Introduction

The Baltimore Medical Malpractice Lawyer Blog reports on a recent Appellate Court of Maryland reported opinion. It is on the legal landscape surrounding psychiatric immunity for medical malpractice and third-party liability. The case is Jacob Caples, et al. v. Sinai Hospital of Baltimore, Inc., et al. (No. 1527, September Term, 2024; filed May 1, 2026). The court addressed an issue regarding the statutory immunity traditionally granted to mental health care providers. 

Specifically, the court was asked to determine whether the Circuit Court for Baltimore City erred. It dismissed a wrongful death lawsuit under Maryland Code, Courts and Judicial Proceedings Article (“CJP”) section 5-609. This statute generally protects psychiatric professionals from civil liability for failing to predict or warn of a patient’s violent behavior. In reversing the lower court’s dismissal, the Appellate Court applied a legal precedent: psychiatric immunity does not apply when a patient expresses generalized homicidal intent and is directly discharged into the care of a readily identifiable victim within a foreseeable zone of danger.

Factual Background – Psychiatric Care Immunity & Medical Malpractice

The tragic facts under review are derived from the plaintiffs’ complaint and an accompanying case summary prepared by a doctor.  On November 17, 2020, the patient voluntarily admitted himself to the inpatient psychiatric unit at the defendant hospital after experiencing severe suicidal ideation involving a plan to harm himself with a knife. Hospital’s initial documentation recorded that the patient suffered from suicidal tendencies, irrational suspicion thoughts, and catatonic symptoms.

While hospitalized, the patient’s psychological state deteriorated into severe homicidal ideation. Hospital records revealed that on two separate occasions—including the very morning of his discharge—the patient explicitly told hospital staff that he wanted to kill “anyone that came near him” and “anyone who comes close”. Furthermore, the patient twice failed to check the assessment boxes confirming he was free of homicidal or suicidal thoughts on paper forms provided by staff. He also exhibited episodes of aggression that required chemical restraint/medication.

Despite these indicators, on November 24, 2020—just four hours after his second homicidal declaration—hospital discharged the patient “home to wife”. The hospital signed off on his release into the care of his spouse, without providing her, or the patient’s outpatient provider, any warning regarding his explicit homicidal ideations or aggressive episodes.

Eight days later, the patient acted on those thoughts. He bludgeoned and stabbed his wife to death in their home. A court later convicted the patient of first-degree murder and found him criminally responsible, resulting in a life sentence.

The Parties and Their Arguments

The action was brought in April 2024 by the adult sons of the decedent, and the decedent’s father, and as co-representatives of the estate. They filed a wrongful death and survival lawsuit alleging that the hospital and nurse practitioner who authorized the discharge were profoundly negligent in failing to warn the decedent of the imminent danger she faced.

The Defense’s Position

The hospital moved to dismiss the case prior to discovery, operating on literal interpretation of the immunity statute CJP § 5-609. The hospital argued it was completely insulated from liability because:

• Patient did not explicitly name his wife as his target, meaning he had not identified a “specified victim or group of victims” under the text of the law.
• His statements did not communicate an “imminent” threat since he did not act aggressively before discharge and explicitly denied homicidal intent directly prior to walking out the door.
• Relying on the 1999 case Falk v. Southern Maryland Hospital, Inc., hospital claimed that verbal declarations alone do not establish a legal “propensity for violence” without prior overt acts of violence.

The Plaintiffs’ Position

The plaintiffs countered that they had pled more than enough facts to bypass statutory immunity. They argued that hospital possessed direct knowledge of the patient’s violent inclinations. Most importantly, they asserted that because the hospital specifically discharged the patient directly into the care of his wife to return to their shared home, the hospital knew exactly who would be in his immediate physical proximity. Therefore, she was a readily identifiable victim within an obvious, localized zone of danger

The Court’s Decision on Psychiatric Care Immunity & Medical Malpractice

The Appellate Court of Maryland reversed the Baltimore City Circuit Court’s dismissal and remanded the case for trial. The court broke the text of CJP § 5-609 down into three key elements: Foreseeability/Specificity of the Victim, Imminent Threat, and Propensity for Violence.

1. Foreseeability and the “Zone of Danger”

The court distinguished this case from prior landmarks like Falk, Shaw v. Glickman, and Furr v. Spring Grove State Hospital. In those older cases, patients either escaped or were released broad-scale into the general public, making the pool of potential victims vast and unpredictable.

Here, the court noted that “anyone who comes close” is technically a broad category. However, the hospital possessed concrete knowledge of who would fit that definition. The hospital knew the patient was going home with his wife. The court explicitly held:

“Where a patient expresses an intent to kill or harm anyone in their proximity, we hold that the provider, at a minimum, must warn those to whom the patient is being discharged, as they are undoubtedly ascertainable potential victims within a zone of danger.” 

2. Deconstructing “Imminent Threat”

The court rejected the hospital’s claim that a temporary, last-minute denial of homicidal thoughts or a lack of overt acts erased the immediacy of the danger. Citing dictionary definitions and criminal law parallels (Porter v. State), the court noted that “imminent” simply means “ready to take place” or “happening soon”. Given that the patient made severe threats the morning of his discharge, whether the threat was legally “imminent” is a question of fact for a jury to evaluate, not a matter of law for a judge to dismiss.

3. Establishing a “Propensity for Violence”

Finally, the court ruled that an “overt violent act” is not a prerequisite to establishing a propensity for violence.  A history of suicidal ideation mixed with recurrent homicidal thoughts, a failure to verify safety on written assessments, and a documented need for aggressive-episode medication are legally sufficient to allow a jury to conclude a patient is naturally inclined toward violence.

Commentary by Baltimore Medical Malpractice Lawyer Mark Kopec on Psychiatric Care Immunity & Medical Malpractice

As a Baltimore medical malpractice lawyers, I closely watch how courts interpret medical immunity laws. The Appellate Court’s decision in Caples v. Sinai Hospital is a well-reasoned, correctly decided opinion that applies common sense to psychiatric liability in Maryland.

The court rightfully looked past semantics to address the reality of clinical proximity. The patient stated he would kill “anyone who comes close.” When the hospital released him to go home with his wife, his wife became a definitive, predictable target. To claim she was an “unforeseeable” victim places form over substance.

When a hospital actively facilitates a discharge directly into the hands of a loved one, they hold an unyielding ethical and legal obligation to disclose that the patient voiced a desire to kill the very people surrounding him.

This ruling is a victory for patient advocacy, domestic safety, and medical accountability in Maryland.  It ensures that the families of victims who suffer from horrific, preventable tragedies will finally get their day in court.

Practical Considerations – Psychiatric Care Immunity & Medical Malpractice

While the plaintiffs will get their day in court, the practical challenges in these cases make it too early to celebrate. The court’s opinion was focused on facts in a light most favorable to the plaintiffs. The defendants can be counted on to develop a record supporting their release of the patient.

The defense will develop the picture by that the time of discharge, the patient was denying that he was going to hurt anybody. The hospital also likely will give the big picture challenges of treating patients who often will go back-and-forth between making threats and taking them back over the course of days in the hospital.

Causation

I suspect that the defense also will vigorously challenge causation. The murder was not until eight days after the discharge. The hospital can be counted on to develop, including through deposing the adult son, what happened during those days. The aim will be to make a case that even if the hospital had disclosed the exact things that happened during the patient’s hospitalization, that nothing different would’ve happened. In other words, the wife and adult son still would have taken the patient home. There is no indication that anything happened in those eight days that caused the wife and adult son to seek further treatment for the patient on an emergency basis. There was a follow up appointment the day before the murder. The parties will further explore all of this in discovery.

These are very tough cases for plaintiffs in general. Of course, further development of the case also could expose additional facts that are helpful to the plaintiffs. Not many of these types of cases get past motions or go to trial. If this one goes to trial, it should be interesting.

You can read other Blog posts on cases involving Immunity 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.

The Baltimore Medical malpractice Lawyer Blog provides this post to analyze the May 4, 2026, Appellate Court of Maryland reported opinion in James Smith, Jr., et al. v. Upper Chesapeake Medical Center Inc. In the early months of 2020, the healthcare landscape transformed overnight. Hospitals pivoted to manage a global pandemic. The legal system considered how traditional standards of medical malpractice would apply to providers operating under “crisis standards of care.”  This legal opinion clarified the scope of statutory immunity for medical malpractice by healthcare providers during the COVID catastrophic health emergency.

Factual Background: A Patient in the Eye of the Storm

On March 5, 2020, the Maryland Governor declared a state of emergency and a catastrophic health emergency due to the COVID-19 pandemic. This declaration triggered specific powers under the Public Safety Article (“PS”) of the Maryland Code. It allowed the state to relax licensing requirements, mandate the suspension of elective procedures, and implement strict infection control protocols.

On April 5, 2020, the plainitff admitted to the emergency room at Upper Chesapeake Medical Center. He was suffering from acute respiratory failure, low oxygen, and intermittent fevers. Because his symptoms mirrored those of COVID-19, the hospital classified him as a “Person Under Investigation” (PUI). Medical providers intubated the plaintiff, placed him on a ventilator in the Intensive Care Unit (ICU), and kept him in strict isolation.

Throughout his stay, the plaintiff tested negative for COVID-19 on April 8, April 11, and April 29. Despite the negative tests, his deteriorating respiratory status and high clinical suspicion led the hospital to maintain his PUI status and isolation precautions until April 22, 2020, in accordance with their emergency response policies.

During this period, the plaintiff required repositioning every two hours to prevent skin breakdown. However, the hospital’s documentation indicated that staff failed to meet this standard between April 7 and April 14. On April 14, medical providers discovered a deep tissue injury on his sacrum. This injury progressed into an infected sacral decubitus ulcer that required multiple debridement and skin graft procedures. It ultimately left the plaintiff permanently disabled.

The Parties and Their Legal Arguments – COVID Immunity for Medical Malpractice

Plaintiffs

The litigation involved a patient and his spouse (the plaintiffs). They filed a negligence and loss of consortium lawsuit against a medical center and its health system (the defendants) in the Circuit Court for Harford County. This followed a permanent injury sustained during a month-long hospitalization in April 2020. The core of the dispute centered on whether statutory immunity under PS § 14-3A-06 shielded the hospital. That statute protects healthcare providers acting in good faith under a catastrophic health emergency proclamation.

The plaintiffs sought a narrow, patient-specific application of the immunity statute. They argued that while the patient initially admitted with symptoms consistent with COVID-19, this thereby justified a period of immunity. However, that protection should have “popped like a bubble” once multiple tests returned negative. According to their theory, once the medical providers ruled out the virus, the patient transitioned to “non-COVID” status. The hospital was then required to adhere to the normal, routine standard of care for his subsequent treatment. They contended that the failure to perform routine preventative measures, such as body repositioning to avoid deep tissue injuries, was a “normal” medical error unrelated to the pandemic emergency.

Defendants

In contrast, the defendants argued for a broader, operational interpretation of the law. They asserted that the pandemic’s impact was systemic. It could not be extricated from the care of any individual patient in an acute setting. The hospital provided evidence that it was operating under an Emergency Response Plan that mandated restrictive protocols for all “Persons Under Investigation” (PUI), regardless of their final diagnosis. These protocols included:

• Strict requirements for staff to don and doff full Personal Protective Equipment (PPE) before and after entering patient rooms.
• Policies aimed at conserving limited PPE and minimizing staff exposure, which reduced the frequency with which nurses and doctors could physically enter rooms.
• The use of “temporary disaster privileges” and modified documentation practices due to the “chaotic and busy” environment of the ICU.

The hospital maintained that because these emergency-driven protocols directly altered the delivery of care and resource allocation, the staff was acting in “good faith” under the Governor’s proclamation. They argued that it was illogical to expect providers to “switch gears” and maintain two different standards of care simultaneously within the same unit based on fluctuating test results.

The Court’s Decision on COVID Immunity for Medical Malpractice

The Appellate Court of Maryland affirmed the circuit court’s grant of summary judgment in favor of the hospital. The court held that statutory immunity under PS § 14-3A-06 does not hinge on whether a patient actually has the illness caused by the biological agent (COVID-19).

Key Findings

Key findings of the court included:

1. Good Faith as the Compass: The court emphasized that the General Assembly conditioned immunity on two factors. First, acting in good faith. Second, acting under a catastrophic health emergency proclamation. There was no dispute that the hospital acted in good faith.
2. Rejection of the “Bubble” Theory: The court found the plaintiffs’ “clean break” argument—that immunity should evaporate upon a negative test—to be “unreasonable and unrealistic”. It noted that it would force providers to run two different systems of care in the same ICU. There is one for COVID patients and one for non-COVID patients. That would “defy logic” and create “minefields” for frontline workers.
3. Systemic Impact: The court recognized that the emergency proclamation required the hospital to adopt modified protocols that “undoubtedly” affected the resources and level of care available to all patients. Because the hospital’s deviations from the standard of care were grounded in good-faith protocols responding to the emergency (such as PPE conservation and isolation policies), the hospital was entitled to immunity.
4. Legislative Intent: The court looked at the history of the statute (originally passed post-9/11). It noted that the law was intended to ensure hospitals had the capacity to handle large-scale epidemics without the paralyzing fear of liability for every deviation from normal routine caused by the crisis.

In conclusion, the court held that the statute does not provide “absolute” or “blanket” immunity for all actions. However, it protects care delivered in good faith in compliance with emergency directives. Because the hospital’s pandemic response directly influenced the plaintiffs care, immunity shielded the hospital from the negligence claim.

Commentary by Baltimore Medical Malpractice Lawyer Mark Kopec on Covid Immunity in Medical Malpractice

The court’s decision highlights a significant shift in the legal burden typically found in medical malpractice litigation. Under a standard negligence framework, every case is assessed based on the specific “facts and circumstances” confronting the provider at the time of the alleged error. Ordinarily, a defendant hospital might be required to demonstrate specifically how the pressures of a pandemic—such as staffing shortages or equipment scarcity—directly prevented them from meeting the standard of care in a particular instance.

However, the application of PS § 14-3A-06 suggests that the government may have overextended immunity. It may go beyond what is strictly necessary to protect providers from the “chaos” of a crisis. It centers the defense on a broad “good faith” standard rather than a specific showing of impossibility or extreme difficulty. Therefore, there is no need for the hospital to prove a direct causal link between the pandemic and the specific failure to reposition the patient.

Critical Points

Critical points regarding this legal threshold include:

• The Good Faith Blanket: The hospital was not required to show that the pandemic made repositioning this specific patient impossible. They only had to show they were acting in “good faith” under a general emergency response plan.
• Presumptive Immunity: First, the hospital establishes it was following state-mandated or internal emergency protocols. Then immunity attaches regardless of whether those protocols were the actual reason the standard of care was missed.
• Shift in Accountability: The “bubble” theory is where immunity would lift once a patient tested negative. The court rejected it and prioritized systemic operational protection over individual patient outcomes.

This creates a robust shield for the healthcare industry during times of crisis. However, it arguably leaves patients who suffer “routine” injuries with little recourse. In a catastrophic emergency, the mere existence of a “good faith” effort to follow emergency protocols is sufficient. This waives liability, even if the provider could have reasonably met the standard of care despite the surrounding circumstances. This is a high bar for plaintiff. The statutory immunity provided by the General Assembly functions less like a nuanced defense. Rather, more like a broad jurisdictional bar for nearly any care delivered during a declared emergency.

You can read other Blog posts on Immunity, including another COVID case: Statutory Immunity: Constantine v. BWEP

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 21-year-old patient died of a cardiac arrest following an asthma attack. Afterward, his parents and estate filed a wrongful death claim in the Circuit Court for Baltimore County. The defendants were a paramedic and an EMT. They responded to the 911 call for the patient, and their employer, Baltimore County, was also a defendant. The circuit subsequently granted the defense motion for summary judgment, and the plaintiffs filed an appeal. (Op. at 1). 

The defendants, the paramedic and EMT, argued that they were entitled to paramedic immunity under CJP 5-603 (the Good Samaritan Act) and CJP 5-604 (Fire & Rescue Companies Act). Baltimore County also argued for governmental immunity under CJP 5-301. The plaintiffs, on the other hand, contended that there was sufficient evidence of gross negligence. Also, the defendants’ policies and customs, which they argued were not in line with standard emergency medical procedures, prevented them from receiving immunity.

The plaintiffs then responded that there was sufficient evidence of gross negligence and that the defendant’s policies and customs, which they argued were not in line with standard emergency medical procedures, kept them from receiving immunity. (Id.).

CSA

The Court of Special Appeals adopted the opinion of the circuit court. (Id. at 2). The CSA rejected the plaintiffs’ assertion that the defendants were willful and grossly negligent in their pre-arrival and post-arrival and were not entitled to paramedic immunity. Paramedic immunity, as provided under the Good Samaritan Act and the Fire & Rescue Companies Act, protects emergency responders from liability when giving care in good faith. The courts found the evidence did not establish willful or grossly negligent conduct. (Id. at 9-10, 11). As a result, the responders were to receive paramedic immunity based on the Good Samaritan Act and the Fire & Rescue Companies Act and to judgment as a matter of law (Id.).

The courts also found that the plaintiffs were required to have a medical expert to establish causation, but they did not have one. (Id. at 12).

Appellate Court on County Immunity

The plaintiffs also brought a claim against Baltimore County, the employer of the paramedic and EMT. They argued that the patient’s constitutional rights “were violated as a direct result of Baltimore County policies and customs which contributed to the deprivation of Mr. Coit’s federal constitutional or statutory rights to life” (Id. at 13).

The plaintiffs argued that a lack of a delayed response policy would require emergency medical service providers to notify a dispatcher if there will be a delay in responding to an emergency. Afterward, Baltimore County responded that it is entitled to immunity. (Id.). The person seeking emergency assistance could then make a decision regarding their course of action based on that information. (Id.).

The courts concluded: “There is no legal or factual basis for a direct claim against Baltimore County” (Id.). Firstly, there was no evidence of a delayed response. There was also no evidence that a delayed response policy would have provided a better outcome for the patient (Id.).

Commentary by the Baltimore Medical Malpractice Lawyer on County Immunity

The courts recognized that a plaintiff can bring suits against a county under 42 USC 1983 for violating federal constitutional or statutory rights. (Id.). However, the courts’ opinions do not tell us whether the plaintiffs ever identified the “federal constitutional or statutory rights to life” upon which they based their claims against Baltimore County.

We also cannot tell from the courts’ opinions where the plaintiffs got their delayed-response policy theory. There is no indication that it came from a court case that has upheld liability based on such a policy.

The courts did not expend much analysis in rejecting liability based on county immunity. The three Blog posts on this case make it apparent that the plaintiffs did not come close to satisfying their burden on the three issues involved.

It is unclear why the court decided to publish this opinion. In addition, I’m not sure what the experienced practitioner gains from the case. Based on the prior Maryland cases asserting claims against paramedics, the fact pattern described by the court had no chance of prevailing. It did not matter how it was couched or presented.

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 21 year old patient died of a cardiac arrest following an asthma attack. Afterward, his parents and estate filed a wrongful death claim in the Circuit Court for Baltimore County. The defendants were a paramedic and EMT. They responded to the 911 call for the patient. An additional defendant was their employer, Baltimore County. The circuit court subsequently granted the defense motion for summary judgment, and the plaintiffs filed an appeal. (Op. at 1). 

The paramedic & EMT argued that they were to receive paramedic immunity under CJP 5-603 (the Good Samaritan Act) and CJP 5-604 (Fire & Rescue Companies Act). In addition, Baltimore County argued it was to receive governmental immunity under CJP 5-301. The defendants further claimed contributory negligence by the patient and insufficient evidence of negligence. (Id. at 4).

The plaintiffs then responded that there was sufficient evidence of gross negligence and the defendants’ policies and customs kept them from receiving immunity. (Id.).

Appellate Court on Paramedic Immunity

The Court of Special Appeals adopted the opinion of the circuit court. (Id. at 2). The circuit court noted the Maryland definition of gross negligence is:

[G]ross negligence is an intentional failure to perform a manifest duty in reckless disregard of the consequences as affecting the life or property of another and also implies a thoughtless disregard of the consequences without the exertion of any effort to avoid them. (Id. at 6).

The plaintiffs asserted that the defendants were willful and grossly negligent in their pre-arrival and post-arrival and were not entitled to paramedic immunity. In the pre-arrival, the plaintiffs focused on the delayed response time, incorrect information to dispatch, and lack of urgency on arrival. The post-arrival allegations center on the assessment and treatment. (Id. at 8).

Evidence

The courts found that the evidence did not establish willful or grossly negligent pre-arrival conduct. The ambulance arrived less than seven minutes after the call for service. The responders’ failure to run from the ambulance to the patient was not negligent; it was specifically for the safety of the responders. (Id. at 9-10).

The courts also found that the evidence did not establish willful or grossly negligent conduct post-arrival, and paramedic immunity applied. The responders promptly assessed and treated the patient:

“They checked for a pulse, observed agonal respirations, placed an oxygen mask on Mr. Coit, prepared an intravenous line and began administering fluids, began transcutaneous cardiac pacing to address Mr. Coit’s heart rate, administered Narcan, and administered Atropine. Treatment and assessment of Mr. Coit’s condition continued after Mr. Coit was removed from the house and taken to the medic unit for transport to Northwest Hospital. He was intubated with an endotracheal intubation tube. Further assessment resulted in noting the absence of mechanical capture with transcutaneous pacing and agonal electrical rate without a pulse. Emergency medical service providers began administering CPR and administered Epinephrine during transport to Northwest Hospital. Upon arrival at Northwest Hospital, Paramedic Nappi reported to emergency department personnel regarding what treatment had been provided and the status of Mr. Coit’s condition.” (Id. at 10).

The plaintiffs claimed Narcan not needed because there was no indication that the patient was experiencing an opioid overdose. However, Narcan causes no harm. (Id. at 11). 

As a result, the responders were to receive paramedic immunity based on the Good Samaritan Act and the Fire & Rescue Companies Act and to judgment as a matter of law (Id.).

Commentary by the Baltimore Medical Malpractice Lawyer on Paramedic Immunity

Past Maryland cases demonstrate how difficult it is to meet the willful conduct and gross negligence standard in cases against ambulance crews. You can read more generally about this in this Blog’s post on the case of Stracke v. Butler.

This Coit case does not come close to meeting the evidentiary standard to avoid paramedic immunity. The plaintiffs’ case seems to be based mostly on their perception and belief that the responders were not hurrying in their response and treatment of the patient. The case also included a complaint of unnecessary Narcan that caused no harm. Consequently, the defense’s summary judgment was predictable.

In part 2 of the post, I will address the issue of causation that the courts discussed.

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 on Reporter Immunity

The Plaintiff, Ms. Monroe, had two daughters, ages 5 and 6, who had flu symptoms. She gave them several brands of over-the-counter cough medicine over a few days. (Op. at 4, 6). Ms. Monroe called 911 to report that her children, half-sisters, were unconscious and barely breathing. Afterward, an ambulance took them to UMMC. (Id. at 1).

At the emergency room, the staff administered a battery of tests, including VITROS rapid urine tests. That test came back positive for opiates in both children. The staff treated them for acute respiratory failure, intubated them, and they remained in comas and on ventilators for several days. (Id. at 1).

Ms. Monroe told the UMMC toxicologist, Dr. Kim, about giving the kids several brands of OTC medications for flu symptoms. She theorized they were to blame for the kids’ condition. Dr. Kim noted in his records that he disagreed and that there are no known false positives of opiates due to DXM, the active ingredient in the OTC medications. (Id. at 6-8).

The police notified the Department of Social Services (DSS), and the reporter immunity issue arose when the doctors shared the results of the VITROS. UMMC then received blood test results, which were negative for opiates. UMMC promptly notified DSS. The hospital discharged the kids after 11 days, but they would not go home to their mother for four months. The court system removed the children from Ms. Monroe. Still, ultimately, the court adjudicated the children not to be children in need of assistance (CINA). The children made a full medical recovery. (Id. at 1-2). However, tragically, three years later, the older daughter died by suicide. (Id. at 2). 

Lawsuit

The mother and her kids brought suit against UMMC, the emergency physicians’ group, and toxicologist Dr. Kim in the Circuit Court for Baltimore City. Plaintiffs alleged that Dr. Kim started rumors that the kids had overdosed on opiates, instigating DSS to open investigations and driving official proceedings in the face of contradictory evidence. (Id. at 2, 7).

The plaintiffs’ claims included intentional infliction of emotional distress (IIED), false imprisonment, intentional misrepresentation, constructive fraud, and malicious prosecution. They asserted that family members who worked at UMMC said that Dr. Kim spread rumors to persons not involved in the treatment that the mother permitted her children to gain access to opiates and that she was a child abuser.  The plaintiffs also alleged that Dr. Kim told social services that the urine test was more accurate than the blood test. They allege Dr. Kim acted maliciously and reported the VITROS results in bad faith. (Id. at 12-13).

The defendants sought summary judgment on reporter immunity.

Appellate Court on Reporter Immunity

The Appellate Court of Maryland first looked at the initial denial of summary judgment on statutory immunity early in the case. The defense contended that they were entitled to summary judgment under CJP 5-620 and FL 5-708 as persons who, in good faith, make a report of abuse or neglect of a child.

The Appellate Court has defined good faith in the reporter immunity law: “An intangible and abstract quality that encompasses, among other things, an honest belief, the absence of malice, and the absence of design to defraud or to seek an unconscionable advantage.” Catterton v. Coale, 84 Md. App. 337, 342 (1990). Bad faith means “not simply bad judgment or negligence, but it implies a dishonest purpose or some moral obliquity and a conscious doing of wrong.” (Id.).

In addition, courts have held that the law does not require the reporter to make an independent investigation to determine whether there is exculpatory evidence (Op. at 83).

The Appellate Court examined whether there was a genuine dispute about whether the defendants acted in good faith. The court noted that the plaintiffs had expert testimony challenging Dr. Kim’s reliance on the VITROS testing.  They also alleged that racial and economic animus drove the defendants’ actions. The court also observed that the American Medical Association (AMA) has acknowledged that many patients suffer discrimination when receiving health care. (Id. at 81).

The circuit court found the mother’s testimony that the defendants were disregarding her views and treating her disrespectfully compelling. The Appellate Court stated that it rarely overturns a denial of a motion for summary judgment where good faith is the issue and would not do so here (Id. at 92).

Commentary by the Baltimore Medical Malpractice Lawyer on Reporter Immunity

In this case, the Appellate Court’s holdings reflect the plaintiffs’ challenges, particularly in proving a lack of good faith and scientific matters. We must view the Appellate Court’s upholding of the denial of summary judgment in the context of the deferential abuse of discretion standard, which “rarely” results in reversal for denial of summary judgment. Similarly, the circuit court denied summary judgment on the issue of good faith in reporter immunity, where it is “ordinarily” not a matter for summary judgment. Examination of the evidence shows how, when viewed individually, there can be alternative explanations. Still, together, it can form a picture that overcomes summary judgment.

Evidence

AMA report on discrimination in medical care. Such conduct is unacceptable. This report shows that racial discrimination occurs in these situations but does not establish it happened here.

Plaintiff’s Expert: The plaintiffs had an expert toxicologist who opined that Dr. Kim was wrong when he said that cough syrup could not cause a false positive for opiates. The law is clear that being wrong alone does not constitute bad faith. This evidence can support a lack of good faith but can also exist without it.

Dr. Kim’s Involvement in the Investigation: Plaintiffs alleged that Dr. Kim was the “driving” force behind the DSS investigation. The evidence, however, can also be viewed as involving no unusual involvement by Dr. Kim.

The plaintiffs alleged that UMMC employees told the mother that UMMC was spreading rumors about her. The Court’s opinion does not reveal the plaintiffs producing any such evidence.

The circuit court found compelling evidence that the defendants disregarded Ms. Monroe’s views and treated her disrespectfully. This finding is important because the circuit court assesses the witnesses in person. It can certainly support a finding of lack of good faith. However, this mistreatment can also be unacceptable conduct that does not equate with dishonesty.

Dr. Kim’s Reporter Immunity

Interaction between Dr. Kim and Ms. Monroe. Ms. Monroe once spoke with Dr. Kim but did not recall the conversation. She said Dr. Kim said that typically when you see cases like this, there is a positive blood sample from whatever drug your children ingested. Dr. Kim further stated that they would do a drug panel, and one of the drugs would come up positive. Mrs. Monroe then questioned, a typical case for who? (Id. at 18).

Mrs. Monroe further attributed her racial claims to “the entire University of Maryland staff” because they did not listen to her explanation of the OTC medications and only focused on illegal drugs. She felt the University of Maryland saw her as a black woman from her neighborhood. There were also looks and stares. (Id. at 19).

Ms. Monroe also attributed a racial comment to an unidentified white UMMC employee who said two black children with two different fathers would not have a specific metabolism disorder, which was not prominent in blacks but is in whites and Asians. (Id. at 19-20).

The “typical” comment and metabolism comment can be motivated by racial and economic discrimination or have completely innocuous explanations. The other evidence could indicate racial animus or be Ms. Monroe’s subjective interpretation.

Conclusion

Proving a lack of good faith based on racial and economic discrimination can be challenging. Defendants rarely document discriminatory intent. In this case, there were factors that, each alone, could have innocuous explanations. However, together the courts found that the factors supported a finding of lack of good faith for reporter immunity that resulted in denial of summary judgment.

This is a close question that jurists can disagree on. For example, one member of the Appellate Court panel wrote a concurring opinion in which he stated that the standard of review was de novo, not abuse of discretion. In writing that he would have granted summary judgment, he stated: “Unsupported allegations of racial and economic animus and assertions that Dr. Kim could have second guessed the VITROS test result are insufficient to create a question of fact as to the good faith of the mandatory reporter.” (Conc. Op. at 2).

Spoiler alert:  In a later blog post on this case opinion, I will discuss how the result changed when the court removed one of these pieces (Plaintiff’s expert) from the picture.

Additional Reads

In part 2 of the Blog series on Monroe v. UMMC, you can read about the court’s analysis of late motions to compel.

For a discussion of healthcare provider immunity in the context of the COVID-19 pandemic, see this Blog’s post in Constantine v. BWEP.

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 went to the BWMC emergency room in 2020 at the beginning of the COVID-19 pandemic. The first visit was on April 22, and then the second was on April 25. On April 22, the plaintiff reported fever, muscle aches, chills, nausea, mild cough, and diarrhea. She also said a lot of people at her work were sick and suspected to have COVID. The ER staff suspected she had COVID but did not test her because she did not meet the testing criteria in effect at the time. (Op. at 1).

On April 25, the plaintiff returned by ambulance with knee and back pain, sweat, chills, and cough. Specifically, her knee pain was increasing. The ER staff diagnosed her with suspected COVID and knee effusion. It discharged her, instructing her to return if she had difficulty breathing.

On April 30, she went to another ER and was diagnosed to be septic, have Group A strep., and suspected endocarditis. She did not test positive for COVID (Id.).

The plaintiff sued the BWMC emergency physicians in the Circuit Court for Anne Arundel County. The defense moved for summary judgment based on statutory immunity under PS 14-3A-06., which the circuit court granted (Id. at 2).

The plaintiff’s complaint alleges that she had a markedly elevated white blood cell count, including elevated bands indicating a more severe infection. (Id.).

Statutory Immunity

On March 5, 2020, the Maryland governor declared a state of emergency due to COVID-19. Subsequently, he issued executive orders under that declaration. On May 6, the governor issued a proclamation stating:

“Health care providers who act in good faith under this catastrophic health emergency proclamation, including orders issued under the proclamation by the Governor and by other State officials acting at the direction of or under delegated authority from the Governor, have the immunity provided by §14-3A-06 of the Public Safety Article of the Maryland Code.”

A May 6 directive from the MD Health Department stated: “MDH does not construe the immunity provisions in Pub. Safety Art. § 14-3A06 or Health Gen. Art. § 18-907 to apply to a healthcare provider or facility performing non-COVID-19 related procedures or appointments.”

Under PS 14-3A-06, “[a] health care provider is immune from civil or criminal liability if the health care provider acts in good faith and under a catastrophic health emergency proclamation.” 

Appellate Court’s Analysis of Statutory Immunity

The Appellate Court found that the governor’s March 5 proclamation triggered this application of statutory immunity. The Appellate Court observed no allegation of failure to act in good faith. As a result, the question is what does it mean to act “under” the proclamation. (Op. at 8-9).

The Court found that the ER physicians had provided COVID-related care even though they had not provided the care allegedly needed for another infection process in the knee (Id. at 11). As a result, the Appellate Court found that the care was “sufficiently related” to the emergency proclamation to be entitled to statutory immunity under PS 14-3A-06 (Id. at 11-12).

The Court held that the May 6 directive did not apply because the official issued it after the care (Id. at 11-13). The Court also noted that other factual scenarios may raise various issues relating to statutory immunity.

Commentary By the Baltimore Medical Malpractice Lawyer

This commentary is more related to the nature of the statutory immunity than the Court’s interpretation.

Officials’ Response to COVID

Many of the decisions that government officials made during COVID were questionable. They include expansive lockdowns, frequently changing (and sometimes inconsistent) directives on mask mandates, “physical distancing,” limits on gathering sizes, quarantine requirements, and testing guidelines. Officials had to make many decisions without all of the information they would have liked about COVID, including its contagiousness and prospects for treatment. Despite this limitation, however, there is ample evidence that many decisions could have been more wise regardless of the state of knowledge.

Some of the difficulties with the policy decisions are the inevitable challenges that “one size fits all” rules always present. These same challenges apply to healthcare provider statutory immunity. Perhaps more importantly, however, statutory immunity is arguably unnecessary to accomplish its goals.

Maryland’s Standard of Care is Sufficient

Suppose the immunity is to protect healthcare workers in a public emergency. In that case, the medical malpractice system already does that. In Maryland, the standard of care for healthcare workers is the standard of practice among members of the same healthcare profession, with similar training and experience, situated in the same or similar communities at the time of the alleged malpractice. CJP 3-2A-02(c)(1).

Two components apply to this discussion: “standard of practice . .. at the time of the alleged malpractice.” Any medical malpractice case related to care provided during a public health emergency would use a standard of care that reflects the circumstances of the emergency. In this public health situation, that would include the knowledge at the time about COVID and its testing and treatment.

Because of this standard, some aspects of COVID cases make them unviable as medical malpractice cases. Throughout the COVID pandemic, I spoke to many potential clients who had bad outcomes from COVID-19. I did not see a possible medical malpractice case in nearly all of those instances. The reason was usually the lack of any proven treatment and the unpredictability of the outcomes. There often was no pattern. Some young and otherwise healthy patients died or had permanent complications, and some older, health-compromised patients made complete recoveries.

Consequences of Statutory Immunity

Constantine, however, was not a COVID case. It was a suspected COVID case. Other facts indicated an unrelated, serious infection process. These options are the essence of differential diagnosis. The health care providers got it wrong.

Statutory immunity has given the healthcare providers an automatic pass at the expense of the plaintiff’s permanent loss. The medical malpractice system, however, was equipped to weigh the healthcare provider’s actions according to the appropriate standard to determine whether the plaintiff was entitled to compensation. 

As the Appellate Court recognized, it is unknown how many other plaintiffs will be denied the protection of the justice system under statutory immunity.

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.

A case is possible, but the law on these claims differs significantly from the law that applies to doctors. Below, I discuss the legal standard and a case using it, then provide a commentary for Maryland medical malpractice lawyers.

Suing Ambulance EMTs: Gross Negligence

Instead of an ordinary negligence standard, the standard for these claims in Maryland is gross negligence. Section 5-604(a) of the Courts & Judicial Proceedings part of the Maryland Code provides:

“[n]otwithstanding any other provision of law, except for any willful or grossly negligent act, a fire company or rescue company, and the personnel of a fire company or rescue company, are immune from civil liability for any act or omission in the course of performing their duties.”

Application: Stracke v. Butler

In Stracke v. Butler (August 16, 2019), the Court of Appeals of Maryland issued a reported opinion applying this gross negligence standard. Mrs. Butler called 911, saying that her husband was having chest pains, and an ambulance arrived. At trial, the parties told different versions of the EMTs’ actions in treating Mr. Butler. The EMTs ended up taking Mr. Butler to a nearby hospital. While he was waiting in the emergency room, he had a fatal heart attack.

The plaintiffs sued the ambulance EMTs and argued that the EMTs were grossly negligent in failing to respond to Mr. Butler’s symptoms. The Court explained the difference between the legal standards: 

Ordinary, simple negligence is “any conduct, except conduct recklessly disregardful of an interest of others, which falls below the standard established by law for the protection of others against unreasonable risk of harm.” On the other hand, this Court has explained that “gross negligence is an intentional failure to perform a manifest duty in reckless disregard of the consequences as affecting the life or property of another, and also implies a thoughtless disregard of the consequences without the exertion of any effort to avoid them.” We have made clear that a claim for gross negligence “sets the evidentiary hurdle at a higher elevation.” (Op. at 11).

The Court also explained gross negligence applicable to suing ambulance EMTs this way:

Gross negligence is not just big negligence. For these purposes, gross negligence “must be sufficient . . . to establish that the defendant . . . had a wanton or reckless disregard for human life . . . . Only conduct that is of extraordinary or outrageous character will be sufficient to imply this state of mind.” (Id.)

Court’s Analysis

In reviewing the evidence before it, the Court found that the evidence failed to establish gross negligence. There was insufficient evidence to conclude that the EMTs made a deliberate and conscious choice not to help Mr. Butler survive. They responded to the call, provided Mr. Butler with immediate attention and treatment, and transported him to the nearest hospital in under 10 minutes. Even though the paramedics failed to follow procedures and protocols, that was not enough. They did not knowingly, consciously, and deliberately do so. The evidence did not indicate that the ambulance crew had a wanton and reckless disregard for Mr. Butler’s life, nor did they present an utter indifference to his rights and well-being. (Id. at 12-13, 16-18).

The Stracke decision was 4-3, and three judges determined that the jury could find gross negligence. The dissent wrote, “If what the defendants did and failed to do does not arise to gross negligence, what would?” (Dissent at 23 fn. 10).

Commentary By the Baltimore Medical Malpractice Lawyer

Where Does Stracke Leave Us?

What can Maryland medical malpractice lawyers do when suing ambulance EMTs under Stracke? The dissent’s question is a good one. If Stracke wasn’t gross negligence, what is?

Several situations are probably not gross negligence. Suppose paramedics attempt to treat the patient but make a misdiagnosis. Also, they may fail to give the correct treatment or provide the wrong treatment. Even if there are multiple instances of failing to comply with professional standards, it is probably not gross negligence.

What would be “reckless disregard” for the patient’s life? The Stracke Court found that “there was not sufficient evidence to conclude that the EMTs made a deliberate and conscious choice to not help Mr. Butler survive.” (Op. at 13.) Under this language, a deliberate choice not to help a patient may qualify. Presumably, the deliberate choice has to have no basis. For example, suppose the EMTs decide not to treat the patient. Their decision is because it would require them to enter into a life-threatening situation. In that case, it is hard to see how that would meet the standard.

As long as Stracke remains the law, Maryland medical malpractice lawyers will face challenging circumstances when suing ambulance EMTs.

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.