Daniel Ertz v. Cooper University Health Care

NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION This opinion shall not "constitute precedent or be binding upon any court."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-3794-24 DANIEL ERTZ and SHARON VOGEL ERTZ, h/w, Plaintiffs-Appellants, v. COOPER UNIVERSITY HEALTH CARE, COOPER UNIVERSITY HOSPITAL, LYNDSEY PEREA, DO, ERIK LANHAM, DO, CHRISTOPHER SMITH, DO, JU- LIN WANG, MD, FELIPE GUZMAN, MD, LUDMIL MITREV, MD, ANNA GOLDENBERG- SANDAU, MD, RACHEL SENSENIG, MD, MERYL ABRAMS, MD, KEVIN OH, CRNA, AMANDA RADER, ROWAN UNIVERSITY, and ROWAN UNIVERSITY SCHOOL OF OSTEOPATHIC MEDICINE, Defendants, and MICHAEL WAVERKA,  Defendant-Respondent. _______________________________ Argued October 19, 2026 – Decided November 6, 2026 Before Judges Sabatino and Torregrossa-O'Connor. On appeal from the Superior Court of New Jersey, Law Division, Camden County, Docket No. L-3677-20. Saul J. Steinberg argued the cause for appellants (Zucker Steinberg & Wixted, PA, attorneys; Saul J. Steinberg, on the briefs). Claire Beth Neiger argued the cause for respondent (Goldberg Miller & Rubin, PC, attorneys; Claire Beth Neiger, on the briefs). PER CURIAM In this medical malpractice case, we review on appeal the trial court's grant of summary judgment to Nurse Michael Waverka, one of the many defendants who had been named in plaintiffs' complaint. For the reasons that follow, we affirm the summary judgment order and the court's denial of reconsideration. We do so substantially because plaintiffs have failed to retain a nursing expert necessary to establish and explain to a jury the pertinent standards of care governing Nurse Waverka's conduct. 2 A-3794-24  I. Because the parties are well familiar with the factual contentions and procedural history of this case, we need not set forth that background here comprehensively. The following summary will suffice. This case arises out of a hospital's post-surgery administration of a drug, succinylcholine, to plaintiff Daniel Ertz. The drug was contraindicated to administer to plaintiff because he had a family history of a rare condition known as malignant hyperthermia ("MH"). 1 After nevertheless receiving the drug in the Trauma Intensive Care Unit ("TICU"), plaintiff's fever spiked and he became very ill, causing him to be paralyzed. Plaintiff's theory is that during the 1 "Malignant Hyperthermia" is defined in Stedman's Medical Dictionary 928 (28th ed. 2013) as a "rapid onset of extremely high fever with muscle rigidity, precipitated by exogenous agents in genetically susceptible people, especially by halothane or succinylcholine." MH has been described as "a severe reaction to certain anesthetic medications, including halothane, isoflurane, sevoflurane, desflurane, or succinylcholine. The reaction is sometimes fatal. It is caused by a rare, inherited muscle abnormality." Robert H. Shmerling, M.D., Malignant hyperthermia, Medications and Treatments, (Mar. 31, 2026), https://www.health.harvard.edu/medications-and-treatments/malignant- hyperthermia-a-to-z. (Emphasis added). "When a person with this condition is exposed to one of these drugs: [(1)] muscle cells have unregulated accumulation of calcium[; (2)] the muscles contract and stiffen at the same time[; and (3)] there is a dramatic and dangerous increase in body temperature (hyperthermia)." Ibid. 3 A-3794-24 "handoff" of plaintiff to the TICU team after his surgery, no one informed the TICU team that plaintiff had a family history of MH. Sometime in the early 2000s, plaintiff Daniel Ertz and his wife (co- plaintiff Sharon Ertz) 2 first became aware that their children were genetically susceptible to MH. The couple learned of their family's predisposition to this ailment after one of their children suffered an MH "event" while undergoing surgery. Years later, in March 2019, while performing on stage at the high school where he was employed, plaintiff fell off the stage. He sustained serious injuries as a result of his fall, including a mild traumatic brain injury, multiple fractures of the lumbar transverse processes, a closed cervical fracture, and a displaced fracture of the left radius. Following his fall, plaintiff was taken to defendant Cooper University Hospital ("Cooper"), 3 where he was transferred to the hospital's TICU, specifically to undergo surgery for his radial fracture. It is undisputed by the parties that, leading up to the surgery, certain Cooper staff were made aware of plaintiffs' family history of MH. Accordingly, 2 We henceforth use the term "plaintiff" in this opinion to refer solely to Daniel Ertz, the hospital patient, unless the context is otherwise. 3 The complaint also names as a codefendant Cooper University Health Care. We use the term "Cooper" to refer to the hospital. 4 A-3794-24 a written anesthesia plan for the surgery was subsequently developed by plaintiff's treating physicians that specifically excluded the use of any MH- inducing anesthetics, including succinylcholine. 4 On March 7, 2019, surgery was performed on plaintiff without any immediate resulting complications. After his surgery had concluded, plaintiff was "handed off" 5 back to the TICU by defendant Waverka. 6 Plaintiffs allege that critical information regarding plaintiff's susceptibility to MH was not 4 "Succinylcholine" is defined in Stedman's Medical Dictionary 1861 (28th ed. 2013) as "[a] neuromuscular relaxant with short duration action that characteristically first depolarizes the motor endplate (phase I block) but is often later associated with a curare-like, nondepolarizing neuromuscular block (phase II block); used to produce relaxation for tracheal intubation and during surgical anesthesia." (Emphasis added). 5 According to deposition testimony subsequently elicited from former defendant in this matter Dr. Ludmil Mitrev, M.D., Waverka's designated "mentor and teacher" at the time of plaintiff's surgery, a "handoff" amounts to an event where medical professionals "hand off the care of the patient, and the purpose is to convey the information of what was done in the operating room so that care can continue." See also Jo Freel, MSN, RN, and Brandon Fleharty, MHA, MSN, RN-BC, PMP, CPHIMS, Standardizing handoff communication (Mar. 5, 2021), https://www.myamericannurse.com/standardizing-handoff- communication/ (defining a handoff as "a real-time process that involves the transfer of essential patient data from one caregiver to another.") 6 Please note that the record is somewhat inconclusive regarding whether anyone else participated in plaintiff's handoff along with Nurse Waverka, although it largely suggests that Dr. Mitrev accompanied defendant during the March 7, 2019 handoff. 5 A-3794-24 properly communicated to the Cooper team that took over plaintiff's care following the post-operative handoff. Two days after his surgery, while still in the TICU, plaintiff began experiencing increased respiratory problems, for which his treating physicians determined that intubation was needed. Not realizing plaintiff's susceptibility to MH, one of these treating physicians (later named as a defendant in this suit, but who is not a subject of the current appeal) authorized the use of succinylcholine for plaintiff's intubation, which was administered to him on the night of March 9, 2019. The following morning, plaintiff's internal temperature had risen to approximately 107.1 degrees Fahrenheit. Plaintiff was diagnosed with having experienced an MH episode as a direct result of having been administered succinylcholine. As a result of these events, plaintiff developed tetraplegia, 7 severe speech difficulties, and other related conditions that have purportedly rendered him totally disabled. 7 "Tetraplegia" is a synonym of the term "quadriplegia," which itself is defined by Stedman's Medical Dictionary 1616 (28th ed. 2013) as a "[p]aralysis of all four limbs." 6 A-3794-24  Plaintiffs originally sued the hospital and numerous doctors and staff. All but one of the named defendants have either settled or had their cases dismissed, except for a nurse involved in the handoff, Waverka, who is the sole respondent. At the time of the handoff, Waverka was working as a "Student Registered Nurse Anesthetist" ("SRNA"). His recollection is that Dr. Mitrev, the physician anesthesiologist for plaintiff's surgery, was with him during the handoff. Notably, as we will discuss in detail, the hospital's written policy concerning handoffs places responsibility on either the anesthesiologist doctor or a "Certified Registered Nurse Anesthetist" ("CRNA") to communicate the "patient" (not explicitly "family") history regarding contraindicated drugs. The policy is silent about students serving as SRNAs. Discovery in this litigation was extensive and took many years to complete. In the spring of 2023, plaintiffs timely served defense counsel with a report of their anesthesia expert, Dr. Paul D. Allen, M.D., Ph.D. In his report, Dr. Allen opined that the "[standard] of care for [an] anesthesiologist who is told of [a] confirmed MH event in [the] child of [a] patient" is to: (a) "[c]onsider [the] patient to be MH susceptible and prepare [an] anesthesia plan accordingly;" and (b) "[e]ither attend the handoff or make as sure as possible that whoever from [Cooper's anesthesia department] is handing off the patient fully informs 7 A-3794-24 the original sending unit of the MH family history and to avoid volatile gases/succinylcholine going forward." (Emphasis added). Plaintiffs have not retained an expert witness to opine about the standards of care for SRNAs concerning handoff information. Plaintiffs attempt to excuse the lack of such an expert by relying on Waverka's testimony during his deposition. Plaintiffs contend that, given Waverka's deposition answers, a jury could evaluate his actions and inactions without a nursing expert, under principles of "common knowledge." In an oral opinion dated May 27, 2025 and corresponding order, the motion judge granted summary judgment to Waverka because of plaintiffs' failure to obtain a nursing expert to opine on the appropriate standard of care for an SRNA involved in the handoff of a patient. Among other things, the judge stated: This case involves the proper procedures and protocols for a hand-off from the operative team, the surgical team to the [Critical Care Unit ("CCU")]. 8 The medical issue here requires expert medical proofs concerning the requisite standard of care in that particular setting, that is the hand-off, especially – well, in that particular setting, again, the hand-off. 8 The judge appears to be referring to the hospital department otherwise denoted in the record and the parties' appellate briefs as the "TICU." 8 A-3794-24  The [c]ourt finds that in this circumstance, consistent with [Cowley v. Virtua Health Sys., 242 N.J. 1, 22 (2020)], ["]a jury does not have common knowledge in regard to what should be done in this situation.["] The standard of care for a nurse in this case requires clarity in what should have been done and the effect of patient's refusal on the mandate, again, as occurred in Cowley. As such, [] plaintiff requires an expert in the field of nursing to testify as to the standard of care for this student nurse. Again, [] Nurse Waverka was described as a student RN, that is, a student registered nurse anesthetist, SRNA. The judge continued: Dr. Mitrev under the arrangement with LaSalle University became a preceptor or mentor and teacher, as he described in his deposition, to Nurse Waverka. There are issues as to whether Dr. Mitrev was present, what information was actually conveyed, what information should be conveyed, who should convey that information. In this instance, the policies and procedures that would apply to a student nurse under the circumstance of such a hand-off need to be established in the form of testimony from a qualified expert that would have to be a nurse. . . . Plaintiff did present an affidavit of merit for Nurse Waverka. It was done by I think a Dr. Evans, [M.D.], who would not be competent to testify as a standard of care, as I understand, of a nurse. That would have to be an expert nurse. [P]laintiff does not 9 A-3794-24  have an expert nurse to establish the standard of care and the deviation from that standard of care.[ 9] .... So the Court finds that plaintiff is required to have an expert in the field of nursing to establish the standard of care for a student nurse anesthetist. [P]laintiff argues that the jury should be permitted to establish for themselves the standard of care based on [] plaintiff's position that it is as described a discrete moment where the patient plaintiff was being handed over from after surgery to the CCU and what information was conveyed, particularly in the sense that this was a student nurse and the expectations or obligations of the student nurse is a major issue in this case. What was that student nurse's obligation? Was Dr. Mitrev present? And while these could be argued as being issues of material fact, the bottom line here is that the plaintiff needs an expert in nursing to establish the standard of care and deviation of Nurse Waverka. Plaintiff does not have that. As such, I'm granting summary judgment. I find no material issue of fact based on [] plaintiff's failure to produce an expert to testify as to deviation of the lone remaining defendant Nurse Waverka. [(Emphasis added).] 9 The affidavit of merit ("AOM") from "Dr. Evans," has not been furnished to us in either of the parties' respective appendices. The sufficiency of the AOM is not an issue before us. See N.J.S.A. 2A:53A-27. (Regarding the AOM requirement for licensed professionals such as nurses). 10 A-3794-24  Plaintiffs moved for reconsideration. After oral argument, the court denied the motion, emphasizing the critical need of plaintiffs to present a standard-of-care expert: In [his] motion, [] plaintiff argues – and, of course, the [c]ourt is applying the reconsideration standard naturally, but the argument is that the [c]ourt overlooked matters, specifically that [d]efendant Waverka was a nurse and apparently training . . . possibly to be a nurse anesthetist. In any event, nonetheless, a student nurse at the time. That he received his bachelor's degree in 2014, he began at Cooper in 2017. He knew the importance of a hand-off and knew that conveying significant information. These are all matters that have been argued and the [c]ourt – let's be clear, the plaintiff has not offered an expert witness. I don't know that we can go, you know, past that. Plaintiff's counsel argues that, no, [d]efendant Waverka had done a lot of hand-offs in similar circumstances, that [d]efendant Waverka knew how this should be done. [That] [d]efendant Waverka will provide the standard of care and then the plaintiff will be able to utilize the standard of care established by [] defendant and contend that that was breached. I made clear at the time of ruling on this matter that the basis for the dismissal is the failure of [plaintiffs] to provide expert testimony. The [c]ourt vehemently disagrees with plaintiff's counsel that he doesn't require expert testimony. Had there been expert testimony establishing some level of responsibility for this student nurse, perhaps, depending, that would give [] plaintiff an opportunity to seek to establish responsibility against Waverka. Without an expert 11 A-3794-24  establishing the standard of care and breach of that standard of care, the claim fails. So for the reasons previously stated, and certainly with regard to this motion to reconsider, the [c]ourt wishes to be clear that the [c]ourt did not fail to appreciate any facts. The [c]ourt did not fail to consider appropriate applicable law. The [c]ourt was thorough in analyzing the aspect and again falling squarely on the principle that in this case the standard of care does not establish itself. [Plaintiff] has an obligation to establish that and [] plaintiff can't establish that through the defendant. Problems might arise. The idea is you get a nurse or an expert that can testify as to a nurse student anesthetist. Maybe fundamentally that was the problem. The point is that however it plays out, an expert is required and there is no expert. The matter is denied. The motion for reconsideration is denied for that reason. [(Emphasis added).] The present appeal then followed. Essentially, plaintiffs reiterate their position before the trial court, namely that they had no need to retain a nursing expert to evaluate Nurse Waverka's conduct in the handoff, and that his own deposition testimony amply fills the supposed gap on standards of care. II. In reviewing this appeal, we apply familiar principles concerning summary judgment. An appellate court reviews a trial court's grant or denial of 12 A-3794-24 a motion for summary judgment "de novo, applying the same standard used by the trial court." In re Est. of Jones, 259 N.J. 584, 594 (2025) (citing Samolyk v. Berthe, 251 N.J. 73, 78 (2022)). This standard requires that "[t]he appellate court consider[] 'whether the competent evidential materials presented, when viewed in the light most favorable to the non-moving party, are sufficient to permit a rational factfinder to resolve the alleged disputed issue in favor of the non-moving party.'" Ibid. (quoting Padilla v. Young II An, 257 N.J. 540, 547 (2024)) (emphasis added); see also Brill v. Guardian Life Ins. Co. of Am., 142 N.J. 520, 540 (1995); R. 4:46-2(c). We accord no special deference to the motion judge's assessment of the documentary record, as the decision to grant or withhold summary judgment does not hinge upon a judge's determinations of the credibility of testimony, but instead amounts to a ruling on a question of law. See Manalapan Realty, L.P. v. Manalapan Comm., 140 N.J. 366, 378 (1995) (noting that no "special deference" applies to a trial court's legal determinations). We also are guided by basic substantive principles of the law of medical malpractice. A medical malpractice plaintiff generally bears the burden of proving: "'(1) the applicable standard of care; (2) a deviation from that standard of care; and (3) that the deviation proximately caused the injury.'" Wiggins v. 13 A-3794-24 Hackensack Meridian Health, 259 N.J. 562, 583 (2025) (quoting Haviland v. Lourdes Med. Ctr. of Burlington Cnty., Inc., 250 N.J. 368, 384 (2022)); see also Model Jury Charge (Civil), 5.50A, "Duty and Negligence" (2002); Model Jury Charge (Civil), 6.10, "Proximate Cause — General Charge to Be Given in All Cases" (1998). The plaintiff in a medical malpractice case generally must provide competent expert testimony in order to establish that each defendant deviated from that applicable standard of care. Ibid.; see also Schueler v. Strelinger, 43 N.J. 330, 345 (1964); Model Jury Charge (Civil), 5.50A, "Duty and Negligence" (2002). The plaintiff generally must also provide competent expert testimony that "the deviation was the reasonably probable cause of the injurious condition arising thereafter." Germann v. Matriss, 55 N.J. 193, 208 (1970); see also Model (Civil) Jury Charges § 6.10. Subject to the so-called "common knowledge" exception discussed below, infra, it is well settled that a claim for medical malpractice or professional negligence by a health care worker must be supported by expert opinion. Parker v. Goldstein, 78 N.J. Super. 472, 479-81 (App. Div. 1963); see also Rosenberg v. Tavorath, 352 N.J. Super. 385, 399 (App. Div. 2002); N.J.S.A. 2A:53A-27 (requiring an affidavit of merit at the commencement of the action by an 14 A-3794-24 appropriate expert vouching for the legitimate grounds for the claim of deviation). Such an expert must detail the standard of care for the professional and identify how the professional deviated from that standard. Parker, 78 N.J. Super. at 479-80; see also Wiggins, 259 N.J. at 583 (same) (quoting Haviland, 250 N.J. at 384). In the present case, plaintiffs essentially rely on three sources to satisfy their evidentiary burden respecting the applicable standards of care for Waverka: (1) the May 2023 expert report of Dr. Allen; (2) the hospital's policies and affiliation agreement for student nurses; and (3) Waverka's own deposition testimony. None of these sources is adequate to establish the applicable standards of care for an SRNA involved in a patient handoff. Dr. Allen's Expert Report As we have noted, Dr. Allen is a physician and not a nurse. His report addresses both issues of causation and liability. We agree with plaintiffs that the report is arguably sufficient to support a claim of medical causation at the hospital, i.e., that the improvident administration of succinylcholine to plaintiff proximately caused plaintiff's severe reaction to the drug and his injuries. However, we agree with the trial court that Dr. Allen's report does not 15 A-3794-24 substantiate the standards of care governing the conduct of an SRNA such as Waverka. Dr. Allen's report focuses on the standard of care for the "anesthesiologist who is told of [the] confirmed MH event in [the] child of patient." The expert thus places accountability on the anesthesiologist in supervising the staff involved in the handoff, such as Nurse Waverka. Presumably the report was utilized to plaintiffs' advantage in resolving their claims against the now- dismissed hospital and defendant physicians. But it does not establish the standards of care for an SRNA, even one who already is a licensed nurse without a CRNA certificate. The Hospital's Affiliation Agreement and Policies The arrangements for Waverka's role at Cooper as an SRNA are described in the record as follows: An "affiliation agreement" between the Cooper Health System, to which the hospital belongs, and LaSalle University, where Waverka received his master's degree in nursing, obliges Cooper to carry out the following responsibilities: 1.7 Students shall be under the direction, supervision, and control of Cooper with respect to their relationship with Cooper's patients and employees. Cooper may set standards and establish reasonable rules and regulations that may govern the conduct of all Students rotating at Cooper. 16 A-3794-24  1.8 Cooper shall make available to students and faculty its Administrative and Departmental Policies and Procedures via the Cooper intranet. [(Emphasis added).] In October 2016, section 3.1.3 of the affiliation agreement, listed under the heading "joint responsibilities," was further amended to read: "Graduate Nursing Experience: Students will be under the direct supervision of Cooper Physicians and/or Cooper Advance Practice Nurse preceptors." Section 3.2 of the agreement also provides that: School and Cooper shall assure the Clinical Site is conducted, and Students are required to conduct themselves, in accordance with (a) the Commission on Collegiate Nursing Education (CCNE); (b) all applicable policies, procedures, rules and regulations of Cooper; (c) full observance of all appropriate professional conduct; (d) full cooperation with other health care professionals; and (e) safe and effective patient care under supervision commensurate with the Students' level of advancement and responsibility. [(Emphasis added).] In his deposition testimony, Waverka testified to the following regarding his education and work experiences in the field of nurse anesthesia before plaintiff's care: Q. Where are you currently employed? A. Cooper University Hospital. 17 A-3794-24 Q. What capacity? A. I'm a certified registered nurse anesthetist. Q. When did you become certified? A. In November of 2019. Q. All right. When did you start training – let me go back. What is your nursing background by way of education and then employment? A. So I originally received my associate degree in nursing in 2012 from Ocean County College, New Jersey, and then in 2014 I finished my bachelor's at Rutgers University, and then I graduated with my master's in November of 2019. Q. Okay. Where did you get – you got your master's from Rutgers? A. From LaSalle University. That's for my training. Q. When did you first start working in the capacity of being a nurse? A. A nurse, would be September of 2012. Q. And what type of nursing duties were you doing? A. Sorry. I was a critical care nurse. Q. At where? Where? A. So I started at – so long ago. Let me think. I was in Toms River, Community Medical Center. .... 18 A-3794-24 Q. So that in March of 2019, were you a visiting nurse from Kennedy? A. March of 2019, I was a student at Cooper University Hospital. Q. Okay. In what program? A. LaSalle University? Q. You were a student at LaSalle but working at Cooper as part of your training? A. I was not working there. I was there for my clinical rotations. Q. Okay. Okay. So while at LaSalle, were all your clinical rotations done at outside hospitals? A. Correct. So I was at Einstein Medical Center, Cooper, and that's it. Q. Okay. How long were you at Cooper? A. I started Cooper in September of – I'm sorry, December of 2017. Q. And when did you leave Cooper, or did you ever leave Cooper? A. I technically never left. So I stayed on when I graduated as a per diem. So I never left Cooper once I started there from December of 2017. I graduated, like I said, in November of 2019, and then waiting for credentialing and state licensure. I started with them per diem in February of 2020. [(Emphasis added).] 19 A-3794-24 Waverka went on to describe his training this way: Q. Okay. What training did you receive to become a certified registered nurse anesthetist? A. Clinically or educationally? Q. Educationally, and we'll start there. A. Be [sic] a master's degree of nursing with a certificate in anesthesia. Q. In anesthesia? A. Uh-huh. Q. All right. And then clinically, what training did you receive? A. It's set by our credentialing agency and we would have to meet a minimum of clinical hours as well as certain case logs that we have to meet to graduate our program. So Cooper was my main clinical site, and I can't tell you how many hours I would have done there without looking at my logs. Q. When you were at Cooper, before you became certified, was your title student – A. Yes. Q. – registered nurse anesthetist? A. Yes. Q. SRNA, correct? A. SRNA, correct. 20 A-3794-24  Q. And in March of 2019, while at Cooper, were you an SRNA? A. Yes. [(Emphasis added).] Elsewhere in the record, in the deposition testimony of Dr. Mitrev, Waverka's status as an SRNA at the time of plaintiff's surgery was similarly confirmed, both by plaintiffs' counsel and by Dr. Mitrev himself: Q. . . . So if, in fact – and we all can agree that Michael [Waverka] was an SRNA on March 7th[, 2019]. Did he have a mentor, teacher, preceptor, something like that from a CRNA standpoint with him at all times? A. No. At the stage of his training, he does not require such a mentor from the standpoint of CRNAs. I would have been his mentor and teacher. Q. Okay. So when you progress to a certain stage, then you can – it's like a transition, you can start doing well, but you still have an attending [physician] there? A. Yeah, yeah, exactly, after the first however long, however many months. [(Emphasis added).] Although plaintiffs have stressed before us that Waverka had been present at or taken part in dozens of handoffs before the March 7, 2019 handoff at issue here, he nonetheless was a student rather than a fully qualified nurse anesthetist 21 A-3794-24 at the time. As such, the applicable standard of care in this case is that which governs an SRNA, rather than a CRNA. Plaintiffs point to a one-page hospital policy, which they contend governed Waverka's conduct as a person under the supervision and authority of Cooper's Anesthesia Department during plaintiff's handoff. Section I of the Cooper policy, titled "purpose," specifies that the document "define[s the] responsibilities of the anesthesia care team in transitioning patients postoperatively to ensure appropriate post-operative monitoring and transition of care/patient handoff." [(Emphasis added).] Under Section II of the policy, titled "scope," the document additionally states that it applies to "[a]ll anesthesia personnel." [(Emphasis added).] On its face, at first blush, such broad language arguably might include SRNAs like Waverka. However, Section III of the policy reads as follows: The following items should be noted, at a minimum, when the patient enters the recovery unit and conveyed to the receiving care team: 1. Condition of the patient upon arrival in the recovery unit. 2. Amount of fluids administered. 3. Drugs administered. 4. Vital signs monitored. 22 A-3794-24  5. Invasive lines and airway devices. 6. Pertinent patient history, labs and test results 7. Perioperative course. 8. Items for follow up. 9. If patient is to be discharged immediately post-operatively to the Critical Care Unit on a ventilator,[ 10] the following should be carried out: a. It shall be the responsibility of the anesthesiologist to ensure that appropriate ventilator orders are written in conjunction with the attending critical care physician or fellow. b. It shall be the responsibility of the Anesthesiologist or CRNA transporting the patient to make sure that the personnel who will follow his/her course in the ICU (e.g. Surgical Resident, Surgical Attending, Critical Care Group, etc.) are aware of all relevant patient status data which he/she considers significant. c. Further orders for the patient's management will be written by the ICU Surgical Resident. [(Emphasis added).] 11 10 As plaintiff apparently was. 11 Notably, the policy does not contain any explicit mention of "family" history. 23 A-3794-24  Hence, subsection 9(b) of that policy explicitly places responsibility for the transmission of "all relevant patient status data" during a handoff in this context upon either the anesthesiologist or the CRNA, not upon SRNAs such as Waverka. Moreover, at his deposition, when Waverka was asked if Cooper had "any policy or procedure in place that you were aware of as of March 7, 2019, as to who was supposed to participate in the hand-off of a ventilated patient?" Waverka responded: "[n]ot that I know of." Hence, the pertinent standard of care for an SRNA is not established by Cooper's affiliation agreement or its hospital policies. Waverka's Own Deposition Testimony As a third evidentiary possibility, plaintiffs argue the deposition testimony of Waverka himself suffices to express the applicable standards of care governing his own conduct during the handoff. Like the motion judge, we are unpersuaded by that contention. We are mindful that, during his deposition, Waverka did state at several points his personal understanding of his duties as an SRNA during the handoff. For instance, he testified about his computer review and logging tasks: Q. So would you have reviewed with the receiving person the types of anesthetics that were used? 24 A-3794-24 A. Yes, because below that I would say medications that I gave, so . . . Q. Okay. So you would review that Rocuronium was used, that Propofol was used, Lidocaine was used, etc., correct? A. Correct. So when we give hand-off, we log into the anesthetic record and review it with the person that we're handing off to. Q. Where do you log into the record during the hand- off? A. On a computer. Q. And would the computer be the one that's in the patient's room? A. It would depend. Q. Or outside it? A. Right, in the vicinity. Q. Okay. And the vicinity would be either in the room or within ten feet of the room; is that a fair statement? A. It depends, because they have mobile computers, too. Q. Okay. But in any event, during the hand-off, when you get to the patient's area, TICU, and you're handing the patient off to the receiving person, you log into the anesthesia record; is that correct? A. I do personally, yes. 25 A-3794-24  Q. And has that been your practice the entire time you've been practicing? A. Yes. Q. Was that your practice before March 7, 2019? A. Yes. That's how I was trained to do it. Q. Okay. As we sit here today, from the time you began your training through and including March 7, 2019, is there any memory you have as to not following the practice of logging into the anesthesia record to discuss with the receiving person? A. Not that I can recall, no. Q. Okay. It says in this hand-off section, anesthetic complications reviewed, right? A. Correct. Q. Prepopulated or something you selected? A. Something I would select. Nevertheless, in describing these handoff situations, Waverka acknowledged that a physician would also "typically" be present: Q. Okay. So on the receiving end at Cooper, from the time you first started working there through March 7, 2019, was there always a nurse there to receive the patient? A. Per hand-off? Q. Yes. I'm sorry. I meant during the hand-off. 26 A-3794-24 A. Yes. Q. How about a resident physician or an attending or a fellow at the receiving unit, was there typically a physician? A. In the ICU, yes. Q. So a[t] TICU, there was probably a physician there, as you recall, when you handed off [plaintiff] to TICU? A. Most likely. I don't recall specifically, but most likely. Q. And why do you say that it's most likely that there would be a physician there at a TICU hand-off? A. It would depend on if the patient, or they were busy at the time. You know, they're not required to be there when we give the hand-off because they're just not required to be there. Q. Okay. But you said typically there would be a physician there – A. Correct. Q. – for the hand-off. Okay. A. If they're available. Q. Okay. Fair enough. Do you have any recollection one way or the other was to whether or not there was a physician there for the hand-off of [plaintiff]? A. I do not