszsynski v. Atlantic Health Sys</i></b>.

The facts in the Ptaszynski case are similar to many medical malpractice and NHA actions and were central to the Appellate Court's decision. The plaintiff's decedent, Regina Ptaszynski (Mrs. Ptaszynski) was 86 years old and had significant pre-existing conditions including heart disease, high blood pressure, cardiac arrhythmia, diabetes, hypothyroidism and peripheral vascular disease. She had undergone triple coronary artery bypass grafting surgery in 1998 and she had suffered a stroke in 2000, which weakened her left side. Mrs. Ptaszynski suffered a fall at home, which resulted in a fractured left hip. Her hip surgery was delayed when she had a serious heart attack at St. Peter's Hospital. Mrs. Ptaszynski was transferred from St. Peter's to Mt. Kemble Rehabilitation at Morristown Memorial Hospital (MKR) on June 24, 2006, to recover from her hip surgery. MKR, a non-incorporated campus of AHS Hospital Corp., operated a 78-bed rehabilitation facility, which included outpatient services, an inpatient rehabilitation unit, and a sub-acute hospital-based rehabilitation unit.

Mrs. Ptaszynski was admitted to MKR's sub-acute rehab unit with the intent of being rehabilitated and discharged home. However, at MKR, Mrs. Ptaszynski developed pressure ulcers, a fever and was transferred to Morristown Memorial Hospital (MMH) on July 19, 2006. At the hospital, she was diagnosed with a methicillin-resistant staphylococcus aureus (MRSA) infection in her toe. The infection was treated with antibiotics, but the toe required amputation on July 30, 2006. The patient's condition continued to deteriorate and, on Aug. 2, 2006, she was placed on a ventilator. In accordance with her advance directives, life support was soon discontinued and she died the next day.

The plaintiff, Mrs. Ptaszynski's daughter and the executrix of her estate, filed a four-count complaint against AHS Hospital Corp. Count one alleged a negligence claim against AHS relating to Mrs. Ptaszynski's treatment, including allegations that the defendant failed to comply with New Jersey and federal statutes and regulations relating to the care of nursing home residents. Counts two and three asserted claims under the NHA. Count two alleged that MKR violated New Jersey Statutes Annotated (N.J.S.A.) 30:13-3(h), which requires nursing homes to “ensure compliance with all applicable state and federal statutes, rules and regulations.” Count three alleged that AHS had violated Mrs. Ptaszynski's right “to a safe and decent living environment and considerate and respectful care that recognizes the dignity and individuality of the resident,” as set forth in N.J.S.A. 30:13-5(j). Count four set forth a wrongful death claim to recover pecuniary losses resulting from Mrs. Ptaszynski's death.

The case was tried before a jury, which found that the defendant's negligence proximately caused harm to Mrs. Ptaszynski. The jury found AHS liable under the NHA, because MKR violated “one or more of the rules, regulations, or State or Federal statutes applicable” to Mrs. Ptaszynski's care, proximately harming her. The jury awarded the plaintiff $250,000 on the negligence claim, $250,000 on the NHA claims, and $50,000 on the wrongful death claim. The trial court also awarded attorneys' fees to the plaintiff, pursuant to the NHA.

Rights vs. Responsiblities

On appeal, the Appellate Division held that N.J.S.A. 30:13-4.2 of the NHA does not authorize a private cause of action to enforce the “responsibilities” provision of the Act, N.J.S.A. 30:13-3, including the responsibility set forth in subsection (h) “to comply with applicable state and federal statutes, rules and regulations.” Rather, N.J.S.A. 30:13-4.2 merely authorizes suits to enforce an accompanying amendment under N.J.S.A. 30:13-4.1, which sets forth requirements for the management of nursing home security deposits. In addition, the Appellate Division held that a private plaintiff can bring suit under the NHA provision, N.J.S.A. 30:13-8, to enforce the “rights” of nursing home residents under N.J.S.A. 30:13-5, including the “right to a safe and decent living environment and considerate and respectful care that recognizes the dignity and individuality of the resident.” N.J.S.A. 30:13-5(j).

In so holding, the Appellate Division differentiated between the “responsibilities” and “rights” sections of the NHA based upon the NHA's legislative history and plain language of the statute. In that regard, N.J.S.A. 30:13-8(a), which was included in the NHA as originally enacted in 1976, provides that “Any person or resident whose rights as defined herein are violated shall have a cause of action against any person committing such a violation (emphasis added).” N.J.S.A. 30:13-8, therefore, allows a nursing home resident to bring suit to enforce the NHA's “bill of rights” for nursing home residents, found in N.J.S.A. 30:13-5(a)-(n), which include the rights to manage one's own financial affairs, to privacy, to retain the services of one's own physician, to have unrestricted communication and personal visits at reasonable hours, to be provided with food that meets religious dietary requirements and to have “a safe and decent living environment and considerate and respectful care that recognizes the dignity and individuality of the resident.” N.J.S.A. 30:13-5. An award of attorney fees is available to the prevailing plaintiff on such a claim. N.J.S.A. 30:13-8(a).

The plain language of N.J.S.A. 30:13-8(a) does not, however, authorize a private action to enforce the “responsibilities” provision of the NHA, N.J.S.A. 30:13-3. Only New Jersey's Department of Health and Senior Services, now known as the Department of Health, could bring such an action, said the Appellate Division. It also found that N.J.S.A. 30:13-4.2 only authorized a suit to enforce an accompanying amendment, N.J.S.A. 30:13-4.1, setting forth requirements for the management of nursing home security deposits.

Because the Ptaszysnki jury returned a single verdict on plaintiff's two NHA claims ' one of which was the N.J.S.A. 30:13-3(h), which was held invalid ' the Appellate Division set aside the verdict on the plaintiff's NHA claims.

In next month's issue, the authors will discuss further reasons for the reversal of the verdict and offer their analysis of the impact Ptaszysnki may have on medical malpractice cases in New Jersey.

Katelyn E. Cutinello, who co-authored the briefs in the Ptaszynski appeal discussed above, is a partner at Bubb, Grogan & Cocca, LLP, where she concentrates her practice on complex litigation, including medical malpractice and general liability litigation. Anthony Cocca, who tried the Ptaszynski case, co-authored the briefs and argued the appeal, is a partner at the firm, where he concentrates his practice on complex litigation, including medical malpractice and liability litigation. Robert E. Spitzer , a member of this newsletter's Board of Editors, is an attorney with Post, Polak, Goodsell, MacNeill & Strauchler, P.A.

The New Jersey Appellate Division's opinion in Ptaszynski v. Atlantic Health Sys. Inc. , 440 N.J. Super. 24 (App. Div. 2015), will impact not only New Jersey nursing home litigation, but also that state's medical malpractice litigation in general.

In Ptaszynski, the plaintiff presented as a nursing home case what might otherwise be described as a garden-variety medical/nursing malpractice case. This styling of the case was an attempt to obtain a more favorable presentation to the jury by utilizing numerous provisions of New Jersey's Nursing Home Responsibilities and Rights of Residents Act (NHA), N.J.S.A. 30:13-1 to -17, as well as to obtain additional damages and the statute's fee-shifting provision, not otherwise available in a medical malpractice case. On appeal, the Appellate Division limited the manner in which a case alleging medical malpractice and NHA violations can be presented to a jury and held, inter alia, that duplication of damages for those claims is not permitted.

The Case

The facts in the Ptaszynski case are similar to many medical malpractice and NHA actions and were central to the Appellate Court's decision. The plaintiff's decedent, Regina Ptaszynski (Mrs. Ptaszynski) was 86 years old and had significant pre-existing conditions including heart disease, high blood pressure, cardiac arrhythmia, diabetes, hypothyroidism and peripheral vascular disease. She had undergone triple coronary artery bypass grafting surgery in 1998 and she had suffered a stroke in 2000, which weakened her left side. Mrs. Ptaszynski suffered a fall at home, which resulted in a fractured left hip. Her hip surgery was delayed when she had a serious heart attack at St. Peter's Hospital. Mrs. Ptaszynski was transferred from St. Peter's to Mt. Kemble Rehabilitation at Morristown Memorial Hospital (MKR) on June 24, 2006, to recover from her hip surgery. MKR, a non-incorporated campus of AHS Hospital Corp., operated a 78-bed rehabilitation facility, which included outpatient services, an inpatient rehabilitation unit, and a sub-acute hospital-based rehabilitation unit.

Mrs. Ptaszynski was admitted to MKR's sub-acute rehab unit with the intent of being rehabilitated and discharged home. However, at MKR, Mrs. Ptaszynski developed pressure ulcers, a fever and was transferred to Morristown Memorial Hospital (MMH) on July 19, 2006. At the hospital, she was diagnosed with a methicillin-resistant staphylococcus aureus (MRSA) infection in her toe. The infection was treated with antibiotics, but the toe required amputation on July 30, 2006. The patient's condition continued to deteriorate and, on Aug. 2, 2006, she was placed on a ventilator. In accordance with her advance directives, life support was soon discontinued and she died the next day.

The plaintiff, Mrs. Ptaszynski's daughter and the executrix of her estate, filed a four-count complaint against AHS Hospital Corp. Count one alleged a negligence claim against AHS relating to Mrs. Ptaszynski's treatment, including allegations that the defendant failed to comply with New Jersey and federal statutes and regulations relating to the care of nursing home residents. Counts two and three asserted claims under the NHA. Count two alleged that MKR violated New Jersey Statutes Annotated (N.J.S.A.) 30:13-3(h), which requires nursing homes to “ensure compliance with all applicable state and federal statutes, rules and regulations.” Count three alleged that AHS had violated Mrs. Ptaszynski's right “to a safe and decent living environment and considerate and respectful care that recognizes the dignity and individuality of the resident,” as set forth in N.J.S.A. 30:13-5(j). Count four set forth a wrongful death claim to recover pecuniary losses resulting from Mrs. Ptaszynski's death.

The case was tried before a jury, which found that the defendant's negligence proximately caused harm to Mrs. Ptaszynski. The jury found AHS liable under the NHA, because MKR violated “one or more of the rules, regulations, or State or Federal statutes applicable” to Mrs. Ptaszynski's care, proximately harming her. The jury awarded the plaintiff $250,000 on the negligence claim, $250,000 on the NHA claims, and $50,000 on the wrongful death claim. The trial court also awarded attorneys' fees to the plaintiff, pursuant to the NHA.

Rights vs. Responsiblities

On appeal, the Appellate Division held that N.J.S.A. 30:13-4.2 of the NHA does not authorize a private cause of action to enforce the “responsibilities” provision of the Act, N.J.S.A. 30:13-3, including the responsibility set forth in subsection (h) “to comply with applicable state and federal statutes, rules and regulations.” Rather, N.J.S.A. 30:13-4.2 merely authorizes suits to enforce an accompanying amendment under N.J.S.A. 30:13-4.1, which sets forth requirements for the management of nursing home security deposits. In addition, the Appellate Division held that a private plaintiff can bring suit under the NHA provision, N.J.S.A. 30:13-8, to enforce the “rights” of nursing home residents under N.J.S.A. 30:13-5, including the “right to a safe and decent living environment and considerate and respectful care that recognizes the dignity and individuality of the resident.” N.J.S.A. 30:13-5(j).

In so holding, the Appellate Division differentiated between the “responsibilities” and “rights” sections of the NHA based upon the NHA's legislative history and plain language of the statute. In that regard, N.J.S.A. 30:13-8(a), which was included in the NHA as originally enacted in 1976, provides that “Any person or resident whose rights as defined herein are violated shall have a cause of action against any person committing such a violation (emphasis added).” N.J.S.A. 30:13-8, therefore, allows a nursing home resident to bring suit to enforce the NHA's “bill of rights” for nursing home residents, found in N.J.S.A. 30:13-5(a)-(n), which include the rights to manage one's own financial affairs, to privacy, to retain the services of one's own physician, to have unrestricted communication and personal visits at reasonable hours, to be provided with food that meets religious dietary requirements and to have “a safe and decent living environment and considerate and respectful care that recognizes the dignity and individuality of the resident.” N.J.S.A. 30:13-5. An award of attorney fees is available to the prevailing plaintiff on such a claim. N.J.S.A. 30:13-8(a).

The plain language of N.J.S.A. 30:13-8(a) does not, however, authorize a private action to enforce the “responsibilities” provision of the NHA, N.J.S.A. 30:13-3. Only New Jersey's Department of Health and Senior Services, now known as the Department of Health, could bring such an action, said the Appellate Division. It also found that N.J.S.A. 30:13-4.2 only authorized a suit to enforce an accompanying amendment, N.J.S.A. 30:13-4.1, setting forth requirements for the management of nursing home security deposits.

Because the Ptaszysnki jury returned a single verdict on plaintiff's two NHA claims ' one of which was the N.J.S.A. 30:13-3(h), which was held invalid ' the Appellate Division set aside the verdict on the plaintiff's NHA claims.

In next month's issue, the authors will discuss further reasons for the reversal of the verdict and offer their analysis of the impact Ptaszysnki may have on medical malpractice cases in New Jersey.

Katelyn E. Cutinello, who co-authored the briefs in the Ptaszynski appeal discussed above, is a partner at Bubb, Grogan & Cocca, LLP, where she concentrates her practice on complex litigation, including medical malpractice and general liability litigation. Anthony Cocca, who tried the Ptaszynski case, co-authored the briefs and argued the appeal, is a partner at the firm, where he concentrates his practice on complex litigation, including medical malpractice and liability litigation. Robert E. Spitzer , a member of this newsletter's Board of Editors, is an attorney with Post, Polak, Goodsell, MacNeill & Strauchler, P.A.