Factual Background to the One Satisfaction Rule

​The appellate court noted that the plaintiff has an extensive and complex medical history. (Op. At 2).

In 2009, the plaintiff reported chronic myalgias and extreme fatigue affecting her shoulders, wrists, neck, thoracic area, hips, knees, and ankles. Doctors then diagnosed her with osteoporosis and degenerative spine disease.  (Id.).

In 2012, the plaintiff suffered a traumatic brain injury (“TBI”) when she fell down a flight of stairs, resulting in massive intracranial bleeding that left her cognitively and physically disabled. Following her TBI, the plaintiff suffered from vision problems, balance disturbances, and reduced strength. She required assistance with virtually all activities of daily living, was unable to walk without assistance, dress, or use the bathroom independently, and was found to be “disabled” by the Social Security Administration. (Id.).

This history preceded the events that gave rise to one satisfaction rule issue.

Alleged Medical Malpractice

​On July 19, 2017, the plaintiff visited the defendant hospital’s emergency department with complaints of ongoing and worsening low back pain. She denied any recent falls and denied incontinence. On examination, she had normal strength in her lower legs. She was diagnosed with nontraumatic back pain, and, after a few hours, she improved in the emergency department and was released to receive physical therapy at home. (Id.).

On July 31, 2017, a physician saw the plaintiff following complaints of back pain and urinary incontinence. An MRI revealed a “severe compression deformity” and “stenosis and disc protrusion” in her lumbar spine. The plaintiff visited a spine surgeon on August 4, 2017, who prescribed her a back brace that she refused to wear and scheduled her for spine repair surgery to be conducted ten days later. Before the surgery could take place, however, the plaintiff was discharged from the surgeon’s practice after her sister was abusive toward the office. (Id.).

On August 19, 2017, the plaintiff was evaluated at a different hospital’s emergency department for the onset of generalized weakness and told staff that she had been falling several times a day due to her weakness. The following day, she required immediate medical intervention as a result of severe, life-threatening, or potentially disabling conditions. She transferred to the Johns Hopkins emergency department, where they admitted her. (Id. at 3-4).

The plaintiff subsequently underwent spine surgery on August 23, 2017. While recovering after the surgery in her hospital room, she fell when she attempted to go to the bathroom. Her right hip was fractured as a result of this fall, and corrective surgery was performed the following day. (Id. at 4). This was the unsettled claim part of the one satisfaction rule in this case.

Medical Malpractice Claim

​The plaintiffs filed a complaint in the Circuit Court for Frederick County on April 2, 2019, alleging medical malpractice during the July 19, 2017, emergency department visit. The plaintiffs’ complaint contended that the defendants’ negligent failure to diagnose contributed to the plaintiff’s development of cauda equina syndrome, conus medullaris syndrome, and permanent damages, including bowel and bladder incontinence, severe back and leg pain, numbness, and weakness. (Id. at 4-5).

The court twice postponed the trial until ultimately scheduling it for May 20, 2024. (Id. at 5).

Car Accident

​While awaiting the trial, on May 1, 2021, nearly four years after the alleged medical malpractice, the plaintiff was involved in a motor vehicle accident resulting in multiple injuries, including a left hip fracture. She had left hip surgery on May 2, 2021. Her medical records documented both current problems and historical ones. (Id. at 5-6).

On November 17, 2022, the plaintiff filed a complaint concerning the car accident case. The plaintiff settled the suit for $100,000 and gave a release concerning the accident. (Id. at 6-7). This was the settled claim in the one satisfaction rule issue. The release did not mention or carve out exceptions for the plaintiff’s then-pending medical negligence suit or any other injuries before the May 1, 2021, motor vehicle accident. (Id. at 7).

The plaintiffs did not disclose the motor vehicle negligence proceedings or the release to their trial counsel in the medical negligence case. Counsel learned afterward of the release. (Id.).

The defense moved for summary judgment based on the release, and the court granted it under the one satisfaction rule. (Id. at 8). The plaintiffs appealed. (Id. at 9).

Appellate Court of Maryland on the One Satisfaction Rule

The one satisfaction rule states that there can be only one satisfaction for the same injury. The first step is to identify what constituted the plaintiff’s alleged satisfaction. Satisfaction is an acceptance of full compensation for an injury. In addition, the unresolved negligence must flow legitimately as a natural and probable consequence of the satisfied injury. (Id. at 13).

In the second step, the court decides whether the satisfaction from the first-resolved action encompassed all of the injuries sustained by the plaintiff, including those injuries, in the subsequent proceeding, alleged to be attributable to the negligence in the second, unresolved action. (Id. at 14).

The alleged satisfaction here is the $100,000 payment that the plaintiff accepted in the motor vehicle negligence case. The Release was limited to injuries arising out of the car accident. This did not make the plaintiff whole for medical malpractice claims arising four years before the car accident. (Id. at 15-16).

In addition, the car accident case focused on the fracture of the left hip, while the medical malpractice case focused on matters that preceded the car accident: cauda equina syndrome, conus medullaris syndrome, and permanent damage, including bowel and bladder incontinence, severe back and leg pain, numbness, and weakness.

Because the motor vehicle negligence release did not represent a satisfaction of the plaintiff’s medical negligence claims, the Appellate Court held that the one satisfaction rule does not bar the medical negligence action from proceeding. (Id. at 19).

Commentary By Baltimore Medical Malpractice Lawyer Mark Kopec on the One Satisfaction Rule

​The analysis of the one-satisfaction rule in this case is straightforward. The medical malpractice did not flow from the car accident injury. It preceded it.  (Unlike a situation where a car accident caused injury, and during treatment for the injury, the plaintiff was harmed by medical malpractice. See Blog post, One Satisfaction: Gallagher v. Mercy)

Moreover, the plaintiff got separate injuries in the two events. The medical malpractice allegedly resulted in incontinence and pain in the lower back. The car accident resulted in a broken left hip.

There is no reasonable analysis that could conclude that the car accident settlement compensated the plaintiff for the medical malpractice injuries.

Practical Considerations

In the context of releases, I’ve previously written in this Blog about the importance of medical malpractice and car accident lawyers coordinating their efforts to ensure that their claims do not interfere with each other’s. In this case, no one told the medical malpractice lawyer about the car accident, the injury, the claim, or the settlement until afterward. That should not happen.

The bigger concern for the plaintiff in this case should not be the one satisfaction rule or the car accident injury. Rather, it is her prior history of disabling medical conditions. There is no question that the incontinence caused by cauda equina syndrome and conus medullaris syndrome is a horrible thing to have to live with. On remand, however, the defense will emphasize how difficult the plaintiff’s daily life was for years before the alleged medical malpractice occurred.

You can read other Blog posts on cases involving Damages and Settlement issues.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

Factual Background

In this case, the decedent received medical bills totaling $451,956. The plaintiff and her insurers paid $389,014.30, having received $62,941.70 in write-offs. (Op. at 3).

The plaintiffs then filed survival and wrongful death claims against the hospital in the Circuit Court for Baltimore County. At trial, the jury favored the survival claim and awarded $451,956 in past medical bills but nothing for non-economic damages. The jury also rejected the wrongful death claims. (Id. at 4).

The hospital then filed a motion to reduce the verdict/judgment. (Id). CJP 3-2A-09 allows a motion for reduction by the amount of the write-offs. (Id. at 2). The plaintiff opposed the motion, arguing that the federal Medicare Secondary Payer Act preempted the Maryland Act. The reason is that Medicare had a medical lien that would recoup $18,500 less if the Maryland Act is applied. The trial judge granted the motion and reduced the verdict to $389,014.30. (Id. at 6-7). The plaintiff appealed on the preemption issue. (Id. at 7).

Court of Special Appeals on Past Medical Bills

Medicare’s right to recoup its payments includes lawsuits where someone is found liable for causing the injury that produced the medical bills. 42 U.S.C. § 1395y(b)(2)(B)(ii). This right did not always exist, but Congress established it in 1980. Congress created the right to repayment to achieve major savings. (Id. at 8-10). The plaintiff relied on this to argue that the Medicare law must preempt the Maryland law. (Id. at 12).

The court rejected the plaintiff’s argument. Even with the Maryland law, the hospital has to pay 100% of the paid medical bills to the plaintiff, who has to reimburse Medicare. The fact that Medicare has regulations that provide it pays for procurement costs, which in this case will be higher based on paid medical bills rather than total bills, does not change the shifting of payment under the Medicare law, which happened as dictated. (Id.). The Maryland law only restricts verdicts by prohibiting a plaintiff from recovering medical expenses never incurred. The Maryland law does not conflict with the Medicare provision that mandates full reimbursement of conditional payments made by Medicare. (Id. at 17).

Commentary by Baltimore Medical Malpractice Lawyer Mark Kopec on Past Medical Bills

The Court of Special Appeals’ reasoning is sound. The application of Maryland law specifically affected only the part of medical bills that no one paid. As a result, Medicare’s ability to seek reimbursement for what it paid was unaffected.

It is true that Medicare received less than it would have if the court had not applied the Maryland law. That is because Medicare regulations grant an accommodation for the procurement costs of the medical malpractice lawyer. If the lawyer could recover medical bills that no one paid, Medicare’s share of the procurement cost would be less than if the lawyer only recovered medical bills paid. However, Medicare chose that accommodation, and it does not negate its right to recoup.

Consequently, the application of Maryland law does not significantly interfere with the purpose or functioning of Medicare law.

Practical considerations

Next to a complete defense verdict, the jury’s verdict in this case was the worst thing that could happen to a plaintiff. The jury thought they were awarding the plaintiff approximately $451,000. Under the law, the court did not tell the jury that the court would reduce this verdict amount to the amount actually paid, $389,000. Nor did the court instruct them that Medicare would have a right to recoup the entire amount. The court also did not tell the jury that Medicare would reduce that reimbursement by an amount to allow a legal fee to the lawyer. Under the law, the jury does not get this information.

Do you see someone who needs to be added to this equation? The plaintiff. When the jury denied claims of pain and suffering of the decedent of state and family members and only awarded medical bills, they effectively were awarding the plaintiff nothing.

As a practical matter, after the trial, the plaintiff, the medical malpractice lawyer, and Medicare probably discussed how the money that was awarded would be split so that no one would be left out. All three probably received less than they had hoped from this case.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

Factual Background

The plaintiff suffered injuries in a car accident in January 2009. (Op. at 1).  She then underwent two reconstructive breast surgeries in April of 2011 and October of 2012. In the month following the second surgery, the plaintiff developed an infection. When the medical provider inserted a PICC line to administer antibiotics, it damaged her brachial artery. The plaintiff had surgery to repair the artery and developed Reflex Sympathetic Dystrophy in her arm. (Id. at 2).

The plaintiff filed a lawsuit against the other driver and her own insurer for underinsurance coverage. (Id. at 2). In April and May of 2012, the plaintiff settled her claim against the driver. The driver paid $25,000, which was the full policy amount. The plaintiff provided a release to the driver that reserved her claim against her own insurer but did not mention the hospital. The plaintiff filed a dismissal with prejudice of her claim against the driver. (Id. at 3).

The plaintiff’s claim proceeded against her insurer. The damages that she sought would be important to the one satisfaction rule. In discovery responses, the plaintiff stated that she was seeking damages relating to both surgeries, the infection that followed, and the permanent arm injury that resulted. The plaintiff had expert witnesses testify to the causal connection between the breast surgeries and the car accident. (Id. at 4). 

As part of a discovery dispute, the trial court excluded some of the plaintiff’s medical bills from the PICC line procedure because they were produced too late. During the trial in January 2015, the parties settled the underinsurance claim for $125,000, which they dismissed with prejudice. (Id. at 5).

Medical Malpractice Lawsuit

In November 2015, the plaintiff filed a medical malpractice case against the hospital that had treated her. HCADRO transferred the case to the Circuit Court for Baltimore City. She claimed damages relating to the PICC line procedure. (Id. at 5-6).

Application of One Satisfaction Rule

The hospital filed a motion for summary judgment based on the one-satisfaction rule. The circuit court found that the damages the plaintiff sought were the same as she accepted in settlements in the car accident case. The court granted the motion for summary judgment. (Id. at 6-7).

The plaintiff appealed, and the Court of Special Appeals affirmed. The plaintiff appealed to the Court of Appeals. (Id. at 7).

Court of Appeals

A negligent driver can be liable for additional harm when others render aid, regardless of their negligence. There can be situations where a driver and subsequent doctor can both be liable for the same damage. However, where multiple people are responsible for harm, the plaintiff is entitled to compensation for her injuries. (Id. at 8).

The one satisfaction rule establishes that a plaintiff is entitled to one compensation for their loss, and satisfaction of the plaintiff’s claim prevents the plaintiff from pursuing another who may be liable for the same damages. (Id.). It is an equitable rule to prevent double recovery for the same injuries. (Id. at 9).

Satisfaction is an acceptance of full compensation for an injury. Once a plaintiff obtains total satisfaction, she cannot pursue another who may be liable for the same damages. (Id. at 9-10).

To assess the application of the one satisfaction rule, the court must compare the injuries for which the plaintiff received compensation in her first action and the injuries for which the plaintiff seeks compensation in the subsequent action. The court examines various materials from the earlier action, such as the complaint, the settlement agreement, and any expert reports, to make this determination. This process ensures the plaintiff does not receive double recovery for the same injuries. 

Application of the Rule

The plaintiff argued that the one satisfaction rule only applies when a defendant in the first suit pays a judgment in full. The court found that prior cases contradicted this argument. (Id. at 13-14).

The litigation between the plaintiff and the insurer encompassed years, and voluminous materials were available to the circuit court to assess the application of the rule. The court also had many materials from the medical malpractice case. There was no dispute about what the materials showed. (Id. at 14-15). The court found that these materials showed that the plaintiff’s settlement with the insurer covered all of the injuries that the plaintiff later sought in the medical malpractice suit. (Id. at 15-16).

The plaintiff argued that the settlement with her insurer did not constitute a full satisfaction of all of her injuries. She specifically relies on the court’s exclusion of some PICC line medical bills. She also says there was no total satisfaction because she compromised her claim for far less than she sought. (Id. at 17). The court rejected these assertions. The plaintiff voluntarily settled her first action, and the court would not revisit the value received. (Id. at 18). The court upheld the summary judgment. (Id. at 19).

Commentary by the Baltimore Medical Malpractice Lawyer on the One Satisfaction Rule

The one satisfaction rule, while straightforward in its statement, can be a labyrinth of complexities to navigate. The unique situation in this case, where a car accident victim becomes a victim of medical malpractice, is a scenario that arises from time to time, demanding a meticulous understanding of the rule.

The analysis of what damages to seek in each case can be complex. It can depend on the strengths and weaknesses of claims and defenses and the amounts of insurance available, among other factors.

It can be particularly challenging for a medical malpractice lawyer who did not handle the car accident case. In such a scenario, seamless coordination with the car accident lawyer becomes crucial to ensure there are no overlapping claims for medical malpractice damages. Even if the car accident lawsuit has concluded, the medical malpractice lawyer must meticulously review the file to determine its impact on the one satisfaction rule.

In this case, where the same law firm handled both cases, the plaintiff, following the Court of Appeals decision, sued her own law firm. This case serves as a stark reminder and a cautionary tale for medical malpractice lawyers, underlining the need for vigilance and foresight in their legal practice.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

Court of Special Appeals

The question before the court was what must be proven in a wrongful death medical malpractice case for a parent to recover damages for loss of household services from a deceased adult child under the Wrongful Death Act, CJP 3-901 et seq. On appeal, the Court of Special Appeals had vacated a $500,000 award in the Circuit Court for Baltimore City for loss of household services, which she would have received from her adult daughter, who died after receiving medical treatment from the defendant’s doctor. (Op. at 1). The CSA held that the evidence was insufficient, applying a three-part test:

[A] beneficiary must: (1) identify domestic services that have a market value; (2) have reasonably expected the decedent to provide the identified services, which—absent the decedent’s legal obligation to provide the services—will typically require evidence showing that the decedent was regularly providing the services in the past, and also (3) present some evidence concerning the duration the decedent would have likely provided the services. (Id. at 2-3).

The CSA was specifically concerned with the lack of market-value evidence and the absence of proof that the child intended to continue to provide the services in the future. (Id. at 4). 

Court of Appeals

The Court of Appeals upheld the CSA, ruling that the plaintiff had not introduced evidence to show the deceased child’s intent to continue to perform household services in addition to what the parent expected. (Id. at 5-6). 

There must be evidence that the deceased intended to continue providing the services. Specifically, this evidence can relate to a legal obligation, a written or verbal promise to provide the services, or actions by the deceased that show their intent. (Id. at 22). The court disagreed with the CSA’s emphasis on the duration of the services. (Id. at 32).

In this case, there was no proof that the deceased had a legal duty to provide services to her mother. There was no evidence of any promise, written or oral, by the decedent to her mother or provided to another that the daughter intended to provide services for any period. (Id. at 33).

The court noted that the daughter was in the habit of providing household services to her mother. Further, the daughter had lived with her mother her entire life. Moreover, the parent wanted to live with her daughter her entire life. However, those pieces of evidence needed to be sufficient to go to the jury, who would then determine the deceased’s intent. Allowing that evidence would let the jury speculate about the decedent’s intent. (Id.).

As a result, the court affirmed the CSA’s reversal of the $500,000 economic damages for household services. (Id. at 34).

Commentary by the Baltimore Medical Malpractice Lawyer on Household Services

In cases where there is no legal duty to provide household services, like in Fowlkes, the Court of Appeals has specified that the medical malpractice lawyer must present evidence of the deceased’s statements or actions that indicate an intent to continue providing the services in the future.

Comprehensive proof is key. The parent or another family member can testify that the adult child had stated that they intended to provide the services for their parent’s life. This kind of evidence can make a significant difference in the case.

It is less clear what actions will suffice. In Fowkes, it was not enough that the daughter had lived with her mother her entire life. But what if the adult child moves the parent into the child’s home? I believe that would be sufficient to indicate an intent to continue to provide the services in the future. But I wonder if the Maryland courts would agree.

That takes us back to statements. One way to make the intention to provide household services clear is to record the intention on paper and keep it with important papers. If that sounds unusual, then consider that it would take only a moment. Consider it like an insurance policy. In Fowlkes, the lack of proof of future intention cost the plaintiff $500,000.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

Case

The Appellate Court of Maryland recently issued an unreported opinion in Rivera-Ramirez v. Hall (February 12, 2023), addressing a per diem argument. The defendants provided medical services to correctional facilities. The plaintiff was a prisoner in Glen Burnie, Maryland. He injured his wrist in a fight with another inmate. (Op. at 1).

The defendants’ doctor saw the plaintiff. The doctor diagnosed him with a fractured wrist, gave him an ace bandage, and then told him the wrist would self-heal. However, the plaintiff continued to have pain and immobility and filed complaints. Six weeks later, an orthopedic specialist evaluated the plaintiff. The orthopedist then diagnosed the plaintiff with a severe wrist injury that had collapsed and would require a hand surgeon to do extensive surgery. (Id. at 1-2).

Trial

The defendants stipulated liability, and the trial court held a jury trial on damages. The plaintiff filed a motion in limine, asserting that he would be seeking non-economic damages only and seeking to exclude evidence of his medical bills. He argued that the bills were irrelevant to pain and suffering and would be misleading to the jury. The defendants opposed the motion, and the circuit court granted it. (Id. at 2).

At trial, the plaintiff introduced expert testimony that the delay in treatment resulted in a malunion of the bones, causing a permanent injury to his wrist. He also presented expert testimony that his life expectancy was approximately 50 years. (Id.).

In closing argument, the plaintiff’s lawyer requested an award of $100 per day for the plaintiff’s remaining life expectancy. The defendants objected, and the trial allowed the argument. Then the jury awarded $3 million, which the circuit court reduced to $770,000 under the Maryland cap on non-economic damages. CJP 3-2A-09(b)(1). (Id. at 4).

Appellate Court Decision Allowing Per Diem Argument

The Appellate Court noted that per diem arguments have been extensively debated outside Maryland. However, “it is clear that per diem arguments are permissible in this State.” (Id. at 6).

The defendants argued that the plaintiff’s number was improper because it was arbitrary and unrelated to any evidence. Not surprisingly, the Court rejected this argument, finding that the trial court was within its significant leeway in allowing the argument. The circuit court also rejected the defense’s argument that excluding the medical bills denied them the only effective way of opposing the per diem argument. The Court then repeated its prior holdings that there is no relevance between medical bills and pain and suffering. (Id. at 5-6). The Appellate Court upheld the circuit court judgment.

Commentary By the Baltimore Medical Malpractice Lawyer

Theory Behind Per Diem Argument

The idea behind the per diem argument is to give the jury a small dollar number to compensate the plaintiff for the injury for one day. Then the lawyer then shows how long the plaintiff will have to live with the injury. The lawyer usually does this by introducing the plaintiff’s life expectancy. Last, the lawyer puts these two together and arrives at a total damage figure.

Here is an example using the information from the Rivera case, first without the per diem argument and then with:

Without: The plaintiff has a permanent injury that he will have to live with for the rest of his life. His life expectancy is 50 years. You should award him $1,825,000.

With: The plaintiff has a permanent injury that he will have to live with for the rest of his life. Every day, he will be in pain in everything he does. $100 is reasonable compensation for a day of his pain. His life expectancy is 50 more years, that is 18,250 days of pain. As a result, the total award should be 18,250 times 100, which equals $1,825,000.

By focusing on one day, the lawyer can start small and get the jury on board with a fair number for one day. While that number is the lawyer’s opinion, what happens to that number is not. The life expectancy is evidence, not argument, and math ties the two together.

Given the attractiveness of per diem arguments for plaintiff lawyers, it is easy to see why defense lawyers try so hard to exclude them. However, examining the Rivera case shows that the defense has no basis for excluding per diem arguments in Maryland.

Result in Rivera

Part of the plaintiff’s strategy included excluding the medical bills. When medical bills are small, defendants use that number as an anchor to suggest that any pain and suffering award should also be small. However, the Rivera court excluded the bills on the well-established principle that there is no connection between medical bills and the amount of pain.

The plaintiff’s lawyer in Rivera employed the per diem strategy to obtain an excellent result of $770,000. That sum is the maximum the plaintiff could get under Maryland’s cap on non-economic damages. The jury’s verdict was $3,000,000. Apparently, the jury awarded significantly more than the plaintiff’s lawyer’s per diem argument requested. (By my calculation, the per diem argument totaled about $1.825 million)

Conversely, the defense of this case could not have gotten a worse result. To make the defense result even worse, the defendants paid their lawyers to pursue an appeal with little chance of success. The defense did not provide one Maryland case that supported excluding a per diem argument. Its availability in Maryland is well established. Predictably, they lost the appeal.

The defense’s result was likely made even worse by having to pay post-judgment interest to the plaintiff for the time it took the Appellate Court to decide the appeal. Maryland’s rule provides for post-judgment interest of 10%. Based on the trial court docket, the total post-judgment interest alone paid could have exceeded $120,000.

Conclusion: Per Diem Arguments Are Clearly Allowed

Per diem arguments are well established in Maryland. They are effective for plaintiffs, and the courts recognize that there is nothing unfair about them.

The defense opposing a per diem argument has options. They can request a cautionary instruction from the court that the per diem presentation is an argument, not evidence. They can also direct that observation to the jury without the court’s assistance. Additionally, the defense can argue to the jury that the plaintiff’s damage request is excessive by focusing on the total and not the per diem components.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.

Facts

The plaintiff had been in a single-car accident. As a result, he hit the guard rail and flipped several times. The defendant doctor did a fasciotomy to address compartment syndrome in the plaintiff’s right leg. The plaintiff alleged that the doctor negligently performed the procedure, resulting in an above-the-knee amputation of the leg. (Op. at 3). 

The plaintiff had other severe, permanent injuries from the car accident that were unrelated to the medical malpractice. They included an above-the-knee amputation of the left leg and severe and permanent damage to the left arm. (Id.).

The parties disputed over whether the life care plan was addressing needs and economic damages from the other car accident injuries. They also disagreed on the allocation of the burden of proof.

Plaintiff’s Witnesses

At trial, the plaintiff called five expert witnesses concerning the extent of his injuries and damages. They included an expert in prosthetics and orthotics. An orthopedic expert also testified. If the plaintiff had been treated timely, he probably would have had a leg he could walk on. However, he would have had trouble with recreational activities. (Id. at 5-6).

A physical medicine and rehabilitation expert also testified to the plaintiff’s current and future needs. A life care planner took the testimony of the other experts and created a care plan. (Id. at 6). She calculated the total care the plaintiff would need. She assumed he retained his right leg and subtracted that amount from the total cost of care he now requires. (Id. at 7). Additionally, an economist testified on economic damages that the present value of life care was $6.3-$6.5 million. (Id. at 9).

Defense Witnesses

The defense called four experts. An orthopedic surgeon testified that the right leg would have had nerve damage and constant pain. It would not have been very functional. An expert in prosthetics observed that the plaintiff’s chronic pain keeps him in bed 4-5 times per week. He added that every attempt to use a prosthetic had been unsuccessful so far. As a result, the expert concluded that the plaintiff was not a candidate for prosthetics. (Id. at 10).

The defense life care planner observed that the plaintiff had a nonfunctional left arm from the accident and that the subsequent medical treatment did not cause it. The plaintiff also would have had chronic back and body pain even if he kept his right leg. As a result, the defense expert concluded that the amount of care the plaintiff now needed was no different than the care he would have needed if he kept his leg. (Id. at 10-11).

Court Decision on Economic Damages

The jury found for the plaintiff and awarded over $6.2 million, all of which was economic damages except for $300,000 in non-economic damages.

The parties disputed whether the plaintiff’s injuries were divisible and, if so, who had the burden of showing apportionment of damages.

The Court noted that none of the parties had asked the trial court to determine if the injuries were divisible as a matter of law. The time to do so was at the admission of expert testimony or consideration of jury instructions. (Id. at 43). As a result, the Court did not address divisibility. Instead, it examined the plaintiff’s evidence to see if it was sufficient to support the jury’s award and concluded that it was. (Id. at 49).

Commentary By the Baltimore Medical Malpractice Lawyer

Economic Damages

The plaintiff and the defendant had facts to support their arguments on the plaintiff’s future needs. Even before the additional amputation attributed to the malpractice, the plaintiff had one leg amputation, a severe arm injury, and significant chronic pain. On the other hand, the plaintiff had an expert opinion that the amputation of the plaintiff’s only remaining leg caused him much greater needs than he would have had.

The Williams Court noted that each side had failed to ask the trial court for a ruling as a matter of law in its favor on the issue of divisibility. This observation surely is significant guidance for future cases. But would it have made a difference in this case? 

Based on the expert testimony discussed it would have been unlikely that the Court would have ruled on this issue as a matter of law. The trial court likely would have found that admissible expert testimony was disputed on the issue and would have let the jury decide the question. Therefore, the result would have been the same.

However, Williams is prompting lawyers on both sides to raise the issue of divisibility as a matter of law where appropriate and to address the accompanying burdens in jury instructions.

Mark Kopec is a top-rated Baltimore medical malpractice lawyer. Contact us at 800-604-0704 to speak directly with Attorney Kopec in a free consultation. The Kopec Law Firm is in Baltimore and helps clients throughout Maryland and Washington, D.C. Thank you for reading the Baltimore Medical Malpractice Lawyer Blog.