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Md. high court rejects contractor argument, restores medmal verdict

“In most instances in which a patient in acute distress – or one acting in the patient’s interest – seeks emergency medical assistance, that person looks to the hospital or emergency facility rather than to a specific health care provider,” Judge Robert N. McDonald wrote for the majority. (Capital News Service Photo)

A divided Maryland high court has reinstated a medical malpractice verdict against Prince George’s Hospital Center, saying it shares the $6.1 million in liability for an emergency room surgeon’s negligence even though he was an independent contractor and not an employee of the Cheverly facility.

The Court of Appeals rejected the hospital’s argument that it was immune from liability because the orthopedist was not a staff physician and hence not an “agent” of the center when his delayed treatment of a car crash victim’s right leg necessitated its amputation.

In it 5-2 decision last month, the court said a hospital’s liability rests not on its contractual relationship with the doctor but on the patient’s reasonable perception that the physician was acting at the hospital’s behest.

People in physical or mental distress are concerned with getting to the hospital and not with the doctor’s contractual status with the facility, the court added.

“In most instances in which a patient in acute distress – or one acting in the patient’s interest – seeks emergency medical assistance, that person looks to the hospital or emergency facility rather than to a specific health care provider,” Judge Robert N. McDonald wrote for the majority. “In other words, the patient, or the person acting for the patient, relies on the facility’s representation that its personnel will provide the required treatment as that person has no time to either choose among individual physicians or make fine distinctions on their precise contractual relationship with the facility.”

A Prince George’s County Circuit Court jury in 2019 awarded $6.1 million to Terence Williams, whose severely injured right leg was belatedly treated by Dr. Montague Blundon. The jurors held both the hospital and doctor liable for the award.

Following a post-trial motion by the hospital, Prince George’s County Circuit Judge Thomas P. Smith ruled the facility could not be held liable because of the doctor’s independent contractor status. The intermediate Court of Special Appeals agreed, saying Williams had failed to show he believed Blundon was an agent of the hospital.

The Court of Appeals overturned those decisions.

“There was sufficient evidence at trial, viewed in the light most favorable to Mr. Williams, that he and the EMS personnel attending to him, relied on the representation of the hospital that it would provide the requisite medical staff to treat Mr. Williams’ injuries on an emergency basis,” wrote McDonald, a retired judge sitting by special assignment. “This was an occasion where the patient, and those acting in his interest, chose the hospital, not Dr. Blundon or any other provider, to provide necessary treatment.”

McDonald was joined in the opinion by Judges Shirley M. Watts, Michele D. Hotten, Steven B. Gould and Irma S. Raker, a retired jurist sitting by special assignment.

Williams’ attorney, Stephan Y. Brennan, said Monday that “we believe the Court of Appeals opinion took into account the realities of patients seeking emergency care in hospitals.”

Brennan is with Iliff, Meredith, Wildberger & Brennan PC in Pasadena.

In dissent, Judge Joseph M. Getty said Williams never testified that he believed Blundon was an employee of the hospital, testimony that was needed for the jury to validly conclude the doctor was an apparent agent of the facility.

In addition, Williams never personally relied on the hospital’s representation that it provides emergency care because he was taken there by emergency medical service personnel who did not give him a choice, added Getty, a retired judge sitting by special assignment.

“Under the (majority’s) broadened standard of what satisfies the requisite subjective belief to establish the reliance element (of apparent agency), it is unclear what actions a medical provider, emergency facility or hospital could take to shield itself from vicarious liability in circumstances where a patient is in distress and transported to the facility by a third party, such as EMS personnel,” Getty wrote. “Here, the majority’s analysis creates a strict liability scenario, which is not supported by the court’s established precedent and is nearly impossible for medical providers, emergency facilities and hospitals to overcome.”

Judge Jonathan Biran joined Getty’s dissent.

The University of Maryland Medical System acquired the hospital in 2017 when UMMS assumed ownership of Dimensions Health Corp.

“We are disappointed with the decision reached by the Court of Appeals in the Williams case, and share the view of the two dissenting judges that the majority decision changes the apparent agency analysis under Maryland law in the context of hospitals and emergency providers,” UMMS said in statement.

“In circumstances where a patient is in distress and transported to the facility by a third party, such as EMS personnel, the court’s holding broadens the concept of apparent agency in a way that is one step short of establishing a strict liability standard,” UMMS added. “Significantly, as pointed out in the dissent, no other Maryland entity, such as businesses, schools, and religious organizations, is subject to this approach to apparent agency liability.”

The hospital was represented at the Court of Appeals by Derek M. Stikeleather of Goodell, DeVries, Leech & Dann LLP in Baltimore.

Williams was rushed to Prince George’s Hospital Center at about 1:30 a.m. on May 3, 2014, suffering from vascular, bone and muscle injuries sustained in a rollover vehicle crash. However, he was not seen by Blundon, the on-call orthopedic trauma surgeon, for more than four hours, according to the lawsuit.

Blundon failed to properly treat Williams’ compound fracture, a failure not noticed until three days later when another doctor performed a pressure-relieving and circulation-restoring procedure in hopes of saving the leg but found too much deterioration had occurred, the lawsuit stated.

The hospital and Blundon denied the allegations of malpractice.

The jury’s award of $6,137,049 against the hospital and Blundon included nearly $6 million in economic damages and $300,000 for Williams’ pain and suffering.

The Court of Appeals issued its decision in Terence Williams v. Dimensions Health Corp., No. 42 September Term 2021.