Comprehensive Neurosurgical, P.C. v. The Valley Hosp.

• Decision Date: 08 August 2022
• Docket Number: A-2866-19
• Parties: COMPREHENSIVE NEUROSURGICAL, P.C., d/b/a NORTH JERSEY BRAIN AND SPINE CENTER, PATRICK A. ROTH, MD, ROY D. VINGAN, MD, GEORGE J. KAPTAIN, MD, DANIEL E. WALZMAN, MD, HOOMAN AZMI, MD, HARSHPAL SINGH, MD, KANGMIN DANIEL LEE, MD, REZA J. KARIMI, MD, BRUCE C. ZABLOW, MD, UGO PAOLUCCI, MD, and MOHAMMED FARAZ KHAN, MD, Plaintiffs-Respondents/ Cross-Appellants, v. THE VALLEY HOSPITAL, THE BOARD OF TRUSTEES OF THE VALLEY HOSPITAL, and VALLEY HOSPITAL PRESIDENT AUDREY MEYERS, Defendants-Appellants/ Cross-Respondents, and NEUROSURGICAL ASSOCIATES OF NEW JERSEY, P.C., and ANTHONY D'AMBROSIO, MD, Defendants.
• Court: New Jersey Superior Court — Appellate Division

COMPREHENSIVE NEUROSURGICAL, P.C., d/b/a NORTH JERSEY BRAIN AND SPINE CENTER, PATRICK A. ROTH, MD, ROY D. VINGAN, MD, GEORGE J. KAPTAIN, MD, DANIEL E. WALZMAN, MD, HOOMAN AZMI, MD, HARSHPAL SINGH, MD, KANGMIN DANIEL LEE, MD, REZA J. KARIMI, MD, BRUCE C. ZABLOW, MD, UGO PAOLUCCI, MD, and MOHAMMED FARAZ KHAN, MD, Plaintiffs-Respondents/ Cross-Appellants, v. THE VALLEY HOSPITAL, THE BOARD OF TRUSTEES OF THE VALLEY HOSPITAL, and VALLEY HOSPITAL PRESIDENT AUDREY MEYERS, Defendants-Appellants/ Cross-Respondents, and NEUROSURGICAL ASSOCIATES OF NEW JERSEY, P.C., and ANTHONY D'AMBROSIO, MD, Defendants.

No. A-2866-19

Superior Court of New Jersey, Appellate Division

August 8, 2022

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.

Argued May 3, 2022

On appeal from the Superior Court of New Jersey, Law Division Bergen County, Docket No. L-6794-16.

R Scott Thompson (Wollmuth Maher &Deutsch LLP) argued the cause for appellants/cross-respondents (Lowenstein Sandler LLP, attorneys; Joseph A. Fischetti, of counsel and on the briefs; R. Scott Thompson and Camila A. Garces, on the briefs).

Joseph B. Fiorenzo argued the cause for respondents/cross-appellants (Sills Cummis &Gross, PC, attorneys; Joseph B. Fiorenzo, of counsel and on the briefs; Stephen M. Klein, on the briefs).

Ross A. Lewin argued the cause for amicus curiae New Jersey Hospital Association (Faegre Drinker Biddle &Reath LLP, attorneys; Ross A. Lewin, of counsel and on the brief).

Before Judges Hoffman, Whipple, and Geiger.

PER CURIAM

Defendant The Valley Hospital (Valley Hospital or the Hospital), appeals from a February 6, 2020 final judgment entered by the Law Division in favor of plaintiffs in the amount of $26,341,828.35. The judgment represents $24.3 million in damages awarded by a jury, $662,387.25 in costs, litigation expenses, and attorney's fees, and $1,379,441.10 in prejudgment interest.

Plaintiffs are eleven neurosurgeons, individually, and their practice group, New Jersey Brain and Spine Center (NJBSC). Plaintiffs held privileges at several hospitals, including Valley Hospital, located in Ridgewood, and Hackensack University Medical Center (Hackensack). For more than a decade before the subject litigation, NJBSC doctors provided on-call coverage in the emergency department (ED) at Valley Hospital; during this time, plaintiffs were instrumental in Valley Hospital acquiring specialized equipment, including biplane angiography and Gamma Knife,^[1] equipment that allowed stroke patients to receive treatment at Valley Hospital.

Plaintiffs' long-standing arrangement changed in 2015, when Valley Hospital entered into an exclusive agreement with defendant Neurosurgical Associates of New Jersey (also known as Columbia Group), another practice group of neurologists with privileges at Valley Hospital. The agreement granted Columbia Group exclusive rights to the ED coverage and to the use of the Gamma Knife and biplane angiography. On December 22, 2015, Valley Hospital issued a memorandum advising the hospital's entire Department of Neuroscience that, after "almost a year of study,"^[2] the Board of Trustees "unanimously voted to have Emergency Department on-call coverage for unassigned neurosurgery patients, as well as Gamma Knife services and neurointerventional bi-plane angiography procedures at the Hospital provided via an exclusive arrangement" with Columbia Group.

In response, plaintiffs filed suit against Valley Hospital, its Board of Trustees (the Board), its president, Audrey Meyers, and Columbia Group. Plaintiffs asserted multiple contract and tort claims, including breach of contract, breach of the implied covenant of good faith and fair dealing, and tortious interference with prospective economic advantage. Plaintiffs alleged that Valley Hospital and its president "have had a longstanding contentious rivalry with Hackensack," which motivated the termination of "the clinical privileges [that plaintiffs] have long enjoyed at Valley [Hospital], and as to services they helped develop and create," as punishment for plaintiffs' affiliation with Hackensack.

By the time of trial, Valley Hospital was the only remaining defendant. After the conclusion of testimony, only two claims remained for the jury to consider - breach of contract and breach of the implied covenant of good faith and fair dealing. The jury returned a no-cause verdict on plaintiffs' breach of contract claim, finding a contract existed but no breach occurred; however, on the implied covenant claim, the jury returned a verdict in favor of plaintiffs and concluded that plaintiffs sustained damages of $24.3 million as the result of Valley Hospital's wrongful conduct.

On appeal, Valley Hospital argues that the implied covenant claim should not have made it past summary judgment and that the trial judge improperly ruled on a motion that allowed plaintiffs to retain documents that Valley Hospital had attempted to claw back. Valley Hospital additionally contends that the damages were excessive, challenges the admission of the testimony of plaintiffs' expert, and the trial court's decision to limit the testimony of its own expert. Valley Hospital also asserts that opposing counsel's comments during summation requires reversal and that the trial court erred in granting offer of judgment awards.

The New Jersey Hospital Association (NJHA) has submitted an amicus curiae brief in support of Valley Hospital's appeal, asserting that the verdict in this case represents an "impermissible expansion of the rights of medical staff members to challenge managerial actions undertaken by a hospital's board."

After carefully reviewing the record and the arguments presented, we affirm, finding no basis to disturb the judgment entered in plaintiffs' favor.

I.

We derive the following facts from the record.

Plaintiffs' History with Valley Hospital

In approximately 2003, Valley Hospital reached out to plaintiff Patrick Roth, M.D. and his neurosurgical group to become part of the medical staff there. According to Dr. Roth, Valley Hospital made this request because the hospital "only had . . . three active neurosurgeons," and they were older doctors, who had "restricted their practice considerably to just [the] spine"; as a result, if patients had "difficult brain problems[,] the neurosurgeons "who were handling the ED call "wouldn't even come in, they would just" order "an automatic transfer to Columbia University in New York." Dr. Roth explained that, as he understood it, part of the job of his group was to "stop this flow out of Valley Hospital . . . and to build a . . . modern neurosurgical practice [at Valley Hospital]."

To accomplish this goal, Dr. Roth testified that plaintiffs "made a huge investment" and expended "a tremendous amount of time and energy into cultivating the relationships with the people [who] man the emergency room." As an example of his group's efforts and commitment, Dr. Roth cited the 2005 hiring of plaintiff Daniel E. Walzman, M.D., who started the endovascular program at Valley Hospital, allowing for the completion of endovascular procedures without transferring the patient to another hospital. When he arrived in 2005, Dr. Walzman discovered that Valley Hospital lacked the necessary equipment to treat strokes, leading to detrimental delays in treatment. As an interim measure, Dr. Walzman repurposed equipment intended for cardiac patients for stroke diagnosis. He then assembled a proposal for a biplane suite, after multiple out-of-state trips to view other hospitals' equipment, helped obtain state funding for the biplane, and then trained Valley Hospital's technicians and staff in the treatment of endovascular events.

In large part due to Dr. Walzman's efforts, Valley Hospital became one of only a handful of facilities in New Jersey to receive the designation of Comprehensive Stroke Center by the Department of Health and Senior Services. Dr. Walzman testified he was on emergency endovascular call at Valley Hospital from 2006 until 2010, except for three weeks, "covering every patient with an ischemic stroke [who] was eligible for a stroke thrombectomy."

Dr. Roth further explained that plaintiffs "employ[ed] mid-level providers to help . . . with quality," and expanded the number of neurosurgeons in their group from two neurosurgeons to twelve, between 2003 to 2015. As a result of these efforts, Dr Roth testified that plaintiffs expected the ED call at Valley Hospital "would be ours forever." He explained,

I looked at it as a quid pro quo, meaning . . . we're going to build this emergency room, we're going to modernize it, we're going to stop this flow of patients from outside your hospital to Columbia [University] and . . . we're going to do a great job of manning it and . . . in return[,] it's ours to lose.

According to Dr. Roth, plaintiffs continued to operate the ED with that understanding until December 2015.

Six years earlier, in 2009, the amicable relationship between NJBSC and Valley Hospital began to deteriorate. At that time Valley Hospital began an unsuccessful battle to stop Hackensack from reopening Pascack Valley Hospital, rebranded as Hackensack North, six miles from Valley Hospital. Initially, Valley Hospital made an unsuccessful attempt to purchase the site. Thereafter, Meyers opposed Hackensack's proposal in the press and testified against it before the State Health Planning Board, where she asserted that Hackensack North "will have an adverse impact on the health care in the region[,] [w]ith annual losses projected to be as high as a loss of $35 million to Valley Hospital ...." ...