Cassandra Gigi Smith v. Newark Community Health Centers, Inc. ( 2024 )

NOT FOR PUBLICATION WITHOUT THE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-2138-22
CASSANDRA GIGI SMITH,
Plaintiff-Appellant,
v.
NEWARK COMMUNITY
HEALTH CENTERS, INC.,
Defendant-Respondent.
Argued April 16, 2024 – Decided July 30, 2024
Before Judges Rose, Smith and Perez Friscia.
On appeal from the Superior Court of New Jersey, Law
Division, Essex County, Docket No. L-0547-21.
Margaret E. Quinlan argued the cause for appellant
(Lowenthal & Abrams, PC, attorneys; Margaret E.
Quinlan, on the brief).
Samuel P. Reisen argued the cause for respondent (Law
Offices of James H. Rohlfing, attorneys; Samuel P.
Reisen, on the brief).
PER CURIAM
Plaintiff Cassandra Gigi Smith appeals from a February 9, 2023 Law
Division order granting the summary judgment dismissal of her negligence
claim against defendant Newark Community Health Centers, Inc. pursuant to
the New Jersey Charitable Immunity Act (CIA), N.J.S.A. 2A:53A-7 to -11.
Plaintiff asserted she was seriously injured on February 14, 2019, when she
slipped and fell on a wet floor outside an examination room at defendant's East
Orange facility after receiving an injectable medication paid by Medicare.
Defendant raised several affirmative defenses, including immunity from suit
pursuant to N.J.S.A. 2A:53A-7 (Section 7), based on its status as "a nonprofit
corporation, society[,] or association organized exclusively for religious,
charitable, educational[,] or hospital purposes."
On appeal, plaintiff maintains the CIA's immunity does not apply to her
claim, asserting defendant neither was organized exclusively for educational
purposes nor demonstrated it received sufficient funding to qualify for charitable
immunity under Section 7. Contending defendant was organized for hospital
purposes, plaintiff asserts defendant's immunity is circumscribed by the
$250,000 cap on damages under N.J.S.A. 2A-53A-8 (Section 8). Finally,
plaintiff argues the CIA's immunity does not apply to her claim because she was
not a beneficiary of defendant's charitable activities at the time of the incident.
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For the reasons that follow, we conclude Section 7 applies to plaintiff's
claims and immunizes defendant from her suit. Accordingly, we conclude
summary judgment was properly granted.
We review the trial court's grant of summary judgment de novo. Conforti
v. County of Ocean, 255 N.J. 142, 162 (2023). Employing the same standard as
the trial court, we review the record to determine whether there are material
factual disputes and, if not, whether the undisputed facts viewed in the light
most favorable to the non-moving party, nonetheless entitle the movant to
judgment as a matter of law. See Samolyk v. Berthe, 251 N.J. 73, 78
(2022); Brill v. Guardian Life Ins. Co. of Am., 142 N.J. 520, 540 (1995); see
also R. 4:46-2(c). We focus only on the motion record before the judge. See Ji
v. Palmer, 333 N.J. Super. 451, 463-64 (App. Div. 2000).
We owe no deference to the trial court's legal analysis or interpretation of
a statute. Palisades at Fort Lee Condo. Ass'n v. 100 Old Palisade, LLC, 230 N.J.
427, 442 (2017). Accordingly, "a trial court's determination of the applicability
of charitable immunity is reviewed de novo because an organization's right to
immunity raises questions of law." Green v. Monmouth Univ., 237 N.J. 516,
529 (2019).
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I.
In his written decision accompanying the February 9, 2023 order, the
motion judge set forth the governing sections of the CIA and summarized the
policy underlying the CIA. Quoting our decision in Estate of Komninos v.
Bancroft Neurohealth, Inc., 417 N.J. Super. 309, 319 (App. Div. 2010), the judge
recognized the legislative intent behind the act "foster[s] the private provision
of services that benefit the general welfare, thus relieving the government of the
obligation to provide those services." Further, the CIA's "strong public policy
. . . compels its liberal construction." Id. at 320; see also N.J.S.A. 2A:53A-10
(providing the CIA "shall be deemed to be remedial and shall be liberally
construed").
The judge correctly stated the three-prong test to determine immunity
under the CIA. Applying the language of Section 7, our Supreme Court
reiterated in Green, "an entity qualifies for charitable immunity when it (1) was
formed for nonprofit purposes; (2) is organized exclusively for religious,
charitable[,] or educational purposes; and (3) was promoting such objectives and
purposes at the time of the injury to plaintiff who was then a beneficiary of the
charitable works." Id. at 530-31 (quoting Ryan v. Holy Trinity Evangelical
Lutheran Church, 175 N.J. 333, 342 (2003)); see also N.J.S.A. 2A:53A-7(a).
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"Charitable immunity is an affirmative defense, as to which, like all affirmative
defenses, defendants bear the burden of persuasion." Abdallah v. Occupational
Ctr. of Hudson Cnty., Inc., 351 N.J. Super. 280, 288 (App. Div. 2002); see also
F.K. v. Integrity House, Inc., 460 N.J. Super. 105, 116 (App. Div. 2019).
A.
The motion judge found defendant satisfied the three-prong test.
Although the first prong was not in dispute, the judge found defendant was
incorporated under New Jersey law as a nonprofit corporation. Plaintiff does
not challenge this finding on appeal.
B.
Turning to the second prong, the judge initially found defendant's 1986
certificate of incorporation (COI) demonstrated the entity was formed
"exclusively [for] charitable and educational purposes." As further support, the
judge also cited the deposition testimony of defendant's Chief Operating Officer,
Bridget Hogan. According to Hogan, as a federally qualified health center,
defendant "deliver[ed] primary care to patients, regardless of their ability to
pay." Further, defendant's "populations are insured, uninsured, underinsured"
and services are performed regardless of the patient's ability to pay. Defendant
utilized a sliding fee scale for uninsured patients. Regarding plaintiff's $281.16
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fee for services performed on February 14, 2019, Hogan testified plaintiff
"wasn't billed. The insurance company was billed." As the judge noted
elsewhere in his opinion, it was undisputed that plaintiff's bill was paid by
Medicare. Further, in her answers to defendant's statement of undisputed
material facts supporting its summary judgment motion, plaintiff admitted
"there was no co[-]pay."
Plaintiff challenges the judge's prong two determination, arguing
defendant neither is a traditional educational institution, such as "schools of all
sorts," nor provided "education" as defined in Pomeroy v. Little League
Baseball, 142 N.J. Super. 471, 474 (App. Div. 1976), that is, "discipline of mind
or character through study or instruction." As plaintiff correctly recognizes, in
Pomeroy, we concluded Little League Baseball was organized exclusively for
educational purposes where
[t]he only proof presented on the summary judgment
motion was that [the] defendant's exclusive purpose
was the education of young people in the ideals of good
sportsmanship, honesty, loyalty, courage and
reverence, to the end that they may be stronger and
happier, and that they may grow to be productive
citizens. The fact that the objective was accomplished
through the teaching and supervision of baseball skills
d[id] not vitiate the purpose.
[Ibid.]
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We were persuaded the defendant in Pomeroy was indistinguishable from other
organizations, including the Young Women's Christian Association and the Boy
Scouts, which were found to have an educational purpose. Ibid.However, plaintiff attempts to distinguish the "discipline of the mind or
character" afforded by "athletic clubs, little league organizations, [and] boys and
girls clubs" from defendant's "primary objective" in the present matter, deemed
by plaintiff as "medical exams and treatment." Plaintiff's argument is misplaced.
As used in the CIA, "education" broadly defines instructional pursuits and
is not limited to scholastic institutions. See Estate of Komninos, 417 N.J. Super.
at 320. Indeed, citing our decision in Pomeroy, the Court in Ryan noted the
phrase, "organized exclusively for educational purposes" has been broadly
construed.175 N.J. at 347; see also Roberts v. Timber Birch-Broadmoore
Athletic Ass'n, 371 N.J. Super. 189, 194 (App. Div. 2004) (recognizing the
"[defendant]'s purpose of teaching and promoting good citizenship and
sportsmanship and assembling teams and groups for participation in sports
qualifie[d] it as a non[]profit organization within the scope of the charitable
immunity statute"); Auerbach v. Jersey Wahoos Swim Club, 368 N.J. Super.
403, 413 (App. Div. 2004) (holding the defendant, a nonprofit corporation
organized to train swimmers at various competitive levels, was organized
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exclusively for educational purposes and entitled to invoke charitable
immunity); Morales v. N.J. Acad. of Aquatic Sciens., 302 N.J. Super. 50, 54
(App. Div. 1997) (recognizing "a non[]profit corporation may be organized for
'exclusively educational purposes' even though it provides an educational
experience which is 'recreational' in nature").
A nonprofit organization exclusively dedicated to religious or educational
purposes is afforded "substantial latitude in determining the appropriate avenues
for achieving [its] objectives." Bloom v. Seton Hall Univ., 307 N.J. Super. 487,
491 (App. Div. 1998). Thus, engaging in other activities or services will not
necessarily "eviscerate[]" charitable status "as long as the services or activities
further the charitable objectives the [entity] was organized to advance."
Kuchera v. Jersey Shore Family Health Ctr., 221 N.J. 239, 252-53 (2015) (citing
Bieker v. Cmty. House of Moorestown, 169 N.J. 167, 176 (2001)); see, e.g.,
Bloom, 307 N.J. Super. at 491-92 (concluding operation of an on-campus pub
did not alter the fundamental educational nature of the college); Rupp v.
Brookdale Baptist Church, 242 N.J. Super. 457, 465 (App. Div. 1990) (noting
utilization of crafts and games to "foster sportsmanship, honesty and creativity"
did not thwart religious day camp's educational purpose).
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Although we agree with the motion judge's conclusion that defendant
satisfied the second prong, further analysis is required. We must review the
extent and nature of defendant's non-educational activities and distinguish
whether they have supplanted or furthered the educational objectives of the
organization.
Having conducted "a fact-sensitive" review of the record, Kuchera, 221
N.J. at 252, we are satisfied defendant provides more than "medical exams and
treatment," and its health care services foster its educational objectives .
According to its COI, defendant "[wa]s formed for scientific, educational, and
charitable purposes within the meaning of Section 501(c)(3) of the Internal
Revenue Code" and designed to: provide "health education services and
services which promote optimal use of primary and supplemental health services
including as necessary and appropriate services of bi-lingual outreach workers";
"serve as an active partner with the consumer, business labor, professional and
political groups and leaders to identify, address and take action on the region's
short and long term public health, environmental, and medical problems";
"advance the health status of the region's population through the provision of
appropriate health and medical care, programs of education, and research
activity"; "conduct and support research in the area of health services delivery
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and health education"; "provide information on the availability and proper use
of health services"; "conduct or support health care educational programs for
health care providers, health care managers and [the] general public"; and
"engage in or support scientific, clinical and health systems research and
disseminate the results thereof."
The parties have not cited, nor has our research revealed, binding authority
addressing a nonprofit medical center's non-educational activities. As stated in
the COI, those activities include the provision of "comprehensive primary health
services" and "supplemental health services." Much the same way the operation
of an on-campus pub in Bloom, and the provision of crafts and games in Rupp
did not eviscerate the educational nature of the defendants in those cases, we
conclude the medical services rendered in this case did not thwart defendant's
educational purpose. Rather, as evidenced by defendant's mission statement, its
mission is consistent with that purpose:
The mission of Newark Community Health
Centers is to provide affordable, high quality, and
accessible healthcare to the communities that we serve.
As one of the largest providers of comprehensive
primary care services for uninsured and medically
underserved populations in one of the country's most
populated areas, our primary goal is to eliminate health
disparities and help people live stronger, healthier, and
happier lives.
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Because we conclude defendant was organized exclusively for educational
purposes, as broadly construed by our jurisprudence, we need not conduct the
source-of-funds assessment required when an entity is organized exclusively for
charitable purposes. "Entities that can prove they are organized exclusively for
educational or religious purposes automatically satisfy the second prong of the
charitable immunity standard"; that is, "no further financial analysis is
required." Ryan, 175 N.J. at 346; see also O'Connell v. State, 171 N.J. 484, 491
(2002).
C.
As to the third prong, the motion judge correctly recognized the court must
make successive inquiries: whether, at the time in question, defendant was
promoting the objectives it was organized to advance; and whether plaintiff was
a "direct recipient of those good works." Green, 237 N.J. at 531. On appeal,
plaintiff only challenges the second inquiry. Contending she "did not need the
charity," plaintiff asserts she "presumably pa[id] full price for [her treatment]"
and, as such, "derived no benefit from . . . [d]efendant's non[]profit, charitable[]
practice." We are unpersuaded.
A party is a beneficiary of good works when he or she receives, in some
way, a benefit from the "charitable activities at the time of the accident." Hehre
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v. DeMarco, 421 N.J. Super. 501, 508 (App. Div. 2011). Thus, immunity from
liability does not extend to any person who is "unconcerned in and unrelated to
and outside of the benefactions" of the charitable corporation. N.J.S.A. 2A:53A-
7(a); see also Ryan, 175 N.J. at 353. However, a plaintiff's individual motivation
is not relevant to whether he or she was a "direct recipient" of the charity. See
Ryan, 175 N.J. at 350.
The second inquiry "is to be interpreted broadly, as evidenced by the use
of the words 'to whatever degree' modifying the word 'beneficiary' in the
statute." Id. at 353. That is, "[t]o be deemed a beneficiary, [the] plaintiff need
not have personally received a benefit." Auerbach, 368 N.J. Super. at 414; see
also Hehre, 421 N.J. Super. at 508. Thus, the third prong is satisfied where the
plaintiff's "'presence was clearly incident to accomplishment' of [the]
defendant's charitable purposes." Bieker, 169 N.J. at 180 (quoting Gray v. St.
Cecilia's Sch., 217 N.J. Super. 492, 495 (App. Div. 1987)).
Here, plaintiff's presence at defendant's premises – to receive an injectable
medication – was as a beneficiary of defendant's charitable works and in
accordance with defendant's mission statement: "to provide affordable, high
quality, and accessible healthcare to the communities" served by defendant .
Although plaintiff was charged a fee for the service, as Hogan acknowledged at
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deposition, Medicare paid less than the amount billed and plaintiff was not
required to pay the difference. Nor was plaintiff charged a co-payment. We
afford "substantial latitude" to the manner defendant advances its charitable
objectives. Bloom, 307 N.J. Super. at 491. We conclude plaintiff's treatment
fell within the scope of effectuating defendant's charitable purpose.
II.
Having concluded defendant is entitled to absolute immunity under
Section 7, we need not address plaintiff's alternate argument under Section 8.
We briefly do so for the sake of completeness.
Contending defendant was organized exclusively for hospital purposes,
plaintiff argues "a cap on damages rather than full immunity is applicable" under
Section 8, which provides, in pertinent part:
Notwithstanding the provisions of [Section 7],
any nonprofit corporation . . . organized exclusively for
hospital purposes shall be liable to respond in damages
to such beneficiary who shall suffer damage from the
negligence of such corporation . . . to an amount not
exceeding $250,000, together with interest and costs of
suit, as the result of any one accident.
To support her argument, plaintiff cites our Supreme Court's decision in
Kuchera. Similar to the present matter, in Kuchera, the "[p]laintiff slipped and
fell on a wet spot on a floor in an outpatient health care facility," 221 N.J. at
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241, and the facility "provides medical care for those 'who are uninsured,
underinsured, without a primary care physician and/or who lack access to
regular medical care,'" id. at 243. Unlike the present matter, however, the
defendant facility was "owned and operated by a nonprofit hospital." Id. at 241.
We upheld the summary judgment dismissal of the plaintiff's complaint,
"rejecting [her] argument that the health care entity that owned and operated the
facility was 'organized exclusively for hospital purposes,' and, therefore, [wa]s
entitled to the protections of [Section 8]." Id. at 241-42. Instead, we concluded
"the parent-hospital's provision of charity care and medical education rendered
the hospital a hybrid nonprofit institution organized exclusively for charitable
and educational purposes," thereby affording the hospital absolute immunity
under Section 7. Id. at 242.
The Court disagreed, stating: "Whether a nonprofit organization is
entitled to charitable immunity or subject to the limitation on damages afforded
to those institutions organized exclusively for hospital purposes turns on the
purpose of the institution, not the use to which the facility is put on any given
day." Ibid. Noting the outpatient health care facility was "an integral unit of
the [hospital] system," id. at 254, the Court concluded our decision failed to
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"account for the multi-function nature of the modern hospital and its role in the
provision of health care in this society," id. at 255.
Simply stated, unlike the health care facility in Kuchera, defendant is
neither owned nor operated by a nonprofit hospital. Rather, as stated above,
defendant was organized exclusively for educational purposes. We therefore
conclude defendant is not subject to the $250,000 limit set forth in Section 8.
To the extent not addressed, plaintiff's remaining contentions lack
sufficient merit to warrant discussion in a written opinion. R. 2:11-3(e)(1)(E).
Affirmed.
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