Articles Posted in Medical Malpractice Law in Maryland

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In Maryland medical malpractice cases, there generally are two types of claims that can be asserted. The first is a garden-variety medical malpractice claim that alleges that a physician provided negligent care (care that fell below the standard of care), which caused injuries and damages to the patient. The second is called lack of “informed consent” claim, through which a patient alleges that the physician failed to properly, appropriately and/or fully explain the treatment to the patient and to warn of any material risks or dangers of the treatment so that the patient can make an intelligent and informed decision about whether or not to go forward with the proposed treatment.

At trials in which only medical malpractice claims are at issue, attorneys who represent the doctor often try to introduce evidence that the doctor had conversations with the patient about the potential risks and complications of the treatment and that the patient agreed to move forward anyway. In other words, the medical malpractice defense attorneys try to show that the doctor complied with his obligation under the informed consent doctrine even where there has been no allegation that that doctrine was breached. The purpose of this strategy is to try to convince the jury: (a) that the medical malpractice victim assumed the risk of what happened; and (b) that the cause of what happened could not have been negligence or medical malpractice because the doctor warned the patient that the issue could occur.

Recognizing the flaws in that logic, the Maryland Court of Special Appeals held in the 2012 case of Schwartz v. Johnson that evidence that a physician warned the patient of the potential risks and complications of treatment is inadmissible in a pure medical malpractice lawsuit where no informed consent claim has been made. In coming to that decision, the Court of Special appeals held that such evidence is “irrelevant” to the patient’s medical malpractice claim and also “highly prejudicial” to the patient’s case.

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Understandably, one of the questions that we get asked most often when we first meet with new clients is “what is my case worth?” The law divides personal injury awards into two categories: economic damages and non-economic damages. While the facts of each particular case dictate which types of damages can be recovered, the following is a broad discussion of some of the types of damages available.

Economic damages are those which are easily capable of being quantified. In short, they are actual, monetary losses that a plaintiff has suffered as the result of a medical mistake (or other personal injury). The most obvious example of economic damages is lost wages. When an injury renders a person unable to work when they were able to work before, they generally can make a lost wage claim. Such a claim analyzes what their average earnings were, determines what their work-life expectancy would have been (i.e., how many more years they would have worked had they not been killed or injured), and then determines what their average earnings would have been over that period of time (taking into consideration factors such as wage increases and inflation). Importantly, a plaintiff may only make a claim for the present value of future lost wages. For example, if it is determined that a person would have earned an additional $1 million over a period of years if they had been able to keep working, the defense does not need to pay them $1 million today to settle that claim. Rather, the defense need only pay an amount which, when invested at reasonable rates of return currently available in the market, will yield a total recovery in the future of approximately $1 million. Usually, plaintiffs’ lawyers employ an expert economist to make this determination.

Another example of economic damages that a plaintiff can claim in a medical malpractice lawsuit is the medical bills and other care expenses incurred as the result of the malpractice. One important thing to remember about making a claim for medical bills is that most health insurers include “subrogation” clauses in their policies. These provisions obligate you, as the insured, to repay to your insurance company some or all of the medical expenses that the company paid out on your behalf in the event that you recover such expenses from a liable third party.

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In the context of any kind of medical malpractice lawsuit, there are generally two types of damages that can be claimed by the Plaintiff and/or ultimately awarded by a judge or jury: Non-Economic Damages and Economic Damages. Many times, our clients struggle with understanding the differences between these two types of damages and it is important to understand the distinction.

Economic damages are financial costs of an injured party’s trauma, including things such as past medical bills, future medical bills, future care costs and past and future wage/earnings loss. Future care costs, in particular, can often times range in the millions of dollars depending on the age of the injured party and the severity of the injuries suffered. For example, if a newborn infant has suffered a brain injury as the result of the negligence of an obstetrician, a medical expert known as a life care planner is often hired to project what types of care, equipment and services that child will require for the rest of their life, at each stage of their life. These types of damages include everything from the patient’s medications, motorized wheelchairs, physical/occupational/speech therapies, nursing care, in-home attendant care, etc. Other types of economic damages include the cost of modifying an injured party’s home to make it handicapped accessible for them or the provision of a modified van or car to allow them to operate it safely within the scope of their physical limitations. With respect to past or future loss of earnings/wages, once again, these damages can add up into the millions depending on the age of the plaintiff. In many instances, our office will retain an economist to examine what the injured party was earning prior to his/her injury and project those earnings forward to that individual’s reasonable work life expectancy (e.g., age 62, 65, 67 or 70). For individuals who are injured prior to the time that they enter the workforce, our economists are able to make projections as to their anticipated income based upon the education levels and work histories of their parents or guardians. There is no cap on economic damages.

Non-Economic damages, on the other hand, are designed to compensate an individual for less tangible losses related to the patient’s injury. In Maryland, this type of damage is generally referred to as the “pain and suffering” of the injured party. It is difficult to place a true number on this type of damage because often times the pain and suffering is immeasurable. Take for instance, someone who was injured through the fault of a health care provider and subsequently dies. Obviously, the pain and suffering they experienced is immeasurable as is the loss that the surviving family members (spouse, mother, father, children) have experienced. In Maryland, however, there are caps on non-economic damages. The current cap, for injuries occurring in 2015, stands at over $750,000 and legislation requires that it be raised each year by an additional $15,000. In the event of the death of an individual due to medical malpractice, certain family heirs are entitled to make a claim for the non-economic damages associated with the loss of their family member. This amount is also capped, but depends upon the number of beneficiaries that are bringing the claim.

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Most medical malpractice, wrongful death and personal injury lawyers in Maryland are hired by clients through a contingency fee agreement. In such an arrangement, the law firm generally is paid a legal fee based upon a percentage of the total amount recovered in the case plus expenses. If there is no recovery, there is no legal fee or expense. But what happens when the client fires the lawyer before there is any recovery.

The Maryland Court of Appeals recently had the opportunity to address this issue in the case of Brault Graham v. Law Offices of Peter Angelos. A copy of the court’s decision can be found here..

According to the court, “the client’s power to end the relationship is an implied term of the retainer contract,” and therefore, “if the client terminates the representation, with or without cause, the client does not breach the retainer contract, and thus, the attorney is not entitled to recover on the [contingency] contract.” The Court then made it clear, however, that an attorney may be entitled to recover legal fees on a quantum meruit basis. According to the court: “[W]here a client has a good faith basis to terminate the attorney-client relationship but there is no serious misconduct warranting forfeiture of any fee, the attorney is entitled to compensation based on the reasonable value of services rendered prior to discharge, considering as factors the reasonable value of the benefits the client obtained as a result of the services rendered prior to discharge and the nature and gravity of the cause that led to the attorney’s discharge.”

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In Maryland, the doctrine of informed consent requires a physician, before a patient undergoes a non-emergency medical procedure, to explain the proposed medical procedure to the patient including warning the patient of the benefits, risks and alternatives. The District Court for the District of Maryland recently had the occasion to review this law in the case of Robertson v. Iuliano, et al. A copy of the Memorandum Opinion can be found here.

In that case, Robertson underwent back surgery at St. Agnes Hospital in 2006 following an accident. After the surgery, Robertson developed an infection and two additional surgeries were required. The surgery was performed by Luliano, a doctor employed by Nuerosurgery Services, LLC. Robertson signed informed consent forms for the second and third surgery, but not for the initial surgery. Robertson subsequently filed suit against Luliano, Neurosurgery Services and St. Agnes claiming that he would not have undergone the surgery if he had known of the risk of infection and seeking damages from, among other things, loss of income and medical bills.

In the court’s opinion, the court determined whether to grant Motions for Summary Judgment filed by Neurosurgery Services and St. Agnes. In deciding summary judgment was warranted, the court took note of the fact that Robertson testified that he “did not know, did not care and did not ask” who employed Luliano at the time of the initial surgery. In Maryland, courts have declined to extend the duty to obtain informed consent from the patient to hospitals unless they “specifically assumed the duty” or the physician was an agent of the hospital. Here, the court found neither as Neurosurgery Services and St. Agnes never specifically assumed the duty and Luliano was not acting as their agent.

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Popular movies and television shows involving lawyers and lawsuits sometimes create misperceptions about how the justice system actually works. For one thing, while courtroom drama makes the most riveting entertainment, in reality the vast majority of cases end with amicable agreements between the parties involved. Actual trials are certainly more an exception than a rule.

In addition, fictional portrayals often present the image of a check being cut for the plaintiff in a case as soon as the verdict is handed down. The reality, however, is sometimes much more muddled. That is because there is often intense disagreement regarding various parties who may be involved, individual doctors, hospitals, speciality clinics, and multiple insurance companies. Sometimes the fighting after liability is handed down is far more contentious than the original trial itself. This is one of many reasons why it is important to have a medical malpractice attorney who is experienced in these cases and familiar with all of the ancillary issues that may come up and delay payment of damages.

Recent Maryland Med Mal Case

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In an opinion reported on November 27, 2012, the Court of Appeals of Maryland held that a settlement agreement executed in a Maryland medical malpractice case involving Mercy Medical Center was not effective to end the hospital’s liability. A copy of the Court of Appeals opinion can be found here.

In the case, Spence v. Julian, a Baltimore medical malpractice case that involved multiple defendants, Mercy Medical Center entered into a settlement agreement with the plaintiffs regarding the extent of Mercy’s liability. Prior to trial, the hospital was dismissed from the case, but the plaintiffs were successful against the remaining defendants. When the other defendants filed a contribution lawsuit against Mercy Medical Center, or an action to compel the hospital to contribute money toward the judgment, the hospital argued that it was shielded from liability under the terms of the release. The Court of Appeals found that the settlement agreement did not meet the statutory requirements set out in section3-1405 of the Courts and Judicial Proceedings Article of the Annotated Code of Maryland, and thus Mercy Medical Center was potentially liable to the remaining defendants under the contribution suit.

This case is another example of the increasingly complex nature of cases involving catastrophic injury, including medical malpractice, wrongful death, product liability, and major collisions.

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In a decision handed down by the Court of Special Appeals on June 6, 2012, Maryland’s intermediate appellate court clarified section 3-2A-02(c)(2)(ii)1B of the Courts and Judicial Proceedings Article of the Annotated Code of Maryland, which sets forth the requirement that, if the defendant in a medical malpractice action is board certified in a specialty, any expert witnesses who testifies that the defendant violated the standard of care must be board certified in the same or a “related” specialty. A copy of the Court of Special Appeals opinion can be found here.

The case, DeMuth v. Strong, was a medical malpractice case action initially brought by Strong in the Circuit Court for Cecil County against Dr. DeMuth, a board certified orthopedic surgeon. When Strong called a board certified vascular surgeon as an expert witness to testify that Dr. DeMuth had breached the standard of care in his treatment of Strong and that the breach had caused Strong’s injuries, Dr. DeMuth objected which ultimately formed the basis of the appeal.

The medical negligence Strong complained of began with a visit to Dr. DeMuth in 2005 as a result of knee pain due to arthritis. It was ultimately determined that Strong required total knee replacements for both knees. In 2007 at Harford Memorial Hospital, Dr. DeMuth performed a successful total knee replacement surgery on Strong’s right knee and, following recovery from the first surgery, a total knee replacement surgery on Strong’s left knee. The outcome and care rendered in the period following the surgery was the issue in this case.

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A recent study conducted by Massachusetts General Hospital in Boston reviewed over 10,000 medical malpractice claims filed across the country and found that plaintiffs rarely win medical malpractice cases that go all the way to a jury verdict. An article discussing the study can be found here.

Most claims that are filed, over ninety-five percent (95.5%), never even make it to a jury. More than half (54.1%) are dismissed or settled before trial. Of those four and a half percent (4.5%) of medical malpractice claims that go to a jury, almost eighty percent (79.6%) result in verdicts in favor of the physician.

The study also highlights the extremely long length of time spent resolving medical malpractice claims. Understandably, the cases that were settled out of court were often resolved the quickest at just over eleven and a half months (11.6), but those that were litigated in court often lasted over twenty-five (25) months. When cases progressed all the way to a jury verdict, those won by the physician, took thirty-nine (39) months whereas those in which the patient was successful took an outstanding forty-three and half (43.5) months – almost four years!

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A recent Court of Appeals decision, issued on January 27, 2012, involved a case that began over ten years ago and determined that awards for future medical expenses cannot be voided after the death of the personal injury plaintiff. A copy the judicial opinion regarding the case can be found here.

The case, Spangler, et al. v. McQuitty (McQuitty II), stems from what was initially a medical malpractice action. McQuitty, a minor, by and through his parents, sued an obstetrician and primary care physician, and their practice, for failing to obtain informed consent to treatment, after which McQuitty suffered severe injuries during his birth. In the first case, McQuitty I, the jury awarded McQuitty $13,078,515.00 in damages; $8,442,515.00 of which accounted for future medical expenses. Various post-trial motions were filed regarding this verdict, but McQuitty died in 2009 prior to the resolution of all proceedings.

Spangler, one of the doctors, subsequently filed motions seeking a new trial or reduction in the award of future medical expenses, arguing that McQuitty’s death changed the posture of the case and an award should not exceed that which would actually be expended. McQuitty’s family argued, conversely, that the death of a personal injury patient should not lead to the reopening of the case or the extinguishment of damages as a matter of public policy.