COVID Immunity: Smith v. UCMC
Maryland’s Appellate Court Defines Healthcare Protection During COVID-19
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:
- 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.
- 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.
- 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.
- 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.