Letter of Administration

Medical malpractice cases often hinge on a deceased person’s medical records. However, accessing those records and initiating a lawsuit on behalf of the deceased requires navigating specific legal hurdles in Maryland, primarily involving probate law and patient privacy regulations. The Letter of Administration issued by the probate court is often the key to proceeding in a medical malpractice case.

Patient Privacy and Medical Records After Death

When someone passes away, the privacy of their medical information remains protected, primarily under the Health Insurance Portability and Accountability Act (HIPAA), specifically the Privacy Rule.

Why Family Members are Prevented from Requesting Records

The HIPAA Privacy Rule generally mandates that covered entities (like hospitals and doctors) protect a patient’s individually identifiable health information (PHI) even after death, for a period of 50 years following the date of death.

For a living patient, HIPAA grants the patient the right to their records. When the patient is deceased, this right is transferred to the “Personal Representative” of the estate. A family member, even a spouse or child, is not automatically deemed the Personal Representative.

• Lack of Automatic Authority: A family relationship alone (e.g., being the decedent’s son or daughter) does not confer the necessary legal authority to act on behalf of the deceased’s estate. Without being formally appointed by the court as the Personal Representative, a family member is a “third party” under HIPAA.
• The “Relevance” Exception: While HIPAA does permit covered entities to disclose a decedent’s PHI to a family member or other person involved in the decedent’s care or payment for care prior to death, this disclosure is limited to the information relevant to that person’s involvement. This limited exception is generally insufficient for a comprehensive medical malpractice investigation, which often requires a complete and unedited set of records spanning a significant period.
• Need for a Personal Representative: To overcome these privacy restrictions and obtain all necessary records for litigation, the only person with the unequivocal legal right to the decedent’s medical records is the duly appointed Personal Representative of the deceased person’s estate, who steps into the shoes of the deceased for legal purposes.

The Role of the Estate (Letter of Administration) in Medical Malpractice Litigation

Medical malpractice claims following a death in Maryland often involve two distinct causes of action. They are a Wrongful Death claim and a Survival Action claim. The estate is critical for the latter.

• Survival Action: The estate brings this claim (through the Personal Representative) to recover damages the deceased person suffered between the time of the injury (the malpractice) and their death. These damages can include medical expenses, lost wages, and pain and suffering. This claim requires the formal establishment of a legal estate.
• Wrongful Death Claim: This claim is brought by the statutory beneficiaries. These are usually the surviving spouse, children, or parents. They sue for their own losses resulting from the death. These can be loss of companionship and financial support. The beneficiaries bring this claim. The Personal Representative is often the necessary party to also pursue the related Survival Action.

The Small Estate for Litigation Purposes

In Maryland, the process of opening an estate that would otherwise be very small—perhaps because the decedent left most assets in a trust or with payable-on-death designations—is simplified. This simplified process is particularly useful when the primary purpose of opening the estate is to pursue a personal injury or medical malpractice lawsuit.

Defining a Small Estate in Maryland

In Maryland, an estate qualifies as a “small estate” if the gross value of the assets subject to administration in Maryland is $50,000 or less, or $100,000 or less if the surviving spouse is the sole heir or legatee.

The “Litigation Exception” or Purpose

For medical malpractice litigation, the estate often has zero or minimal assets at the time of opening. The potential value of the lawsuit itself—the anticipated settlement or judgment—does not count toward the small estate threshold at the time of initial filing because it is merely a contingent, unliquidated claim, not a present asset.

Therefore, attorneys often pursue the Small Estate process to quickly and inexpensively:

1. Obtain the Letter of Administration, which grants the authority to gather medical records.
2. Appoint a Personal Representative, who can then initiate the Survival Action lawsuit.

If the lawsuit is successful and the recovery (settlement or judgment) exceeds the small estate threshold, the party may then convert the estate from a Small Estate to a Regular Estate to handle the distribution of the large incoming funds according to Maryland’s probate rules. The initial small estate, however, serves as the necessary “place holder” to begin the legal claim and investigation.

Opening the Small Estate for Medical Malpractice and the Letter of Administration

Where to Open the Estate

A party opens a Small Estate in Maryland in the Office of the Register of Wills for the county in which the deceased person had domicile (had their permanent residence) at the time of death. Maryland’s Orphans’ Courts (which oversee the Register of Wills) handle all probate matters, including the appointment of the Personal Representative.

The Process of Opening the Estate

The process generally involves filing several forms with the Register of Wills, including:

1. A Petition for Administration (Small Estate).
2. A List of Interested Persons (heirs and beneficiaries).
3. A List of Assets and Debts (Schedule B), which for litigation purposes will often show minimal or no probate assets.
4. The decedent’s Will (if one exists).
5. A certified copy of the Death Certificate.

The Letter of Administration and Medical Malpractice

The Letter of Administration (or Letter Testamentary if there was a Will naming an executor) is a crucial document. The Register of Wills/Orphans’ Court issues it. They give it upon the successful opening of the estate and the appointment of the Personal Representative.

• What it Is: It is a court order. It serves as proof of the appointed person’s legal authority to act on behalf of the deceased individual’s estate.
• Authority to Request Medical Records: Armed with the Letter of Administration, the appointed Personal Representative is now the legal successor to the deceased patient and is the “person in interest” under Maryland law and the “Personal Representative” under HIPAA. This legal authority obligates health care providers to disclose the complete medical record upon request.
• Authority to Bring a Lawsuit: The Personal Representative is the only party that the law authorizes to legally step into the shoes of the deceased. They file and manage the Survival Action component of the medical malpractice lawsuit. The estate itself brings this claim.

In summary, the Letter of Administration is the single most important document. It bridges the gap between patient death, privacy laws, and the initiation of a medical malpractice lawsuit in Maryland. It effectively transforms a grieving family member into a legally empowered Personal Representative.

If you have a potential medical malpractice case, then visit the Kopec Law Firm free consultation page or video. Then contact us at 800-604-0704 to speak directly with Attorney Mark Kopec. He is a top-rated Baltimore medical malpractice lawyer. The Kopec Law Firm is in Baltimore and pursues cases throughout Maryland and Washington, D.C.