CQE Connect: Teague v. Meritus

The Baltimore Medical Malpractice Lawyer Blog examines issues in medical malpractice cases from Maryland appellate court opinions. In this post, the issue is whether a certificate of qualified expert (CQE) and accompanying report in a medical malpractice case satisfy the Health Care Malpractice Claims Act when they list multiple medical providers and multiple breaches collectively but do not connect specific departures to individual providers. The case is Tsague v. Meritus Medical Center, Inc., No. 632, September Term 2025 (filed September 29, 2026). The Appellate Court of Maryland issued this unreported opinion.

Factual Background on Medical Malpractice CQE Connect

A infant girl was born roughly eight weeks prematurely. Following initial care, medical staff transferred her to a neonatal intensive care unit (NICU) at another facility. After making steady progress, then she returned to the primary hospital, where she appeared to be improving toward discharge.

However, her medical condition deteriorated over the next week. The patient stopped displaying feeding cues, her overall intake decreased, and she showed signs of fatigue, mottled skin, abdominal distention, and weak feeding. Staff administered feedings through a nasogastric tube. Her condition worsened further, requiring intubation and transfer for severe complications, including sepsis, septic shock, and cardiovascular collapse. Brain examinations revealed devastating brain damage. Her parents eventually made the painful decision to withdraw life-sustaining care, and the infant passed away at thirty-six days old.

The surviving family members filed a claim in the Health Care Alternative Dispute Resolution Office (HCADRO). The claim specifically named seven separate medical providers. These defendants included a medical center, a physician practice group, a neonatologist, and also four registered nurses. Along with their filing, the plaintiffs submitted a CQE and a supporting report from a board-certified neonatologist. The plaintiffs then waived arbitration and transferred the action to the Circuit Court for Washington County. The named defendants then filed motions to dismiss, alleging that the expert filing failed to comply with statutory requirements.

Arguments of the Parties

The defendants argued that the expert’s report failed to satisfy Maryland Law. Specifically, they pointed out that the report listed a hospital, a practice group, a doctor, and four nurses, but then attributed a long list of sixteen broad medical failures to all of them collectively. The defendants also emphasized that these providers had vastly different professional roles, clinical scopes, and treatment duties. Therefore, the report failed to specify which provider committed which act or omission.

In response, the plaintiffs contended that their filing met the legal baseline. They argued that the circuit court had established an unnecessarily heightened pleading standard not required by statute. The plaintiffs asserted that the expert report outlined clear, medically meaningful theories of negligence. They believed the report adequately described failures to detect infection, administer antibiotics, and communicate changes in condition. Furthermore, the plaintiffs argued that even if the report had a flaw, the court should stay the lawsuit to allow post-hoc supplementation rather than dismiss it. They also highlighted the harsh reality that dismissing the case after the statute of limitations had run would permanently bar their recovery.

The Court’s Ruling

The Appellate Court of Maryland affirmed the trial court’s decision to dismiss the lawsuit. The court explained that Maryland’s Health Care Malpractice Claims Act serves a vital screening role. Under the statute, a qualified expert must identify how a specific defendant departed from the standard of care and how that departure directly caused the injury.

The court recognized that the expert report contained legitimate theories of negligence. However, the fatal flaw was that the report failed to connect those theories to any single provider. Presenting two disconnected lists—one containing seven diverse defendants and another listing sixteen generalized failures—leaves the reader guessing. The law requires an explicit link showing who owed what duty, who breached that duty, and how that breach caused harm. Grouping dissimilar professionals together under passive, collective allegations does not meet this threshold.

Finally, the appellate court held that dismissal without prejudice was the required statutory remedy. The court noted that when a mandatory condition precedent is missing, a trial judge cannot simply issue a stay to allow post-hoc amendments. Even though a dismissal without prejudice becomes devastating when the statute of limitations has run, judges cannot rewrite legislative requirements to avoid that result.

Commentary by Baltimore Medical Malpractice Lawyer Mark Kopec on CQE Connect

This decision offers lessons for counsel dealing with medical injury litigation. The court’s opinion explicitly noted that the plaintiffs had potentially supportable claims. The case was not lost because the medical care was flawless; it was lost because the procedural gateway was not properly constructed.

Various prior cases under Maryland law have focused on distinct procedural defects. Some cases turned on the failure to identify the defendant properly, while others focused on the failure to state specifically what the defendant did. In this matter, both elements were present in isolation. The expert identified seven defendants and listed sixteen clear clinical mistakes. Yet, the court found the connection between the two to be insufficient.

Pointers on Medical Malpractice CQE Connect

To avoid this outcome in future litigation, attorneys and experts must take several key precautions:

• Avoid Undifferentiated Group Pleading: Avoid lumping multiple medical professionals into a single paragraph of general criticisms. Every named defendant needs an individualized assessment.
• Match Roles with Duties: A nurse, a attending doctor, and a hospital institution can have different clinical responsibilities. Your expert report must explain what the standard of care required from each specific professional discipline.
• Establish a Clear Causal Chain: Avoid relying on sweeping statements that “these breaches” caused the injury. The expert should connect a specific failure by a named provider to the ultimate medical outcome.
• Act Well Before Limitations Expire: As this ruling demonstrates, a dismissal “without prejudice” offers no real comfort when the statute of limitations has already run out. Once the limitations clock expires, a dismissal without prejudice functionally becomes a dismissal with prejudice.

This reality is a compelling reason for both parties and lawyers to get moving on cases as soon as possible. When claimants initiate claims early, counsel has ample time to review medical records, consult experts, draft detailed reports, and fix potential flaws long before the statute of limitations creates a fatal trap. Careful attention to detail at the outset preserves valid claims and ensures that injured parties receive their fair day in court.

Additional Reading

You can read additional Blog posts on categories of Expert Testimony, including the following filing issues involving CQEs and reports:

• CQE Cured: Barnes v. GBMC
• Identifying Defendant: Otto v. UPMC 2
• Related Specialty: Otto v. UPMC 1
• CQE & Report: Powell v. Wurm
• No Report: Wilcox v. Orellano
• Nurse CQE: Robinson v. Canton
• CQE Employees: Retina Group v. Crosetto
• CQE Extension Right: Dunham v. UMD 2
• CQE Agents: Dunham v. UMD
• CQE Extension: A.C. v. Kennedy
• CQE Teaching Experience: Jordan v. Elyassi’s
• HCADRO Refiling: Puppolo v. Adventist
• CQE Diagnosis: Canton Harbor v. Robinson 2

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.