Under the Maryland Health Care Malpractice Claims Act (“HCMCA” or “Act”), unless the sole issue in a claim is lack of
informed consent, a claimant must file a “certificate of a qualified expert … attesting to departure from standards of care, and that the departure from standards of care is the proximate cause of the alleged injury[.]” Md. Code Ann., Cts. & Jud. Proc. (“CJP”) § 3-2A-04(b)(1)(i)1 (1974, 2020 Repl. Vol.).
A plurality of the Supreme Court of Maryland held in its July 29, 2025 Opinion that where a patient was previously diagnosed as having developed a pressure ulcer at a skilled nursing facility, a registered nurse may be qualified to attest in a certificate that a breach of the applicable standards of nursing care at the facility proximately caused the pressure ulcer. A registered nurse who relies on a pre-existing diagnosis does not make a diagnosis concerning the injury itself in a certificate filed under the HCMCA. Rather, the nurse accepts the accuracy of the pre-existing diagnosis made by another health care provider(s). A registered nurse does not exceed the bounds of nursing practice when the nurse opines in a certificate that a departure from the standards of nursing care is the proximate cause of a previously diagnosed pressure ulcer that developed while the patient resided at a skilled nursing facility.
The Supreme Court of Maryland further held that the HCMCA contains a peer-to-peer requirement with respect to a “health care provider” who signs a certificate of a qualified expert: such a “health care provider … [s]hall have had clinical experience, provided consultation relating to clinical practice, or taught medicine in the defendant’s specialty or a related field of health care, or in the field of health care in which the defendant provided care or treatment to the plaintiff, within 5 years of the date of the alleged act or omission giving rise to the cause of action[.]” CJP § 3-2A-02(c)(2)(ii)1A. A registered nurse is included in the HCMCA’s definition of a “health care provider.” Id. § 3-2A-01(f)(1). A registered nurse meets the HCMCA’s peer-to-peer requirement to the extent the nurse attests to alleged breaches of standards of nursing care. A nurse does not meet the peer-to-peer requirement to the extent the nurse attests to the standard of care applicable to a physician and to a physician’s alleged departure from that standard of care.
There were concurring and dissenting opinions following the majority opinion.
Source Canton Harbor Healthcare Center, Inc. v. Felicia Robinson, et al., No. 22, September Term, 2024.
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