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Puppolo v. Adventist Healthcare, Inc.

Court of Special Appeals of Maryland

December 19, 2013


Zarnoch, Nazarian, Davis, Arrie W. (Retired, Specially Assigned), JJ. [1]



In this medical malpractice case, Celeste Puppolo ("Puppolo"), in her capacity as personal representative of the estate of Nancy Puppolo ("Mrs. Puppolo"), sued Adventist Healthcare, Inc. ("Adventist") and Dr. Sabyasachi Kar alleging negligence in the death of Mrs. Puppolo. Puppolo now seeks review of an order of the Circuit Court for Montgomery County, which granted Adventist's and Dr. Kar's motions for summary judgment and granted Adventist's motion to dismiss pursuant to the statute of limitations and for Puppolo's failure to comply with the Maryland Health Care Malpractice Claims Act ("HCMCA"), Md. Code (2006, 2013 Repl. Vol), Courts & Judicial Proceedings Article ("CJP"), § 3-2A-02. We find no error and therefore affirm the decision of the circuit court.


On August 12, 2006, Mrs. Puppolo, age 81 at the time, arrived at Washington Adventist Hospital ("WAH") by ambulance. The paramedics indicated that she had a stroke the previous night, resulting in right side weakness and general incoherence. The emergency department ordered a CT scan of the head, a chest x-ray, and blood work. Dr. Kar, a hospitalist[1] at WAH, examined Mrs. Puppolo around 7:35 p.m. and wrote an admitting note.[2]A radiologist interpreted the CT scan and concluded that the scan did not show a new stroke or bleeding. Dr. Kar devised a treatment plan that admitted Mrs. Puppolo to the Medical/Surgical Telemetry Unit, ordered an MRI to confirm there was no new stroke, and requested a neurologist to evaluate her condition. Dr. Kar prescribed Lovenox[3] based on her weight to "bridge her anticoagulation and to manage the risk of stroke due to atrial fibrillation." Dr. Kar's shift ended at 8:00 p.m. and he left the hospital. A neurologist saw the patient and agreed with Dr. Kar's plan; the Lovenox was then administered around 9:00 p.m.

The next day, Dr. Shahid Shamim assumed responsibility for Mrs. Puppolo's care. Dr. Shamim had previously treated her on a different occasion, and it was hospital policy to have patients see the same hospitalist. Along with the attending neurologist and other treating providers, Dr. Shamim cared for her for the remainder of her time at WAH. While still in the hospital on August 19, 2006, Mrs. Puppolo suffered a massive intracranial hemorrhage, which caused her to lapse into a coma. Her providers observed the hemorrhaging during an MRI scan the next day. They discontinued the Lovenox and transferred her to the University of Maryland Shock Trauma Center, where she remained in a coma for six weeks. From August 20, 2006 to June 27, 2007, Mrs. Puppolo suffered from complications relating to her hemorrhage, coma, and extended hospitalization. The complications included hospital-acquired bacterial infections, bedsores on her lower back and right heel that resulted in surgeries and toe amputations, numerous bodily contusions, multiple instances of hypoglycemic shock, renal failure, lung collapse, sepsis accompanied by systemic inflammatory response syndrome, and pain and suffering. Mrs. Puppolo ultimately passed away in December 2008.


On August 12, 2009, Puppolo filed a claim with the Maryland Health Care Alternative Dispute Resolution Office ("HCADRO") against Adventist and Dr. Kar.[4] Puppolo filed a Certificate of Merit and Report prepared by Dr. Joseph Jeret, a neurologist, in October 2009. The parties waived out of arbitration and Puppolo filed a complaint in the Circuit Court for Montgomery County on May 7, 2010, alleging that appellees breached the standard of care when treating her mother. Specifically, she alleged that Mrs. Puppolo received an inappropriate dosage of Lovenox from appellees, and that they failed to diagnose her stroke and intercranial bleeding in a timely manner. She alleged that as a proximate cause of their negligence and breach of the standard of care, her mother suffered injuries and damages. After Adventist moved to dismiss for "Deficient Certificate of Qualified Expert and Report, " the court, on January 28, 2011, dismissed the complaint against Adventist without prejudice because the court determined that Puppolo's certificate did not specifically identify the licensed professionals at WAH whom she alleged breached the standard of care. The court did not dismiss the complaint as to Dr. Kar. Dr. Kar filed multiple motions to strike Puppolo's medical expert's certificate of merit and report, arguing that a neurologist could not be a qualified expert with respect to a hospitalist. The court denied these motions.

On March 29, 2011, Puppolo filed a second complaint against Adventist in the Circuit Court for Montgomery County. The court consolidated this new complaint against Adventist with the previous complaint against Dr. Kar. On August 25, 2011, Adventist filed a motion to dismiss, arguing that the statute of limitations had expired in August 2009, three years after the alleged malpractice. Adventist also argued that Puppolo did not comply with the HCMCA when she filed the second complaint in circuit court, instead of beginning again before the HCADRO. In addition to the motion to dismiss, Adventist filed a motion for summary judgment, arguing that Puppolo did not identify any expert witnesses in accordance with the court's scheduling order and therefore could not present a prima facie case of negligence against Adventist. On December 2, 2011, the court held a hearing and, over Puppolo's opposition, granted both of Adventist's motions.[5]

On March 26, 2012, Dr. Kar filed a motion to dismiss and a motion for summary judgment. On June 7, the court initially denied these motions, but then, on a motion to reconsider, the court ruled in favor of Dr. Kar because Puppolo conceded that her neurologist expert could not opine on the standard of care for a hospitalist. On June 18, Puppolo filed a motion to alter or amend the court's judgment. Dr. Kar opposed this motion, and on August 24, the court denied Puppolo's motion. Puppolo timely filed her appeal, requesting review of the judgments concerning both Adventist's and Dr. Kar's motions. Additional facts will be provided as necessary in our discussion of the issues.


Puppolo presents the following questions, which we have rephrased:[6]

1. Did the court err in granting Adventist's and Dr. Kar's motions to dismiss?
2. Did the court err in granting Adventist's and Dr. Kar's motions for summary judgment?
3. Did the court abuse its discretion in denying Puppolo's request to correct deficiencies and her ...

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