explaining that the FTCA “does not itself create a substantive cause of action against the United States” but instead “provides a mechanism for bringing a state law tort action against the federal government in federal court” (quotation omitted)
How later courts described this case
- explaining that the FTCA “does not itself create a substantive cause of action against the United States” but instead “provides a mechanism for bringing a state law tort action against the federal government in federal court” (quotation omitted)
- finding N.J.S.A. 2A:53A-41(a) requires that an expert offering testimony against a board - certified specialist share that specialty and meet the requirements of either N.J.S.A. 2A:53A-41(a)(1) or (a)(2)
- holding that the United States, as deemed employer of volunteer physicians, stood in shoes of free nonprofit health center in answering for alleged tortious conduct of volunteer physicians
Written by the judges who cited it.
The opinion
PRECEDENTIAL
UNITED STATES COURT OF APPEALS
FOR THE THIRD CIRCUIT
______________
No. 11-1957
______________
INES LOMANDO,
as Administratrix Ad Prosequendum of the
Estate of Laura Lomando, deceased,
Appellant
v.
UNITED STATES OF AMERICA;
STEPHANIE REYNOLDS, D.O.; TREVOR TALBERT,
M.D.;
DAVID HYPPOLITE, M.D.; PARKER FAMILY HEALTH
CENTER;
RIVERVIEW MEDICAL CENTER;
EMERGENCY PHYSICIAN ASSOCIATES NORTH
JERSEY, PC;
JOHN DOE, #1 through #5, MARY MOE #1 through #5, and
XYZ CORPORATION #1 through #5 (fictitious names
representing
unknown physicians, nurses, technicians, medical groups,
medical facilities)
______________
On Appeal from the United States District Court
for the District of New Jersey
(D.C. Civ. No. 08-4177)
Honorable Freda L. Wolfson, District Judge
______________
Submitted under Third Circuit LAR 34.1(a)
October 6, 2011
BEFORE: McKEE, Chief Judge, and FUENTES and
GREENBERG, Circuit Judges
(Filed: December 30, 2011)
______________
Anthony A. Lenza, Jr.
Law Offices of Carl M. Erman
618 Newark Avenue
Elizabeth, NJ 07208
Attorneys for appellant
Tony West
Assistant Attorney General
Paul J. Fishman
United States Attorney
Karen H. Shelton
Office of the United States Attorney
402 East State Street
Trenton, NJ 08608
2
Mark B. Stern
Helen L. Gilbert
Attorneys, Appellate Staff,
Court Division
United States Department of Justice
Appellate Section
Room 7261
950 Pennsylvania Avenue, N.W.
Washington, DC 20530-0000
Attorneys for appellee United States of America
George H. Cortelyou
Mark A. Petraske
Buckley & Theroux
932 State Road
Princeton, NJ 08540-0000
Attorneys for David Hyppolite, M.D.
and for appellees Stephanie Reynolds, D.O.,
Trevor Talbert, M.D., and Emergency
Physician Associates of North Jersey
Martin J. McGreevy
P.O. Box 820
Oakhurst, NJ 07755
Attorney for David Hyppolite, M.D.
______________
OPINION OF THE COURT
3
______________
GREENBERG, Circuit Judge.
I. INTRODUCTION
This matter comes on before this Court on appeal from
the District Court’s March 18, 2011 order implementing a
comprehensive opinion granting motions that certain defendants,
now the appellees in this appeal, brought seeking summary
judgment. See Lomando v. United States, No. 08-4177, 2011
WL 1042900 (D.N.J. Mar. 18, 2011). Appellant Ines Lomando
(“Lomando”), as administratix ad prosequendum of the estate of
her daughter, Laura Lomando (“Laura”), brought this medical
malpractice and wrongful death action against parties involved
in Laura’s health care that culminated in her death on September
21, 2006. For the reasons that follow, we will affirm in part,
reverse in part, and remand the case to the District Court for
further proceedings with respect to one defendant.
II. FACTUAL and PROCEDURAL HISTORY
On August 23, August 28, September 9, and September
11, 2006, Laura sought and received treatment at the Parker
Family Health Center (“Parker Health”), a free New Jersey non-
profit health clinic, for an area of swelling on the left side of her
neck. Three volunteer physicians at Parker Health, Drs. Zaven
Ayanian, Lynn Helmer, and Timothy Sullivan, none of whom
has been a party in this case, cared for Laura during these visits.
4
Effective in January 2006, and during all periods that Laura
received treatment from Parker Health, the United States
Department of Health and Human Services deemed those
physicians to be Public Health Service (“PHS”) employees
pursuant to a provision of the Public Health Service Act
(“PHSA”), as amended, 42 U.S.C. § 233(o). By virtue of that
designation, the physicians fell within the scope of the Federal
Tort Claims Act (“FTCA”), 28 U.S.C. §§ 1346, 2671-2680,
which precluded a suit against them individually for their
services at Parker Health and substituted a suit against the
United States as the exclusive remedy for their alleged
malpractice.
In September 2006, Laura also sought treatment for her
swollen neck and other symptoms at the Riverview Medical
Center’s Emergency Room Department, a facility where the
physicians did not enjoy the PHSA and FTCA protections from
litigation shielding the Parker Health physicians. Specifically,
Laura visited Riverview on September 3, 5, 15, and 20, 2006,
where Ms. Theresa Biedenbach, a physician assistant, and Drs.
Stephanie Reynolds, Trevor Talbert, and David Hyppolite
evaluated her. Laura’s September 20 visit to Riverview would
be her last, for the next day she died of spontaneous tumor lysis
syndrome caused by an underlying condition of non-Hodgkins
lymphoma.
Lomando filed suit under the FTCA and New Jersey law
in the District Court on August 20, 2008, and filed an amended
complaint on September 30, 2008. 1 She named the following
1
Initially, Lomando filed suit in the New Jersey Superior Court,
5
defendants in the action: the United States, Parker Health,
Riverview Medical Center, Drs. Reynolds, Talbert, and
Hyppolite, and Emergency Physician Associates of North Jersey,
P.C. (“Emergency Physician Associates”), the employer of the
three individual defendants and Ms. Biedenbach. Lomando,
however, did not include Ms. Biedenbach as a defendant, an
omission that, as we shall see, had significant consequences in
this litigation.
On February 23, 2011, the District Court granted Parker
Health’s unopposed motion for summary judgment predicated
on its claim of immunity under the New Jersey Charitable
Immunity Act, which we discuss at length below. Inasmuch as
Lomando is not challenging this disposition Parker Health is not
participating in this appeal. On March 18, 2011, the District
Court granted summary judgment to all remaining defendants
except Dr. Hyppolite who did not seek summary judgment, but
in the exercise of its discretion the Court declined to exercise
supplemental jurisdiction over the claims against him and
therefore the action was terminated in the District Court. 2
The District Court had different reasons for granting the
contested motions for summary judgment to different
defendants. The Court granted summary judgment to Riverview
but that court dismissed the case without prejudice on October
31, 2008.
2
Lomando since has filed suit in the New Jersey Superior Court
against Dr. Hyppolite.
6
Medical Center because Lomando failed to provide expert
testimony against Riverview as required to establish a prima
facie case of liability for medical malpractice under New Jersey
law. We, however, are not concerned with this disposition as
Lomando does not challenge it on this appeal. Thus, Riverview,
like Parker Health, is not participating in this appeal.
The District Court addressed two distinct but related
questions in dealing with Lomando’s FTCA claim against the
United States. The United States contended that because a
provision of the FTCA, 28 U.S.C. § 2674, provides that the
United States “shall be entitled to assert any defense based upon
judicial or legislative immunity which otherwise would have
been available to the employee of the United States whose act or
omission gave rise to the claim,” the United States was entitled
to claim any immunity available to the volunteer physicians of
Parker Health. In support of this claim of immunity, the United
States invoked the Volunteer Protection Act of 1997 (“VPA”),
42 U.S.C. § 14503(a), which immunizes volunteers of nonprofit
organizations and governmental entities from claims alleging
negligence based on acts committed within the scope of such
volunteerism, and the New Jersey Charitable Immunity Act
(“NJCIA”), N.J. Stat. Ann. § 2A:53A-7 (West 2011), which
immunizes charitable nonprofit entities and their volunteers
from liability for negligence in similar circumstances. Lomando
countered that 28 U.S.C. § 2674 did not permit the United States
to rely on immunities available to the volunteer physicians at
Parker Health because under the FTCA “the [U]nited States
stands in the shoes of the nonprofit health center and may assert
only those immunities available to such centers under federal
and state law.” Lomando, 2011 WL 1042900, at *5.
7
The parties’ contentions thus raised the independent but
intertwined questions of: first, whether under the FTCA the
United States assumes the role of a similarly-placed private
employer or stands in the shoes of the immunized employee,
and, second, whether under the FTCA the United States can
assert its employees’ immunities and defenses. The District
Court dealt with these questions first by citing variant case law
that illustrated that the United States has been equated to both a
private employer and an immunized employee in FTCA cases.
Shifting its analysis, the Court then examined section 2674, and
stated that the text “strongly suggests that it permits the United
States to assert immunities available to its employees.” Id. at
*6. Ultimately, however, the Court did not rule on either issue,
but, instead, held that under the NJCIA both Parker Health, as a
nonprofit health center, and Drs. Ayanian, Helmer, and Sullivan,
as volunteer physicians at Parker Health, are immune from suit.3
Accordingly, the Court concluded that pursuant to section 2674
the United States is entitled to the immunity from suit that the
NJCIA granted, regardless of whether it derived that immunity
from the immunity of Parker Health or the individual
physicians. 4
3
As we have indicated, Parker Health predicated its uncontested
successful motion for summary judgment on its claim to
immunity under the NJCIA. Lomando does not challenge that
disposition on this appeal.
4
A firm decision on the issue of whether the United States is
entitled to assert its deemed employees’ defenses under 28
U.S.C. § 2674 would have been necessary if the Court had
8
The District Court held that Drs. Reynolds and Talbert,
physicians who evaluated Laura at Riverview, were entitled to
summary judgment because Lomando’s experts’ qualifications
failed to meet the requirements of N.J. Stat. Ann. § 2A:53A-41
(West 2011) with respect to witnesses in medical malpractice
actions. That statute ordinarily requires that in cases alleging
medical malpractice by a health practitioner in a medically-
recognized specialty where the care at issue involved that
specialty, a plaintiff must offer expert testimony from a
practitioner in that same specialty. In this regard, the Court held
that because Drs. Reynolds and Talbert are board-certified
specialists in emergency medicine, a specialty that the American
Board of Medical Specialties recognizes, and Laura’s care
involved emergency medicine, Lomando was required to
produce expert testimony from specialists in emergency
medicine. Thus, statements that Lomando’s experts, Drs. Mark
Fialk and James Hayes, neither of whom is an emergency
medicine specialist, submitted were insufficient to satisfy N.J.
Stat. Ann. § 2A:53A-41.
Finally, the Court concluded that Emergency Physician
Associates was entitled to summary judgment because Lomando
had not produced any expert statements alleging that it had
deviated from the applicable standard of care, apart from the
testimony against Drs. Reynolds and Talbert that the Court had
predicated the United States’ immunity on the VPA, because
that act differs from the NJCIA in that it grants immunity only to
volunteers of nonprofit organizations and not to the
organizations themselves. 42 U.S.C. § 14503(a).
9
rejected. 5 In granting Emergency Physician Associates
summary judgment, the Court declined to consider statements
that Lomando’s experts submitted alleging deviations from the
applicable standard of care by Emergency Physician Associates’
employee, Ms. Biedenbach, because Lomando “ha[d] not named
[Ms. Biedenbach] as a defendant.” Lomando, 2011 WL
1042900, at *10 n.10.
Lomando asserts that the District Court erred in holding
that the United States is immune from suit under the NJCIA, as
she contends that: (1) the physicians at Parker Health were not
“volunteers” for purposes of the NJCIA because they were
“employees” of the Public Health Service and (2) the decision
permitting the United States to avail itself of the NJCIA
immunity conflicted with the scheme that the FTCA envisioned
and thus created a conflict between state and federal law.
Lomando also argues that the Court erred in its conclusion that
N.J. Stat. Ann. § 2A:53A-41 applies to the present case, and
contends that Drs. Reynolds and Talbert provided care that did
not involve the practice of emergency medicine. Alternatively,
Lomando asserts that even if that statute applies, Dr. Fialk’s
qualifications were sufficient for him to give expert testimony in
this case. Finally, Lomando challenges the Court’s decision not
to consider treatment that Ms. Biedenbach provided to Laura in
5
Because Lomando had not made specific allegations against
Emergency Physician Associates apart from those predicated on
the treatment by the individual practitioners that it employed, the
Court “treat[ed] all arguments applicable to the doctors as
equally applicable to the group.” Lomando, 2011 WL 1042900,
at *10 n.10.
10
support of Lomando’s claims against Emergency Physician
Associates.
III. JURISDICTION and STANDARD of REVIEW
The District Court had jurisdiction over Lomando’s
FTCA claims pursuant to 28 U.S.C. § 1346(b), and over her
state law claims pursuant to 28 U.S.C. § 1367(a). We have
jurisdiction under 28 U.S.C. § 1291.
We exercise plenary review over the order granting
appellees summary judgment, applying the same standard that
the District Court applied. See Knopick v. Connelly, 639 F.3d
600, 606 (3d Cir. 2011); Azur v. Chase Bank, USA, Nat’l Ass’n,
601 F.3d 212, 216 (3d Cir. 2010). In this plenary review, we
can affirm the summary judgment only if “there [wa]s no
genuine issue as to any material fact and the [prevailing
defendants were] entitled to judgment as a matter of law.” Fed.
R. Civ. P. 56(a); see also Melrose, Inc. v. City of Pittsburgh, 613
F.3d 380, 387 (3d Cir. 2010). A genuine dispute is one that
“may reasonably be resolved in favor of either party.” Anderson
v. Liberty Lobby, Inc., 477 U.S. 242, 250, 106 S.Ct. 2505, 2511
(1986). A material fact is one “that might affect the outcome of
the suit under the governing law.” Id. at 248, 106 S.Ct. at 2510.
We must view the record in the light most favorable to
Lomando as the non-moving party, and we must draw all
reasonable inferences that the record supports in her favor. See
Kaucher v. Cnty. of Bucks, 455 F.3d 418, 423 (3d Cir. 2006).
To the extent that the District Court’s opinion contains
11
conclusions of law, our review is de novo. See Azur, 601 F.3d
at 216.
IV. DISCUSSION and ANALYSIS
(1) Whether the District Court erred as a matter of law in
determining that the United States is immune from suit
under the NJCIA, N.J. Stat. Ann. § 2A:53A-7(a), and 28
U.S.C. § 2674?
(a) The Role of the United States under the FTCA and 42
U.S.C. § 233(o)
Under 42 U.S.C. § 254b(c)(1)(A), the government “may
make grants to public and nonprofit private entities for projects
to plan and develop health centers which will serve medically
underserved populations.” As the court described in Wilson v.
Big Sandy Health Care, Inc., 576 F.3d 329, 333 (6th Cir. 2009),
“[i]n part due to the relatively high cost of obtaining malpractice
insurance for treatment of . . . high-risk patients . . . the efforts to
provide necessary medical care in . . . underserved areas initially
faced significant roadblocks.” In response, Congress passed the
Federally Supported Health Centers Assistance Act of 1992
(“1992 Act”), Pub. L. No. 102-501, 106 Stat. 3268 (codified as
amended at 42 U.S.C. §§ 201, 233).
The 1992 Act created a process by which “public and
nonprofit private entities” receiving federal funds pursuant to 42
U.S.C. § 254b(c)(1)(A) and health practitioners that such entities
employ “shall be deemed to be [employees] of the Public Health
12
Service.” 42 U.S.C. § 233(g)(1)(A). This treatment of health
care centers receiving section 254b funding and practitioners at
them is highly significant, for an action against the United States
under the FTCA is the exclusive remedy for persons alleging
“personal injury, including death, resulting from the
performance of medical . . . or related functions” by Public
Health Service employees acting within the scope of their
employment. 42 U.S.C. § 233(a); see also 42 U.S.C. §
233(g)(1)(A) (reiterating subsection 233(a)’s exclusivity clause).
In 1996 in an effort to “expand access to health care
services to low-income individuals in medically underserved
areas,” H.R. Rep. No. 104-736, at 234 (1996) (Conf. Rep.),
reprinted in 1996 U.S.C.C.A.N. 1990, 2091, Congress conferred
the same deemed “employee” status and attendant FTCA
coverage on a second and distinct category of persons: health
practitioners who volunteer at free clinics. See Health Insurance
Portability and Accountability Act of 1996 (“HIPAA”), Pub. L.
No. 104-191, § 194, 110 Stat. 1936, 1988-91 (1996) (codified as
amended at 42 U.S.C. § 233(o)). Congress did not condition the
award of this immunity on the government making grants to the
clinics. Under the HIPAA, volunteer health practitioners who at
free clinics provide a “qualifying health service” “shall in
providing services for the free clinic, be deemed to be
[employees] of the Public Health Service.” 42 U.S.C. §
233(o)(1). 6 The HIPAA likewise made explicit that an FTCA
6
Unlike a health care center receiving section 254b funding
which may be deemed an employee of the PHS under 42 U.S.C.
§ 233(g), a free clinic is not deemed an employee of the PHS
13
action against the United States is the sole remedy through
which medical malpractice and similar claims may be brought
on account of the services of such volunteers. See 42 U.S.C. §
233(o)(5). In this case, the physicians who treated Laura at
Parker Health were deemed employees of the Public Health
Service pursuant to 42 U.S.C. § 233(o) because Parker Health is
a free clinic and the physicians there provided their services as
volunteers. 7 See app. at 215 (Letter from Department of Health
and Human Services to Volunteers in Health (Jan. 27, 2006)
(deeming Parker Health physicians employees of PHS pursuant
to 42 U.S.C. § 233(o))).
Subject to exceptions not at issue in this case, the FTCA
waives the sovereign immunity of the United States in its district
courts for tort claims “caused by the negligent or wrongful act or
and thus the FTCA did not preclude Lomando’s suit against
Parker Health. See 42 U.S.C. § 233(o)(5)(B) (The subsection
extending FTCA coverage to volunteers at free clinics “may not
be construed as deeming any free clinic to be an employee of the
Public Health Service.”).
7
42 U.S.C. § 233(o) specifies the criteria for an entity to be
regarded as a “free clinic,” what conditions must be met in order
for a health care practitioner to be considered a “free clinic
health professional,” and what constitutes a “qualifying health
service.” See 42 U.S.C. § 233(o)(2)-(o)(4). Because the parties
do not dispute that Parker Health is a free clinic, and that the
Secretary of Health and Human Services deemed the volunteer
physicians who treated Laura at Parker Health to be federal
employees, we do not set forth those provisions.
14
omission of any employee of the Government while acting
within the scope of his office or employment, under
circumstances [in which] the United States, if a private person,
would be liable to the claimant in accordance with the law of the
place where the act or omission occurred.” 28 U.S.C. §
1346(b)(1). Section 1346 contains two basic principles that
govern FTCA claims.
First, “the FTCA does not itself create a substantive
cause of action against the United States; rather, it provides a
mechanism for bringing a state law tort action against the
federal government in federal court.” In re Orthopedic Bone
Screw Prod. Liab. Litig., 264 F.3d 344, 362 (3d Cir. 2001); see
also CNA v. United States, 535 F.3d 132, 141 (3d Cir. 2008)
(“The cause of action in an FTCA claim . . . must come from
state tort law.”). Accordingly, “the extent of the United States’
liability under the FTCA is generally determined by reference to
state law.” In re Orthopedic, 264 F.3d at 362 (internal quotation
marks and citation omitted); see also Santos ex rel. Beato v.
United States, 559 F.3d 189, 193 (3d Cir. 2009) (noting that
“substantively the FTCA follows state liability law”). The
parties agree that because Laura’s treatment and death were in
New Jersey, the law of that state is applicable here.
Second, the United States is liable only to the extent that
in the same circumstances the applicable local law would hold
“a private person” responsible. 28 U.S.C. § 1346(b)(1).
Congress reiterated that precept in 28 U.S.C. § 2674, which
provides that the United States is answerable under the FTCA
“in the same manner and to the same extent as a private
individual under like circumstances.” See also United States v.
15
Olson, 546 U.S. 43, 46, 126 S.Ct. 510, 512 (2005) (“Our cases
have consistently adhered to this ‘private person’ standard.”).
The FTCA’s provision that the United States shall be liable to
the same extent as “a private person” or “private individual”
does not specify whether the United States is liable to the extent
that a similarly-placed private employer would be liable or to the
extent its employee if not an employee of the federal
government would be liable. Seemingly, this omission has
engendered the variant case law that the District Court cited.
We addressed this distinction between employer and
employee in McSwain v. United States, 422 F.2d 1086, 1087-88
(3d Cir. 1970), in which we clarified that the United States
occupies the role of a similarly-placed private employer under
the FTCA:
Under the Federal Tort Claims Act, 28
U.S.C. §§ 1346(b), 2674, the United States is
liable for injury caused by the negligent act of a
government employee to the same extent a private
employer would be liable. Such liability for the
acts or omissions of a civilian or military federal
employee is determined by the law of respondeat
superior of the state in which the act or omission
occurred.
(citing Williams v. United States, 350 U.S. 857, 76 S.Ct. 100
(1955)); see also Matsko v. United States, 372 F.3d 556, 561 (3d
Cir. 2004) (distinguishing plaintiff’s claim that United States
failed to protect him from an intentional tort by a government
employee from traditional FTCA “respondeat superior claim
16
for” the government employee’s actions). 8
8
Most courts of appeals have determined consistently with this
view that the FTCA imposes liability on the United States to the
extent that a private employer would be liable in similar
circumstances in the pertinent locality. See Haceesa v. United
States, 309 F.3d 722, 729 (10th Cir. 2002) (“[T]he
Government’s liability under the FTCA is limited to that of a
private employer under like circumstances.”); Day v.
Massachusetts Air Nat’l Guard, 167 F.3d 678, 681 (1st Cir.
1999) (The United States has consented to be sued under the
FTCA “provided that in the same circumstances a private
employer would be liable for the acts of his employee under the
local law.”); Taber v. Maine, 67 F.3d 1029, 1048 (2d Cir. 1995)
(“Pursuant to the FTCA, courts merely determine whether
analogous behavior by a private-sector employee would give
rise to some form of fault-based vicarious liability on the part of
a private-sector employer.”); Johnson v. Sawyer, 47 F.3d 716,
730 (5th Cir. 1995) (en banc) (“All FTCA liability is respondeat
superior liability. . . . Under the FTCA, the United States is not
liable if the private employer would not be liable pursuant to
local law.”). But courts do not always follow this approach for
in Knowles v. United States, 91 F.3d 1147, 1150 (8th Cir. 1996),
the court held that the United States is liable to the extent the
immunized employee would be liable under local law. But see
St. John v. United States, 240 F.3d 671, 676 (8th Cir. 2001)
(“The FTCA is a limited waiver of sovereign immunity,
allowing the federal government to be sued for the actions of
‘any employee of the Government while acting within the scope
of his office or employment’ under circumstances where the
17
The Supreme Court likewise has described the United
States’ role under the FTCA as equivalent to that of an employer
answering under respondeat superior liability. In Gutierrez de
Martinez v. Lamagno, 515 U.S. 417, 427, 115 S.Ct. 2227, 2232
(1995), the Court observed that where the United States certifies
in response to an FTCA claim that an employee was acting
within the scope of his employment with respect to his actions
concerning the claim, “the United States, by certifying, is . . .
exposing itself to liability as would any other employer at
common law who admits that an employee acted within the
scope of his employment.” (citing Restatement (Second) of
Agency § 219 (1958)) (emphasis added); Lamagno, 515 U.S. at
420, 115 S.Ct. at 2229 (“Generally, [FTCA] cases unfold much
as cases do against other employers who concede respondeat
superior liability.”); see also Laird v. Nelms, 406 U.S. 797, 801,
92 S.Ct. 1899, 1901-02 (1972) (“Congress intended to permit
liability essentially based on the intentionally wrongful or
careless conduct of Government employees, for which the
Government was to be made liable according to state law under
the doctrine of respondeat superior . . . .”).
Looking to the text of the FTCA, we note that the act
shadows precisely the common law of respondeat superior
liability, providing that the United States is subject to suit for the
negligent acts of “any employee of the Government while acting
within the scope of his office or employment.” 28 U.S.C. §
1346(b)(1) (emphasis added); see 1 S. Speiser, C. Krause, & A.
Gans, The American Law of Torts § 4.3, pp. 581-82 (2003)
(“[I]t is hornbook law that the doctrine of respondeat superior
United States would be liable if it were a private employer.”).
18
renders an employer or master vicariously liable for a tort
committed by his employee or servant while acting within the
scope of employment.”); Restatement (Third) of Agency § 2.04
(“An employer is subject to liability for torts committed by
employees acting within the scope of their employment.”).
Thus, the plain language of the FTCA, which treats the United
States as liable for the tortious actions of its employees, creates
a remedial scheme under which the United States would be
liable as an employer in like circumstances. See also 28 U.S.C.
§ 2671 note (“The United States, through the Federal Tort
Claims Act, is responsible to injured persons for the common
law torts of its employees in the same manner in which the
common law historically has recognized the responsibility of an
employer for torts committed by its employees within the scope
of their employment.”) (emphasis added).
In sum, the FTCA provides that the United States will be
liable to the extent that a private employer would be liable in
similar circumstances in the same locality. In this case, then, the
United States stands in the shoes that a similarly-placed private
employer of the physicians, i.e., a free non-profit health center,
would stand and answers for the allegedly tortious conduct of
the United States’ deemed employees, the volunteer physicians
at that health center. 9 We turn now to the question of what
9
This case appears to be the first precedential opinion to address
squarely the interaction of 42 U.S.C. § 233(o) and the FTCA.
The District Court stated that Knowles v. United States, 29 F.3d
1261 (8th Cir. 1994), stands for the proposition that the United
States “stands in the shoes of both health institutions and
physicians” in cases such as this one. Lomando, 2011 WL
19
defenses the United States may invoke in that position.
(b) The Defenses of the United States under the FTCA
In 1988, Congress clarified the terms of the United
States’ waiver of sovereign immunity under the FTCA through
the Federal Employees Liability Reform and Tort Compensation
1042900, at *5 n.6 (citing Knowles, 29 F.3d at 1265 (“In this
case, the United States is standing in the shoes of a hospital, a
doctor, two nurses, and the [Medical Service Specialists].”)).
We think, however, that Knowles is of limited precedential
value here as it did not deal with private physicians who were
“deemed” federal employees under 42 U.S.C. § 233(o), but
rather involved a suit against a military base hospital and its
employees. See 29 F.3d at 1262-63. Though there is a dearth
of guidance on the issue of how to characterize a similarly-
placed private employer of a volunteer physician deemed an
employee of the PHS under 42 U.S.C. § 233(o), it seems that
equating the United States to a free clinic, rather than a hospital
or practice group that employs the physicians for compensation,
is the only way to ensure that the United States’ liability under
the FTCA is the same as that of a “private person” in similar
circumstances. If the United States is treated as a paying
employer, the entire statutory predicate of this case, that the
physicians were deemed employees precisely because they were
volunteers at a free clinic, must be ignored, and, further, the
United States’ liability would be expanded beyond that of a
similarly-placed entity, simply by virtue of application of the
FTCA.
20
Act of 1988 (“Westfall Act”), Pub. L. No. 100-694, 102 Stat.
4563 (codified as amended at scattered portions of the United
States Code). The Westfall Act provided for absolute immunity
to federal employees in the wake of Westfall v. Erwin, 484 U.S.
292, 108 S.Ct. 580 (1988), by making suit against the United
States under the FTCA the exclusive remedy for negligent or
wrongful acts by federal employees committed within the scope
of employment. 10 As significant to this case, the Westfall Act
also added the following provision to the FTCA:
With respect to any claim under [the FTCA], the
United States shall be entitled to assert any
defense based upon judicial or legislative
immunity which otherwise would have been
available to the employee of the United States
whose act or omission gave rise to the claim, as
well as any other defenses to which the United
States is entitled.
28 U.S.C. § 2674. The text of section 2674 is straightforward,
and its import clear. See United States v. Gregg, 226 F.3d 253,
257 (3d Cir. 2000) (“If the language of the statute expresses
Congress’s intent with sufficient precision, the inquiry ends
10
In Westfall, the Court held that government employees were
absolutely immune only from suits based on acts that were both
within the scope of employment and discretionary in nature.
484 U.S. at 300, 108 S.Ct. at 585. The Westfall Act eliminated
the requirement that for the employee to have immunity the
allegedly wrongful acts must have involved the exercise of
discretion.
21
there and the statute is enforced according to its terms.”). The
United States as the employer may assert any defense rooted in
judicial or legislative immunity which would have been
available to its employee had he not been a deemed employee of
the PHS and, instead, had been a defendant in the action at hand.
In this case, section 2674 thus allows the United States to avail
itself of any judicially- or legislatively-based immunity to which
the individual physicians — its employees for purposes of the
FTCA — would have been entitled if they were the defendants.
This provision for immunity is superimposed on Congress’s
intent in enacting the FTCA to position the United States for
liability purposes in the position of a private employer.
It is important to note that section 2674 does not state
exhaustively those defenses to which the United States is
entitled; rather, it reserves explicitly the United States’ right to
assert “any other defenses to which [it] is entitled.” The “other
defenses” to which the United States is entitled include not only
those defenses the United States may invoke independently, but
also any defenses available to a similarly-placed private
employer answering for the alleged torts of its employee. In this
vein, Congress clarified in the report accompanying the Westfall
Act that “the specific designation of these immunities does not
imply that traditional common law defenses are not available. . .
. [O]rdinary tort defenses, such as contributory negligence,
assumption of risk, estoppels, waiver and res judicata, as
applicable, continue to be available to the United States.” H.R.
Rep. No. 100-700, at 4 (1988), reprinted in 1988 U.S.C.C.A.N.
5945, 5948; see also id., at 7, 1988 U.S.C.C.A.N. at 5952 (28
U.S.C. § 2674 “would authorize the United States to utilize all
of the defenses to which it is independently entitled.”).
22
Defenses available to a similarly-placed employer may be rooted
in the common law, or they may be created statutorily, as in the
case of the immunity conferred on charitable nonprofit entities
and their volunteers under the NJCIA. Of course, the actual
availability, vel non, of these defenses generally will depend on
the law of the state in which the allegedly wrongful act occurred
because the applicable state law defines the scope of the United
States’ liability under the FTCA. See, e.g., Rodriquez v. United
States, 823 F.2d 735, 741-44, 745 (3d Cir. 1987) (New Jersey
law on comparative negligence established extent to which
recovery by plaintiffs against United States could be limited in
FTCA case).
Having determined the scope of the defenses available to
the United States in an action under the FTCA, we decide now
whether the NJCIA provides an immunity defense in this case.
The NJCIA, N.J. Stat. Ann. § 2A:53A-7, confers immunity on
nonprofit entities organized for a charitable purpose as well as
on the volunteers of those entities. The act reads, in pertinent
part:
No nonprofit corporation, society or association
organized exclusively for . . . charitable . . .
purposes or its . . . volunteers shall . . . be liable to
respond in damages to any person who shall
suffer damage from the negligence of any agent
or servant of such corporation . . . where such
person is a beneficiary, to whatever degree, of the
works of such nonprofit corporation . . . .
N.J. Stat. § 2A:53A-7(a). A further provision of the NJCIA
23
provides similarly that “no person who provides volunteer
services or assistance for any nonprofit corporation . . . shall be
liable in any action for damages as a result of his acts of
commission or omission arising out of and in the course of his
rendering the volunteer service or assistance.” N.J. Stat. §
2A:53A-7.1(b). 11
Lomando concedes that if the volunteer physicians “were
not deemed federal employees and if they were named
defendants in a state court action [for the injuries involved in
this case] they would be immune from liability under [the
NJCIA].” Appellant’s br. at 13. 12 Nevertheless, Lomando
contends that “once [the volunteer physicians] are deemed
federal employees, they should no longer be viewed as
volunteers.” Id. at 12. Lomando bases this argument on the
theory that “the definition of an employee is directly contrary to
that of a volunteer,” with the former expecting some form of
compensation and the latter rendering his or her services without
such an expectation. Id. Lomando asserts, as well, that a
decision applying the statutory immunity derived from the
11
Although Parker Health is a free clinic, there is no requirement
in the NJCIA that an entity must be free to be organized for a
charitable purpose.
12
Because Lomando does not dispute that all aspects of the
NJCIA would have been satisfied here in the absence of the
deemed employee designation, we do not review the District
Court’s conclusion that the requirements of the NJCIA were
satisfied. Consequently, we treat Parker Health and its
volunteers as being immune from suit under New Jersey law.
24
NJCIA in this case would contravene the Supremacy Clause of
the United States Constitution, U.S. Const. art. VI cl. 2, because
the NJCIA provides an immunity defense that is inconsistent
with the remedial scheme of recovery in 42 U.S.C. § 233 and the
FTCA. Id. at 16. We find both of these contentions
unpersuasive.
Lomando fundamentally misapplies the effect of the
physicians’ “deemed” employee designation. Under 42 U.S.C. §
233(o), a volunteer physician is “deemed to be an employee of
the Public Health Service” but only “[f]or purposes of [42
U.S.C. § 233].” Section 233 does not provide for remuneration
for employees of the PHS; rather, that section addresses only
“[c]ivil actions or proceedings against commissioned officers or
employees” of the PHS, and provides that an action under the
FTCA is the exclusive basis for such suits. See 42 U.S.C. §
233(a). Accordingly, persons “deemed” to be employees of the
PHS under 42 U.S.C. § 233(o) are not federal employees
receiving compensation for their work by the federal
government to the end that they are no longer rendering their
services as “volunteers” at a free clinic. To the contrary, the
employee designation is a legal construct effective only for the
purposes of section 233. In addressing the status of health care
practitioners at clinics receiving section 254b funding who
similarly are deemed PHS employees, we have noted that
“[h]ealth care workers at private clinics, even ones receiving
some federal aid, are not federal employees in the usual sense.
After all, they do not perform a traditional government function
or work in a government building, and they are not on the
federal payroll.” Santos, 559 F.3d at 200 (quoting Santos ex rel.
Beato v. United States, 523 F. Supp. 2d 435, 442 (M.D. Pa.
25
2007)) (internal quotation marks omitted). 13
Lomando’s contention that the Supremacy Clause
abrogates the NJCIA in the context of this case likewise fails.
The Supremacy Clause invalidates state law that “interferes with
or is contrary to federal law.” Free v. Bland, 369 U.S. 663, 666,
82 S.Ct. 1089, 1092 (1962) (citing Gibbons v. Ogden, 22 U.S. (9
Wheat.) 1, 210, 6 L.Ed. 23 (1824)). Federal law can supersede
state law in three ways: (1) express preemption, (2) field
preemption, and (3) conflict preemption. Farina v. Nokia Inc.,
625 F.3d 97, 115 (3d Cir. 2010) (citing Hillsborough Cnty. v.
Automated Med. Labs., Inc., 471 U.S. 707, 713, 105 S.Ct. 2371,
2375 (1985)). Lomando bases her Supremacy Clause argument
on conflict preemption, which “nullifies state law inasmuch as it
conflicts with federal law, either where compliance with both
laws is impossible or where state law erects an ‘obstacle to the
accomplishment and execution of the full purposes and
objectives of Congress.’” Farina, 625 F.3d at 115 (quoting
Hillsborough Cnty., 471 U.S. at 713, 105 S.Ct. at 2375).
Lomando urges that under 42 U.S.C. § 233(a) Congress
intended to provide a means of financial recovery for tort
victims injured by volunteer physicians and “[r]ecoveries that
13
This is, of course, to say nothing of the fact that Lomando’s
position on this point, if accepted, would render null the entirety
of 42 U.S.C. § 233(o) dealing with volunteers at free clinics.
Under 42 U.S.C. § 233(o)(2)(D), an individual must not receive
recompense, i.e., he or she must render “[v]olunteer services,” to
be deemed an employee of the PHS. In Lomando’s view,
however, once deemed an “employee” by virtue of such
volunteerism, the individual is no longer a “volunteer.”
26
are allowed under [s]ection 233(a) should not be immunized by
state law,” because that immunization leaves victims without a
remedy. Appellant’s br. at 17.
It is true that Congress has waived the sovereign
immunity of the United States for tort actions against volunteer
physicians “deemed” federal employees under 42 U.S.C. §
233(o), and thereby has provided that a claim against the United
States under the FTCA is an injured party’s exclusive remedy in
such circumstances. However, 28 U.S.C. § 2674, which permits
the United States to invoke the defense provided by the NJCIA,
circumscribes that waiver. See United States v. Jicarilla Apache
Nation, __ U.S. __, __, 131 S.Ct. 2313, 2323 (2011) (“The
Government consents to be liable to private parties ‘and may
yield this consent upon such terms and under such restrictions as
it may think just.’” (quoting Murray’s Lessee v. Hoboken Land
& Improvement Co., 59 U.S. 272, 283 (1856)). Section 2674
clearly expresses Congress’ objectives in this regard, and that
intent is made all the more forceful by the legislative history
surrounding the enactment of 42 U.S.C. § 233(o). In addressing
subsection 233(o), Congress stated:
The Committee is aware that each of the
50 states have passed laws to limit the liability of
volunteers in a variety of circumstances. This
provision does not preempt those laws beyond the
preemption provided in the Federal Tort Claims
Act. Instead, the United States shall be liable in
the same manner and to the same extent as a
private individual in the same circumstances
under State law.
27
H.R. Rep. No. 104-736, at 279, 1996 U.S.C.C.A.N. at 2092
(emphasis added).
Application of the NJCIA coupled with the exclusive
force of the FTCA preclude Lomando from making a recovery
from the United States predicated on the alleged malpractice of
the Parker Health volunteer physicians. Contrary to Lomando’s
contentions, however, this outcome is not at all inconsistent with
Congress’ objectives. See H.R. Rep. No. 100-700, at 6, 1988
U.S.C.C.A.N. at 5950 (“The ‘exclusive remedy’ provision of
[the FTCA] is intended to substitute the United States as the
solely permissible defendant . . . . Therefore, suits against
Federal employees are precluded even where the United States
has a defense which prevents an actual recovery.”) (emphasis
added); see also United States v. Smith, 499 U.S. 160, 166, 111
S.Ct. 1180, 1185 (1991) (“Congress recognized that the required
substitution of the United States as the defendant in tort suits
filed against Government employees would sometimes foreclose
a tort plaintiff’s recovery altogether.”). Accordingly, in
upholding the District Court decision applying the NJCIA to bar
this action against the United States, we are not making a ruling
in any way contrary to the terms or intent of 42 U.S.C. § 233(o)
or the FTCA. Therefore, the Supremacy Clause does not bar the
result we reach in this case.
In summary, we hold that the District Court did not err in
holding that the United States was immune from this suit. The
United States is entitled to the protection of the immunity the
NJCIA provides because a similarly-placed private employer
28
would be entitled to that defense and the United States’ deemed
employees in this case, the individual physicians, would be
entitled to that defense as well. 14
(2) Whether the District Court erred in deciding that the
treatment provided to Laura by Drs. Reynolds and
Talbert constituted emergency medicine such that N.J.
Stat. Ann. § 2A:53A-41 applies? If the Court did not so
err, did one of Lomando’s experts, Dr. Fialk, satisfy N.J.
Stat. Ann. § 2A:53A-41?
To state a prima facie case of medical malpractice in
New Jersey, ordinarily “a plaintiff must present expert testimony
establishing (1) the applicable standard of care; (2) a deviation
from that standard of care; and (3) that the deviation proximately
caused the injury.” Gardner v. Pawliw, 696 A.2d 599, 608 (N.J.
1997) (citations omitted). As part of an effort at comprehensive
tort reform and to counter a severe increase in medical
malpractice liability insurance premiums, in 2004 the New
Jersey Legislature enacted the New Jersey Medical Care Access
and Responsibility and Patients First Act (“Access and
Responsibility Act”), N.J. Stat. Ann. §§ 2A:53A-37 to -42 (West
2011). Among other things, the Access and Responsibility Act
“provides more detailed standards for a testifying expert . . . ,
generally requiring the challenging expert to be equivalently-
qualified to the defendant.” Ryan v. Renny, 999 A.2d 427, 436
14
Inasmuch as we conclude that the United States is immune
from suit under the NJCIA, we need not determine whether the
VPA also may have provided it with an immunity defense.
29
(N.J. 2010). 15
The legislature set forth these standards in N.J. Stat. Ann.
§ 2A:53A-41, which provides, in relevant part:
In an action alleging medical malpractice,
a person shall not give expert testimony . . . on the
appropriate standard of practice or care unless the
person is licensed as a physician or other health
care professional in the United States and meets
the following criteria:
(a) If the party against whom or on
whose behalf the testimony is offered is a
specialist or subspecialist recognized by
the American Board of Medical Specialties
[‘ABMS’] or the American Osteopathic
Association [‘AOA’] and the care or
treatment at issue involves that specialty or
subspecialty recognized by the [ABMS] or
[AOA], the person providing the testimony
shall have specialized at the time of the
occurrence that is the basis for the action
in the same specialty or subspecialty,
recognized by the [ABMS] or the [AOA],
15
These standards apply also to an affidavit of merit supporting a
malpractice claim that a New Jersey statute requires for the
initiation of a malpractice action, N.J. Stat. Ann. § 2A:53A-27
(West 2011), but compliance with that statute is not raised as an
issue in this case.
30
as the party against whom or on whose
behalf the testimony is offered, and if the
person against whom or on whose behalf
the testimony is being offered is board
certified and the care or treatment at issue
involves that board specialty or
subspecialty recognized by the [ABMS] or
the [AOA], the expert witness shall be:
(1) a physician credentialed by a
hospital to treat patients for the
medical condition, or to perform
the procedure, that is the basis for
the claim or action; or
(2) a specialist or subspecialist
recognized by the [ABMS] or the
[AOA] who is board certified in the
same specialty or subspecialty
recognized by the [ABMS] or the
[AOA], and during the year
immediately preceding the date of
the occurrence that is the basis for
the claim or action, shall have
devoted a majority of his
professional time to either:
(a) the active clinical
practice of the same health
care profession in which the
defendant is licensed, and if
31
the defendant is a specialist
or subspecialist recognized
by the [ABMS] or the
[AOA], the active clinical
practice of that subspecialty
recognized by the [ABMS]
or the [AOA]; or
(b) [the instruction of
students in an accredited
medical school, accredited
health professional school,
accredited residency
program or research
program] in the same health
care profession in which the
defendant is licensed, and, if
that party is a specialist or
subspecialist recognized by
the [ABMS] or the [AOA]
[one of the aforementioned
programs] in the same
specialty or subspecialty
recognized by the [ABMS]
or the [AOA]; or
(c) both.
N.J. Stat. Ann. § 2A:53A-41(b) also governs the scenario in
which the defendant health-care provider is a “general
practitioner.” Thus, “[t]he statute sets forth three distinct
32
categories embodying this kind-for-kind rule: (1) those who are
specialists in a field recognized by the [ABMS or AOA] but
who are not board certified in that specialty; (2) those who are
specialists in a field recognized by the ABMS [or AOA] and
who are board certified in that specialty; and (3) those who are
‘general practitioners.’” Buck v. Henry, 25 A.3d 240, 247 (N.J.
2011).
Drs. Reynolds and Talbert are board-certified specialists
in emergency medicine, a specialty that the ABMS and the AOA
recognize. 16 Lomando submitted statements by two experts,
Drs. Fialk and Hayes, neither of whom is a specialist in the field
of emergency medicine, in the District Court. Lomando
contended, however, that N.J. Stat. Ann. § 2A:53A-41 did not
apply to her claims against Drs. Reynolds and Talbert because
they provided care that did not “involve” their specialty of
emergency medicine. The Court rejected this argument, finding
that they rendered care on September 5, 15, and 20 that
constituted the practice of emergency medicine, as the ABMS
and American Board of Emergency Medicine (“ABEM”) define
that field. 17 Lomando contends that the Court erred in making
16
Dr. Reynolds is a doctor of osteopathic medicine; thus, the
AOA certified her in emergency medicine.
17
As noted, Laura visited the Riverview Medical Center’s
Emergency Room Department on September 3, 5, 15, and 20,
2006. Ms. Biedenbach evaluated Laura on September 3, see
appellant’s br. at 5, and because the District Court refused to
consider the treatment Ms. Biedenbach provided, the Court did
not include the events of September 3 in its discussion of N.J.
33
this finding, and argues that the physicians’ treatment of Laura
on September 5 and 15 “involved [the] general skill and
knowledge of a physician and did not require the specialized
training of an emergency department physician.” Appellant’s
br. at 9. 18
Lomando now raises an additional argument that she did
not present squarely to the District Court. Lomando contends
that because Dr. Fialk “is board certified in oncology and has
hospital appointments to treat patients with cancer” and because
“the basis” for Lomando’s claim is the “failure to diagnose
lymphoma,” Dr. Fialk’s qualifications satisfy N.J. Stat. Ann. §
2A:53A-41(a)(1). Appellant’s br. at 18-19. We address these
arguments in turn. 19
Stat. Ann. § 2A:53A-41.
18
Lomando seemingly has abandoned her contention that the
care rendered on September 20 did not constitute emergency
medicine. See appellant’s br. at 9, 23.
19
“‘Generally, failure to raise an issue in the District Court
results in its waiver on appeal.’” Webb v. City of Philadelphia,
562 F.3d 256, 263 (3d Cir. 2009) (quoting Huber v. Taylor, 469
F.3d 67, 74 (3d Cir. 2006)). Nonetheless, the waiver rule “is
one of discretion rather than jurisdiction,” and “it may be
relaxed whenever the public interest . . . so warrants.” Barefoot
Architect, Inc. v. Bunge, 632 F.3d 822, 834-35 (3d Cir. 2011)
(internal quotation marks and citations omitted); see also Webb,
562 F.3d at 263. When considering whether to address an issue
34
(a) The Care Provided by Drs. Reynolds and Talbert
Involved Emergency Medicine.
The ABMS defines the specialty of emergency medicine
as:
the immediate decision making and action
necessary to prevent death or any further
not previously raised, a court considers whether the issue is “a
pure question of law . . . where refusal to reach the issue would
result in a miscarriage of justice or where the issue’s resolution
is of public importance.” Huber, 469 F.3d at 74-75. In
considering a waiver claim, a court takes into account also the
dual purposes of the doctrine: “ensuring that the necessary
evidentiary development occurs in the trial court, and preventing
surprise to the parties when a case is decided on some basis on
which they have not presented argument.” Barefoot, 632 F.3d at
835 (citing Hormel v. Helvering, 312 U.S. 552, 556, 61 S.Ct.
719, 721 (1941)); see also Huber, 469 F.3d at 75.
It would not serve the purposes of the waiver rule to
apply it in this case. Evidentiary development is largely
irrelevant to the question of law at issue here, and appellees
were on notice from the inception of this case that the
application of N.J. Stat. Ann. § 2A:53A-41 was at issue, even if
Lomando did not invoke the specific paragraph we now
consider. In this vein, appellees explicitly argued in the District
Court that Lomando’s experts did not satisfy N.J. Stat. Ann. §
2A:53A-41(a)(1). See app. at 300.
35
disability in both the pre-hospital setting by
directing emergency medical technicians and in
the emergency department. This special[ty
involves] immediate recognition, evaluation, care,
stabilization and disposition of a generally
diversified population of adult and pediatric
patients in response to acute illness and injury.
Lomando, 2011 WL 1042900, at *12; see also Buck, 25 A.3d at
249 (referencing the ABMS definition of “emergency
medicine”). The ABEM describes the practice of emergency
medicine as “begin[ning] with the recognition of patterns in the
patient’s presentation that points to a specific diagnosis or
diagnoses. Pattern recognition is both the hallmark and
cornerstone of the clinical practice of Emergency Medicine,
guiding the diagnostic tests and therapeutic interventions during
the entire patient encounter.” Lomando, 2011 WL 1042900, at
*12 (emphasis in original deleted). 20 Bearing in mind these
definitions of emergency medicine, we agree with the District
Court that Drs. Reynolds and Talbert provided Laura with care
involving the practice of emergency medicine.
On September 5, Laura arrived at Riverview Medical
20
The ABEM is “one of 24 medical specialty certification boards
recognized by the [ABMS]” and is the entity actually
responsible for certifying physicians in emergency medicine.
http://www.abem.org/PUBLIC/portal/alias__Rainbow/lang__en
-US/tabID__3333/DesktopDefault.aspx. Because we are not
aware of an AOA definition of emergency medicine, we
reference only the ABMS and ABEM definition.
36
Center’s Emergency Department complaining of the acute
symptoms of chest pain and tightness, nausea, diarrhea, and
shortness of breath. In response, Dr. Reynolds examined Laura,
ordered that she be given medication intravenously for her chest
tightness, and instructed her to stop taking certain medication,
the consumption of which coincided with the advent of Laura’s
chest tightness, nausea, and diarrhea. During the examination,
Dr. Reynolds became aware that Laura’s left lymph node was
swollen. Once Laura’s nausea and chest pain improved, she was
discharged from the hospital with a working diagnosis of
reaction to medication, muscle strain, and a swollen salivary
duct. In line with the ABMS definition of emergency medicine,
Laura’s symptoms on this visit were largely acute, and Dr.
Reynolds engaged in the task of “evaluation” and “stabilization”
of Laura in response to those symptoms.
On September 15, Laura presented to Riverview’s
Emergency Department with a history of Epstein-Barr
Syndrome, a fever, and showing signs of dehydration. Laura’s
incoming patient report notified Riverview that she was
suspicious for meningitis, had neck pain, and an enlarged lymph
node on the left side of her neck. Upon examination, Dr.
Talbert observed that Laura had left anterior adenopathy. Dr.
Talbert ordered that fluids and medication be given to Laura to
treat her dehydration and fever, and ordered that she be given a
mononucleosis test. Once Laura’s fever decreased and she was
in stable condition, she was discharged from the hospital.
Again, consistently with the ABMS definition of emergency
medicine, Dr. Talbert engaged in the “immediate decision
making and action necessary” to care for and ultimately
“stabiliz[e]” Laura. Further, based on Laura’s pattern of
37
symptoms at that visit, Dr. Talbert ordered the diagnostic test for
mononucleosis.
Though we do not hold that treatment provided in an
emergency room necessarily involves the practice of emergency
medicine, the care that Drs. Reynolds and Talbert provided was
emergency medicine and falls within the practice of emergency
care as the applicable certifying bodies define that field.
Accordingly, the District Court correctly concluded that N.J.
Stat. Ann. § 2A:53A-41(a) applied.
(b) Dr. Fialk’s qualifications do not satisfy N.J. Stat.
Ann. § 2A:53A-41(a)(1).
We turn now to Lomando’s contention, that even if N.J.
Stat. Ann. § 2A:53A-41(a) applies, Dr. Fialk’s qualifications
meet the requirements of N.J. Stat. Ann. § 2A:53A-41(a)(1). As
stated, Drs. Reynolds and Talbert are board-certified specialists
in emergency medicine; thus, Lomando was required to provide
testimony prepared by experts who met the requirements
imposed on experts who testify against board-certified
specialists. There is a question, however, as to what those
requirements may be. In Lomando’s view, an expert offering
testimony against a board-certified specialist need not share that
specialty, but rather the expert only must satisfy the hospital
appointment mandate of N.J. Stat. Ann. § 2A:53A-41(a)(1) or
the board certification plus clinical or instructional experience
requirements of N.J. Stat. Ann. § 2A:53A-41(a)(2). In this
regard, Lomando contends that because Dr. Fialk has “hospital
appointments to treat patients with cancer,” appellant’s br. at 18,
his qualifications satisfy the mandates of N.J. Stat. Ann. §
38
2A:53A-41(a)(1).
The Supreme Court of New Jersey has observed that N.J.
Stat. Ann. § 2A:53A-41 is “far from a model of clarity.” Buck,
25 A.3d at 247. In Ryan, however, that court had provided its
interpretation of the statute, describing it thusly:
[W]here the defendant is a specialist or
subspecialist, the person providing the testimony
against him ‘shall have specialized at the time of
the occurrence that is the basis for the action in
the same specialty or subspecialty[.]’ N.J. Stat.
Ann. § 2A:53A-41(a). Further, where the
defendant is board certified, the witness against
him must also be board certified in the same
specialty or subspecialty, [Here, the Court
inserted the following footnote: ‘Alternatively,
the witness shall be “a physician credentialed by a
hospital” to treat the condition or perform the
procedure that is the basis of the claim. N.J. Stat.
Ann. § 2A:53A-41(a)(1).’], and ‘during the year
immediately preceding the date of the occurrence
that is the basis of the claim or action, shall have
devoted a majority of his professional time to’
active clinical practice or teaching of the specialty
or subspecialty. N.J. Stat. Ann. § 2A:53A-
41(a)(2).
999 A.2d at 440 (original emphasis omitted and current
emphasis added); see also Buck, 25 A.3d at 247 (labeling the
requirements imposed by N.J. Stat. Ann. § 2A:53A-41(a)(1) and
39
-41(a)(2) as “additional qualifications” an expert witness must
meet beyond those delineated in N.J. Stat. Ann. § 2A:53A-
41(a)); New Jersey State Bar Ass’n v. State, 902 A.2d 944, 952-
53 (N.J. Super. Ct. App. Div. 2006) (adopting the same
formulation for N.J. Stat. Ann. § 2A:53A-41). Thus, the
Supreme Court of New Jersey has construed N.J. Stat. Ann. §
2A:53A-41(a) to require that an expert offering testimony
against a board-certified specialist share that specialty and meet
the requirements of either N.J. Stat. Ann. § 2A:53A-41(a)(1) or -
41(a)(2). In this way, the court made clear that the hospital
credential provision of N.J. Stat. Ann. § 2A:53A-41(a)(1) is an
alternative to the board certification plus teaching or clinical
practice requirements of N.J. Stat. Ann. § 2A:53A-41(a)(2), but
it is not an alternative to the specialization requirement of N.J.
Stat. Ann. § 2A:53A-41(a).
Accordingly, Dr. Fialk may not offer testimony against
Dr. Reynolds or Dr. Talbert regarding the care provided by those
physicians to Laura because he is not a specialist in the field of
emergency medicine.
(3) Whether the District Court erred in refusing to
consider the treatment Ms. Biedenbach rendered for
purposes of Lomando’s claim against Ms. Biedenbach’s
employer, Emergency Physician Associates? If the Court
so erred, does N.J. Stat. Ann. § 2A:53A-41 apply to
testimony concerning Ms. Biedenbach?
(a) Lomando was not required to name Ms. Biedenbach
as a defendant.
40
The District Court stated that it would “not consider the
treatment provided by Ms. Biedenbach in connection with”
Emergency Physician Associates’ summary judgment motion
solely because Lomando “ha[d] not named [Ms. Biedenbach] as
a defendant.” Lomando, 2011 WL 1042900, at *10 n.10.
Lomando contends that the Court’s refusal to consider treatment
that Ms. Biedenbach provided in support of Lomando’s claim
against her employer, Emergency Physician Associates, was
legal error, and we agree.
New Jersey courts apply the common law principle of
respondeat superior liability, and thus in that state “an employer
can be found liable for the negligence of an employee causing
injuries to third parties, if, at the time of the occurrence, the
employee was acting within the scope of his or her
employment.” Carter v. Reynolds, 815 A.2d 460, 463 (N.J.
2003) (citing Lehmann v. Toys ‘R’ Us, Inc., 626 A.2d 445, 461-
62 (N.J. 1993)). New Jersey law, however, does not include a
requirement that a litigant include the allegedly negligent
employee as a defendant in an action seeking to impose
respondeat superior liability on an employer. See Zukowitz v.
Halperin, 821 A.2d 527, 530 (N.J. Super. Ct. App. Div. 2003)
(“The judge erred in dismissing plaintiff’s common law claim
based upon vicarious liability for the negligence of defendant’s
employees. See, e.g., Printing Mart-Morristown v. Sharp Elecs.
Corp., [563 A.2d 31, 47-48 (N.J. 1989)]. Whether the
[employees] were named as defendants is legally irrelevant to
defendant’s liability for their conduct under the doctrine of
respondeat superior. See McFadden v. Turner, [388 A.2d 244
(N.J. Super. Ct. App. Div. 1978)].”); Marion v. Borough of
Manasquan, 555 A.2d 699, 702 (N.J. Super. Ct. App. Div. 1989)
41
(“In cases not involving the [Tort Claims Act, N.J. Stat. Ann. §
59:2-2 (West 2011)] 21 in which a plaintiff seeks recovery on the
theory of respondeat superior, there is no requirement that the
plaintiff join as a defendant the individual upon whose act or
failure to act vicarious liability is predicated. Indeed, the
plaintiff has the option to sue the party vicariously liable for the
conduct of an agent in one law suit and thereafter, pursue the
agent in a separate suit. In such cases, the concept of mandatory
joinder does not apply.” (citing McFadden, 388 A.2d 245-46));
Moss v. Jones, 225 A.2d 369, 372 (N.J. Super. Ct. App. Div.
1966) (“We conclude that a person injured by the negligence of
an agent or servant may sue the agent or servant and the
principal or master in one suit, or may proceed against them in
separate suits . . . .”); see also Great Northern Ins. Co. v.
Leontarakis, 904 A.2d 846, 853 (N.J. Super. Ct. App. Div. 2006)
(“The rationale of the rule — ‘that plaintiff is entitled to pursue
all those who are independently liable to him for his harm until
one full satisfaction is obtained’ — is equally applicable
whether the liability is actual or vicarious.” (quoting McFadden,
388 A.2d at 247)). 22 Furthermore, “[i]t is well-established that
21
The Tort Claims Act deals with claims against public entities
and employees and is not applicable here.
22
In Cogdell v. Hospital Center at Orange, 560 A.2d 1169, 1178
(N.J. 1989), the New Jersey Supreme Court adopted a
mandatory joinder rule requiring that “to the extent possible”
New Jersey courts “determine an entire controversy in a single
judicial proceeding[,]” that determination “necessarily
embrac[ing] not only joinder of single related claims between
the parties but also joinder of all persons who have a material
42
[Federal Rule of Civil Procedure] 19 does not require the joinder
of joint tortfeasors[;] [n]or does it require joinder of principal
and agent.” Nottingham v. Gen. Am. Commc’ns Corp., 811
F.2d 873, 880 (5th Cir. 1987) (per curiam) (citations omitted);
see also Temple v. Synthes Corp., Ltd., 498 U.S. 5, 7, 111 S.Ct.
315, 316 (1990) (“It has long been the rule that it is not
necessary for all joint tortfeasors to be named as defendants in a
single lawsuit.”).
Accordingly, we hold that the District Court erred when it
excluded from consideration the care that Ms. Biedenbach
provided in assessing Lomando’s claim against Emergency
Physician Associates. The Court was not precluded from taking
into account Ms. Biedenbach’s care in considering Lomando’s
claim against her employer notwithstanding Ms. Biedenbach’s
non-party status.
(b) N.J. Stat. Ann. § 2A:53A-41 does not apply to
physician assistants.
We now reach the final issue in this appeal, which also
relates to Ms. Biedenbach: whether N.J. Stat. Ann. § 2A:53A-41
applies to expert testimony offered to evaluate the care she
interest in the controversy.” That rule proved to be highly
controversial and has been replaced by a mechanism of
disclosure whereby “a party to any litigation is obligated to
reveal the existence of any non-party who should be joined or
who might have ‘potential liability to any party on the basis of
the same transactional facts.’” Kent Motor Cars, Inc. v.
Reynolds and Reynolds, Co., 25 A.3d 1027, 1037 (N.J. 2011).
43
provided. Lomando contends that N.J. Stat. Ann. § 2A:53A-41
does not apply to non-physicians, while appellee Emergency
Physician Associates asserts that the statute encompasses
physician assistants. Because the question of whether N.J. Stat.
Ann. § 2A:53A-41 applies to Ms. Biedenbach is a potentially
dispositive legal question in this case, we will address the
matter.
To the best of our knowledge, the New Jersey Supreme
Court has yet to confront explicitly the question of whether N.J.
Stat. Ann. § 2A:53A-41 applies only to physicians, or whether
its scope is broader. 23 “In the absence of a controlling decision
by the [New Jersey] Supreme Court, we must predict how it
would rule if faced with the issue.” See Spence v. ESAB Grp.,
23
Notably in Buck the New Jersey Supreme Court appeared to
assume that the statute applied only to physicians. 25 A.3d at
247 (“The basic principle behind [N.J. Stat. Ann. § 2A:53A-41]
is that the challenging expert who executes an affidavit of merit
in a medical malpractice case, generally, should be equivalently-
qualified to the defendant physician.”) (emphasis added)
(internal quotation marks and citation omitted); id. at 248
(“Under [N.J. Stat. Ann. § 2A:53A-41(a)], the first inquiry must
be whether a physician is a specialist or general practitioner. If
the physician is a specialist, then the second inquiry must be
whether the treatment that is the basis of the malpractice action
‘involves’ the physician’s specialty.”) (emphasis added). But
we cannot regard Buck as conclusive on the point, as the court’s
use of the word “physician” merely might reflect the identity of
the parties in that case.
44
Inc., 623 F.3d 212, 216 (3d Cir. 2010). In making this
prediction, we look to “‘decisions of state intermediate appellate
courts, of federal courts interpreting that state’s law, and of
other state supreme courts that have addressed the issue,’” as
well as to “‘analogous decisions, considered dicta, scholarly
works, and any other reliable data tending convincingly to show
how the highest court in the state would decide the issue at
hand.’” Id. at 216-17 (quoting Norfolk S. Ry. Co. v. Basell
USA Inc., 512 F.3d 86, 92 (3d Cir. 2008)).
Of course, in interpreting a statute, we first examine its
text as the Supreme Court of New Jersey would do in any case
of statutory interpretation. 24 DiProspero v. Penn, 874 A.2d
1039, 1049 (N.J. 2005) (“Our analysis . . . begins with the plain
language of the statute.”) (citing Miah v. Ahmed, 846 A.2d
1244, 1249 (N.J. 2004)). “If the language is plain and clearly
reveals the statute’s meaning, the Court’s sole function is to
enforce the statute according to its terms.” Frugis v.
Bracligliano, 827 A.2d 1040, 1058 (N.J. 2003). “If the statute
suggests more than one interpretation, the broader legislative
scheme, its history, and relevant sponsor statements may also
inform the Court’s interpretation in light of the statute’s overall
policy and purpose.” Id. In interpreting a statute, the New
24
We are not aware of any precedential opinions by the New
Jersey Superior Court, Appellate Division, on whether N.J. Stat.
Ann. § 2A:33A-41 applies to a physician assistant. In
conformity with the practice of this Court, we will not refer to
the Appellate Division’s not precedential opinions dealing with
the issue.
45
Jersey courts’ “overriding goal must be to determine the
Legislature’s intent.” Frugis, 827 A.2d at 1058 (quoting
Cornblatt, P.A. v. Barow, 708 A.2d 401, 407 (N.J. 1998)); see
also DiProspero, 874 A.2d at 1048 (“The Legislature’s intent is
the paramount goal when interpreting a statute.”).
N.J. Stat. Ann. § 2A:53A-41(a) applies to Ms.
Biedenbach only if she is “a specialist or subspecialist
recognized by the [ABMS] or the [AOA] and the care or
treatment at issue involves that specialty or subspecialty
recognized by the [ABMS] or [AOA].” N.J. Stat. Ann. §
2A:53A-41. 25 The ABMS is made up of Member Boards,
including the ABEM, which are responsible for “certify[ing]
physicians.”
http://abms.org/who_we_help/physicians/specialties.aspx.
Similarly, the AOA oversees Specialty Certifying Boards, which
certify doctors of osteopathic medicine.
http://www.osteopathic.org/inside-aoa/development/aoa-board-
certification/Pages/default.aspx. Thus, it would seem that N.J.
Stat. Ann. § 2A:53A-41(a) applies only to persons offering
testimony against specialized or licensed physicians. In this
vein, we reject Emergency Physician Associates’ argument that
N.J. Stat. Ann. § 2A:53A-41(a) applies because Ms. Biedenbach
practices in emergency rooms and because “Ms. Biedenbach’s
care and treatment of [Laura] involved the ABMS recognized
25
Emergency Physician Associates does not contend that Ms.
Biedenbach qualifies as a board-certified specialist in
emergency medicine.
46
specialty of Emergency Medicine.” Appellee’s br. at 22. 26 It
may be that Ms. Biedenbach practices emergency care as the
general public understands that term, and it may be that the care
she provided to Laura involved that practice; however, it cannot
be said that Ms. Biedenbach is a specialist in emergency
medicine as the ABMS or AOA define that field or that the
treatment she rendered to Laura involved that recognized
specialty because those entities define and recognize specialties
applicable only to physicians.
Concededly, N.J. Stat. Ann. §§ 2A:53A-41 includes some
text in tension with our reading of the statute. Paragraph
41(a)(2)(a) provides that an expert must be engaged in “the
active clinical practice of the same health care profession in
which the defendant is licensed,” and paragraph 41(a)(2)(b)
provides similarly that the expert must have participated in the
“instruction of students . . . in the same health care profession in
which the defendant is licensed.” (emphasis added). This
language, of course, gives rise to the inference that the statute
encompasses more than one type of health care profession.
Nevertheless, these provisions apply only in the circumstance
that the defendant is board-certified in a specialty that the
ABMS or AOA recognizes, and as explained above, those
26
Emergency Physician Associates appears to argue as well that
because the training required to become a physician assistant is
“almost the same at that obtained by physicians,” appellee’s br.
at 21, N.J. Stat. Ann. § 2A:53A-41(a) applies. The level of
training required to become a physician assistant is entirely
irrelevant to whether those professionals are encompassed by
N.J. Stat. Ann. § 2A:53A-41(a).
47
entities recognize specialties only for physicians. 27
Considering the text of the statute as a whole, we
conclude that N.J. Stat. Ann. § 2A:53A-41(a) applies only to
physicians. We note that this conclusion is in line with the New
Jersey Legislature’s purpose in enacting the Access and
Responsibility Act. In New Jersey State Bar Ass’n v. State, 888
A.2d 526, 535 (N.J. Super. Ct. Ch. Div. 2005), the Superior
Court extensively recounted the legislative history of the Access
and Responsibility Act, and described the purpose thusly: “The
overarching concern that came out of the hearings [on the Act]
and the problem the bill aimed to solve (as noted in the
legislative purpose) . . . [was that] ‘as a consequence of the cost
of medical malpractice insurance, many physicians feel they
cannot afford to practice medicine, and, therefore the medical
services needed will not be available to [New Jersey’s]
citizens.’” (quoting August 2002 Hearing (comments of
27
The ambiguous drafting of N.J. Stat. Ann. § 2A:53A-41
renders strict reliance on the text problematic. For example,
paragraphs 41(a)(2)(a) and 41(a)(2)(b) also include language
that reads “if the defendant is a specialist or subspecialist
recognized by the [ABMS] or the [AOA]” the clinical practice
or pedagogical experience must be in that recognized specialty
or subspecialty. Again, paragraphs 41(a)(2)(a) and 41(a)(2)(b)
apply only where the defendant is a board-certified specialist in
a recognized specialty. A board-certified specialist is,
obviously, a specialist recognized by the ABMS or AOA.
Accordingly, the purpose of the “if” language of paragraphs
41(a)(2)(a) and 41(a)(2)(b) is not clear.
48
Assemblyman Edwards)) (emphasis added). In this regard, the
legislature sought to remedy the situation that the physicians
being forced out were often specialists in obstetrics and
gynecology, emergency medicine, and surgery, and that
“physicians in other specialties report[ed] high double-digit
premium increases and fewer companies willing to write
coverage.” 888 A.2d at 535 (emphasis added) (internal
quotation marks and citation omitted); id. at 536 (“Of particular
concern was the number of doctors, particularly
obstetrician/gynecologists, who discontinued parts of their
practice or retired altogether due to the inability to afford their
liability coverage.”) (emphasis added). Accordingly, “[t]he
goals of the final legislation were to ‘reform the State’s ailing
medical malpractice insurance system to provide insurance relief
for doctors and ensure that patients in New Jersey’ will be able
to get the treatment they seek.” Id. at 536 (quoting Press
Release from offices of Senators Vitale and Lesniak (Mar. 22,
2004)).
As a physician assistant, Ms. Biedenbach thus is excluded
from the criteria for testimony that N.J. Stat. Ann. § 2A:53A-
41(a) specifies. We express no opinion as to whether the expert
statements that Lomando submitted are otherwise sufficient for
the case against Emergency Physician Associates to proceed,
and we remand the matter to the District Court so that it may
determine the course of the case against that defendant. 28
28
Of course we do not express an opinion on whether the District
Court should decline to exercise supplemental jurisdiction over
the case against Emergency Physician Associates. Assuming
49
V. CONCLUSION
For the foregoing reasons, we will affirm the order of
March 18, 2011, in part, will reverse it in part, and will remand
the case to the District Court for further proceedings but only
against Emergency Physician Associates as we are affirming the
summary judgments in favor of all other appellees. Costs are
allowed on this appeal in favor of all appellees other than
Emergency Physician Associates against Lomando and in favor
of Lomando against Emergency Physician Associates.
that it retains the case, the question for the Court will remain
whether the standards applicable to experts offering testimony
against a “general practitioner,” N.J. Stat. Ann. § 2A:53A-41(b),
apply to Ms. Biedenbach. So far as we are aware, the New
Jersey courts have not addressed this question with respect to a
physician assistant. We note, however, that N.J. Stat. Ann. §
2A:53A-41(b) does not reference the ABMS or AOA, and
provides simply that if the defendant “is a general practitioner,”
the expert, during the year preceding the date of the alleged
negligence, must have devoted a majority of his professional
time to “active clinical practice as a general practitioner” or
active clinical practice encompassing the condition or procedure
that is the basis for the claim, or the instruction of students in a
school, residency, or research program “in the same health care
profession” as the defendant. We do not offer our opinion on
this point, which the parties have not addressed in their briefs.
50