Background Facts
The wife and children of decedent, Everett Robinson, filed a Maryland medical malpractice claim against Canton Harbor Healthcare Center, a skilled nursing facility, in the Circuit Court for Baltimore City. With their complaint, the Robinsons provided a required certificate of qualifying expert (“CQE”). The CQE was authored by a registered nurse, who opined both that Canton Harbor breached the standard of care for skilled nursing facilities and that this breach caused Mr. Robinson to develop pressure ulcers.
Canton Harbor moved to dismiss the complaint, arguing that a registered nurse is not qualified to provide an opinion on medical causation. The circuit court agreed and dismissed the complaint. The Robinsons then appealed.
Maryland Medical Malpractice Law
CJP § 3-2A-04 provides, in pertinent part: (b) Unless the sole issue in the claim is lack of informed consent: (1)(i)1. Except as provided in item (ii) of this paragraph, a claim or action filed after July 1, 1986, shall be dismissed, without prejudice, if the claimant or plaintiff fails to file a certificate of a qualified expert with the Director attesting to departure from standards of care, and that the departure from standards of care is the proximate cause of the alleged injury, within 90 days from the date of the complaint . . . .
The Appellate Court of Maryland held in its April 24, 2024 Opinion that in a case against a skilled nursing facility alleging pressure ulcer injury, a nurse with sufficient training and experience can attest to the cause of a patient’s pressure ulcer injury in a CQE. CJP § 3-2A-02 provides that a “health care provider” may serve as the expert in a CQE. Registered nurses are included in the statutory definition of “health care provider.” Various Maryland and federal statutes and regulations relating to RNs and skilled nursing facilities indicate that the prevention and treatment of pressure ulcers are tasks entrusted primarily to nursing staff. Furthermore, COMAR 10.27.09.02 provides that the functions of registered nurses include nursing diagnosis, developing a plan of care that prescribes interventions to achieve expected outcomes, and revising the plan of care based on the effectiveness of the interventions. Together, these statutes and regulations indicate that a sufficiently experienced and trained RN may qualify as an expert on the cause of pressure ulcers: “we conclude that in a negligence case against a skilled nursing facility for decubitus ulcer injury, Maryland’s CQE requirement under the HCMCA may be predicated on a proximate causation opinion by a registered nurse with sufficient education and experience in preventing and treating the ulcer injury alleged in the complaint. Here, the CQE and Jones-Singh’s accompanying report and affidavit are sufficient to support her attestation that Canton Harbor breached nursing standards of care in a manner that proximately caused ulcer injuries to Mr. Robinson, as alleged in Count One of the complaint.”
The Appellate Court of Maryland cautioned, however: “The scope of our holding is narrow. We hold only that in negligence cases alleging breach of nursing standards for preventing and treating decubitus ulcers, a registered nurse
is not disqualified per se to attest that failure to adhere to such standards proximately caused the plaintiff’s ulcer injury. In these limited circumstances, we do not share Canton Harbor’s concerns about registered nurses overstepping their expertise in managing pressure ulcers by predicating their proximate cause opinions on impermissible medical diagnoses. If and when that happens in a particular case, the same remedy at issue here—dismissal—will be available to court and counsel.”
Source Felicia Robinson, et al. v. Canton Harbor Healthcare Center, Inc., No. 2169, September Term, 2022.
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