McNULTY, U.S.D.J.
Plaintiff Craig Francis Szemple, while an inmate at the New Jersey State Prison in Trenton, developed a dental problem.
In 2010, Szemple brought this action alleging, inter alia, state law claims of dental malpractice.
Defendants brought their motion as one to dismiss for failure to state a claim under FED. R. CIV. P. 12(b)(6). An AOM, however, is not strictly speaking an element of a claim. In addition, the defendants' motion attaches exhibits and affidavits extraneous to the pleadings. (ECF Nos. 84, 85) I therefore invoked my discretion under FED. R. CIV. P. 12(d) to convert the motion to one for summary judgment. (See Memorandum and Order, ECF No. 99, citing Nuveen Mun. Trust ex rel. Nuveen High Yield Mun. Bond Fund v. WithumSmith Brown, P.C., 692 F.3d 283, 303 n. 13 (3d Cir.2012)). Because Szemple did not have fair warning that he was in jeopardy of summary judgment, I gave him 14 days to submit any additional proofs. He opted not to do so. (ECF No. 100) In the end, however, it matters little; as plaintiff's counsel implies, id. the issue is predominantly one of law, based on matters of procedural history.
In an action alleging professional malpractice, New Jersey requires an Affidavit of Merit ("AOM"). See the Affidavit of Merit Statute ("AMS"), N.J. Stat. Ann. §§ 2A:53A-26 to 29.
Here, the claim is one of dental malpractice. It is brought against, among others, Dr. Getzoff, who is a dentist specializing in oral surgery. The plaintiff, Szemple, filed and served an AOM on November 5, 2014. (ECF No. 79) That AOM, signed by Dr. Martin Giniger, DMD, MsD, PhD, FICD, states that there is "a reasonable probability that the skill, care, and knowledge exercised by the dental (and other) professional defendants during Mr. Szemple's tooth extraction and thereafter, fell below the accepted professional standard of care." Id.
The requirement of an AOM is intended to screen out meritless malpractice claims:
Ryan v. Renny, 203 N.J. 37, 999 A.2d 427, 435-36 (2010) (internal quotations and citations omitted).
The AMS sets forth the basic AOM requirement as follows:
N.J. Stat. Ann. § 2A:53A-27. A plaintiff's failure to file an AOM from an appropriate licensed person, unless excused by extraordinary circumstances, is grounds for dismissal of the complaint with prejudice. See N.J. Stat. Ann. § 2A:53A-29; Palanque v. Lambert-Woolley, 168 N.J. 398, 774 A.2d 501, 505 (2001).
The AMS defines the class of cases in which an AOM must be filed. An AOM is required, not just in medical cases, but in "all actions for damages based on professional malpractice," Ryan, 999 A.2d at 435, brought against "a licensed person in his profession or occupation," N.J. Stat. Ann. § 2A:53A-27. The AMS specifies sixteen such professions and occupations.
The AMS imposes time limits. The AOM must be filed within 60 days after the filing of the defendant's answer. The court, on a showing of good cause, may extend that deadline for an additional 60 days. N.J. Stat. Ann. § 2A:53A-27.
The AMS also states who is qualified to be an affiant on an AOM. For that purpose, N.J. Stat. Ann. § 2A:53A-27 draws a distinction between medical malpractice cases and others:
N.J. Stat. Ann. § 2A:53A-27 (emphasis and paragraph break added for clarity).
As to medical malpractice cases, then, § 2A:53A-27 incorporates by reference a separate statute. That statute, N.J. Stat. Ann. § 2A:53A-41, sets a high standard of eligibility to be an AOM affiant:
N.J. Stat. Ann. § 2A:53A-41 (emphasis added).
For non-medical malpractice cases, however, N.J. Stat. Ann. § 2A:53A-27 retains its own standard. The AOM affiant must be appropriately licensed, and must have particular expertise in the general area or specialty involved in the action, as evidenced by board certification or five years' relevant experience. Id.
From now on I will refer to those two statutes, N.J. Stat. Ann. §§ 2A:53A-27 and 2A:53A-41, as "Section 27" and "Section 41."
Defendants' motion claims that Dr. Giniger's AOM was not timely, and that the complaint must therefore be dismissed. They press that argument with less force in their reply. They continue to stress, however, that if Dr. Giniger's AOM is found inadequate, the statutory deadline of 60 or 120 days implies that it is now too late to submit another. I find that the original AOM was filed timely. And because
First, I find that the deadline is 120 days, not 60. As noted above, Section 27 imposes a deadline of 60 days from the filing of defendant's answer, but provides that the deadline may be extended an additional 60 days for good cause. There are no rigorous procedural prerequisites to such an extension: "The New Jersey Supreme Court has held that a plaintiff is not required to file a motion for an extension for `good cause' within the original 60-day period in order to gain an additional 60 days within which to file the required affidavit of merit." See Costa v. Cnty. of Burlington, 566 F.Supp.2d 360, 362 (D.N.J. 2008) (citing Burns v. Belafsky, 166 N.J. 466, 766 A.2d 1095, 1100-01 (2001)).
The "good cause" threshold, moreover, is low; counsel's inadvertence is enough. The key issue is whether "demonstrable prejudice" would flow from a 60-day extension:
Burns, 766 A.2d at 1100-01 (quoting Appellate Division decision below, Burns v. Belafsky, 326 N.J.Super. 462, 741 A.2d 649, 654 (1999); bracketed material in original). The AOM is not a device to bar stale claims, but to screen meritless ones. Particularly where prejudice is lacking and a claim is meritorious, attorney inadvertence should not bar application of the 60-day extension. Id.
I find sufficient cause to extend the deadline an additional 60 days, for a total of 120 days. First, Defendants have not established any prejudice that accrued by November 2014 as a result of the 60-day extension. This action, although four years old, had been pursued pro se and had not progressed substantially. (A trip up and down the appellate ladder added some delay.) Second, pro bono counsel for plaintiff had been appointed relatively recently. They had to familiarize themselves with an ongoing case and deal with the legacy effects of the plaintiff's unfamiliarity with legal procedures. Third, as outlined below, there is at least an ambiguity in the statute as to whether the deadline runs from each defendant's answer, or from the time that all defendants have jointly answered. If plaintiff's counsel erred — and, as established below, I do not believe they did — their inadvertence should not be visited on the client. Fourth, this case did not enjoy the clarifying effect of two state procedures that are intended to guard against the severe consequences of failure to file an AOM:
Nuveen, 692 F.3d at 291. Those state-law procedural safeguards do not apply in federal court. Id. at 304-05. Nevertheless, I consider their absence as an additional factor tending to excuse any inadvertence and support a grant of the "good cause" 60-day extension.
The good cause extension is granted; the deadline, is 120, not 60, "days following the date of filing of the answer to the complaint by the defendant." See Section 27.
From what date does the 120-day period run? The relevant defendants jointly have filed serial amended answers — five in all — to the First Amended Complaint. The first answer on behalf of Dr. Getzoff (the Second Amended Answer, ECF No. 69) was filed on July 17, 2014. A Third Amended Answer followed quickly, and the Fourth Amended Answer filed on behalf of Dr. Getzoff and others on August 15, 2014.
There is no case law that deals with precisely this procedural configuration. To me, however, the liberal spirit of the case law suggests that the 120 day deadline should run from the filing of the Fourth Amended Answer. See, e.g., Costa, 566 F.Supp.2d at 362-63 ("Dr. Evans's Answer to the second Amended Complaint, which is presently the answer to the final amended complaint, was filed on May 30, 2008. Therefore, Costa has at least 120 days from that date to file an appropriate affidavit of merit before this Court may consider any motion to dismiss filed by Dr. Evans.") (emphasis added). Cf. Snyder v. Pascack Valley Hosp., 303 F.3d 271, 276 (3d Cir.2002) (AOM deadline runs from defendant's answer to the amended complaint, not from his answer to the original complaint, even though the amended complaint did not change the allegations against him in particular). I am inclined to think that the relevant Answer is the one currently in effect when the AOM is filed. An amended pleading supersedes what went before. To require an AOM before the pleadings are finally settled would result in uncertainty, as well as needless duplication of effort as AOMs must be revised to conform to new allegations. A plaintiff should not be placed in the position of guessing how "new" a "new" amended joint answer is (or will be, once it is filed) as to each individual defendant.
I therefore count the 120 day period from the filing of the Fourth Amended Answer on August 15, 2014. So reckoned, the deadline fell on December 13, 2014. The AOM, filed on November 5, 2014, was therefore timely. (And the AOM was filed before the filing of a Fifth Amended Answer on January 19, 2016.)
I therefore deny the motion to dismiss to the extent that it rests on the alleged untimeliness of the AOM.
Defendants' motion also challenges the substance of the AOM, asserting that Dr. Giniger is not a qualified affiant under Sections 27 and 41, quoted above. They note correctly that Dr. Giniger, a general dentist, does not practice in the same dental specialty as defendant Dr. Getzoff, an oral surgeon. But that disparity, in my view, does not disqualify Dr. Giniger as an affiant.
Although both parties focus on Section 41, the proper analysis must begin with the affiant eligibility scheme set out in Section 27, as amended by the Patients First Act of 2004.
As to the standards for eligibility of an AOM affiant, Section 27 imposes a clear division of labor, described in more detail above. In cases of "medical malpractice," Section 27 incorporates by reference the exacting standards of Section 41. "In all other cases" of professional malpractice, Section 27 sets its own, somewhat lower standard.
The significance of that Section 27/Section 41 division of labor lies in the amendment history of the AMS. Section 27 was originally enacted in 1995. At that time, the general Section 27 affiant eligibility standard was the only one, and it applied to all malpractice cases:
Ryan, 999 A.2d at 436.
In 2004, however, the legislature passed the New Jersey Medical Care Access and Responsibility and Patients First Act, L. 2004, c. 17. The Patients First Act was a so-called "tort reform" package, designed to address the "dramatic escalation in medical malpractice liability insurance premiums." N.J. State Bar Ass'n v. State, 387 N.J.Super. 24, 902 A.2d 944, 951 (N.J.Super.App.Div.) (quoting preamble to 2004 bill), certif. denied, 188 N.J. 491, 909 A.2d 726 (2006). The 2004 Patients First Act added Section 41, a more stringent eligibility standard for cases of "medical malpractice":
Id. See also Hill Int'l, Inc. v. Atl. City Bd. of Educ., 438 N.J.Super. 562, 106 A.3d 487, 493 (N.J.Super.App.Div.2014) (Sabatino, P.J.) (describing, post-2004, the "more stringent specialization requirements imposed for affiants in medical malpractice cases in N.J.S.A. 2A:53A-41"), appeal granted, 221 N.J. 283, 112 A.3d 589 (2015), 222 N.J. 13, 116 A.3d 1069 (2015).
Viewed from a post-2004 perspective, then, Section 27 embodies a vertical division of cases by subject matter: medical vs. non-medical. But viewed from a historical perspective, Section 27 contains horizontal, archaeological layers. Before the 2004 amendments, all malpractice actions were subject to the general affiant eligibility standard of Section 27. Post-2004, non-medical malpractice cases remain subject to that same Section 27 eligibility standard. Medical malpractice cases, however, are now subject to the heightened affiant eligibility standard of Section 41.
A threshold issue, then, is this: Are Szemple's claims of dental malpractice "medical malpractice" claims, subject to the stringent AOM eligibility standard of Section 41? Or are they "other claims," subject to the lesser eligibility standard of Section 27? I hold that this is a dental, not a medical, malpractice case, and that Section 41 therefore does not apply.
To summarize and simplify a bit, Section 41 embodies a "same-specialty" rule, at least for doctors. In a medical malpractice case, where the physician alleged to be at fault practices in a specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association, the plaintiffs AOM affiant must practice in the same specialty. See Nicholas v. Mynster, 213 N.J. 463, 64 A.3d 536, 539 (2013) (Section 41 "requires that plaintiffs medical expert must `have specialized at the time of the occurrence that is the basis for the [malpractice] action in the same specialty or subspecialty' as defendant physicians"). Thus, under Section
Defendants, citing that same-specialty rule of Section 41, say that Dr. Gininger is not qualified to offer an AOM. (DBr 9) Dr. Getzoff specializes in oral surgery and was acting as an oral surgeon when he treated Mr. Szemple. Oral and Maxillofacial Surgery is a specialty recognized by the American Dental Association. See
I start, as always, with the plain wording of the statute, Section 41. It speaks strictly in terms of "medical," not dental, malpractice. In common parlance, medicine and dentistry are not considered equivalent. A dentist is not a physician, and is not required to possess a medical degree. Neither Giniger nor Getzoff is an M.D., or physician.
The structure of Section 41 confirms that it does not extend to dentistry. It requires that the affiant and the defendant practice in the "same specialty or subspecialty, recognized by the American Board of Medical Specialties or the American Osteopathic Association."
Consider the issue from the medical specialty side. Section 41 lists medical, not dental, specialties and subspecialties. The American Board of Medical Specialties lists no specialty or subspecialty in Oral or Maxillofacial Surgery. See
Or look at the question from the dental specialty side; the result is the same. Defendants identify Dr. Getzoff's relevant specialty as Oral and Maxillofacial Surgery, as recognized by the American Dental Association. (DBr 9) Section 41 does not refer to that or any dental specialty. The American Dental Association, its recognized specialties, and indeed the entire subject of dentistry, are absent from Section 41.
I must follow the statute's plain language, except in the rare cases where "absurd results" and "`the most extraordinary showing of contrary intentions' justify a limitation on the `plain meaning' of the statutory language." First Merchs. Acceptance Corp. v. J.C. Bradford & Co., 198 F.3d 394, 402 (3d Cir.1999) (quoting Garcia v. U.S., 469 U.S. 70, 75, 105 S.Ct. 479, 83 L.Ed.2d 472 (1984)); see also Thorpe v. Borough of Thorpe, 770 F.3d 255, 263 (3d Cir.2014), cert. denied, ___ U.S. ___, 136 S.Ct. 84, 193 L.Ed.2d 207 (2015) (denying family members' application for reinterment, holding that broad definition of "museum" in statute concerning return of plundered Native American cultural items will not be applied to include the borough of Jim Thorpe, PA, or the grave where the athlete's remains were buried in accordance with his wife's wishes).
Szemple's reading of Section 41 is not absurd; far from it. The state legislature could rationally have decided to confine
I turn to the case law. It is sparse and unpublished,
For example, Meehan v. Antonellis, No. L-2205-12, 2014 WL 5800811 (N.J.Sup.Ct. App.Div. Nov. 10, 2014) (unpublished), certif. granted, 221 N.J. 218, 110 A.3d 931 (2015), agrees with the plaintiff as to this narrow point: "We recognize that the Patient First Act's detailed standards for experts executing an AOM pertain to actions alleging medical malpractice and not dental
Rab v. Doner, No. L-9931-07, 2010 WL 2869528 (N.J.Super.Ct.App.Div. July 19, 2010) (unpublished) holds that, while Section 41 "applies to medical specialists and subspecialists, it does not apply to dentists." Id. at *6. Rab reasoned, as do I, that the medical specialties invoked by Section 41 simply do not relate to dentistry at all. Thus it permitted a physician specializing in infectious disease to testify
Bashford v. Olawyoe, No. HNT-L-188-11, 2011 N.J. Super. LEXIS 3163 (N.J.Super.Ct. Law Div. Hunterdon Cnty., Dec. 16, 2011) (unpublished), cited Rab and elaborated on it:
Bashford, 2011 N.J. Super. Unpub. LEXIS 3163 at *7-8.
For all of those reasons, then, I hold that a dental malpractice case is not a medical malpractice case. It is not governed by the stringent AOM eligibility standards of Section 41. Rather, it is subject to the general eligibility standard of Section 27. To Section 27 I therefore turn.
The question remaining is whether Dr. Giniger, as a dentist, meets the less stringent standards of Section 27. I hold that he does, and is eligible to submit an AOM in this case.
Under Section 27, the AOM affiant (1) must hold an appropriate "license" and (2) must possess "particular expertise." I discuss those two requirements.
Dentistry is separately listed as a profession in Section 26. To satisfy the "license" requirement, it suffices that Dr. Giniger is, like Dr. Getzoff, a dentist. Giniger is an appropriate licensed professional, without regard to specialties or subspecialties.
Unlike Section 41, Section 27 does not clearly prescribe the breadth of the area of professional expertise. It refers only to the "general area or specialty involved in the action." That disjunctive formulation appears to be a broad one, and the case law confirms that impression.
Recall that the Section 27 standard is a carryover from 1995; before the 2004 amendments, it applied to all malpractice cases, whether medical or not. Thus the pre-2004 medical malpractice case law can still illuminate post-2004 non-medical cases (but not post-2004 medical cases, which now fall under Section 41). That Section 27 standard was (and as to non-medical cases, still is) fairly forgiving:
Ryan, 999 A.2d at 436.
The cited case, Burns v. Belafsky, was a pre-2004 medical malpractice case under the general Section 27 standard. There, the plaintiff filed a malpractice complaint against a radiologist, and proffered an AOM from Dr. Salcman, a neurosurgeon. The New Jersey Supreme Court upheld the Appellate Division's decision that Salcman was an acceptable affiant. The Section 27 standard, Burns held, is not a same-specialty rule:
766 A.2d at 1102. Implicit in Section 27 is a recognition that separate specialties may overlap, and that a doctor with five years' relevant practice experience in the area of overlap is qualified to execute an AOM. Id. (citing Wacht, supra) (citing Rosenberg by Rosenberg v. Cahill, 99 N.J. 318, 492 A.2d 371, 377-79 (1985)) (pre-AMS case holding that medical doctor is appropriate expert witness in case of chiropractic malpractice involving x-rays and diagnosis); (Sanzari v. Rosenfeld, 34 N.J. 128, 167 A.2d 625, 629 (1961) (pre-AMS case holding that medical doctor is appropriate expert witness in case of alleged malpractice involving dental anesthesia)); see also Kindig v. Gooberman, 149 F.Supp.2d 159, 168 (D.N.J.2001).
Burns found it "unlikely that a neurosurgeon would not be qualified to discuss various radiological diagnosis techniques, given the need [in his practice] to locate the area and determine the type of surgical intervention needed." 766 A.2d at 1102 (quoting 741 A.2d at 655 (Appellate Division decision on review)). The two specialties overlap in practice, making the neurosurgeon an appropriate affiant under Section 27.
I find a similar overlap in the practices of Dr. Giniger and Dr. Getzoff. Getzoff is, of course, an oral surgeon; he, like the defendant radiologist in Burns, has a specialty. Dr. Giniger, however, is well credentialed and qualified in the dental field, and he has been practicing for 30 years. He, like the neurosurgeon in Burns, practices in an area that overlaps with that of the defendant. As a general dentist, Dr. Giniger is qualified to extract teeth, the procedure that is the subject of Szemple's claim. Giniger has extracted teeth as part of his 30-year practice, and his residency at Newark Beth Israel Hospital focused on tooth extraction. Indeed, Dr. Giniger was in 1984-85 a staff dentist at the very state prison where Szemple was confined, and he performed extractions there. (Declaration of Martin Giniger, ECF No. 85-2 ¶¶ 5-9) Like Dr. Salcman in Burns, Dr. Giniger is not in the same specialty as the defendant, but he has for many years practiced the procedure — tooth extraction — in which the malpractice allegedly occurred.
The strict Section 41 same-specialty requirement, if it applied, would not permit an AOM from a specialist in another field who happened to be qualified to perform the same procedure. See Nicholas, supra, 64 A.3d at 551. But Section 41 does not apply. Dr. Giniger's qualification to perform extractions, and his long experience in doing so, demonstrate that he meets the more practice-based AOM standard of Section 27.
Defendants cite Meehan v. Antonellis, 2014 WL 5800811 (N.J.Super.Ct.App.Div. November 10, 2014), certif. granted, 221 N.J. 218, 110 A.3d 931 (2015) (discussed as to Section 41 at pp. 434-35, supra). There, in an action against an orthodontist, the trial court had excluded an AOM signed by a prosthodontist and sleep apnea expert. Meehan, disagreeing with the trial court, held that the medical malpractice standard of Section 41 did not apply in that dental case. Nevertheless, Meehan opined that the Section 27 standards were similar and would require the same result: "Nonetheless, they [i.e., the Section 41 standards] are consistent with the limitations found in the AMS, which, as noted, mandates that experts in other professional malpractice actions possess particular expertise in the specialty involved in the action." Id. Seemingly applying Section 27 and adverting to
The New Jersey Supreme Court has granted certification in Meehan, but argument has not yet been held.
Instead, I simply state that I find Meehan unpersuasive as to the application of Section 27 to a dental malpractice case. For the reasons expressed above, I do not think that the Section 27 standards are similar to those under Section 41, or that the Section 41 standards have any application here.
Under Section 27, Dr. Giniger is eligible to act as AOM affiant in this case.
For the foregoing reasons, the defendants' motion to dismiss the complaint for failure to file a compliant AOM is denied.
N.J. Stat. Ann. § 2A:53A-26 (emphasis added).
N.J. State Bar Ass'n, 902 A.2d at 951.