Related Specialty: Hinebaugh v. Garrett Hosp.
The Baltimore Medical Malpractice Lawyer Blog examines issues in medical malpractice cases. In this post the issue is whether a board-certified oral and maxillofacial surgeon, under Maryland law, is a related specialty that can issue a certificate of qualified expert (CQE) on the standard of care for family medicine doctors and radiologists. The case is Hinebaugh v. Garrett County Memorial Hospital, et al., 207 Md. App. 1, 51 A.3d 673 (2012). The Court of Special Appeals of Maryland (now the Appellate Court of Maryland) issued this reported opinion.
Factual Background
A twenty-two-year-old incarcerated individual had facial injuries when another person struck him in the face. A family medicine physician initially saw the plaintiff and requested basic x-rays of his facial structure. Two radiologists looked at those x-rays and found that no broken bones were visible. Days later, the plaintiff experienced continuing cheek pain and facial numbness. The family medicine physician saw him again but provided no further tests or interventions.
After his release from jail weeks later, the plaintiff sought medical care at a hospital emergency room due to severe, worsening facial pain. An emergency medicine physician ordered a comprehensive facial CT scan. The scan revealed a displaced facial fracture that required extensive reconstructive surgery.
The plaintiff filed a misdiagnosis medical malpractice lawsuit against the initial family practice physician, the two radiologists, and their practice groups. To comply with statute requirements under the Health Care Malpractice Claims Act, the plaintiff filed a CQE and the related specialty issue arose. The attesting expert witness was a board-certified oral and maxillofacial surgeon. The expert alleged that the medical providers breached the standard of care by failing to order a prompt CT scan. The defendants moved to strike the expert certificate and dismiss the lawsuit. They argued that a dentist specializing in oral surgery does not hold board certification in the same or a related specialty as family physicians or radiologists. The trial court granted the motion to dismiss without prejudice. The plaintiff filed an appeal.
Parties’ Arguments
The plaintiff argued that oral and maxillofacial surgery qualifies as a related specialty to family medicine and radiology when managing traumatic facial injuries. He argued that oral surgeons frequently evaluate imaging to diagnose facial fractures. The plaintiff also claimed statutory exceptions applied. Specifically, he asserted that the family practice physician was providing emergency care rather than routine family medicine. He further argued that the oral surgeon taught medical residents in related surgical disciplines. Additionally, the plaintiff claimed the trial court acted prematurely by dismissing the lawsuit before formal discovery occurred.
The defendants argued that dentistry and oral surgery are distinct professional disciplines from family medicine and radiology. They said that oral surgeons are specialists called in after front-line clinicians make a preliminary diagnosis. Therefore, the defendants argued that the specialties do not overlap during front-line patient evaluations. The defendants maintained that neither statute exception applied because the family physician provided basic first-contact care, and the oral surgeon only taught dentistry residents rather than family practice or radiology residents.
Court’s Ruling on CQE Related Specialty
The Court of Special Appeals affirmed the dismissal of the lawsuit. The appellate court reviewed whether two fields are related specialties by analyzing if an overlap in treatment or diagnostic procedures exists between them.
The court held that oral surgery is not a related specialty to family medicine or radiology for front-line diagnostic evaluations. Family physicians and radiologists act as primary evaluators across a wide array of conditions. Conversely, oral surgeons operate as secondary specialists who treat established injuries after a referral. While oral surgeons possess advanced knowledge regarding facial fractures, they do not share the same clinical baseline as generalists during initial patient intake.
Furthermore, the court determined that neither statute exception rescued the certificate:
- The family physician performed basic first-contact care, which falls directly within the scope of family medicine rather than an unrelated field.
- The oral surgeon taught dentistry residents rather than family practice or radiology trainees.
Finally, the court held that pre-motion discovery was not necessary. The plaintiff had full knowledge of his expert’s qualifications and credentials prior to filing. Because the certificate failed on legal grounds, the court correctly dismissed the case.
Commentary by Baltimore Medical Malpractice Lawyer Mark Kopec on CQE Related Specialty
This decision offers guidance on how to comply with the statute requirements for expert qualification in a medical malpractice case. Attorneys must carefully analyze board certification overlaps before selecting a certifying expert.
When dealing with these these issues, legal practitioners should consider the following strategies:
- Match Board Certifications: Always attempt to retain an expert certified by the exact same board as the defendant provider. If a defendant is a board-certified family medicine physician, secure an a CQE from a board-certified family medicine physician. Matching specialties avoids procedural challenges regarding expert qualifications.
- Establish Clinical Overlap: If using an expert from a different discipline, ensure the expert’s CQE clearly documents a direct overlap in routine clinical practice. The overlap must exist at the clinical phase where the alleged negligence occurred. Demonstrating that a specialist manages a condition after a referral may not establish that the specialist understands front-line diagnosis standards.
- Audit Teaching and Scope Exceptions: Do not rely on broad statements regarding an expert’s teaching background. Verify that the expert has taught students or residents within the specific specialty of the defendant.
- Conduct Pre-Filing Audits of Certificates: Review expert certificates before filing to ensure complete compliance with statute mandates. Early efforts prevent costly delays and protects claims from statute of limitations problems.
You can read other Blog posts on Expert Testimony, including CQE related specialty issues:
- Related Specialty: Nance v. Gordon
- Related Specialty: Reid v. BACE 1
- Related Specialty: Otto v. UPMC 1
- Related Specialty: Street v. UPMC 1
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.