Long-Term Care Liability

In a unanimous, unpublished opinion issued on February 24, 2026, the New Jersey Superior Court, Appellate Division, affirmed the dismissal of claims against a rehabilitation facility based on the plaintiffs’ failure to prove proximate causation—an essential element of negligence claims as well as claims brought under New Jersey’s Nursing Home Act (NHA). Although unpublished, Burckhardt v. Advanced Subacute Rehabilitation Center at Sewell, LLC provides important guidance for defendants facing nursing home malpractice and Resident-Rights Act litigation. Background of the Case The decedent, Burckhardt, was a 72-year-old resident at Advanced Subacute Rehabilitation Center at Sewell (Advanced). He had numerous medical conditions, including encephalopathy, diabetes mellitus, hypertension, urinary tract infection, respiratory failure, dysphagia, and required assistance with activities of daily living, including eating. The plaintiffs alleged that Advanced failed to follow Burckhardt’s care plan by leaving him alone in his room while eating and failing to follow his care plan.  During that time, he choked and required emergency medical intervention and was hospitalized.  Burckhardt suffered cardiac arrest and died two days later. His children, the Estate representatives, filed suit against Advanced, alleging negligence and violations of the NHA based on the alleged failure to appropriately “monitor” him during meals as care planned for. Trial Court’s Ruling After five days of testimony, the trial court granted a directed verdict in favor of Advanced, dismissing all claims. The court concluded that the plaintiffs failed to present sufficient evidence of proximate causation. Specifically, Advanced argued, previously via summary judgment and again at trial, that neither of the plaintiffs’ medical experts offered sufficient testimony establishing that the alleged lack of staff presence was a “but-for” or “substantial factor” cause of Burckhardt’s injuries and death, as required under New Jersey law. The trial court agreed. It emphasized that the plaintiffs’ nursing expert, Bonnie Tadrick, testified only as to the applicable standard of care and an alleged failure to monitor, but admittedly did not offer an opinion on causation. The plaintiffs’ physician expert, Dr. Hood,  testified about the mechanics of choking and identified choking as the cause of death. However, Dr. Hood failed to opine that any conduct by the Advanced staff caused, increased the risk or worsened the choking episode. Without expert testimony linking the alleged breach of care to the outcome, the court found the plaintiffs’ proofs legally insufficient and dismissed the case. Appellate Division’s Analysis The Appellate Division affirmed, carefully analyzing the causation requirements for both negligence and NHA claims. The court held that the Estate failed to establish the essential causal link between any alleged lapse in care and Burckhardt’s injury. With respect to Nurse Tadrick, the court noted that while she testified about the standard of care and the need for monitoring, she admitted she was not offering a causation opinion—and could not do so under New Jersey law, which prohibits nurses from testifying about medical causation. Her testimony did not explain how staff presence in the room would have prevented the choking, altered its severity or the ultimate outcome. As to Dr. Hood, the Appellate Division acknowledged that he was qualified to testify on causation but found his testimony inadequate. Although he explained how choking occurs and identified it as the cause of death, he never testified that the alleged absence of staff caused the choking or was a substantial factor in producing the injury. He also never opined that the staff failed to timely respond to the alleged incident. The court stressed that to reach a jury, plaintiffs were required to present evidence from which a jury could reasonably conclude that the absence of staff increased the risk of harm and that earlier intervention would likely have changed the outcome. In this case, the plaintiffs failed to meet that minimal threshold. Nursing Home Act Claims and Causation The Appellate Division also squarely addressed whether NHA claims require proof of causation. The Estate argued they did not. The court rejected that argument, holding that causation is required even though the NHA does not explicitly use the word. The court reasoned that damages are, by definition, compensation for harm, and recovery without a causal connection would make little sense. The court further held that the NHA claims failed for an additional reason: the Estate did not establish a separate or distinct injury attributable to the alleged resident-rights violation. Even if causation had been established, the absence of proof that the alleged NHA violation resulted in an independent injury was fatal to the claim. Significance of Burckhardt Although unpublished, Burckhardt is a meaningful decision for defendants in nursing home litigation. The Appellate Division’s clear statement that NHA claims require proof of proximate causation—and an identifiable injury tied to the alleged statutory violation—provides defendants with a powerful basis for early motion practice. The decision supports dispositive motions at the summary judgment stage where plaintiffs’ experts fail to connect alleged care deficiencies to a specific injury. It also serves as a lesson to defense counsel to renew the dispositive motion grounds at the end of a plaintiff’s case, where appropriate.