The opinion
NOT FOR PUBLICATION WITHOUT THE
APPROVAL OF THE APPELLATE DIVISION
This opinion shall not "constitute precedent or be binding upon any court." Although it is posted on the
internet, this opinion is binding only on the parties in the case and its use in other cases is limited. R. 1:36-3.
SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
DOCKET NO. A-1893-22
TONYELLE R. JAMISON, as
administratrix ad prosequendum
of the ESTATE OF RUBY NELL
KING,
Plaintiff-Appellant,
v.
JERSEY CITY MEDICAL
CENTER, KEVIN DIMARCO,1
and ARMANDO VALLES,2
Defendants-Respondents,
and
NATIA MOLINEROS,
Defendant.
______________________________
Argued September 12, 2024 – Decided October 1, 2024
Before Judges Mawla, Natali, and Vinci.
1
Improperly pled as Kevin Demarco.
2
Improperly pled as Armando Vailes.
On appeal from the Superior Court of New Jersey, Law
Division, Hudson County, Docket No. L-1210-20.
Richard A. Grodeck argued the cause for appellant
(Piro, Zinna, Cifelli, Paris & Genitempo, LLC,
attorneys; Richard A. Grodeck, on the briefs).
Douglas F. Ciolek argued the cause for respondents
(Rosenberg, Jacobs, Heller & Fleming, PC, attorneys;
Gayle M. Halevy, on the brief).
PER CURIAM
Plaintiff Tonyelle R. Jamison, as administratrix ad prosequendum of the
Estate of Ruby Nell King, appeals from the Law Division's February 17, 2023
order granting summary judgment in favor of defendants Jersey City Medical
Center (JCMC), Kevin DiMarco, and Armando Valles.3 We affirm.
I.
Shortly after 2:00 p.m. on March 30, 2018, sixty-one-year-old Ruby Nell
King collapsed while visiting friends and family in Jersey City. At 2:04 p.m., a
friend who was with King called 9-1-1 and reached a Hudson County Emergency
Network dispatcher. At 2:05 p.m., a JCMC basic life support (BLS) 4 unit
3
Defendant Natia Molineros was previously dismissed voluntarily and is not a
party to this appeal.
4
BLS "means a basic level of pre-hospital care which includes patient
stabilization, airway clearance, cardiopulmonary resuscitation, hemorrhage
A-1893-22
2
operated by two emergency medical technicians (EMT) 5 was dispatched and was
enroute at 2:06 p.m.
At 2:06 p.m., JCMC supervisor Melissa Isidro was dispatched in a quick
response vehicle (QRV) to "[a]ssist [o]nly." According to Isidro, the QRV is a
pick-up truck that carries only BLS equipment and is "used to respond to priority
calls in order to get aid to incidents where . . . the [QRV] might get there faster
or there is[not] another unit available." The QRV is an "extra" vehicle operated
by a single paramedic or EMT that "roams wherever it wants during a shift" and
responds to emergency calls at the discretion of the supervisor. The QRV does
not carry advanced life support (ALS) 6 equipment, including intubation
equipment or medication.
control, initial wound care and fracture stabilization and other [authorized]
techniques and procedures . . . ." N.J.S.A. 26:2K-21(b).
5
For purposes of this opinion, an EMT is a person trained in BLS care and is
permitted only to administer BLS care.
6
ALS "means an advanced level of pre-hospital . . . and emergency service
care which includes [BLS] functions, cardiac monitoring, cardiac
defibrillation, telemetered electrocardiography, administration of anti -
arrhythmic agents, intravenous therapy, administration of specific medications,
drugs and solutions, use of adjunctive ventilation devices, trauma care and
other [authorized] techniques and procedures." N.J.S.A. 26:2K-7(a) (Mar.
2018). The Legislature amended the definition of ALS services in 2022, see L.
2022, c. 118 (Oct. 2022). We consider the definition in effect at the time of the
incident.
A-1893-22
3
Although Isidro is a mobile intensive care paramedic trained in ALS
services, when she was operating the QRV on March 30, 2018, she was working
without a paramedic partner, in the capacity of a supervisor designated as a BLS
first responder, not a paramedic.7 According to Isidro, because she was not
accompanied by a second paramedic, she was not permitted to provide ALS
services.
At 2:08 p.m., after the dispatcher obtained information necessary to
determine ALS services were needed, ALS unit 454 was dispatched. At 2:09
p.m., Isidro arrived on scene in the QRV. King was unresponsive with no pupil
reaction, breathing, or pulse. Isidro began cardiopulmonary resuscitation (CPR)
and attached an automated external defibrillator (AED) to the patient. The AED
identified a "shockable rhythm," either ventricular fibrillation or ventricular
tachycardia, and indicated defibrillation was appropriate. Isidro continued CPR
and administered two shocks using the AED. At 2:13 p.m., the BLS unit arrived
and the EMTs continued CPR and began administering oxygen using bag-vale-
mask (BVM) ventilation.
7
A mobile intensive care paramedic or EMT-paramedic is a person trained in
ALS and licensed by the Commissioner of the Department of Health to render
ALS services. N.J.S.A. 26:2K-7(h) and N.J.A.C. 8:41-1.3.
A-1893-22
4
At 2:14 p.m., ALS unit 454 advised the dispatcher it was "[d]elayed by
[t]raffic." At 2:17 p.m., ALS unit 452 was dispatched and enroute less than one
minute later. Unit 452 arrived on scene at 2:21 p.m., operated by mobile
intensive care paramedics DiMarco and Valles, and paramedic student
Molineros.8 Unit 452 carried ALS equipment including advanced airway
equipment, intubation equipment, and medication. At 2:23 p.m., King had no
pulse or measurable blood pressure and was in a condition known as pulseless
electrical activity. Valles administered two doses of epinephrine at 2:24 p.m.
and 2:27 p.m., and the crew continued chest compressions and BVM ventilation.
By 2:29 p.m., King's pulse was restored, her cardiac rhythm was improving, and
she had a return of spontaneous circulation.
At 2:30 p.m., Molineros attempted to intubate King, but she was not
successful. The crew continued BVM ventilation and at 2:34 p.m. King's
oxygen saturation was stabilizing even though she had not yet been successfully
intubated. At 2:35, DiMarco successfully intubated King and she was
transported to JCMC. On April 22, 2018, King died from anoxic brain injury
caused by her cardiac arrest.
8
Molineros was certified as an EMT and was in the last four months of her
two-year paramedic training, having already completed classroom and clinical
training in intubation.
A-1893-22
5
Plaintiff filed her complaint in this action alleging defendants "were
negligent in the provision of emergent care and proper life saving protocols were
not performed and [King] was denied oxygen for a prolonged period of time."
Plaintiff served expert reports authored by Paul Werfel, director of the EMT and
paramedic programs at Stony Brook University, and Dr. Kevin Brown, a board-
certified emergency medicine physician.
Werfel opined that the cardiac rhythm identified by Isidro upon her
arrival, Torsade de Pointes (TdP), "is a treatable rhythm for paramedics" and
had Isidro "had the basic paramedic equipment and medications on [the
QRV], . . . King's condition would have been initially treatable and reversible." 9
According to Werfel, the "failure of JCMC to provide Isidro with ALS
equipment meant that her arrival within eight minutes was meaningless." "She
was unable to render 'definitive care' without medication, i.e., [m]agnesium (for
the treatment of [TdP]), epinephrine, and without intubation equipment." 10
9
Isidro contends she did not have any way of identifying the rhythm as TdP
and the entry was made electronically in error. That dispute, however, is not
material to our analysis of the claims before us. We will assume, as plaintiff
contends, the rhythm when Isidro arrived was TdP.
10
Werfel also opined that dispatching the first ALS unit at 2:17 p.m. was a
departure from the standard of care. At his deposition, he conceded he was not
aware the first ALS unit was dispatched at 2:08 p.m. and retracted that portion
of his report.
A-1893-22
6
At his deposition, Werfel testified DiMarco and Valles did not do or fail
to do anything he believed to be a deviation from the applicable standard of care.
Werfel also testified JCMC satisfied the applicable standard of care by
dispatching BLS and ALS units, and JCMC was not also required to dispatch a
supervisor in the QRV. In Werfel's opinion, dispatching the QRV was "extra"
and was not required.
Dr. Brown opined that JCMC was "chronically understaffed by
paramedics and EMTs" and "[t]his understaffing leads to delayed emergency
responses by paramedics to 9-1-1 emergency calls." According to Dr. Brown,
"[t]he paramedic unit that arrived at . . . King's home took an excessive amount
of time to arrive. As a result, . . . King was deprived of life-saving ALS
treatment." He concluded, "[l]ikely, the number of ALS units staffed with
[p]aramedics on the day of . . . King's cardiac arrest was less than scheduled."
Dr. Brown opined, "[h]ad the ALS staffing been at required staffing levels on
that date in 2018, the medic unit would have arrived earlier . . . ."
At his deposition, Dr. Brown conceded he did not know how many ALS
units were scheduled to be in service on March 30, 2018, how many ALS units
were in service, where those units were located at the time of King's cardiac
arrest, or if additional ALS units would have resulted in a faster response time
A-1893-22
7
in this case. He also conceded he did not have an opinion as to the minimum
number of ALS units JCMC should have had in service at that time to meet the
standard of care. Instead, he testified he would need to "defer to [Isidro] and
say you need the number to respond to a priority one assignment to have a BLS
unit there within . . . five minutes and an ALS unit there within . . . nine
minute[s] . . . ." Dr. Brown, however, opined "all indications are that they were
short one unit compared to their ideal staffing" and "[m]ore likely than not there
was one less unit than they were staffed for."
Dr. Brown's opinions were based solely on the deposition testimony of
Isidro who testified that on "most days" there were three JCMC ALS units
available, one of which was not in located in Jersey City. However, Isidro
testified "some days there[ were] four." She continued:
Q: On what days are there four?
A: It depends on staffing.
Q: How many paramedics . . . were employed by
[JCMC] in March of 2018?
A: I don't know.
....
Q: You said on most days there were two ALS
units, but it could be as many as four. I take it
sometimes there w[ere] three?
A-1893-22
8
A: Yes, sir.
Q: Is there any way of determining how many
ALS units were in use on March 30, 2018 at [2:04
p.m.]?
A: Not at this time.
Isidro testified that JCMC switched scheduling programs in 2019 and, as
a result, she did not have access to staffing information for 2018. She was not
aware if any effort was made to obtain staffing information from the prior
system.11
According to Isidro, the ALS units operated in three zones and "mostly"
there was one ALS unit assigned to each zone. Specifically, she testified:
Q: Back in March of 2018, was only one ALS
unit assigned to roam each zone?
A: Mostly, sir.
Q: You say mostly, so I take it sometimes more
than one ALS unit would roam each zone; is that
right?
A: Yes, sir.
Q: Under what circumstances would more than
one unit roam a zone?
11
Notably, Isidro did not testify the information was lost or destroyed, only
that it was not available to her on the system implemented in 2019.
A-1893-22
9
A: On the very rare occasion that all the
paramedic units were available and there were[
not] enough zones for ALS units.
Q: What do you mean by very rare occasion?
A: Due to staffing, it[is] very rare that there
would be an occasion that all the ALS units
would be staffed.
Q: Were there difficulties with staffing in March
of 2018?
A: Yes.
Q: You were short manpower?
A: Yes. . . .
Q: Short both EMT and paramedics . . . ?
A: Short everywhere, sir.
Q: When you say everywhere, you mean among
EMTs and paramedics?
A: ALS, BLS, dispatchers, supervisors. We
were short staffed.
Q: How long had you been short staffed?
A: As long as I can remember, sir.
....
Q: Do you know whether there was any internal
review about dealing with or correcting the staff
shortages?
A-1893-22
10
A: Management was working very hard around
the clock for it, sir.
Dr. Brown also opined "[t]here was a delay in intubating . . . King as the
paramedics allowed a paramedic student, . . . Molineros, to attempt" to intubate
the patient. According to Dr. Brown, King "was not in a stable condition[,] and
the paramedic should not have allowed the student to attempt intubation." At
his deposition, Dr. Brown testified paramedic students are permitted to intubate
patients in the field and conceded he did not know how many intubations
Molineros performed before March 30, 2018. However, he testified allowing
Molineros to intubate King "was horrible, horrible judgment," and "reckless and
dangerous." Dr. Brown testified he did not know why Molineros was unable to
intubate King and he did not "see that she deviated from what a student would
do."
Finally, Dr. Brown opined that the "reader" on the AED Isidro used was
broken and that limited the information available about King's initial condition
because Isidro was not able to download a report of the incident from the AED
into her patient care report. At his deposition, Dr. Brown testified the AED
otherwise functioned properly, King's care was not impacted by the broken AED
reader, and the broken AED reader did not cause King injury.
A-1893-22
11
After the close of discovery, defendants moved for summary judgment.
After briefing was completed, the court granted plaintiff leave to file an
amended complaint. In the amended complaint, plaintiff alleged "[a]s a result
of chronic issues with paramedic understaffing [Isidro] did not have a partner
on March 30, 2018, and as a result was assigned to a [QRV]" and JCMC "was
negligent in that it failed to properly equip the [QRV]." Plaintiff also alleged
DiMarco and Valles "were negligent in the provision of emergent care and
proper life saving protocols were not performed and [King] was denied oxygen
for a prolonged period of time."
On February 17, 2023, the court heard oral argument and granted
defendants' motion in an oral opinion. The court first determined DiMarco and
Valles were entitled to immunity pursuant to N.J.S.A. 26:2K-14 because there
was no evidence they failed to render ALS in good faith by permitting Molineros
to intubate King. The court also found JCMC was entitled to immunity for
claims arising out of the conduct of DiMarco and Valles because "allowing a
paramedic student to perform an intubation . . . is permitted by N.J.A.C. 8:41-
12.1(c)(7)" and doing so "does not negate the good-faith effort in rendering"
ALS.
A-1893-22
12
The court rejected plaintiff's claim that failing to equip the QRV with ALS
supplies was a deviation from the applicable standard of care because
dispatching "a single BLS and a single ALS unit on the scene would have met
the standard of care." Because "the BLS unit and ALS unit were dispatched
along with [Isidro's] unit and dispatching [Isidro's] unit did not affect the arrival
of the other units, [Isidro's] attendance was not required at the scene."
The court rejected plaintiff's claim that chronic understaffing led to a
delayed response finding the "record shows that there were two ALS units that
were dispatched . . . and one of those units arrived and provided at the scene
care." It concluded, "[d]espite Dr. Brown's opinion [] [that] the undertaff[ing]
delay[ed] [King's] care, Dr. Brown nor plaintiff explained how it compared to
the location of the two ALS units, more ALS units, another location would have
led to [an earlier] arrival time that day."
The court also rejected plaintiff's claims regarding the AED reader
because Dr. Brown conceded the reader was "not necessary to administer care."
Ultimately, it found, "the care provide[d to King] was performed in good faith
and neither plaintiff's argument nor [her] experts explain how the systemic flaws
they have highlighted directly caused delay [in] care to [King] on March 30[],
2018."
A-1893-22
13
On appeal, plaintiff argues the court erred in granting summary judgment
because: (1) JCMC is not entitled to immunity under N.J.S.A. 26:2K-14 for
injury caused by the alleged "structural and systemic flaws" in its "emergency
system"; (2) the court failed to recognize that JCMC's structural flaws were a
proximate cause of King's death; and (3) the decision to permit a student to
attempt intubation and then wait five minutes to successfully intubate King after
Molineros's failed effort was not made in good faith.
II.
We affirm substantially for the reasons set forth in the court's oral opinion.
We add the following comments.
We review a grant of summary judgment de novo, Branch v. Cream-O-
Land Dairy, 244 N.J. 567, 582 (2021), "under the same standard that govern[ed]
the court's determination." Goldhagen v. Pasmowitz, 247 N.J. 580, 593 (2021).
We "must 'consider whether the competent evidential materials presented, when
viewed in the light most favorable to the non-moving party, are sufficient to
permit a rational factfinder to resolve the alleged disputed issue in f avor of the
non-moving party.'" Meade v. Twp. of Livingston, 249 N.J. 310, 327 (2021)
(quoting Brill v. Guardian Life Ins. Co. of Am., 142 N.J. 520, 540 (1995)).
"Summary judgment should be granted . . . 'against a party who fails to
A-1893-22
14
make a showing sufficient to establish the existence of an element essential to
that party's case, and on which that party will bear the burden of proof at trial.'"
Friedman v. Martinez, 242 N.J. 449, 472 (2020) (quoting Celotex Corp. v.
Catrett, 477 U.S. 317, 322 (1986)). "[C]onclusory and self-serving
assertions . . . are insufficient to overcome the motion." Puder v. Buechel, 183
N.J. 428, 440-41 (2005). "Competent opposition requires 'competent evidential
material' beyond mere 'speculation' and 'fanciful arguments.'" Hoffman v.
Asseenontv.com, Inc., 404 N.J. Super. 415, 426 (App. Div. 2009) (quoting
Merchs. Express Money Ord. Co. v. Sun Nat'l Bank, 374 N.J. Super. 556, 563
(App. Div. 2005)).
A.
We are satisfied the court correctly determined defendants are entitled to
immunity pursuant to N.J.S.A. 26:2K-14, which provides, in relevant part:
No mobile intensive care paramedic, . . .
hospital . . . first aid, ambulance or rescue squad, . . .
shall be liable for any civil damages as the result of an
act or the omission of an act committed while in
training for or in the rendering of . . . advanced life
support services in good faith and in accordance with
this act.
There is no dispute JCMC's employees are paramedics protected by
N.J.S.A. 26:2K-14, nor is there any dispute intubation and the administration of
A-1893-22
15
medications such as magnesium are ALS services. Plaintiff, however, argues
her claims against JCMC do not fall within the immunity granted by the statute
because the claims are premised on allegations of "systemic and structural
flaws," rather than the rendering of ALS services. We are not convinced.
Plaintiff contends the direct causes of King's injuries were the delay in
successfully intubating her and the failure to administer magnesium when Isidro
arrived in the QRV. These claims fall squarely within the immunity afforded
by N.J.S.A. 26:2K-14 because they are based on acts or omissions committed in
the rendering of ALS services.
Plaintiff's reliance on De Tarquino v. City of Jersey City, 352 N.J. Super.
450 (App. Div. 2002), is not persuasive. In De Tarquino, a patient who had been
treated by EMTs and transported to a hospital died of a hematoma after being
discharged from the emergency room. Id. at 453.12 The plaintiff alleged the
ambulance service was negligent for failing to note in the report the EMTs
provided to the hospital that the patient had vomited while being treated. Id. at
452. We noted plaintiff's claim was "not predicated on alleged negligence in
the 'direct rendering' of [EMT] services but rather in failing to note in the report
12
De Tarquino involved emergency care rendered by EMTs and implicated
N.J.S.A. 26:2K-29 "which provides an immunity that is virtually identical to"
N.J.S.A. 26:2K-14. Id. at 455.
A-1893-22
16
provided to [the hospital] that decedent had been vomiting." Id. at 455. We
determined the immunity afforded to EMTs does not extend to "the preparation
of a report regarding [EMT] services and the patient's condition." Id. at 457.
Here, unlike De Tarquino, plaintiff's claims are based on injury allegedly
caused by acts or omissions in the rendering of ALS services. The alleged
"systemic and structural flaws" plaintiff identifies could not have resulted in
injury to King absent acts or omissions committed in the rendering of ALS
services. Therefore, we conclude the court determined correctly JCMC is
entitled to immunity pursuant to N.J.S.A. 26:2K-14.
B.
Plaintiff next contends the question of whether DiMarco and Valles
rendered ALS services in good faith presents a question of fact that could not be
decided on summary judgment. Specifically, plaintiff contends, given King's
unstable condition, it was not appropriate to permit Molineros to attempt the
intubation, and DiMarco took too long to intubate King after the initial
unsuccessful attempt. We are not persuaded.
Generally, "'good faith'" has been defined as "'honesty of purpose and
integrity of conduct without knowledge, either actual or sufficient to demand
inquiry, that the conduct is wrong.'" Frields v. St. Joseph's Hosp., 305 N.J.
A-1893-22
17
Super. 244, 248 (App. Div. 1997) (quoting Marley v. Borough of Palmyra, 193
N.J. Super. 271, 294 (Law Div. 1983)). While the issue of good faith is often
determined in a plenary hearing, summary judgment is proper where the
defendant demonstrates that the actions "were objectively reasonable or that
they performed them with subjective good faith." Canico v. Hurtado, 144 N.J.
361, 365 (1996). "This test recognizes that even a person who acted negligently
is entitled to a qualified immunity, if [the person] acted in an objectively
reasonable manner." Frields, 305 N.J. Super. at 248 (citing Canico, 144 N.J. at
366).
In Frields, the plaintiff claimed paramedics used excessive force when
putting his son on an ambulance, which caused a brain hemorrhage that resulted
in his death. Ibid. The plaintiff argued the paramedics should have administered
a chemical sedative rather than use physical restraint. Ibid. We held that, while
the plaintiff proffered evidence of a possible negligence claim against the
paramedics, he failed to present any evidence that created a genuine issue of fact
that they did not act in an objectively reasonable manner. Id. at 249. Because
the paramedics acted in good faith, they were entitled to immunity under
N.J.S.A. 26:2K-14. Ibid.
A-1893-22
18
Here, plaintiff's claim is based solely on Dr. Brown's opinion that it was
"horrible" judgment and "reckless and dangerous" for DiMarco and Valles to
permit Molineros to attempt the intubation. Dr. Brown, however, conceded at
his deposition Molineros was, as a paramedic student, expressly permitted
pursuant to N.J.A.C. 8:41-12.1(c)(7), to intubate patients in the field. In
addition, Dr. Brown did not know how many times Molineros intubated patients
before March 30, 2018. Dr. Brown testified he did not know why her intubation
attempt failed and did not believe Molineros "deviated from what a student
would do."
Plaintiff's claim that DiMarco took too long to intubate King after the
initial unsuccessful attempt is not supported by any expert opinion. In fact,
Werfel opined DiMarco did not deviate from any applicable standard of care.
In his report, Dr. Brown does not offer any opinion on this alleged delay. His
opinion is limited to the decision to permit Molineros to attempt the intubation,
not the alleged delay after the unsuccessful attempt.
According to DiMarco, "there were many little things that need[ed] to get
done" before he could attempt the intubation again. These included
troubleshooting the problem with the initial intubation, positioning himself with
the proper equipment, possibly readjusting the patient's position, and confirming
A-1893-22
19
that the intubation tube was clean, which sometimes requires using a new
intubation tube. He also testified it was necessary to continue the BVM
ventilation between attempts.
At best, plaintiff sets forth a viable claim of negligence. Plaintiff does not
offer any evidence to support a finding that DiMarco and Valles did not act in
good faith. We are satisfied, based on the facts and circumstances of this case,
the court correctly determined DiMarco and Valles demonstrated their actions
"were objectively reasonable or that they performed them with subjective good
faith." Canico, 144 N.J. at 365. Summary judgment, therefore, was properly
granted on the issue of good faith.
C.
Even if defendants were not entitled to immunity, the court correctly
determined plaintiff failed to establish JCMC breached any applicable standard
of care and failed to prove the alleged "systemic and structural flaws" caused
King's injuries.
A cause of action for negligence "requires the establishment of four
elements: (1) a duty of care; (2) a breach of that duty; (3) actual and proximate
causation; and (4) damages." Jersey Cent. Power & Light Co. v. Melcar Util.
Co., 212 N.J. 576, 594 (2013). The plaintiff "bears the burden of establishing
A-1893-22
20
those elements 'by some competent proof.'" Davis v. Brickman Landscaping,
Ltd., 219 N.J. 395, 406 (2014) (citations omitted) (first citing Buckelew v.
Grossbard, 87 N.J. 512, 525 (1981), then quoting Overby v. Union Laundry Co.,
28 N.J. Super. 100, 104 (App. Div. 1953)).
Plaintiff relies on the expert reports of Werfel and Dr. Brown in support
of her claims. Expert opinions, however, must "be grounded in 'facts or data
derived from[:] (1) the expert's personal observations, or (2) evidence admitted
at the trial, or (3) data relied upon by the expert which is not necessarily
admissible in evidence but which is the type of data normally relied upon by
experts.'" Townsend v. Pierre, 221 N.J. 36, 53 (2015) (quoting Polzo v. Cty. of
Essex, 196 N.J. 569, 583 (2008)). "The net opinion rule is a 'corollary of
[N.J.R.E. 703] . . . which forbids the admission into evidence of an expert's
conclusions that are not supported by factual evidence or other data.'" Id. at 53-
54 (alteration in original) (quoting Polzo, 196 N.J. at 583).
Therefore, an expert is required to "'give the why and wherefore' that
supports the opinion, 'rather than a mere conclusion.'" Id. at 54 (quoting
Borough of Saddle River v. 66 E. Allendale, L.L.C., 216 N.J. 115, 144 (2013)).
The net opinion rule directs that experts "be able to identify the factual bases for
their conclusions, explain their methodology, and demonstrate that both the
A-1893-22
21
factual bases and the methodology are reliable." Id. at 55 (quoting Landrigan v.
Celotex Corp., 127 N.J. 404, 417 (1992)). In short, the net opinion rule is "a
prohibition against speculative testimony." Harte v. Hand, 433 N.J. Super. 457,
465 (App. Div. 2013) (quoting Grzanka v. Pfeifer, 301 N.J. Super. 563, 580
(App. Div. 1997)).
Dr. Brown's claims that "[l]ikely, the number of ALS units staffed with
[p]aramedics . . . was less than scheduled" and "[h]ad the ALS staffing been at
required staffing levels . . . the medic unit would have arrived earlier" are
speculative and impermissible net opinions. Dr. Brown offered these opinions
without knowing how many ALS units were staffed and available on March 30,
2018, how many were scheduled to be available, or how many were necessary
to meet the applicable standard of care.
Dr. Brown speculated that because Isidro did not have a paramedic
partner, there likely were only two ALS units available. Isidro testified,
however, she did not know how many ALS units were available on March 30
and there could have been as many as four available. Without knowing how
many ALS units were available, how many were scheduled to be available, or
how many JCMC needed in service, Dr. Brown did not have an adequate factual
basis for his opinion that there were an insufficient number of ALS units
A-1893-22
22
available. The court correctly found plaintiff failed to establish JCMC breached
the applicable standard of care.
Dr. Brown's opinion that an additional ALS unit would have resulted in a
faster response in this case likewise is based on nothing more than speculation.
He did not provide any factual basis for this opinion, other than to baldly assert
that additional ALS units would have resulted in a quicker response. An expert
needs to do more than make conclusory assertions without any factual basis. We
are satisfied the court correctly determined plaintiff failed to prove the alleged
understaffing at JCMC caused King's injuries.
Finally, the court properly rejected plaintiff's claim, based on Werfel's
expert report, that JCMC breached its duty of care by not equipping the QRV
with ALS supplies. At his deposition, Werfel conceded JCMC satisfied the
applicable standard of care by timely dispatching both a BLS unit and an ALS
unit. He agreed the QRV was an "extra" unit and JCMC was not obligated to
dispatch the QRV. We are satisfied based on the facts and circumstances of this
case the court correctly concluded JCMC did not breach any duty owed to King
by allegedly failing to equip the QRV with ALS supplies.
Moreover, Isidro testified that in 2018, a single paramedic without a
paramedic partner was not permitted to render ALS services. Therefore, even if
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the QRV carried ALS equipment, she would not have been permitted to render
ALS services until the ALS unit arrived. Without citation to any authority,
plaintiff contends Isidro was incorrect.
Our review of applicable authority has not revealed any basis to conclude
Isidro's understanding of the applicable statutes and regulation in effect in 2018
was incorrect. In fact, effective October 21, 2022, the Legislature amended
N.J.S.A. 26:2K-10 to provide a single "mobile intensive care paramedic shall be
permitted to provide [ALS] services when operating outside of a mobile
intensive care unit in situations directly related to EMS first response . . . ." As
Isidro correctly testified, prior to the 2022 amendment, a single paramedic
operating a unit such as a QRV was not permitted to render ALS services.
Because Isidro would not have been permitted to render ALS services even if
the QRV was so equipped, plaintiff failed to establish the requisite causative
link.
To the extent we have not addressed any of plaintiff's remaining
arguments, including plaintiff's argument relating to the AED reader, it is
because they lack sufficient merit to warrant discussion in a written opinion. R.
2:11-3(e)(1)(E).
Affirmed.
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