Deidre DeMizio and her son Peter S. DeMizio, DDS (“Appellants”) filed a Maryland medical malpractice claim for the death of Peter L. DeMizio, DDS, the Decedent, in the Circuit Court of Montgomery County, on May 22, 2020. Appellees were Johns Hopkins Health System Corporation and Johns Hopkins Community Physicians, Inc. (“Johns Hopkins
Appellees”) along with Michael Lee, M.D., Cardiology Associates, LLC, and Montgomery General Hospital, Inc. (“MedStar Appellees”). The claim alleged that Appellees failed to diagnose the Decedent with cardiac amyloidosis before his death on December 15, 2017. The claim was heard before a jury from January 8 to January 22, 2024, which found that neither Appellees breached their standard of care.

Amyloidosis

Amyloidosis is a disease process involving abnormally folded proteins that deposit in various organs. Amyloidosis effects the heart when amyloid fibrils deposit in the heart tissue. Amyloidosis can lead to thickening of the ventricles in the heart, which can result in impaired filling of the heart or arrythmias. There are two different types of cardiac amyloidosis. The first, immunoglobin light chain amyloidosis (AL), is caused by the overproduction of light chains by a clonal plasma cell population. The second, transthyretin amyloidosis (ATTR), is caused by transthyretin, a protein produced by the liver, misfolding and depositing in the heart. This version can be hereditary or age-related. The Decedent had age-related ATTR. Prior to his death, the Decedent was not diagnosed with cardiac amyloidosis.

The Appellees challenged the trial court’s rulings both before and during trial, which excluded some of their evidence and expert testimony regarding the standard of care. In one instance, the trial court ruled that the plaintiffs’ expert, cardiologist Dr. Hayek, was precluded from testifying that administering the drug tafamidis was the relevant standard of care because it was an unjustified extrapolation where during the relevant treatment period the treatment with tafamidis was not FDA-approved for any purpose. The Appellate Court of Maryland affirmed in its unpublished Opinion filed on May 8, 2026, stating: “Dr. Hayek failed to present sufficient evidence to support the reliability of his conclusion on tafamidis. Instead, Dr. Hayek’s testimony on this issue was precisely the kind of ipse dixit opinion that Maryland courts have said is not sufficiently reliable for admission.”

The trial court further refused to admit into evidence a Cleveland Clinic article about the standard of care of patients with cardiac amyloidosis entitled Cardiac amyloidosis: An update on diagnosis and treatment, which was published in December 2017. The Maryland appellate court affirmed, stating: “In this case, the time of the alleged acts that gave rise to the cause of action was the period between 2015 and 2017 when Appellees provided treatment to the Decedent. The Cleveland Clinic article was published in December of 2017, the same month that the Decedent died. Based on this timeline, Judge Leibowitz ruled that the article cannot be the standard of care “because it was published contemporaneously with the decedent’s death.” The trial court explicitly said that Dr. Hayek could rely on his training and experience to describe the same evidence, just not the article itself. We agree with Judge Leibowitz’s reasoning and find that the article itself was inadmissible for the purpose of establishing the standard of care during the relevant time period when it was not published until the end of that period and therefore inaccessible to Appellees whose conduct and knowledge was at issue in the case … We hold the trial court properly excluded the Cleveland Clinic article from evidence where the article trying to establish the standard of care in a medical malpractice case came from the end of the relevant period of treatment and as a result could not inform the treatment of any of Appellees.”

The trial court had excluded lay testimony regarding the availability and treatment protocols existing when the Decedent passed. The Maryland appellate court affirmed, stating: “We agree with Judge Leibowitz’s ruling that Mr. Lane’s testimony was not relevant to the proceeding. Another patient’s experience with a disease does not make a fact more or less likely in a case of medical negligence. Further, Mr. Lane’s testimony would not have established that he was treated by any of Appellees, if he had a comparable medical history or disease state to the Decedent, or any other testimony that would require an expert medical practitioner. Unlike the other fact witnesses that were at issue in this motion, Mr. Lane had no relationship to the Decedent or the Decedent’s family and would be unable to testify to any personal knowledge about the facts of this specific case. On Appellants’ specific argument that Mr. Lane could testify to the availability and treatment protocols existing when the Decedent passed, we hold Mr. Lane’s testimony would not be relevant for that purpose because he was not diagnosed until 2018, after the Decedent had passed and after the relevant period for determining the standard of care. As a result, Mr. Lane’s testimony was irrelevant in this particular case and would make no fact of consequence more or less probable.”

The Maryland appellate court held: “We find no error or abuse of discretion in any of the decisions that Appellants took issue with. As a result, we affirm the judgment of the Circuit Court for Montgomery County .”

Source DeMizio v. Johns Hopkins Health System Corp., No. 2412 September Term, 2023.

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