REGINALD P. GAMBLE VS. PROGRESSIVE MOTION MEDICAL PRODUCT SOLUTIONS (L-4167-11, BERGEN COUNTY AND STATEWIDE) ( 2018 )


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  •                         NOT FOR PUBLICATION WITHOUT THE
    APPROVAL OF THE APPELLATE DIVISION
    This opinion shall not "constitute precedent or be binding upon any court."
    Although it is posted on the internet, this opinion is binding only on the
    parties in the case and its use in other cases is limited. R. 1:36-3.
    SUPERIOR COURT OF NEW JERSEY
    APPELLATE DIVISION
    DOCKET NO. A-1562-15T4
    REGINALD P. GAMBLE and
    DION M. HOPPER, His Wife,
    Plaintiffs-Appellants,
    v.
    PROGRESSIVE MOTION MEDICAL
    PRODUCT SOLUTIONS, ADVANTUS
    MEDICAL HEADQUARTERS and DJ
    ORTHOPEDICS, LLC,
    Defendants,
    and
    BRIAN VAN GROUW, D.O.,
    Defendant-Respondent.
    ______________________________________________
    Argued December 18, 2017 – Decided July 11, 2018
    Before Judges Messano, Accurso and O'Connor.
    On appeal from Superior Court of New Jersey,
    Law Division, Bergen County, Docket No.
    L-4167-11.
    Paul M. da Costa argued the cause for
    appellants (Snyder Sarno D'Aniello Maceri &
    da Costa, LLC, attorneys; Paul M. da Costa,
    of counsel and on the brief; Sarah L. Davis,
    on the brief).
    Michael J.   McBride argued the cause for
    respondent   (Mattia & McBride, PC, attorneys;
    Phillip F.   Mattia, Haley K. Grieco and
    Zachary G.   Farnsworth, on the brief).
    PER CURIAM
    Following a lengthy trial in this medical malpractice
    action, a jury determined defendant Brian Van Grouw, D.O.,
    deviated from accepted standards of medical care when he treated
    plaintiff Reginald P. Gamble, but found such treatment did not
    proximately cause the damages plaintiff claimed arose from the
    alleged deviations.1   Plaintiff and his spouse, Dion M. Hopper,
    who asserted a per quod claim against Dr. Van Grouw, appeal from
    an October 29, 2015 order denying plaintiffs' motion for
    judgment notwithstanding the verdict, a mistrial, or new trial.2
    After reviewing the evidence adduced at trial, the parties'
    arguments, and the applicable legal principles, we affirm.
    I
    We summarize the salient evidence.    In 2009, plaintiff
    consulted with defendant, an orthopedic surgeon, about pain he
    had been experiencing in both knees.    On May 13, 2009, defendant
    performed an arthroscopy on plaintiff's left knee to remove the
    1
    By the time of trial, Dr. Van Grouw was the sole defendant,
    plaintiff having previously settled with all other defendants.
    2
    For simplicity, for the remainder of this opinion the term
    "plaintiff" shall refer to Reginald P. Gamble only.
    2
    A-1562-15T4
    meniscus.     Following surgery, defendant prescribed a cryotherapy
    device (device) for plaintiff to use at home to help control
    post-surgical pain and swelling.     When in use, cold water from
    the device flowed across plaintiff's bandaged knee.
    Defendant testified that both he and his staff instructed
    plaintiff to use the device continuously during the first
    seventy-two hours following surgery and, thereafter, as needed
    to control any pain or swelling.     In addition, in general he
    advises all patients using the device to contact him if any
    "issues" arise with respect to "drainage, redness, warmth."
    Plaintiff testified he used the device continuously during
    seventy-two hours immediately following surgery and as necessary
    thereafter.    Starting with the third day following surgery,
    plaintiff used the machine every other hour for an hour.      On May
    18, 2009, the fifth day following surgery, plaintiff began to
    feel numbness in his knee.     Because he was also experiencing
    what he believed was an abnormal amount of swelling and
    bleeding, plaintiff contacted and saw defendant in his office
    that day.
    According to defendant's office notes, plaintiff complained
    of having a lot of pain in his knee, swelling, and some
    bleeding.     Defendant testified fluid had accumulated in
    plaintiff's knee, making it appear swollen, a common post-
    3
    A-1562-15T4
    operative occurrence.     It is not disputed defendant aspirated
    the fluid from the knee and instructed plaintiff to return in a
    week for another checkup.
    On May 26, 2009, plaintiff returned to defendant's office
    for the scheduled follow-up visit, during which defendant's
    office notes reflect fluid had again accumulated in the knee.
    Defendant again drained the knee, but testified the knee
    "appeared to be good," and that there was nothing that made him
    "overly concerned."     Plaintiff testified his knee was still
    painful at that second office visit and that defendant advised
    him to continue using the cryotherapy device as needed for pain.
    On June 4, 2009, plaintiff returned to defendant's office
    for a follow-up visit.     Defendant's office notes reflect
    plaintiff was complaining of "a lot" of pain, tenderness, and
    swelling.    Plaintiff testified there was "dark black skin" and
    blisters forming on his knee; defendant's office notes do not
    mention changes in plaintiff's skin color or the presence of
    blisters.    Defendant testified he found a small amount of fluid
    in the knee, which he did not consider to be abnormal.        He
    directed plaintiff to attend physical therapy because the
    muscles around the knee had grown weak and stiff from lack of
    use.
    4
    A-1562-15T4
    On June 12, 2009, plaintiff called defendant's office
    seeking renewal of a prescription for pain medication.
    Defendant's office notes indicate plaintiff reported he was
    "doing better" and that physical therapy was "going well."
    However, on June 20, 2009, plaintiff went to an emergency room
    because he was experiencing increased knee pain and nausea; he
    was subsequently admitted into the hospital, where he remained
    until August.    Defendant did not treat plaintiff after June 20,
    2009.
    At the time of his admission, significant eschar was noted
    to have formed over a wound on plaintiff's knee; eschar is dead,
    necrotic tissue.    Two days after plaintiff's admission, the
    eschar was surgically debrided3 in an effort to induce new skin
    to grow.    However, the wound over plaintiff's knee did not heal,
    and additional eschar developed and had to be removed.
    Subsequent testing and additional surgical procedures
    revealed the bones and joints of plaintiff's knee were
    deteriorating as the result of osteomyelitis, an infection of
    the bone.    In fact, there was concern plaintiff would lose his
    leg.    When plaintiff was discharged in August, the fate of his
    leg was still uncertain.    Eventually, his treating physicians
    3
    Debridement is the removal of damaged tissue or foreign
    objects from a wound. Stedman's Medical Dictionary 496 (28th
    ed. 2006).
    5
    A-1562-15T4
    were able to salvage the leg by fusing plaintiff's knee.
    Plaintiff filed a medical malpractice complaint against
    defendant, alleging he committed various deviations from
    accepted standards of medical care during the period immediately
    following the arthroscopy.   Plaintiff further contended that as
    a proximate result of such deviations, he was forced to and will
    endure pain and suffering, including but not limited to the
    fusion of his knee.
    During trial, each party called various medical experts on
    the issue of liability and damages.     The most sharply contested
    issue was proximate causation.   We address this issue first
    because not only was it the most controversial, it also puts the
    alleged deviations into perspective.
    One of plaintiff's liability experts, orthopedist Stephen
    H. Marcus, M.D., opined the device caused a thermal injury or
    "freezer burn" to plaintiff's knee, and did so within the first
    seventy-two hours of the arthroscopy.     Marcus claimed
    plaintiff's complaints during the post-operative period were
    caused by the thermal injury, and opined the skin over
    plaintiff's knee likely exhibited a change in appearance that
    defendant failed to recognize.
    The expert opined that had defendant properly examined
    plaintiff on June 4, 2009, he would have noted, consistent with
    6
    A-1562-15T4
    plaintiff's observations at that time, signs consistent with a
    thermal injury, specifically, blistering of the skin and the
    start of the formation of eschar, which is black in color.
    Marcus did not state what steps defendant could or should have
    taken had he recognized plaintiff sustained the alleged thermal
    injury during the post-operative visits.
    Marcus concluded plaintiff ultimately required a fusion of
    his knee for the following reason.    The thermal injury destroyed
    the skin on plaintiff's knee, requiring surgical procedures to
    debride the dead tissue.    While recuperating in the hospital
    from such procedures, although bandaged, plaintiff's knee was
    exposed to certain bacteria found in hospital environments.
    Such bacteria invaded the wound and subsequently penetrated the
    bones of plaintiff's knee.    The bacteria caused osteomyelitis,
    which destroyed the bones in plaintiff's knee, necessitating a
    fusion.
    Arnold Lentnek, M.D., plaintiff's infectious disease
    expert, similarly opined plaintiff sustained a thermal injury
    caused by the cold water the device circulated over plaintiff's
    knee, and that such injury likely occurred within seventy-two
    hours of the arthroscopy.    He also stated the thermal injury
    destroyed the tissue around the knee and, while plaintiff was in
    the hospital recuperating from procedures to treat such injury,
    7
    A-1562-15T4
    bacteria entered the wound and eventually infiltrated the bones
    in plaintiff's left knee, necessitating the fusion.
    Plaintiff's experts testified defendant's principal
    deviations from the standard of care were his failure to: (1)
    review the FDA label on the device, which warned it may cause
    frostbite, before prescribing the device to plaintiff; (2) warn
    plaintiff he might suffer a thermal injury as a result of using
    the device; (3) personally instruct plaintiff on how to use the
    device, instead of relegating such task to his staff; (4) advise
    plaintiff he should not use the device continuously for seventy-
    two hours; (5) advise plaintiff to contact him if the skin over
    his knee became red or the sensitivity of the skin changed; and
    (6) recognize plaintiff had sustained a thermal injury during
    the post-operative office visits and advise plaintiff to suspend
    the use of the device.
    On the issue of proximate cause, Michael McIlroy, M.D.,
    defendant's infectious disease expert, opined that when
    plaintiff went to the emergency room on June 20, 2009, he was
    suffering from bullous cellulitis, a blistering form of
    infection of the skin.   McIlroy pointed out that, early in his
    admission, tissue removed from plaintiff's left knee was
    analyzed and revealed the presence of inflammatory cells.     He
    8
    A-1562-15T4
    testified such findings showed an infection was present and is
    not indicative of a thermal injury.
    In addition, he noted the tissue was sent to a microbiology
    laboratory, where a gram stain revealed gram-positive cocci were
    infiltrating the tissue of plaintiff's knee.   McIlroy testified
    such results were "one hundred percent" proof plaintiff's knee
    was not only infected, but significantly so.   He stated the
    morphology of the cocci was highly consistent with
    Staphylococcus aureus (staph aureus), an "aggressive" infection
    capable of causing the damage to plaintiff' knee.    He also
    mentioned eschar forms when one has bullous cellulitis.
    McIlroy further testified the infection in plaintiff's knee
    was going to occur regardless of plaintiff's use of the device;
    in fact, he opined in all probability the cool water from the
    device kept the infection localized, retarding it from spreading
    up and down plaintiff's leg.   McIlroy also noted there were some
    systemic signs of infection when plaintiff appeared in the
    emergency room.   For example, although plaintiff's white blood
    count was normal, neutrophils, the cells that fight bacteria,
    were elevated and very suggestive of infection.
    Orthopedist Joseph Bosco, M.D., defendant's expert on
    deviation, conceded defendant deviated from accepted standards
    of medical care if he failed to warn plaintiff there was a risk
    9
    A-1562-15T4
    he might sustain a thermal injury if he used the device.     Bosco
    also testified defendant deviated if he did not instruct
    plaintiff on how to use the device and to look for redness,
    blisters, and increased pain.   Otherwise, according to Bosco,
    defendant did not deviate from accepted standards of medical
    care.
    Bosco further testified it is more likely than not
    plaintiff did sustain a thermal injury from the device, although
    added he was not convinced plaintiff did so to a "medical
    certainty."   However, Bosco did not opine such injury was the
    proximate cause of the subsequent injuries and damages plaintiff
    claims in this matter.
    As previously stated, the jury found defendant deviated
    from accepted standards of medical care, but found such
    deviations were not a proximate cause of his injuries.
    Following the verdict, plaintiff filed a motion requesting
    judgment notwithstanding the verdict, a mistrial, or new trial.
    The trial court denied the motion and this appeal ensued.
    There was additional evidence adduced and some procedural
    developments that arose during the trial relevant to the issues
    on appeal.    For brevity and clarity, we summarize such evidence
    and developments when we address the particular argument to
    which they pertain.
    10
    A-1562-15T4
    II
    On   appeal,   defendant   reprises   for   our   consideration   the
    following arguments asserted in his post-trial motion before the
    trial court:
    POINT I: THE TRIAL COURT COMMITTED HARMFUL
    ERROR BY FAILING TO SUBMIT SEPARATE JURY
    INTERROGATORIES AS TO EACH ALLEGED DEVIATION
    FROM ACCEPTED STANDARDS OF PRACTICE ON THE
    PART OF DEFENDANT, INCLUDING (A) FAILURE TO
    WARN, (B) FAILURE TO PROPERLY INSTRUCT, AND
    (C) FAILURE TO TIMELY DIAGNOSE AND TREAT
    PLAINTIFF'S THERMAL INJURY.
    POINT II: THE TRIAL COURT COMMITTED HARMFUL
    ERROR BY REFUSING TO INCLUDE AN INFORMED
    CONSENT JURY CHARGE.
    A. THE TRIAL COURT COMMITTED HARMFUL
    ERROR BY REFUSING TO INCLUDE AN
    INFORMED CONSENT JURY CHARGE INSOFAR AS
    THE LEARNED INTERMEDIARY DOCTRINE WAS
    RULED TO APPLY AS A MATTER OF LAW.
    B. THE TRIAL COURT COMMITTED HARMFUL
    ERROR BY REFUSING TO INCLUDE AN
    INFORMED CONSENT JURY CHARGE SINCE THE
    PLAINTIFF PROVIDED AN ADEQUATE
    EVIDENTIAL FOUNDATION IN SUPPORT OF
    SUCH CHARGE.
    POINT III: SINCE THE DOCTRINE OF INFORMED
    CONSENT SHOULD HAVE BEEN CHARGED TO THE
    JURY, THE TRIAL COURT ABUSED ITS DISCRETION
    IN DENYING PLAINTIFF'S MOTION TO BAR ANY
    REFERENCES AS TO THE DOCTRINE OF AVOIDABLE
    CONSEQUENCES.
    POINT IV: THE TRIAL COURT ABUSED ITS
    DISCRETION BY DENYING PLAINTIFF'S MOTION FOR
    PARTIAL JUDGMENT REGARDING DEFENDANT'S
    11
    A-1562-15T4
    FAILURE TO OBTAIN PLAINTIFF'S INFORMED
    CONSENT.
    POINT V: THE TRIAL COURT ABUSED ITS
    DISCRETION BY DENYING PLAINTIFF'S MCKENNEY
    MOTION WHEREIN A CURATIVE INSTRUCTION WAS
    REQUESTED BASED UPON THE DEFENDANT'S
    MATERIAL CHANGE IN TESTIMONY.
    POINT VI: THE TRIAL COURT ABUSED ITS
    DISCRETION IN DENYING PLAINTIFF'S MOTION FOR
    A MISTRIAL BASED UPON THE JURY'S MISCONDUCT
    AND FAILURE TO FULLY AND FAIRLY DELIBERATE.
    We separately address each contention.
    A
    During its final charge to the jury, the court instructed:
    When a physician prescribes a medical device
    approved by the [FDA], the prescribing
    physician assumes a duty from a manufacturer
    of a device to warn patients of known
    potential risks associated with the use of
    the device.
    The court has found as a matter of law that
    it was solely the defendant's legal duty to
    inform and warn the plaintiff, Reginald
    Gamble, regarding the cryotherapy devices.
    Next, I'm going to move on to a discussion
    of duty and negligence.
    Plaintiffs . . . contend that the defendant
    . . . was [1] negligent in failing to
    properly warn and inform the plaintiff
    regarding the cryotherapy device, [2]
    negligent in instructing the plaintiff on
    the usage of the cryotherapy device, and [3]
    negligent in the failure to diagnose and
    threat the alleged thermal injury of
    plaintiff . . . .
    12
    A-1562-15T4
    On the issue of deviation and proximate causation, the
    verdict sheet instructed the jury to answer the following two
    interrogatories:
    1. Have the plaintiffs proven by a
    preponderance of the evidence that the
    defendant, Brian Van Grouw, D.O., deviated
    from accepted standards of medical practice?
    2. Have the plaintiffs proven by a
    preponderance of the evidence that said
    negligence was a proximate cause of injury
    to the plaintiff Reginald P. Gamble?
    The jury answered "yes" to the first and "no" to the second
    question.
    Plaintiff did not object to the charge, but did object to
    the fact that the three deviations set forth in the charge were
    not broken down into three separate questions on the verdict
    sheet.   On appeal, he argues the verdict was ambiguous because,
    in answering the first of the two questions cited above, it is
    not known which of the three alleged deviations the jury found.
    Plaintiff further contends the verdict on deviation was
    "inherently inconsistent and contradictory" when compared to the
    verdict on proximate cause.    Plaintiff's complaint about the
    alleged deficiency of the verdict sheet is confined to the
    allegation defendant deviated by failing to diagnose and treat a
    thermal injury.
    13
    A-1562-15T4
    Plaintiff argues that if the jury found defendant deviated
    because he failed to treat and diagnose a thermal injury, then
    the jury inherently found plaintiff did sustain a thermal injury
    and, therefore, "the jury's final determination as to proximate
    cause was completely contradictory to its finding of
    [deviation]. . . .   As such, . . . the trial court's ambiguous
    and incomplete interrogatories were clearly capable, and did in
    fact, produce an unjust result in the form of a completely
    inconsistent jury verdict."    We disagree.
    "[A] trial court's interrogatories to a jury are not
    grounds for a reversal unless they were misleading, confusing,
    or ambiguous."    Sons of Thunder v. Borden, 
    148 N.J. 396
    , 418
    (1997).    Further, when "reviewing an interrogatory for
    reversible error," the interrogatory should be "consider[ed]
    . . . in the context of the [jury] charge as a whole," as "[a]n
    accurate and thorough jury charge often can cure the potential
    for confusion that may be present in an interrogatory."    Ponzo
    v. Pelle, 
    166 N.J. 481
    , 491 (2001) (citing Thunder, 
    148 N.J. at 415-20
    ).
    First, we note that, although there was evidence from
    plaintiff's experts that defendant deviated because he allegedly
    failed to recognize the signs of thermal injury, there was no
    evidence about the treatment defendant was required to
    14
    A-1562-15T4
    administer once such injury manifested itself, other than to
    advise plaintiff to suspend using the cryotherapy device.
    Second, and more important, even if plaintiff sustained a
    thermal injury, the jury found such injury was not a proximate
    cause of his damages.   Plaintiff contended a thermal injury
    caused the tissue around his knee to deteriorate, the reason he
    went to the hospital on June 20, 2009.   Then, while in the
    hospital for treatment of such condition, he contracted an
    infection that caused him to develop osteomyelitis.   The
    osteomyelitis in turn caused the destruction of the bones in his
    knee, necessitating a fusion.
    Defendant, on the other hand, contended the problem
    plaintiff was having with his knee when he entered the hospital
    was not caused by a thermal injury but by bullous cellulitis, an
    aggressive form of infection.   Defendant claims this particular
    infection, not a thermal injury, proximately caused plaintiff's
    damages.
    In our view, there was ample evidence for the jury to find
    plaintiff's injuries were caused by bullous cellulitis.     The
    jury was at liberty to reject the evidence plaintiff introduced
    in support of his claim the proximate cause of his damages was a
    thermal injury.   Accordingly, even if the jury found defendant
    deviated from accepted standards of medical care by failing to
    15
    A-1562-15T4
    diagnose and treat a thermal injury, it is obvious from its
    answer to the second question on the verdict sheet the jury
    determined such injury was not a proximate cause of plaintiff's
    damages.
    B
    Defendant next contends the trial court erred when it
    declined to charge the jury on informed consent.   Defendant
    argues that, because the learned intermediary doctrine4 applied
    and he provided sufficient evidence thermal injury is a risk of
    using the subject device, the court was obligated to charge the
    jury on informed consent.   He maintains the trial court's
    refusal to "include an informed consent charge was not only
    inconsistent, but also clearly prejudicial to the plaintiffs[,]"
    4
    Because a physician functions as an intermediary between
    manufacturer and consumer, under the learned intermediary
    doctrine, "a pharmaceutical manufacturer generally discharges
    its duty to warn the ultimate user of prescription drugs by
    supplying physicians with information about the drug's dangerous
    propensities." Niemiera by Niewmiera v. Schneider, 
    114 N.J. 550
    , 559 (1989).
    Just before trial, the court determined such doctrine
    applied in this matter. As indicated by the excerpt from the
    jury charge recited above, consistent with its ruling, the court
    instructed the jury that "[t]he court has found as a matter of
    law that it was solely the defendant's legal duty to inform and
    warn the plaintiff, Reginald Gamble, regarding the cryotherapy
    devices."
    16
    A-1562-15T4
    especially given defendant admitted he did not warn plaintiff of
    the risk of thermal injury.   We disagree.
    "[A] patient has several avenues of relief against a
    doctor: (1) deviation from the standard of care (medical
    malpractice); (2) lack of informed consent; and (3) battery."
    Howard v. Univ. of Med. & Dentistry of N.J., 
    172 N.J. 537
    , 545
    (2002) (citing Colucci v. Oppenheim, 
    326 N.J. Super. 166
    , 180
    (App. Div. 1999)).   "Although each cause of action is based on
    different theoretical underpinnings, 'it is now clear that
    deviation from the standard of care and failure to obtain
    informed consent are simply sub-groups of a broad claim of
    medical negligence.'"   
    Ibid.
     (quoting Colucci, 
    326 N.J. Super. at 180
    ).
    To prove a physician was negligent premised upon a theory
    of lack of informed consent, a plaintiff must show:
    (1) the physician failed to comply with the
    applicable standard for disclosure; (2) the
    undisclosed risk occurred and harmed the
    plaintiff; (3) a reasonable person under the
    circumstances would not have consented and
    submitted to the operation or surgical
    procedure had he or she been so informed;
    and (4) the operation or surgical procedure
    was a proximate cause of plaintiff's
    injuries.
    [Newmark-Shortino v. Buna, 
    427 N.J. Super. 285
    , 304 (App. Div. 2012) (quoting Teilhaber
    v. Greene, 
    320 N.J. Super. 453
    , 465 (App.
    Div. 1999)).]
    17
    A-1562-15T4
    Here, the "procedure" at issue was the use of the cryotherapy
    device, and the undisclosed risk was thermal injury.
    In light of the jury's determination defendant's deviations
    from accepted standards of medical care were not the proximate
    cause of his damages, the court's failure to charge the jury on
    informed consent was entirely harmless and clearly not capable
    of producing an unjust result.     See R. 2:10-2 ("Any error or
    omission shall be disregarded by the appellate court unless it
    is of such a nature as to have been clearly capable of producing
    an unjust result . . . .").     As is evident from the jury's
    verdict, neither a thermal injury nor the procedure was deemed a
    proximate cause of plaintiff's injuries.
    C
    Plaintiff contends the doctrine of avoidable consequences
    did not apply in this matter.    The doctrine of avoidable
    consequences "provides that, in instances in which a defendant
    has committed an actionable wrong, damages flowing from that
    wrong will be precluded to the extent that they could have been
    averted by an exercise of reasonable care by the injured party."
    Geler v. Akawie, 
    358 N.J. Super. 437
    , 458 (App. Div. 2003).
    In his brief before us, plaintiff claims defendant made
    "numerous references to the plaintiff's alleged misuse of the
    18
    A-1562-15T4
    cryotherapy device and alluded to his 'responsibility' regarding
    same.   These references were entirely inappropriate and clearly
    prejudicial to plaintiffs."
    With one exception, contrary to Rule 2:6-2(a)(5), plaintiff
    fails to provide citations to the record in support of his
    assertion defendant made numerous comments that plaintiff had
    misused the device.   In the one instance for which he does
    provide a citation to the trial transcript, the record reveals
    defense counsel asked plaintiff if he agreed it was his
    responsibility to read and fully understand the instructions
    that came with the cryotherapy device.    Plaintiff's counsel
    immediately objected and the court sustained the objection.
    Defendant then withdrew the question.
    We are fully satisfied plaintiff was not in any way
    prejudiced by this question.   Further discussion on this point
    is unnecessary.
    D
    Plaintiff contends the trial court erred when it denied his
    motion for a mistrial.    Plaintiff had contended a juror engaged
    in misconduct and failed to fully and fairly deliberate.      The
    details are as follows.
    The jury began its deliberations at 2:18 p.m. on April 21,
    2015 and was discharged for the day at approximately 4:30 p.m.
    19
    A-1562-15T4
    The jury resumed deliberations the following day at 9:20 a.m.
    At approximately 11:01 a.m., the court asked through court staff
    if the jury wanted a recess; the jury responded it needed "five
    more minutes."
    At 11:08 a.m., juror six caught the court clerk's attention
    by opening the door of the jury room.   The juror informed the
    clerk she had just learned her son had been arrested and was
    "really upset."   The juror retreated to the jury room with the
    rest of the jurors.
    While the jury remained in the jury room, the court
    discussed with counsel how best to proceed.   The court
    determined the jury would take a break and, in the meantime, the
    court and counsel would bring juror six into chambers to discuss
    her problem.   The court then brought the jury out to the court
    room and asked if it was ready for a break.   A juror replied the
    jury had reached a verdict.   The jury remained in the court room
    and the court took the verdict.
    After the jury was discharged but before counsel left the
    court room, plaintiff's counsel requested a mistrial because,
    "clearly [juror six] had her cell phone accessible and was, at
    minimum, receiving a call or looking at text messages. . . .
    And the timing of that all was really in close connection with
    this jury's verdict."   In a brief he subsequently filed,
    20
    A-1562-15T4
    plaintiff argued juror six's access to the electronic device
    tainted the jury deliberation process and invalidated the
    integrity of the verdict.
    We note that, at the outset of the trial, the jury was
    instructed that while in the jury room, all cell phones and
    other communication devices had to be turned off.   The jury was
    advised it would be given a telephone number at which a juror
    could be contacted during the trial, if need be.
    The trial court denied the motion for a mistrial, finding:
    While it does indeed appear that juror
    number six accessed an electronic device
    from which she learned about her son's
    crisis, the event did occur contemporaneous
    to the conclusion of the deliberations. One
    must carefully analyze the timing. . . .
    [I]t is clear that juror number six merely
    put on her device after the deliberations
    were complete. . . . [B]etween 11:08 a.m.
    and 11:14 a.m., juror [six] informed [the
    court] of the issue. A sidebar conference
    was held regarding the issue and before the
    discussion was completed, the jury returned
    their verdict. The jury was then polled and
    dismissed at 11:14 a.m.
    It is intuitive that in the six minutes at
    issue there could be no opportunity for
    juror number six to influence the other
    jurors. There simply was inadequate time to
    do so. Thus, one must come to no other
    conclusion that the deliberations were
    complete after which juror number six
    accessed her device. One must also come to
    the conclusion that the jurors were at the
    end of the deliberative process when they
    requested a few minutes more. It is
    21
    A-1562-15T4
    certainly reasonable, observing the process
    as a whole, to find the jury was merely
    completing the final form when juror number
    six put on her cell phone and received her
    distressing news. The deliberations were
    completed at that point.
    The court also noted plaintiff did not object to receiving
    the verdict when the jury advised the court it had a verdict,
    and did not request, before the jury was discharged, further
    exploration into when juror six received the news of her son's
    arrest in relation to when the jury concluded its deliberations.
    On appeal, plaintiff argues the trial court abused its
    discretion by denying his motion for a mistrial, contending the
    "events clearly evidence[]" juror six learned of her son's
    arrest only a short time before the jury reached its verdict.
    Plaintiff asserts because she was in a state of stress, juror
    six was unable to properly deliberate and may have rushed to
    conclusions on some of the issues just to hasten deliberations.
    "The grant of a mistrial is an extraordinary remedy that
    should be exercised only to prevent manifest injustice."
    Belmont Condo. Ass'n, Inc. v. Geibel, 
    432 N.J. Super. 52
    , 97
    (App. Div. 2013) (citing State v. Ribalta, 
    277 N.J. Super. 277
    ,
    291 (App. Div. 1994)).   "Whether manifest necessity mandates the
    grant of a mistrial depends on the specific facts of the case
    and the sound discretion of the court."   State v. Allah, 170
    22
    A-1562-15T4
    N.J. 269, 280 (2002) (citing State v. Loyal, 
    164 N.J. 418
    , 435
    (2000)).   In addition, when the basis for the requested mistrial
    is alleged juror misconduct, the trial court is in the best
    position to gauge the effect of the alleged juror impropriety
    and defer to its decision on a motion for a mistrial.     State v.
    Harvey, 
    151 N.J. 117
    , 205 (1997).
    In our view, the trial court did not abuse its discretion
    when it denied plaintiff's motion for a mistrial.    The court
    carefully reviewed the timing of how events unfolded and
    determined it unlikely the verdict was reached after juror six
    accessed her phone.   We agree with the court's assessment and
    conclusions, and affirm its decision on plaintiff's motion for
    the reasons set forth in its opinion.
    E
    We have considered plaintiff's remaining argument points,
    and have determined they are without sufficient merit to warrant
    discussion in a written opinion.     See R. 2:11-3(e)(1)(E).
    Affirmed.
    23
    A-1562-15T4