Related Specialty: Otto v. UPMC 1
The Baltimore Medical Malpractice Lawyer Blog features Maryland appellate opinions in medical malpractice cases. In this two-part post, I examine a recent case involving the plaintiff’s Certificate of Qualified Expert (CQE) and report. The case is the December 11, 2025, unreported opinion by the Appellate Court of Maryland in Otto v. UPMC Western Maryland Corp., No. 1596. In part 1, I discuss the related specialty requirement in a CQE. In part 2, I then dissect the identification and standard-of-care requirements.
Factual Background
The plaintiff filed a medical malpractice case in the circuit court for Allegany County. He alleged that the hospital was negligent in its prevention, diagnosis, and treatment of his sacral decubitus ulcer. (Op at 1).
The plaintiff went to the emergency room with drowsiness and loss of consciousness. He entered the hospital and stayed for two weeks. Many doctors and nurses treated him. (Id. at 2).
Although the plaintiff was heavy, the medical providers did not order a bariatric bed for him until eight days into his admission. At that time, they diagnosed him with a sacral pressure ulcer. The patient underwent surgical debridement of the ulcer and left after discharge three days later. (Id. at 2-3).
Two weeks after discharge, after losing consciousness, the plaintiff went to another hospital, where they diagnosed him with a stage three sacral decubitus ulcer. He received further treatment, transferred to another hospital, and subsequently discharged. For six months, he would have severe discomfort from the ulcer, including the inability to sit for more than two hours at a time. (Id. at 3).
The plaintiff filed his claim in the Healthcare Alternative Dispute Resolution Office (HCADRO). (Id. at 3). The plaintiff filed a CQE and a report from his proposed expert witness addressing the allegations of breach. The defense moved to dismiss, arguing that the CQE and report were insufficient under CJP 3-2A –01. The circuit court granted the motion to dismiss. (Id. at 1).
The basis for the circuit court’s dismissal was that the plaintiff’s expert in general surgery did not meet the related specialty requirement of overlap in treatment and procedures with providers named in the CQE in internal medicine, pulmonary medicine, and infectious disease. (Id. at 5). The plaintiff appealed. (Id. at 1)
Appellate Court of Maryland
The first issue in this case was the peer-to-peer requirement between the attesting expert and the medical providers:
In addition to any other qualifications, a health care provider who attests in a certificate of a qualified expert concerning a defendant’s compliance with or departure from standards of care shall have had clinical experience, provided consultation relating to clinical practice, or taught medicine in the defendant’s specialty or a related field of health care, or in the field of health care in which the defendant provided care or treatment to the plaintiff, within 5 years of the date of the alleged act or omission giving rise to the cause of action. CJP § 3-2A-02(c)(2)(ii)(1). (Id. at 8).
Related Specialty
Specialties are related when there is an overlap in treatment or procedures within the specialties and therefore an overlap of knowledge of treatment or procedures among those experienced in the fields or practicing in the specialties, and the treatment or procedure in which the overlap exists is at issue in the case. (Id. at 9).
A CQE that satisfies the peer-to-peer requirement as to some named providers, but not others, satisfies the requirement overall because the plaintiff is not required to prove his case with the CQE. In reviewing the CQE, the trial court is to accept the assertions in the certificate, just as courts accept a plaintiff’s well-pleaded facts and allegations in a complaint. (Id. at 10).
Here, the expert was a board-certified general surgeon, and the named physicians were board-certified in internal medicine, infectious diseases, neurology, pulmonary disease, radiology, hospice and palliative medicine, and geriatric medicine, in addition to the nurses. The expert was also trained and certified in advanced wound care and post-surgical follow-up care. The procedure at issue was the failure to monitor the development of, document, and treat sacral decubitus ulcers. (Id. at 11).
Holding on Related Specialty in CQE
The Appellate Court held that the treatment at issue here was the physical examination of a patient who had been sitting for days in a hospital bed. It was one shared between specialties, whether performed by surgeons before or after surgery, or by an internal medicine doctor as a hospitalist. The internal medicine doctors and general surgeons here both had the same type of initial training and shared a basic knowledge and skills of the profession. (Id. at 11).
The Appellate Court held that the circuit court erred. The circuit court acknowledged that the medical specialties overlapped in performing physicals but incorrectly dismissed the case. The court failed to recognize that the procedure at issue involved the proper physical exam of a patient. (Id. at 12).
In this case, examining, documenting, and diagnosing medical problems, including ulcers, was a procedure shared by both general surgeons and internal medicine doctors. Additionally, because the CQE met the peer-to-peer requirement for the named physicians who are board-certified in internal medicine, the CQE is sufficient for that requirement, even though the CQE may not meet the exact requirement for the named nurses or other specialties. (Id.).
Commentary by Baltimore Medical Malpractice Lawyer Mark Kopec on Related Specialty in CQE
CQEs continue to be a stumbling block in litigation for parties, lawyers, and courts. In this case, the circuit court recognized that the specialties overlapped in the physical examination but failed to appreciate that this was the central issue.
With a decubitus ulcer, several medical providers attending to the patient will be involved in preventing, assessing, and treating the ulcer. Even though these specialties each have some training that the others do not, there is a common denominator regarding decubitus ulcers.
Application of the straightforward facts to clear precedent should have resulted in the denial of the motion to dismiss. The plaintiff had met the related specialty requirement in the CQE. The dismissal has real consequences. The plaintiff had to incur the legal costs and expenses of pursuing an appeal and waiting one year and four months to return to the beginning of litigation in the trial court. A party deserves better than this.
A Note on Damages
Due to the extensive time and considerable expense in medical malpractice cases, many medical malpractice lawyers will only pursue cases for permanent physical injuries of a certain level. In a decubitus ulcer case, this usually means the ulcer becomes infected and leads to fatal sepsis. When a decubitus ulcer heals, it can be difficult to obtain substantial damages.
In this case, there’s no indication that the decubitus ulcer led to a permanent physical injury. The complaint seemed to emphasize the six-month period needed for healing. An added factor is that the juries in Circuit Court for Allegany County are generally considered more conservative on medical malpractice cases than in several other Maryland counties.
Another complicating issue for liability is that the plaintiff was heavy. Even with the best equipment, it can be challenging to prevent decubitus ulcers entirely. In this case, however, there appears to be evidence of a significant delay in obtaining the appropriate bed for the plaintiff. It also seems that several medical providers were involved in that failure. This delay may be the evidence that the plaintiff believes is most compelling in pursuing his case. It will be interesting to see what happens on remand.
You can read other Blog posts on issues involving Expert Testimony, including:
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.