Rachele Louise Castello v. Alexander M. Wohler, M.D.

NOT FOR PUBLICATION WITHOUT THE
APPROVAL OF THE APPELLATE DIVISION

SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
DOCKET NO. A-0337-14T3

RACHELE LOUISE CASTELLO,
APPROVED FOR PUBLICATION
Plaintiff-Appellant,
June 20, 2016
v.
APPELLATE DIVISION

ALEXANDER M. WOHLER, M.D.,

Defendant-Respondent.
__________________________________

Argued May 16, 2016 – Decided June 20, 2016

Before Judges Lihotz, Fasciale and Higbee.

On appeal from Superior Court of New Jersey,
Law Division, Bergen County, Docket No.
L-8850-11.

Lewis Stein argued the cause for appellant
(Nusbaum, Stein, Goldstein, Bronstein &
Kron, P.A., attorneys; Mr. Stein, on the
briefs).

Charles E. Murray, III, argued the cause for
respondent (Farkas & Donohue, L.L.C.,
attorneys; Mr. Murray, on the brief).

Abbott S. Brown argued the cause for amicus
curiae The New Jersey Association for
Justice (Lomurro, Munson, Comer, Brown and
Schottland, L.L.C., attorneys; Mr. Brown, on
the brief).

The opinion of the court was delivered by

FASCIALE, J.A.D.
 In this medical negligence case, plaintiff appeals from two

orders dated August 29, 2014: one order granting defendant's

motion to dismiss the complaint with prejudice; and one order

denying plaintiff's cross-motion to adjourn the trial date and

reopen discovery to obtain a new expert.

Defendant is a board-certified cardiothoracic and general

surgeon. Plaintiff retained Dr. John E. Edoga, a general

surgeon, to prepare an affidavit of merit (AOM) and expert

report. Plaintiff's attorney used a copy of Dr. Edoga's

curriculum vitae (the original CV) he had in his office and

simultaneously served defendant with the complaint, AOM, and

original CV.

In his AOM, Dr. Edoga stated he had been in "surgical

practice for more than [thirty-five] years[,] which is set forth

in my [CV] attached hereto." The original CV attached to the

AOM reflected Dr. Edoga was an attending surgeon. Defendant's

attorney waived the need for a Ferreira1 conference and signed a

consent order waiving "any objection" to Dr. Edoga's

qualifications.

In discovery, plaintiff's counsel produced Dr. Edoga's

updated CV (the updated CV) and expert report. The updated CV

stated that Dr. Edoga was an attending surgeon since 1976. This

1
Ferreira v. Rancocas Orthopedic Assocs., 178 N.J. 144 (2003).

2 A-0337-14T3
information was generally consistent with Dr. Edoga's statement

in his AOM that he had been in surgical practice for

approximately thirty-five years.

Defendant's counsel deposed Dr. Edoga and learned, contrary

to the information in the AOM and original and updated CVs, he

had been retired for approximately five years before the medical

procedure in question was performed. Three months after the

deposition and weeks after the January 4, 2014 discovery end

date (DED), defendant's counsel moved to bar Dr. Edoga's

testimony for failure to comply with the New Jersey Medical Care

Access and Responsibility and Patients First Act (PFA), N.J.S.A.

2A:53A-37 to -42, primarily arguing Dr. Edoga was unqualified to

testify because he retired from the practice of medicine. The

motion was returnable approximately two weeks before trial. The

court independently adjourned the trial date to resolve

defendant's motion to bar Dr. Edoga's testimony, as well as

other related motions.

There is no credible evidence that plaintiff or plaintiff's

counsel had knowledge that Dr. Edoga had been retired from the

practice of medicine. Had such information been apparent from

the AOM and original CV during the 120-day period, the parties

would have participated in the Ferreira conference and

identified the problem. At that time, plaintiff would have had

3 A-0337-14T3
ample opportunity to obtain and timely serve a new AOM from a

different expert witness.

Under these facts, we agree that the judge properly barred

Dr. Edoga's testimony because he had been retired for several

years and otherwise failed to meet the statutory requirements of

the PFA. However, we conclude dismissal of the complaint with

prejudice ignored the purposes of the AOM statute (AMS),

N.J.S.A. 2A:53A-26 to -29.2 In our view, and in light of the

strong preference for adjudication on the merits, we conclude

that an extension of discovery was warranted.

We hold, in medical negligence cases, where a plaintiff's

counsel timely serves an AOM and reasonably relies on the AOM

and expert's CV, which erroneously reflects that the witness is

actively practicing medicine, and, through no fault of the

plaintiff's counsel, the error is first discovered after the

expiration of the 120-day deadline imposed under the AMS,

exceptional circumstances exist requiring the judge to allow a

plaintiff sufficient time to retain a different expert witness

who is qualified under the PFA, issue a new AOM, and serve a

corresponding expert report. If warranted, the judge may

2
We note that pursuant to N.J.S.A. 2A:53A-27, "the person
executing the [AOM] shall meet the requirements of a person who
provides expert testimony or executes an affidavit as set forth
in [the PFA]."

4 A-0337-14T3
include other procedures or requests for relief related to the

extension of discovery and service of a new AOM and expert

report.

We therefore reverse the orders dismissing the complaint

with prejudice and denying plaintiff's cross-motion to reopen

discovery. We remand and direct the court to extend discovery,

allow plaintiff sufficient time to retain a new expert, address

any related discovery issues, and address whether other

appropriate relief is warranted.

I.

Plaintiff presented to defendant with difficulty breathing.

Defendant examined plaintiff and diagnosed a giant

paraesophageal hernia. A computerized tomogram showed that

plaintiff's stomach was located in her chest, as opposed to its

usual place below the diaphragm. Plaintiff's medical condition

warranted immediate attention. In June 2010, with plaintiff's

consent, defendant performed surgery to repair the hernia.

Plaintiff experienced post-operative discomfort and her

condition worsened. As a result, defendant performed an

exploratory laparotomy and repaired a tear to the gastro-

esophageal junction. Defendant discharged plaintiff to acute

rehabilitation, but readmitted her to the hospital because of

further complications. Plaintiff remained there until defendant

5 A-0337-14T3
granted plaintiff's request to transfer her to a hospital in

Pittsburgh.

An esophageal surgeon examined plaintiff at the Pittsburgh

hospital, diagnosed an esophageal leak, and performed various

medical procedures, including an esophagectomy, thoracotomy, and

laparotomy. In October 2010, plaintiff was discharged to a

rehabilitation facility. Plaintiff returned home in December

2010, almost six months after defendant performed the hernia

repair operation.

In October 2011, plaintiff filed a complaint against

defendant alleging that he deviated from accepted standards of

medical care and performed the hernia repair negligently, which,

purportedly, caused multiple additional medical procedures and

substantial pain and suffering.

In addition to serving Dr. Edoga's AOM with the complaint,

plaintiff's counsel served defendant with a copy of Dr. Edoga's

original CV, which plaintiff's counsel had retrieved from files

located in his law firm. The original CV stated Dr. Edoga was

an attending surgeon at Morristown Memorial Hospital from "1976

to present," and an assistant clinical professor of surgery from

"1985 to present." The information in the original CV

corroborated Dr. Edoga's statement in his AOM that he had been

in surgical practice for more than thirty-five years.

6 A-0337-14T3
 In December 2011, defendant filed his answer to the

complaint, and denied any negligence. The court scheduled the

Ferreira conference, which prompted a letter from plaintiff's

counsel seeking input as to how defendant intended to proceed.

Defendant's counsel initially intended to object to the AOM

because "[defendant] is a cardiac and thoracic surgeon[,] and

given the fact that this matter would fall within that specialty

or sub-specialty, Dr. Edoga's qualifications do not suffice

under the [PFA]."

Plaintiff's counsel responded by advising that general

surgeons, like Dr. Edoga, also perform laparoscopic repairs of

paraesophageal hernias, especially because the surgery here was

in the abdomen. He referred to the original CV, which also

listed Dr. Edoga's 1997 publication pertaining to laparoscopic

repair of paraesophageal hernias. Defendant's counsel wrote to

plaintiff's counsel, stating "[m]y client advises that some

hospitals do permit general surgeons to perform this procedure."

Defendant's counsel withdrew the objection, waived the need

for the Ferreira conference, and confirmed in a March 14, 2012

consent order that defendant waived "any objection" to the

adequacy of the AOM. Based on the contents of the AOM and

original CV, the parties had no reason to believe that Dr. Edoga

had retired from the practice of medicine, and therefore they

7 A-0337-14T3
did not pursue the Ferreira conference to resolve whether the

retirement rendered Dr. Edoga unqualified pursuant to the

requirements enunciated in case law and the PFA. Consequently,

plaintiff's counsel continued using Dr. Edoga as plaintiff's

expert.

Over the next three years, the parties engaged in extensive

discovery. They propounded interrogatories, produced document

demands, served subpoenas, and deposed several fact witnesses.

Experts on both sides then reviewed the information obtained

during the pretrial discovery.

Plaintiff's counsel served Dr. Edoga's expert report, dated

May 21, 2013, well within the DED. Dr. Edoga opined that

defendant's surgical technique caused esophageal perforations,

which defendant purportedly missed, misinterpreted, or ignored;

defendant used covered stents in a manner well below accepted

standards of care; and defendant failed to properly monitor

plaintiff and seek timely consultations with other doctors. In

his expert report, Dr. Edoga stated that he had published

medical journal articles "on this subject," he had produced

instructional videos and trained surgical residents and

attending surgeons "to safely perform the surgery in question,"

and he had given lectures "dealing with the subject matter at

hand."

8 A-0337-14T3
 Along with Dr. Edoga's expert report, plaintiff's counsel

served defendant's counsel with a copy of the updated CV, which

repeated that Dr. Edoga was an attending surgeon at Morristown

Memorial Hospital from "1976 to present," and an assistant

clinical professor of surgery from "1985 to present." The

updated CV listed Dr. Edoga as the president and chief operating

officer of a company from "2002 to present" and referenced his

teaching assignments, including training in surgical

technologies and techniques.

Defendant's counsel deposed Dr. Edoga on November 1, 2013.

Dr. Edoga's supplemental CV (the supplemental CV) was produced

and marked as an exhibit during the deposition. The

supplemental CV, like the original CV and updated CV, stated

that Dr. Edoga was an attending surgeon at Morristown Memorial

Hospital from "1976 to present," and assistant clinical

professor of surgery from "1985 to present."

In response to questions during his deposition, Dr. Edoga

testified he was affiliated with Columbia University as an

assistant clinical professor, where he "gave a couple lectures"

in 2009 and 2010. He also stated he was on the attending staff

at Morristown Memorial Hospital, where he had privileges as an

emeritus professor. Dr. Edoga admitted, however, that he

retired from the active practice of medicine in 2005 and

9 A-0337-14T3
conceded he volunteered to teach two or three hours per week,

which was not with an accredited medical school. Upon

retirement, Dr. Edoga pursued medical device inventions and

development, which was consistent with the additional reference

to training in the updated CV.

Defendant's counsel did not move to disqualify Dr. Edoga

before the expiration of the DED. Rather, in January 2014,

approximately three months after Dr. Edoga's deposition and well

after the expiration of the DED, defendant's counsel filed a

motion to bar Dr. Edoga's testimony. The motion was returnable

approximately seventeen days before the first trial date.

Defendant's counsel argued in part that Dr. Edoga failed to

satisfy the requirements of the PFA because he was not actively

practicing surgery at the time of the alleged malpractice, a

fact that defendant's counsel urged was not clear until after

Dr. Edoga's deposition.

Plaintiff opposed the motion, in part, by arguing that the

court should waive the "same specialty or subspecialty"

requirement under the PFA, N.J.S.A. 2A:53A-41(c). Plaintiff

maintained there existed a limited availability of surgeons with

defendant's specialty who have surgically repaired giant

paraesophageal hernias. Alternatively, plaintiff's counsel

requested, in the event the judge was inclined to bar Dr.

10 A-0337-14T3
Edoga's testimony, a reasonable time in which to obtain another

expert.

On March 17, 2014, the court granted defendant's motion and

entered an order barring the testimony of Dr. Edoga. The court

did not fully consider the merits of plaintiff's waiver argument

because plaintiff failed to formally file a motion seeking

waiver from compliance with the PFA, pursuant to N.J.S.A.

2A:53A-41(c). Rather, the judge disqualified Dr. Edoga from

acting as an expert witness, concluding that plaintiff failed to

satisfy the requirements of N.J.S.A. 2A:53A-41(a)(1) or (2),

which sets forth the requirements for an expert's testimony

under the PFA.

Discussing whether defendant's objection was timely, the

judge concluded that defendant's counsel was not placed on

"adequate notice of Dr. Edoga's qualifications." She found Dr.

Edoga's original CV "misrepresented his current status and

qualifications at the time it was served." As a result, the

judge determined defendant's counsel was unable to object to Dr.

Edoga's qualifications until after the deposition. Although the

court acknowledged plaintiff's equitable argument and "concerns

. . . in light of the timing of th[e] [motion to bar Dr.

Edoga]," and although she recognized the "apparent prejudice

plaintiff will suffer . . . on the eve of the impending trial

11 A-0337-14T3
date," the court did not grant plaintiff's request for a

reasonable amount of time to obtain another expert. The court

adjourned the trial date, however, from March 2014 to April 28,

2014.

Because plaintiff was without an expert to support her

allegations of medical negligence, defendant's counsel filed a

motion for summary judgment, returnable April 25, 2014. While

that motion was pending, plaintiff moved for reconsideration of

the March 17, 2014 order barring Dr. Edoga's testimony and

sought to adjourn the April 28, 2014 trial date and reopen

discovery. The court denied defendant's motion for summary

judgment without prejudice pending resolution of plaintiff's

motion for reconsideration. The court also independently

adjourned the trial date until October 14, 2014. On June 25,

2014, the court denied plaintiff's motion for reconsideration.

Defendant then filed his "motion to dismiss" plaintiff's

complaint for failure to comply with the PFA. Plaintiff filed a

cross-motion to reopen discovery, adjourn the trial date, and

permit plaintiff an opportunity to provide a new expert.

In plaintiff's motion to reopen discovery to obtain a new

expert, plaintiff's counsel addressed the court's finding that

Dr. Edoga's original CV was misleading on its face. He

reiterated

12 A-0337-14T3
 [t]he [d]efendant is quick to attribute an
inference of deliberate misrepresentation on
Dr. Edoga's qualification by virtue of the
[CVs] presented. As indicated [previously,]
the CVs were delivered . . . not by virtue
of any effort by Dr. Edoga to misrepresent
his status – much less an effort by the
[p]laintiff to misrepresent [Dr. Edoga's]
status.[3]

The judge concluded that plaintiff failed to demonstrate

exceptional circumstances to allow extended discovery, found

that defendant's counsel moved to bar Dr. Edoga's testimony

"immediately and expeditiously" after taking his deposition, and

determined defendant would be prejudiced as a result of

prolonged litigation. On August 29, 2014, the judge entered the

orders under review.

On appeal, plaintiff argues that Dr. Edoga satisfied the

requirements of N.J.S.A. 2A:53A-41(a)(1) and (2); the judge

erred in not applying N.J.S.A. 2A:53A-41(c); and the judge

abused her discretion by failing to adjourn the trial date,

extend discovery, and allow plaintiff an opportunity to retain a

new expert.

3
Although the judge focused on the original CV, the record
establishes that the contents of all the CVs and the AOM
erroneously suggested Dr. Edoga was actively practicing
medicine. On this record, there are no credible facts to
suggest plaintiff's counsel knew before the deposition that Dr.
Edoga had been retired for approximately five years before the
procedure in question.

13 A-0337-14T3
 In June 2015, we granted The New Jersey Association for

Justice (NJAJ) amicus curiae status and permission to

participate in oral argument. NJAJ challenges the

constitutionality of the PFA, argues that the PFA was an

improper exercise of legislative authority, contends that Dr.

Edoga was qualified to testify, and, alternatively, asserts the

judge abused her discretion by failing to give plaintiff time to

replace Dr. Edoga.

II.

We begin by addressing the merits of the order dismissing

the complaint with prejudice. The court granted defendant's

motion to dismiss based on plaintiff's failure to comply with

the PFA. We afford this decision no deference, reviewing all

decisions on motions to dismiss de novo. Giannakopoulos v. Mid

State Mall, 438 N.J. Super. 595, 599 (App. Div. 2014), certif.

denied, 221 N.J. 492 (2015). Our focus here is on whether Dr.

Edoga satisfied the statutory and case law requirements to

testify as an expert.

Plaintiff contends that Dr. Edoga was qualified to testify

as an expert because he satisfied the PFA, particularly the

additional statutory requirements enumerated in N.J.S.A. 2A:53A-

41(a)(1) and (2). In the alternative, plaintiff argues the

judge erred by refusing to waive the expert qualification

14 A-0337-14T3
requirements imposed by the PFA, as permitted by N.J.S.A.

2A:53A-41(c). We address these contentions in turn.

A.

The PFA establishes certain qualifications that expert

witnesses in medical malpractice actions must possess. Nicholas

v. Mynster, 213 N.J. 463, 479 (2013). N.J.S.A. 2A:53A-41

provides, in pertinent part:

In an action alleging medical malpractice, a
person shall not give expert testimony or
execute an affidavit pursuant to the
provisions of P.L. 1995, c. 139 (C. 2A:53A-
26 et seq.) 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 or the American
Osteopathic Association and the
care or treatment at issue
involves that specialty or
subspecialty recognized by the
American Board of Medical
Specialties or the American
Osteopathic Association, 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 American Board
of Medical Specialties or the
American Osteopathic Association,
as the party against whom or on

15 A-0337-14T3
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 American Board
of Medical Specialties or the
American Osteopathic Association,
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 American Board of Medical
Specialties or the American
Osteopathic Association who
is board certified in the
same specialty or
subspecialty, recognized by
the American Board of Medical
Specialties or the American
Osteopathic Association, 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 the defendant is a
specialist or subspecialist
recognized by the American
Board of Medical Specialties

16 A-0337-14T3
 or the American Osteopathic
Association, the active
clinical practice of that
specialty or subspecialty
recognized by the American
Board of Medical Specialties
or the American Osteopathic
Association; or

(b) the instruction of
students in an accredited
medical school, other
accredited health
professional school or
accredited residency or
clinical 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 American Board of
Medical Specialties or the
American Osteopathic
Association, an accredited
medical school, health
professional school or
accredited residency or
clinical research program in
the same specialty or
subspecialty recognized by
the American Board of Medical
Specialties or the American
Osteopathic Association; or

(c) both.

[(Emphasis added).]

In Nicholas, the Court provided critical guidance for the

bench and practitioners when applying these provisions. Supra,

213 N.J. at 479-88. Specifically, the Court explained N.J.S.A.

2A:53A-41(a) imposes certain preliminary qualifications of an

17 A-0337-14T3
expert who seeks to testify against a defendant physician who

practices a specialty, but who is not otherwise board certified.

Nicholas, supra, 213 N.J. at 481-82. Experts must satisfy these

minimum requirements as a prerequisite to presenting testimony.

Moreover, if a defendant is board certified, N.J.S.A. 2A:53A-

41(a) requires that the testifying expert satisfy additional

qualifications set forth in subsections (a)(1) or (a)(2). Id.

at 482.

In her argument that the judge erred by barring Dr. Edoga

from testifying, plaintiff focuses primarily on the added

qualifications enumerated in N.J.S.A. 2A:53A-41(a)(1) (requiring

the expert be credentialed) and (a)(2)(b) (generally requiring

the expert devote a majority of his/her professional time

towards instruction of students in an accredited school).

Certainly, Dr. Edoga needed to meet the additional

qualifications of (a)(1) or (a)(2) because defendant was board

certified. But before we reach whether Dr. Edoga satisfied the

added statutory qualifications, we address whether he met the

preliminary qualifications mandated by N.J.S.A. 2A:53A-41(a).

(i)

As to the preliminary qualification of specialization, the

expert "shall have specialized [in the same specialty as a

defendant physician] at the time of the occurrence." N.J.S.A.

18 A-0337-14T3
2A:53A-41(a). Moreover, "[w]hen a physician is a specialist and

the basis of the malpractice action 'involves' the physician's

specialty, the challenging expert must practice in the same

specialty." Nicholas, supra, 213 N.J. at 481-82 (citing Buck v.

Henry, 207 N.J. 377, 391 (2011)) (emphasis added).

It is undisputed that Dr. Edoga retired from the practice

of medicine in 2005, approximately five years before defendant

performed the hernia repair operation. Dr. Edoga testified that

the last time he performed a paraesophageal hernia repair was in

2005. He also testified that the last time he was involved in

repairing a tear of the esophagus was in 2005. In his marketing

material, Dr. Edoga advertised that he was "retired from the

active practice of surgery [as early as] November of 2004 and

now function[ed] as the Chief Executive Officer of a start-up

surgical device company."

The Court has stated unequivocally that a plaintiff "cannot

establish the standard of care through an expert who does not

practice in the same medical specialties as [a] defendant

physician[]." Nicholas, supra, 213 N.J. at 468. As a result,

Dr. Edoga did not meet the minimum requirement mandated by

N.J.S.A. 2A:53A-41(a).

19 A-0337-14T3
 (ii)

Because Dr. Edoga did not actively practice medicine "at

the time of the occurrence" in the same specialty as defendant,

we need not reach whether he met the added qualifications of

(a)(1) or (a)(2) under the PFA. However, we observe that Dr.

Edoga also failed to meet the additional requirements contained

in (a)(1) or (a)(2). The additional requirements under N.J.S.A.

2A:53A-41(a)(1) and (a)(2) apply when the defendant physician is

board certified and the course of treatment in dispute involves

that specialty. In such a case, the expert must meet one of two

criteria.

First, under N.J.S.A. 2A:53A-41(a)(1), an expert may be "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." This prong is designed to act

as a substitute for board certification. Specifically, although

the expert may not be board certified in the area in question,

he or she may be credentialed by his or her hospital to treat

patients for the medical condition at issue. Nicholas, supra,

213 N.J. at 482. Importantly, "[t]he hospital-credentialing

provision is not an alternative to the same-specialty

requirement." Ibid. However, a necessary precursor to being

20 A-0337-14T3
credentialed by a hospital is that the expert must be actively

practicing and treating the condition at issue.

Here, Dr. Edoga was not credentialed by a hospital to treat

the condition at issue when plaintiff's claim arose. At the

time defendant performed the hernia surgery in 2010, Dr. Edoga

was not privileged to "treat patients for the medical condition,

or to perform the procedure, that is the basis for the claim or

action." N.J.S.A. 2A:53A-41(a)(1). Years before the procedure,

Dr. Edoga failed to maintain his medical malpractice insurance

and forfeited his privileges at Morristown Memorial Hospital.

As a result, Dr. Edoga fails to satisfy the added requirement of

(a)(1).

Second, N.J.S.A. 2A:53A-41(a)(2) requires the expert to be

a board certified specialist or subspecialist in the same

specialty as the defendant physician, and during the year

immediately prior to the occurrence, have devoted the majority

of his or her professional time to active practice in that same

specialty or subspecialty, or the instruction of students in an

accredited medical school, also in the same specialty or

subspecialty, or both.

The undisputed evidence shows Dr. Edoga did not, "during

the year immediately preceding the date of the occurrence,"

devote the majority of his professional time to either active

21 A-0337-14T3
clinical practice or the instruction of students in a

statutorily defined accredited institution. Although Dr. Edoga

stated that he "teaches," he admitted he was not doing so in a

"teaching position . . . or professor[ship]," and he testified

that his instruction amounted to two or three hours per week.

As a result, Dr. Edoga also failed to satisfy the requirements

of N.J.S.A. 2A:53A-41(a)(2).

B.

We reject plaintiff's contention that the judge erred by

refusing to waive the expert qualification requirements imposed

by the PFA. Under certain circumstances, a court may waive

compliance with the PFA pursuant to N.J.S.A. 2A:53A-41(c), which

provides:

A court may waive the same specialty or
subspecialty recognized by the American
Board of Medical Specialties or the American
Osteopathic Association and board
certification requirements of this section,
upon motion by the party seeking a waiver,
if, after the moving party has demonstrated
to the satisfaction of the court that a good
faith effort has been made to identify an
expert in the same specialty or
subspecialty, the court determines that the
expert possesses sufficient training,
experience and knowledge to provide the
testimony as a result of active involvement
in, or full-time teaching of, medicine in
the applicable area of practice or a related
field of medicine.

[(Emphasis added).]

22 A-0337-14T3
 A party seeking a waiver must file a motion for that

relief, which plaintiff failed to do. Instead, plaintiff's

counsel informally asked the court to waive the requirements

pursuant to subsection (c). Even though no motion was filed, we

consider the merits of plaintiff's contentions.

The statutory obligation is to demonstrate good faith

efforts to "identify an expert in the same specialty or

subspecialty." Ibid. There is no evidence that plaintiff was

unable to locate an actively practicing cardiothoracic or

general surgeon to review the merits of plaintiff's medical

malpractice allegations. Plaintiff argues counsel was unable to

locate surgeons who have performed the exact procedure defendant

performed in 2010, but the obligation is only to show good faith

efforts to identify an expert in the same specialty or

subspecialty, which plaintiff failed to do.

Even if plaintiff made the requisite showing of good faith,

Dr. Edoga's training, experience, and knowledge are not derived

from his "active involvement in, or full-time teaching of,

medicine in the applicable area of practice or a related field

of medicine." Ibid. As a result, we see no basis for a waiver

under section (c).

23 A-0337-14T3
 III.

We now turn to the order denying plaintiff's cross-motion

to adjourn the April 28, 2014 trial date, reopen limited

discovery, and allow plaintiff an opportunity to obtain a new

expert. The request to adjourn the trial date is not an issue

because the court had independently adjourned the trial from

April 2014 to October 2014. We focus on the dismissal of the

complaint with prejudice and whether the court should have

permitted plaintiff to reopen discovery and obtain a new expert.

We conclude that denying plaintiff's cross-motion, which

led to the dismissal of the complaint with prejudice,

substantially ignored the purposes of the AMS. We reach this

conclusion reemphasizing the important reasons for a Ferreira

conference and the strong preference for adjudication of

disputes on the merits. Under the unique facts of this case, we

conclude that exceptional circumstances existed to extend

limited discovery.

A.

The dual purpose of the AMS is "to weed out frivolous

lawsuits early in the litigation while, at the same time,

ensuring that plaintiffs with meritorious claims will have their

day in court." Ferreira, supra, 178 N.J. at 150 (quoting

Hubbard v. Reed, 168 N.J. 387, 395 (2001)); see also Buck,

24 A-0337-14T3
supra, 207 N.J. at 383 (explaining "[t]he purpose of the [AMS]

is to weed out frivolous complaints, not to create hidden

pitfalls for meritorious ones"). Considering the facts of the

case before us, dismissing plaintiff's complaint with prejudice

would not serve these purposes. On this record, there is no

credible evidence to suggest that plaintiff's complaint is

frivolous.

Plaintiff's counsel attempted in good faith to comply with

the PFA and N.J.S.A. 2A:53A-27, which provides, in pertinent

part:

In any action for damages for personal
injuries, wrongful death or property damage
resulting from an alleged act of malpractice
or negligence by a licensed person in his
profession or occupation, the plaintiff
shall, within 60 days following the date of
filing of the answer to the complaint by the
defendant, provide each defendant with an
affidavit of an appropriate licensed person
that there exists a reasonable probability
that the care, skill or knowledge exercised
or exhibited in the treatment, practice or
work that is the subject of the complaint,
fell outside acceptable professional or
occupational standards or treatment
practices. The court may grant no more than
one additional period, not to exceed 60
days, to file the affidavit pursuant to this
section, upon a finding of good cause.

In medical malpractice cases, the AMS requires the affiant to

satisfy the requirements of the PFA, pursuant to N.J.S.A.

2A:53A-27, which further provides in relevant part that

25 A-0337-14T3
 [i]n the case of an action for medical
malpractice, the person executing the
affidavit shall meet the requirements of a
person who provides expert testimony or
executes an affidavit as set forth in
section 7 of P.L. 2004, c. 17 (C. 2A:53A-
41).

Here, although the judge concluded that the original CV was

misleading on its face, she did not address the root of the

problem. The record reflects plaintiff's counsel produced the

original CV in good faith and there is no reason to believe from

a review of the original CV or AOM that plaintiff or plaintiff's

counsel knew Dr. Edoga had retired from the active practice of

medicine. Moreover, this is not a situation that amounted to

carelessness or inadvertence by plaintiff's counsel in using the

original CV, because the contents of the AOM and updated and

supplemental CVs also suggest that Dr. Edoga was actively

practicing medicine.

B.

In malpractice cases, the qualifications of a plaintiff's

expert are expected to be addressed early in the litigation.

There exists a well-settled procedure to address potential

problems with compliance with the AMS. In Buck, the Court

reaffirmed the Ferreira requirement for courts to conduct a case

management conference within "ninety days of the service of an

answer in all malpractice actions." Supra, 207 N.J. at 394.

26 A-0337-14T3
The Court further noted that "[t]he painful experience of our

[AOM] jurisprudence reveals the compelling need for such

conferences at an early stage before problems arise." Ibid.

(first alteration in original) (quoting Ferreira, supra, 178

N.J. at 155). A Ferreira conference serves to avoid inadvertent

and technical errors in timely service of the affidavit. See

Ferreira, supra, 178 N.J. at 154-55. It also "require[s] [a

defendant] to advise the court whether he [or she] has any

objections to the adequacy of the affidavit." Id. at 155.

Ultimately, the conference serves to resolve potential discovery

issues — including compliance with the AMS — before they result

in "sideshows" of dueling motions. Id. at 154-55.

Here, defendant's counsel understandably waived the

Ferreira conference in part by relying on the AOM, in which Dr.

Edoga stated he had been in surgical practice for thirty-five

years, and the original CV, which indicated Dr. Edoga was an

attending surgeon at Morristown Memorial Hospital from "1976 to

present," and an assistant clinical professor of surgery from

"1985 to present." Counsel's only concern was whether Dr. Edoga

shared the same specialty under the PFA to issue the AOM and

render expert opinion testimony against defendant.

Had defendant's counsel known that Dr. Edoga had been

retired five years before the alleged malpractice, defendant's

27 A-0337-14T3
counsel would have proceeded with the Ferreira conference

challenging Dr. Edoga's qualifications under the AMS and PFA.

Certainly, had the Ferreira conference occurred, plaintiff would

have had the opportunity to comply with the AMS and PFA by

serving an AOM from a different expert witness before the

expiration of the 120—day deadline. Through no fault of either

counsel, Dr. Edoga's retirement was not known during the 120-day

deadline.

In general, to temper an inflexible application of the AMS,

the Supreme Court has carved out exceptions for extraordinary

circumstances, Cornblatt v. Barow, 153 N.J. 218, 246-47 (1998);

Tischler v. Watts, 177 N.J. 243, 246-47 (2003); for substantial

compliance with the statutory requirements, Fink v. Thompson,

167 N.J. 551, 564-65 (2001); Galik v. Clara Maass Med. Ctr., 167

N.J. 341, 357 (2001); for equitable estoppel and laches, Knorr

v. Smeal, 178 N.J. 169, 178-81 (2003); and for technical

deficiencies in the contents or service of the affidavit that

could have been cured within the statutory time limit, Ferreira,

supra, 178 N.J. at 154-55. In the context of the AMS, these

equitable doctrines are not directly implicated on this appeal

because the question is not whether to permit the use of Dr.

Edoga's AOM, but rather, whether to extend discovery so

plaintiff can retain a new expert.

28 A-0337-14T3
 To illustrate this point, we turn to defendant's reliance

on Medina v. Pitta, 442 N.J. Super. 1 (App. Div.), certif.

denied, 223 N.J. 555 (2015). Defendant argues that the

doctrines of substantial compliance and extraordinary

circumstances are inapplicable. Defendant contends that once

the court barred Dr. Edoga's testimony, he was entitled to

summary judgment. Based on our reasoning in Medina, he

maintains that dismissal with prejudice is appropriate.

Defendant's reliance on Medina is misplaced. There the

parties were only concerned with whether the plaintiff's expert

satisfied the requirements under the PFA; here, the focus is on

the unintended consequences that flowed from plaintiff's

counsel's reasonable reliance on the AOM and original CV, which

erroneously reflected that Dr. Edoga had been practicing

medicine, not whether these equitable doctrines allowed the

continued use of Dr. Edoga's AOM and expert opinions. The focus

is on whether exceptional circumstances existed to extend

discovery, not to continue with Dr. Edoga as plaintiff's expert.

The facts in Medina are distinguishable. There, before

service of the AOM and expert's CV, the expert told the

plaintiff's attorney he was retired and asked if that would be a

problem. Id. at 14. The plaintiff's attorney replied he would

"look into it," but he did not think it would be a problem.

29 A-0337-14T3
Ibid. Here, there is no evidence in the record to show that

plaintiff's counsel had any reason to know, when he served the

original CV with the AOM and complaint, or even service of the

updated CV with Dr. Edoga's expert report, that Dr. Edoga

retired five years before the alleged malpractice. On the

contrary, Dr. Edoga stated in his AOM he had been involved in

surgical practice for roughly thirty-five years.

Additionally, in Medina, the expert gave deposition

testimony that he had retired, but unlike here, the plaintiff in

Medina did not file a motion to obtain a new expert or extend

the DED. Id. at 12-13. Instead, in opposition to the

defendant's motion for summary judgment, the plaintiff

maintained his expert satisfied the PFA. Id. at 13. The court

disagreed and granted summary judgment to the defendant. Ibid.

On reconsideration, the plaintiff reasserted his expert

satisfied the PFA, and for the first time argued that the

doctrines of substantial compliance and extraordinary

circumstances warranted a dismissal without prejudice. Id. at

14.

We agree with defendant's contention that under the facts

of Medina, the equitable doctrines of substantial compliance and

extraordinary circumstances were unavailable. In Medina, we

rejected the plaintiff's contention that the dismissal should

30 A-0337-14T3
have been without prejudice. Id. at 20-25. We determined that

the doctrine of substantial compliance "may be invoked when

dismissal is sought based upon [technical] deficiencies in an

AOM." Id. at 25. The doctrine is "not intended to shield a

plaintiff from the dismissal of a claim that is substantively

defective." Ibid. We pointed out that application of the

doctrine would erode our summary judgment jurisprudence and

eviscerate the remedial purpose of the PFA, to provide stringent

requirements for expert qualification. Ibid. Similarly, we

stated that a summary judgment analysis does not allow

application of the doctrine of extraordinary circumstances.

Ibid.

Here, however, the question is not whether the doctrines of

substantial compliance and extraordinary circumstances warrant

continued use of Dr. Edoga's testimony; rather, the issue is

whether exceptional circumstances exist allowing for an

extension of discovery permitting plaintiff time to retain a

different expert witness because, unbeknownst to plaintiff and

her attorney, the parties learned after the expiration of the

120-day deadline that the references to Dr. Edoga's active

medical practice in the AOM and original CV were inaccurate.

Therefore, Medina's holding does not govern our review.

31 A-0337-14T3
 C.

Our review of the trial judge's decision not to extend

discovery is deferential. Pomerantz Paper Corp. v. New Cmty.

Corp., 207 N.J. 344, 371 (2011). "We generally defer to a trial

court's disposition of discovery matters unless the court has

abused its discretion or its determination is based on a

mistaken understanding of the applicable law." Rivers v. LSC

P'ship, 378 N.J. Super. 68, 80 (App. Div.) (citing Payton v.

N.J. Tpk. Auth., 148 N.J. 524, 559 (1997)), certif. denied, 185

N.J. 296 (2005).

An abuse of discretion "arises when a decision is 'made

without a rational explanation, inexplicably departed from

established policies, or rested on an impermissible basis.'"

Flagg v. Essex Cty. Prosecutor, 171 N.J. 561, 571 (2002)

(quoting Achacoso-Sanchez v. Immigration and Naturalization

Serv., 779 F.2d 1260, 1265 (7th Cir. 1985)). We respectfully

conclude such an abuse of discretion occurred here.

"The right of a trial court to manage the orderly

progression of cases before it has been recognized as inherent

in its function." Casino Reinvestment Dev. Auth. v. Lustgarten,

332 N.J. Super. 472, 488 (App. Div.), certif. denied, 165 N.J.

607 (2000). Rule 4:24-1(c) provides in pertinent part that

"[n]o extension of the discovery period may be permitted after

32 A-0337-14T3
an arbitration or trial date is fixed, unless exceptional

circumstances are shown." The moving party must satisfy four

inquiries to extend discovery based on exceptional

circumstances:

(1) why discovery has not been completed
within time and counsel's diligence in
pursuing discovery during that time; (2) the
additional discovery or disclosure sought is
essential; (3) an explanation for counsel's
failure to request an extension of the time
for discovery within the original time
period; and (4) the circumstances presented
were clearly beyond the control of the
attorney and litigant seeking the extension
of time.

[Rivers, supra, 378 N.J. Super. at 79.]

As to the first prong, plaintiff's counsel diligently

pursued compliance with the AMS and the PFA. Plaintiff's

counsel produced the AOM timely, defendant's counsel waived the

Ferreira conference and "any objection" to Dr. Edoga, and

plaintiff's counsel produced Dr. Edoga's expert report and

updated CV timely. Plaintiff's counsel did not know about any

objection to Dr. Edoga's qualifications until after the DED

expired.

As to the second prong, the additional discovery sought is

essential to plaintiff's case. Without an expert, plaintiff's

case will be dismissed, even though there is no credible

evidence to suggest that plaintiff's claim is frivolous.

33 A-0337-14T3
 As to the third prong, plaintiff's counsel has a reasonable

explanation for not requesting an extension within the DED.

Defendant's counsel did not inform plaintiff's counsel at Dr.

Edoga's deposition that he would be moving to bar the testimony

of Dr. Edoga. Had that occurred, plaintiff's counsel would have

had sufficient time to request an extension of time in which to

retain a new expert. And because a trial date had not yet been

fixed at that point, the standard would have been one of good

cause rather than exceptional circumstances.

As to the fourth prong, the circumstances were beyond

plaintiff's control. There was no need to request an extension

of discovery before the expiration of the DED, even after Dr.

Edoga's deposition, because there was no objection to Dr.

Edoga's qualifications at that point. It was not until after

the DED expired that plaintiff's counsel first learned that

defendant would be seeking to bar Dr. Edoga's testimony.

Certainly, it was reasonable for plaintiff's counsel to rely on

the contents of the AOM and CVs.

We disagree with the finding that defendant's counsel moved

to bar Dr. Edoga's testimony "immediately and expeditiously"

after taking his deposition. The deposition occurred on

November 1, 2013, but the motion was not filed until January 29,

2014. Given the fact that defendant signed the consent order in

34 A-0337-14T3
March 2012, waiving "any objection[s]" to Dr. Edoga's

qualifications, and in light of the fact that defendant did not

object before the DED expired, plaintiff's counsel had no reason

to retain a new expert until defendant filed the motion to bar,

returnable on the eve of trial. Dismissing plaintiff's

complaint with prejudice would encourage procedural gamesmanship

and does not further the purposes of imposing enhanced

qualification requirements for expert witnesses.4 Ferreira,

supra, 178 N.J. at 154.

D.

It is well settled that because "dismissal with prejudice

is the ultimate sanction, it will normally be ordered only when

no lesser sanction will erase the prejudice suffered by the non-

delinquent party." Irani v. K-Mart Corp., 281 N.J. Super. 383,

387 (App. Div. 1995) (quoting Crispin v. Volkswagenwerk, A.G.,

96 N.J. 336, 345 (1984)). "Certainly, there has been no showing

of prejudice to [defendant] that would outweigh the strong

preference for adjudication on the merits rather than final

disposition for procedural reasons, or would warrant visiting on

the innocent client[] an error of [her] attorney." Mayfield v.

Cmty. Med. Assocs., P.A., 335 N.J. Super. 198, 207 (App. Div.

4
The judge did not find that defendant's counsel engaged in
procedural gamesmanship.

35 A-0337-14T3
2000) (citations omitted). We conclude "[t]his is not a case of

a plaintiff sleeping on [her] rights and ignoring statutorily

imposed deadlines." Buck, supra, 207 N.J. at 395. "Rather,

this is a case of a plaintiff who has made good-faith attempts

to satisfy the statute." Ibid.

IV.

Finally, both plaintiff and the NJAJ argue that the PFA

violates Article VI, Section 2, Paragraph 3 of the New Jersey

Constitution, which states, in part:

The Supreme Court shall make rules governing
the administration of all courts in the
State and, subject to the law, the practice
and procedure in all such courts.

Our courts have uniformly recognized the constitutionality of

the PFA. See e.g., Ferreira, supra, 178 N.J. at 149 n.1;

Medina, supra, 442 N.J. Super. at 27. Moreover, to the extent

that NJAJ also argues that the PFA "was an improper exercise of

legislative authority" that "runs afoul of the established

methods for creating new rules of evidence," we conclude this

argument is without sufficient merit to warrant extended

discussion in a written opinion. R. 2:11-3(e)(1)(E). See N.J.

State Bar Ass'n v. State, 387 N.J. Super. 24, 50 (App. Div.)

(reaffirming the constitutionality of the PFA and explaining it

does not unconstitutionally infringe on the rules of evidence),

certif. denied, 188 N.J. 491 (2006).

36 A-0337-14T3
 We reverse the order dismissing the complaint with

prejudice; reverse the order denying plaintiff's cross-motion to

adjourn the trial date and reopen discovery; and remand for

further proceedings consistent with this opinion. We do not

retain jurisdiction. Moreover, the judge has the discretion on

remand to impose, if warranted, other appropriate relief.

37 A-0337-14T3