Standard of Care: Street v. UCMC 4

Kopec Law Firm

This post is part 4 of a series on the recent Maryland medical malpractice case of Street v. Upper Chesapeake Medical Center, Inc., and focuses on the standard of care ruling, and where the case stands on remand. The Appellate Court of Maryland issued a reported opinion on March 1, 2024.

In part 1, I addressed when an expert is in a “similar specialty” to that of the defendant doctor. CJP 3-2A-02(c)(2)(ii)(1)(B). In part 2, I addressed the Court’s ruling on the issue of peremptory challenges. I then in part 3 addressed the informed consent ruling.


Here, I will repeat the basic facts of the case. The plaintiff sued a hospital, an emergency room doctor, a vascular surgeon, and their practice groups in the Circuit Court for Harford County. She alleged that as a result of breaches of the standard of care, she had to undergo a below-the-knee amputation. After a two-week trial, the jury then returned a defense verdict, and the plaintiff filed an appeal. (Op. at 1).

On June 16, 2017, the plaintiff went to the emergency room. Her right foot was numb, pale, and cool. An ultrasound showed an abnormal Ankle-Brachial Index (ABI). After a physical exam, Dr. Lu found no emergent vascular compromise to warrant emergent intervention. However, due to the low ABI, she recommended follow-up with vascular surgery if symptoms continued (Id. at 3-4).

On June 18, the plaintiff then returned to the ER. She reported that the pain was worse and the top of her foot was icy cold. ER Dr. Bassi admitted the plaintiff. The ER doctor requested a vascular surgery consultation. The consultation did not occur for two days. (Id. at 5-6).

Medical malpractice file on the standard of care and judge's gavel
Standard of Care

Maryland Standard of Care

The circuit court precluded the plaintiff’s vascular surgeon expert from testifying that the defendant’s vascular surgeon breached the standard of care by not doing a consult on June 18 or 19. The defendant practice group had a policy of responding to non-stat consult requests within 24 hours. Moreover, Dr. Lu requested a consultation with the group. Dr. Gonze was not on call on the 19th. Therefore, the circuit court precluded the plaintiff from arguing that the failure to consult on either day was a breach.

The Appellate Court ruled that the trial erred in finding that the group’s response policy established the standard of care and that no other evidence could be offered (Id. at 51). The policy can be evidence of the standard of care but cannot control that issue (Id. at 52-53).

Commentary By the Baltimore Medical Malpractice Lawyer

Standard of Care

The defense’s argument that the vascular surgeon group’s policy set the standard of care can be easily dismissed by looking at the ramifications. Such a rule would encourage self-serving guidelines that would be far looser than quality patient care would require. In addition, there would be varying policies within a hospital among specialists of the same type and among hospitals in a community. Moreover, as groups and hospitals amend policies, patients would face differing policies depending on whether they present before or after a policy change. All of this would be under the fiction that these vastly differing and constantly changing policies reflect a reliable and consistent standard of care.

Next for the Standard of Care Claim

Maryland Supreme Court

At this time, the deadline for seeking review in the Maryland Supreme Court has not run. The Appellate Court’s opinion was not a complete win for either side, and as a result, either can seek review in the highest court. However, the Supreme Court does not have to accept any such appeal—it is discretionary. Given the overall soundness of the Appellate Court’s ruling, I would be surprised if either party sought such a review, and I would be even more surprised if the Supreme Court would grant it.

Maryland Circuit Court

As a result, the likely next step is remand in the circuit court, in the Appellate Court’s opinion. The plaintiff’s initial case had a standard of care claim against the ER physician on the 16th for not requesting a vascular consult. It also alleged negligence on the part of the vascular surgeon for waiting until the 20th to do a consult requested on the 18th.

In the first trial, the jury determined that the ER doctor on the 16th did not breach the standard of care. The next jury will not revisit that decision. The first jury, however, had not been allowed to consider the vascular surgeon’s failure on the 18th and 19th. The plaintiff will present this new claim to the jury on remand.

From just reading the opinion, there needs to be more known to comment in detail on the plaintiff’s prospects on the standard of care claim against the vascular surgeon on remand. However, the plaintiff’s causation case has become more difficult. The window of negligence has been reduced from 4 days (16th-20th) to 2 days (18th-20th).

The plaintiff has to show that an earlier vascular surgery consult would have resulted in treatment that saved the leg. The earlier the consult, the better prospects for such proof. If the next jury finds a breach of the standard of care, it will have to determine if the vascular surgeon could have saved the leg in those two days.

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.

What Our Clients Say About Us

At the Kopec Law Firm, we are grateful that satisfied clients express their appreciation!

Mark is a knowledgeable and empathetic lawyer who speaks directly and concisely to evaluate your problem. He doesn't use attorney jargon that confuses people, rather he talks clearly. Although he couldn't help me with my situation, the consultation I had was productive because he answered my questions and gave me some clarity.

Shahnaz in Ellicott City

Dear Mark, I just wanted to express my gratitude for your dedication to my case. As you know, it has been a long and upsetting process for me, which would have been a great deal longer had it not been for the hours you put in helping me with this emotional roller coaster. Thank you again.

Shannon T. in Anne Arundel County

Dear Mark, thank you so much for your help and kindness. You provided the guidance and assistance we needed to obtain some understanding in loss of our child. We will never forget the professional and personal service provided. If anyone is in need of legal representation, I will certainly send them your way. God bless.

Kim C. in Cecil County

I wanted to say thank you for spending time with me regarding my questions about legal issues. Mere words cannot really express my gratitude. You seem to truly care about people.

Client in Baltimore City

Dear Mr. Mark, I’m truly grateful to have had you work on my son’s case. You were up front at all times and were on key every step of the way. I will always recommend your firm. Thank you so much for helping my son. P.S. Every time my son sees you on TV, he says “Mom, that’s my lawyer, Mr. Mark.” 🙂 Thank you again. You did an excellent job on the...

K.N. in Baltimore City

Dear Mark, we want to thank you for all the hard work and time your firm put in our case. You took the time to listen to us and research our case. You were honest and up front regarding the case. You responded to questions and concerns quickly. We would highly recommend your firm and services to anyone who is in need of legal representation. We...

Rebecca T. in Prince George’s County

Super Awesome team and staff! Worked with them for a case they handled for my grandchild about 10yrs ago! Would definitely use them again! I recommend them to everyone I know. Could never thank them enough! Very thorough and knowledgeable! Always kept us in the loop throughout the entire process!!!!

Letha C. in Prince George’s County

Mark explained everything in detail and brought clarity to all of my concerns.

Doris in Edgwater

I am very happy and thankful for your help. You responded very quickly. I am very happy to recommend you.

Linda in Chevy Chase
  1. 1 Free Consultation
  2. 2 Talk to a Lawyer
  3. 3 No Fee Unless You Win
Fill out the contact form or call us at 800-604-0704 to schedule your consultation.

Send Us a Message