In its unreported opinion filed on May 26, 2021, the Court of Special Appeals of Maryland (“Maryland Appellate Court”), Maryland’s intermediate appellate court, held: “Viewing the evidence in the light most favorable to appellants, we conclude that appellants adequately presented evidence regarding a violation of the standard of care, causation and harm resulting therefrom. Whether to credit that a violation of the standard had occurred and causation was a question reserved for the jury.”
Rebecca Morris arrived at St. Joseph Medical Center at approximately 2:00 p.m. on August 6, 2015. Her care was assumed by Michael Giudice, M.D. and Carol Ator, R.N., a labor and delivery nurse employed by St. Joseph. Ms. Morris’ blood pressure was taken four times between 2:34 p.m. and 3:49 p.m. Her blood pressure readings were, successively, 137/89, 133/92, 144/96, and 144/100, which indicated that her blood pressure was increasing. Dr. Giudice conducted a urinalysis at 3:43 p.m., which revealed trace protein in Ms. Morris’ urine.
Ms. Morris’ fetal heart rate was monitored at St. Joseph with results that indicated minimum to moderate variability with no accelerations. Based on these results, Dr. Giudice concluded that Ms. Morris had nonreactive fetal heart rate tracing and ordered a biophysical profile that yielded a result of 8/8, which indicated that the fetus was stable “at that moment in time.” Ms. Morris’ blood pressure was not taken again after her biophysical profile was completed. Dr. Giudice testified that he was aware that Ms. Morris’ blood pressures qualified for gestational hypertension and preeclampsia. Dr. Giudice ordered her to be discharged at 5:24 p.m. Nurse Ator discharged her at 5:39 p.m.
On August 10, 2015, Rebecca Morris called Capital Women’s Care, LLC (“Capital”), complaining of decreased fetal movement. When she reported to Capital for an appointment that day, her blood pressure was 157/99, she had +1 protein in her urine, and a NST showed minimal variability with minimal acceleration. She was then sent to St. Joseph Medical Center for evaluation, where her fetal heart rate tracing showed minimum variability and, according to Dr Giudice, “decelerations that were essentially random in nature.” Due to these results, Dr. Giudice decided to proceed with delivery and to perform an “urgent” Caesarean section.
Peter was born on August 10, 2015 at 5:13 p.m., with low Apgar scores of 1, 3, and 6 at one, five, and ten minutes, respectively. Later that day, he was transferred to the University of Maryland Medical Center (“UMMC”) for brain cooling. An MRI of Peter’s head on August 17, 2015 showed findings most consistent with global hypoxic-ischemic encephalopathy (“HIE”), a brain disorder caused by insufficient oxygen or blood flow during birth. Peter was discharged from UMMC on September 9, 2015 with the following diagnoses: full term liveborn male, small for gestational age (birth weight 2330g less than the 5th percentile), perinatal depression, HIE, metabolic acidosis, and seizures.
In 2018, the plaintiffs filed a Maryland medical malpractice claim against University of Maryland St. Joseph Medical Center, LLC and co-defendants, Capital Women’s Care, LLC and Michael Giudice, M.D., for failure to admit Ms. Morris and deliver Peter on August 6, 2015. The defendants filed a Motion for Summary Judgment, and at the conclusion of a hearing, the court granted the motion. The plaintiffs appealed.
Maryland Appellate Court Opinion
The circuit court granted summary judgment for the defendants without stating a basis for its decision, and the Maryland Appellate Court stated, “In our review of the record, we could not discern the legal grounds relied upon the court, either explicitly or otherwise.”
The Maryland Appellate Court stated: “Here, Dr. Giudice was a treating physician for Ms. Morris on August 6 and his admissible testimony would have been limited to what he observed or did on that date. Thus, his testimony that if he had been informed of Ms. Morris’ last blood pressure, he would not have changed his discharge order was not fact witness testimony. Likewise, Dr. Rossiter’s testimony regarding what she would have done had the chain of command been activated was inadmissible as she did not provide care or make decisions concerning Ms. Morris’ care during her August 6 visit. Dr. Rossiter lacked the requisite personal knowledge and her testimony should have been limited to what she observed or did on August 6. Appellees’ contention that it is “undisputed” that adhering to the chain of command policy would have yielded the same result is premised on testimony from their fact witnesses, Dr. Giudice and Dr. Rossiter. However, conflicts such as these must be viewed in a light most favorable to the non-moving party, in this case, appellants.”
“The circuit court did not, however, provide a ruling as to the admissibility of Dr. Rossiter’s or Dr. Giudice’s testimony. In our view, Dr. Balducci provided a rational explanation as to how he reached his expert opinion. The mere fact that his opinion contrasted with Dr. Giudice’s testimony does not reduce his opinion to “because I say so” testimony. We, therefore, conclude that Dr. Balducci’s testimony was admissible.”
The plaintiffs’ expert, Nurse Shinn, testified that “Nurse Ator knew or should have known that the standard of care for a patient such as Ms. Morris was to admit for delivery in the setting of gestational hypertension or mild pre-eclampsia.” She testified that Nurse Ator violated the standard of care by negligently failing to act pursuant to St. Joseph’s chain of command policy and advocate for Ms. Morris’ admission and delivery with Dr. Giudice, then going up the chain if he disagreed.
The plaintiffs’ expert, Dr. Sibai, testified that defendants deviated from the standard of care by failing to admit Ms. Morris and deliver on August 6 because “a reasonable physician [would] go ahead and move for delivery because there is really no advantage whatsoever to continue [the] pregnancy because it is very well-known that this condition is going to progress and could change suddenly.” Moreover, Dr. Balducci testified that “[defendants’] deviations from the applicable standards of care were the direct and priximate cause of Peter Fitzpatrick’s permanent hypoxic-ischemic encephalopathy and its sequelae.”
Dr. Rosenberg opined that “if the delivery occurred on August 6, 2015, Peter Morris Fitzpatrick would not have been born with a significant metabolic acidosis and would not have suffered hypoxic ischemic encephalopathy and its sequalae.” He also testified that “causation stems from” Nurse Ator’s “breach [of] the standard of care by not questioning Dr. Giudice’s decision to discharge Ms. Morris, and by failing to activate the chain of command as necessary.”
Hence, the Maryland Appellate Court reversed summary judgment entered in favor of the defendants and remanded the case to the circuit court.
Source Fitzpatrick v. University of Maryland St. Joseph Medical Center, LLC, No. 2407 September Term, 2019.
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