Maryland requires plaintiffs to file medical malpractice cases in the Health Care Alternative Dispute Office (HCADRO) before being transferred to the circuit court. CJP 3-2A-03. In a recent case, a plaintiff representing himself failed to do so, and the court dismissed the case. Although this result was predictable, there are situations where it is unclear whether a case constitutes medical malpractice that the plaintiff must first file in HCADRO. Many cases center on whether the plaintiff incurred an HCADRO medical injury.
Waugh v. Dimensions Health Corp.
The Appellate Court of Maryland issued an unreported opinion in Waugh v. Dimensions Health Corp. on January 4, 2024. The plaintiff filed a lawsuit for medical malpractice relating to when a medical student drew his blood. He told the medical student not to probe for a vein if she could not draw blood. The plaintiff claimed that she ignored his request and went deep into his armpit, causing sharp pain and soreness. (Op. at 1).
The plaintiff did not file his claim in the HCADRO before suing in the circuit court. The defense moved to dismiss, and the trial court found an HCADRO medical injury and granted it. (Id.).
A plaintiff must file a case in HCADRO if three criteria are present. The plaintiff claims a “medical injury” committed by a “health care provider” and is seeking over $30,000. CJP 3-2A-02(a)(1). In Waugh, the plaintiff claimed he did not incur a medical injury,
The Appellate Court noted that medical injury arises or results from the rendering or failure to render health care. CJP 3-2A-01(g). The Court then observed that the plaintiff complained that his injury resulted from the student’s rendering health care in a manner contrary to his instruction. As a result, it was a medical injury.
The plaintiff did not allege that his injury resulted from conduct completely lacking in medical validity in relation to the medical care rendered. The Court found that even if performed in a manner contrary to his instruction, the student’s conduct was still medically valid. As a result, the Court confirmed that the plaintiff was required to file with HCADRO before suing in the circuit court, and dismissal was proper.
The result in Waugh is not controversial. Blood drawn by a medical student constituted a health care provider’s rendering of health care. The claim involved a breach of professional standards of care. As a result, the plaintiff had to file the case in HCADRO.
However, some healthcare situations are not always medical injuries. The Waugh Court noted that there can be conduct that occurs in the setting of rendering health care but is completely lacking in medical validity, citing the discussion in Goicochea v. Langworthy, 345 Md. 719, 728 (1997).
The Goicochea court expounded that the “medical injury” was not intended to include non-professional circumstances where there is no violation of the healthcare provider’s professional duty to exercise care. (Id. at 726). A plaintiff can allege facts showing that the health care provider’s tortious conduct had no conceivable validity as part of the doctor’s examination, therefore making HCADRO filing unnecessary. (Id. at 728).
The following are cases on whether a plaintiff incurred a “medical injury” that a plaintiff must file in HCADRO.
HCADRO Medical Injury Found
- Goicochea v. Langworthy, 345 Md. 719 (1997): The plaintiff claimed assault and battery concerning the pressure the doctor used during a hernia examination. The plaintiff’s allegations related to how the doctor conducted the exam and some pressure level was necessary.
- Jewell v. Malamet, 106 Md. App. 265 (1995): Allegation that a doctor conducting a musculoskeletal exam fondled the vaginal and breast areas.
- Roberts v. Suburban, 73 Md. App. 1 (1987): Plaintiff received a blood transfusion and got AIDS and brought claims for strict liability and breach of implied warranties of merchantability and fitness. Blood transfusion was more a service than the sale of a product and, therefore, involved the rendering of health care.
- Long v. Rothbaum, 68 Md. App. 569 (1986): Plaintiff sued for intentional torts for involuntary psychiatric commitment and wrongs done to him during it. Claims sounded in misdiagnosis and unnecessary care. The allegations related to breaches of professional standards of care.
- Brown v. Rabbitt, 300 Md. 171 (1984): Allegations of breach of express and implied warranties concerning a tubal ligation procedure involved professional expertise in rendering health care.
No HCADRO Medical Injury
- Swam v. Upper Chesapeake, 397 Md. 528 (2007): A hospital visitor brought a claim for being stuck by a needle when she placed her hand on the counter in the waiting room. The claim did not involve medical treatment.
- Afamefune v. Suburban, 385 Md. 677 (2005): Psychiatric patient who alleged assault and rape by a fellow patient did not allege a breach of professional standard of care or that the injuries were during the provision of medical care.
- Chew v. Meyer, 72 Md. App. 132 (1987): Plaintiff brought a tort and contract claim against a doctor for failing to send a document that would excuse the plaintiff’s absence from work, resulting in his termination. Claims did not involve a professional standard of care but rather a failure to perform a clerical task promptly.
- Nichols v. Wilson, 296 Md. 154 (1983): A doctor slapped a patient in the face during suture removal led to intentional tort claims.
Davis v. Frostburg, 457 Md. 275 (2018): The plaintiff fell out of bed at a nursing facility, and a mechanical lift also dropped her.
- No Medical Injury: Negligence for falling out of bed while sleeping due to the mattress becoming detached did not involve a professional standard of care.
- Medical Injury Found: Negligence for malfunctioning mechanical lift required examination of nurses and adherence to medical procedures. Additionally, same for respondeat superior claim.
Summary of HCADRO Medical Injury
The HCADRO medical injury issue is very fact-specific. The question is whether a professional standard of care governs the conduct. The label that the plaintiff gives the claim is not determinative – such as international, willful, or malicious. Nor is the type of claim dispositive – assault, battery, or breach of warranty.
When the parties dispute whether the plaintiff has to file the case in HCADRO, there are a variety of ways that it can play out. It can involve a dismissal with or without prejudice, a stay, a transfer, and a relation back.
A plaintiff must be very careful to ensure the case is in the correct forum before the statute of limitations runs. It can be an issue even if the statute of limitations is far from running. For instance, if the parties contest the forum and one side appeals, it can be a multi-year process during which the statute of limitations can run.
An example is a case where the plaintiff does not believe it is a medical injury but anticipates that the defense will claim it is. Although it may not be required, a plaintiff may want to file both in HCADRO and the circuit court and seek a stay of the HCADRO proceeding pending resolution of the medical injury issue in the circuit court case.
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