The Court of Appeals of Maryland (“Maryland Appellate Court”), Maryland’s highest appellate court, held in its opinion filed on January 25, 2019 that the trial court did not abuse its discretion when it gave standard general instructions on negligence and foreseeability in addition to an instruction particularizing the relevant standard of care in a medical malpractice case. Considered as a whole, the trial court’s instructions were not misleading and there was no showing of probable prejudice that would require reversal of the jury’s verdict.
The Maryland medical malpractice plaintiff sued the defendant neurosurgeon, alleging that the defendant negligently performed surgery on the plaintiff that caused him harm. The Maryland medical malpractice jury returned its verdict in favor of the plaintiff in the amount of $329,000, and the defendant appealed.
The trial judge had instructed the Maryland medical malpractice jury with standard pattern instructions on negligence, foreseeability, and causation before particularizing the standard of care applicable to a health care provider – i.e., that the provider must exercise the degree and skill which a reasonably competent health care provider engaged in a similar practice and acting in similar circumstances would use. The defendant argued that while all of these instructions correctly state the law, the trial court misled the jury as to the standard of care applicable to his conduct when it prefaced the instruction on the standard of care applicable to health care providers with two of the general negligence instructions.
The Maryland Appellate Court stated that, generally, the applicable standard of care in a negligence action is whether the defendant acted reasonably as measured against a hypothetical “reasonable” similar actor in similar circumstances. The conduct of a member of a profession who has special training and expertise is thus measured against the standard of a hypothetical reasonable person with similar training and expertise. Such a professional owes a special duty of care to a client or patient that is beyond the duty that would be owed by a general member of the public and that is commensurate with the professional’s training and expertise.
When the general principles of negligence are particularized to the actions of a physician diagnosing and treating a patient, the physician is under a duty to use that degree of care and skill which is expected of a reasonably competent practitioner in the same class to which he belongs, acting in the same or similar circumstances. Thus, under Maryland law, the standard of care applicable to a physician in a negligence action is derivative of the general standard of care in negligence actions, as informed by expert testimony about what a reasonably competent similar practitioner would do in the same circumstances.
The Maryland Appellate Court stated, “No decision of this Court has suggested that a trial court necessarily errs in a medical malpractice action when it prefaces the standard of care applicable to a professional, such as a physician, with instructions that outline the general principles applicable in a negligence action. The heightened standard of care applicable to a professional, acting within the scope of that profession, is derived from the general standard of care – both require the decisionmaker to compare the defendant’s conduct to a hypothetical reasonable counterpart.”
The Maryland Appellate Court continued, “It is neither wrong as a matter of law, nor necessarily misleading, to advise jurors in a negligence case in a general instruction that the tort embodies an objective standard – that the defendant’s conduct is to be measured against that of a hypothetical reasonable person in similar circumstances – before making clear that application of that objective standard in the case before the jury requires comparison to a hypothetical reasonable health care provider. Of course, when a trial court recites general principles governing negligence cases as a prelude to focusing on the particular standard of care applicable to the matter to be determined by the jury, it would be useful (and perhaps in some cases necessary) to be explicit that the preface is a preface. Without clarity, the use of a general negligence instruction could create a potential for confusion.”
In the case it was deciding, the Maryland Appellate Court stated, “the probability of prejudice appears close to nil. First, in the context of the evidence presented, counsels’ arguments, and the jury instructions taken as a whole, there appears to be little possibility that the jury believed it was to assess [the defendant’s] conduct against a hypothetical “reasonable lay person” instead of a hypothetical “reasonable physician.” No one at trial suggested that [the defendant’s] conduct was to be measured against that of a reasonable lay person.”
Furthermore, “to the extent that the jury could have somehow believed that a reasonable lay person standard applied, that standard is less demanding of a professional like [the defendant] than the “reasonably competent practitioner in the same class to which he belongs, acting in the same or similar circumstances” standard … As a skilled professional, [the defendant] could only benefit from application of the lesser standard of a reasonable lay person.”
The Maryland Appellate Court concluded: “In the taxonomy of civil actions, a medical malpractice action is a species of negligence action. Unsurprisingly, the general principles governing negligence actions apply. A trial court does not err in stating those general principles, but should take care to ensure that the jury is focused on how those principles apply in the particular case before it. Thus, in a case against a health care provider, the trial court should include an instruction that particularizes the benchmark of a reasonable person in similar circumstances to a reasonably competent health care provider acting in the same or similar circumstances, as the trial court did in this case. Ideally, the court should make clear how the general standard is customized. Although the trial court in this case might have used transitional sentences or phrases to clarify the relationship of the instructions, in light of the record as a whole (including the instructions, presentation of evidence, and arguments), there appears little possibility that the jury was misled as to the appropriate standard of care. Moreover, even if the jury had somehow believed that it was to compare [the defendant’s] conduct to that of a reasonable lay person, as opposed to the higher standard of care required of a physician, it would not have been to the detriment of [the defendant]. Accordingly, he has not demonstrated the probability of prejudice required to reverse the jury’s verdict.”
Source Mark Armacost v. Reginald J. Davis, No. 69, September Term 2017.
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