United States District Court, D. Maryland
DeBORAH K. CHASANOW, District Judge.
Presently pending and ready for resolution in this medical malpractice case are five motions: (1) a motion for summary judgment filed by Defendants Calvert Memorial Hospital of Calvert County, Emergency Medicine Associates, P.A., and Matthew Christianson, M.D. ("Defendants") (ECF No. 69); (2) a motion for partial summary judgment filed by Defendant United States of America ("Government") (ECF No. 70); (3) a motion to seal exhibits filed by the Government (ECF No. 72); (4) a motion in limine under Daubert v. Merrell Dow Pharm., Inc., 509 U.S. 579 (1993), to strike and preclude any expert testimony regarding cerebral angiopathy filed by Plaintiff Angela Ford (ECF No. 80); (5) a motion for admission of facts or, in the alternative, to compel unqualified responses to Plaintiff's requests for admissions filed by Plaintiff Angela Ford (ECF No. 92); and (6) a motion to set a trial date filed by Plaintiff Angela Ford (ECF No. 103). The issues have been fully briefed, and the court now rules, no hearing being deemed necessary. Local Rule 105.6. For the following reasons, Defendants' motion for summary judgment will be denied. The Government's motions for partial summary judgment and to seal will be granted. Plaintiff's motions to strike and preclude and for admission of facts will be denied. The motion to set a trial date will be denied as moot.
I. Factual Background
On February 3, 2009, Plaintiff Angela Ford began prenatal care at Malcolm Grow Obstetrics and Gynecological Clinic ("Malcolm Grow"). Malcolm Grow is a United States Air Force clinic located at Andrews Air Force Base. On August 31, 2009, Plaintiff began to display elevated blood pressure consistent with preeclampsia and, three days later, laboratory studies showed elevated protein consistent with preeclampsia. On September 22, 2009, Plaintiff gave birth to her child. Five days later, on September 27, 2009, at approximately 8:10 pm, Plaintiff went to the emergency room of Defendant Calvert Memorial Hospital ("CMH"). Plaintiff presented with a blood pressure of 191/104 as well as severe headache, nausea, "tingly" feeling, and light head. She was evaluated by Defendant Dr. Christianson and her blood pressure dropped to 151/95. Plaintiff underwent a CT scan of her head that was interpreted to be normal with no evidence of acute infarction, acute or chronic hemorrhage, or mass effect. Her blood and urine were tested and the urine test revealed no evidence of protein. At 11:30 pm, Plaintiff was discharged by Dr. Christianson without having administered anti-hypertensive medication and she was instructed to follow up with her OB/GYN doctor in the next day or two.
The next day, Plaintiff went to her OB/GYN at Malcolm Grow with a blood pressure of 181/93 and a headache. Plaintiff was seen by Dr. Cortney Harper, an employee of the United States. She was prescribed Labetalol, an anti-hypertensive medication, and instructed to take 100 mg orally twice a day. She was discharged later that day. At 8:10 pm, Plaintiff went to Malcolm Grow's emergency room with a blood pressure of 171/91. Just after midnight on September 29, 2009, Plaintiff was witnessed having a seizure in the emergency room. Ultimately, Plaintiff was found to have suffered a contemporary cortically based hemorrhage in the right middle frontal lobe sulcus caused by eclampsia. She has since been diagnosed with postpartum eclampsia and epilepsy. The cerebral hemorrhage did not occur between the time Ms. Ford was at CMH on September 27 and when she went to Malcolm Grow and saw Dr. Harper at 10:00 am on September 28. Plaintiffs allege that Defendants provided inadequate care and treatment to Ms. Ford.
The Maryland Health Care Malpractice Claims Act (the "Malpractice Claims Act"), Md. Code Ann., Cts. & Jud. Proc. §§ 3-2A-01 et seq., governs procedures for medical malpractice claims in the state of Maryland. See, e.g., Carroll v. Konits, 400 Md. 167, 172 (2007). On September 10, 2011, Plaintiffs filed a Statement of Claim in the Healthcare Alternative Dispute Resolution Office ("HCADRO"). The HCADRO is an administrative body established by the Malpractice Claims Act.
On October 24, 2011, the United States removed the case to this court as the claim against the United States is for negligence performed by one of its employees. 28 U.S.C. § 2679. (ECF No. 1). Plaintiffs filed an amended complaint on March 26, 2012 (ECF No. 42), alleging medical negligence, specifically that Defendants owed Plaintiff Angela Ford a duty to exercise that degree of skill and care ordinarily possessed and used by health care providers acting in the same or similar circumstances. Plaintiffs allege that Defendants breached this duty in multiple ways, including failing to: (1) recognize that Ms. Ford was suffering from the effects of preeclampsia and was at risk for developing eclampsia in the post-partum period; (2) recognize that Ms. Ford was suffering from the effects of eclampsia and/or preeclampsia in post-partum period; (3) monitor and treat Ms. Ford for eclampsia and/or preeclampsia; (4) ensure that Ms. Ford's blood pressure was stabilized prior to releasing her from Malcolm Grow and CMH; (5) monitor and treat Ms. Ford's elevated blood pressure; and (6) take steps to prevent Ms. Ford from suffering a hemorrhagic stroke in the post-partum period. Plaintiffs allege that these breaches of duty directly and proximately caused Ms. Ford to suffer a hemorrhagic stroke, which caused permanent and severe injuries. Ms. Ford also alleges that the United States, including its employees Dr. Cortney Harper and Dr. Marc Hester, breached their duty of care by failing to recognize preeclampsia in the pre-natal setting and being otherwise negligent. Plaintiffs' second claim is for damage to the marital relationship suffered by Mr. Ford, including loss of companionship, affection, assistance, and impairment of sexual relations.
On September 5, 2013, Defendants filed a motion for summary judgment. (ECF No. 69). That same day, the Government also filed a partial motion for summary judgment for all allegations except those relating to Dr. Harper and a motion to seal some of the exhibits to its summary judgment motion. (ECF Nos. 70 and 71). On September 23, 2013, Plaintiffs opposed both motions (ECF Nos. 77 and 78), and the Government and Defendants replied on October 1 and October 10, 2013, respectively (ECF Nos. 79 and 83). The motion to seal is unopposed. On October 8, 2013, Ms. Ford filed a motion in limine to strike and preclude any testimony that Ms. Ford suffered from "cerebral angiopathy." (ECF No. 80). The Government opposed the motion on November 8, 2013 (ECF No. 90), and Ms. Ford replied on November 25, 2013 (ECF No. 91). Finally, on November 26, 2013, Ms. Ford filed a motion to compel admission of facts or, in the alternative, unqualified responses to her requests for admissions. (ECF No. 92). Defendants and the Government separately opposed the motion on December 13, 2013 and January 3, 2014, respectively. (ECF Nos. 96 and 99). Ms. Ford replied on December 30, 2013 and January 21, 2014. (ECF Nos. 97 and 100).
II. Motions for Summary Judgment
A. Standard of Review
A motion for summary judgment will be granted only if there exists no genuine dispute as to any material fact and the moving party is entitled to judgment as a matter of law. See Fed.R.Civ.P. 56(a); Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986); Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 250 (1986). A properly supported motion for summary judgment requires the nonmoving party to show that a genuine dispute exists. If the nonmoving party fails to make a sufficient showing on an essential element of that party's case as to which that party would have the burden of proof, summary judgment is appropriate. Celotex, 477 U.S. at 322-23.
A dispute about a material fact is genuine "if the evidence is such that a reasonable jury could return a verdict for the nonmoving party." Anderson v. Liberty Lobby, Inc., 477 U.S. at 248. Thus, "the judge must ask himself not whether he thinks the evidence unmistakably favors one side or the other but whether a fair-minded jury could return a verdict for the [nonmoving party] on the evidence presented." Id. at 252.
In undertaking this inquiry, a court must view the facts and the reasonable inferences drawn therefrom "in the light most favorable to the party opposing the motion." Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986) ( quoting United States v. Diebold, Inc., 369 U.S. 654, 655 (1962)); see also E.E.O.C. v. Navy Fed. Credit Union, 424 F.3d 397, 405 (4th Cir. 2005). The mere existence of a "scintilla" of evidence in support of the non-moving party's case is not sufficient to preclude an order granting summary judgment. See Anderson, 477 U.S. at 252.
A "party cannot create a genuine dispute of material fact through mere speculation or compilation of inferences." Shin v. Shalala, 166 F.Supp.2d 373, 375 (D.Md. 2001) (citation omitted). Indeed, this court has an affirmative obligation to prevent factually unsupported claims and defenses from going to trial. See Drewitt v. Pratt, 999 F.2d 774, 778-79 (4th Cir. 1993) ( quoting Felty v. Graves-Humphreys Co., 818 F.2d 1126, 1128 (4th Cir. 1987)
B. Analysis: Defendants' Motion
Plaintiffs' claims are for medical malpractice, "which includes the elements of duty, breach, causation, and harm." Barnes v. Greater Balt. Med. Ctr., Inc., 210 Md.App. 457, 480 (2013). Defendants contend that judgment should be granted to them because Plaintiffs have failed to set forth expert testimony to establish causation: i.e., that the alleged breach of the applicable standard of care by Defendants caused Ms. Ford's injuries and alleged damages. To prove causation, Plaintiffs have to:
establish that but for the negligence of the [Defendants], the injury would not have occurred. Jacobs v. Flynn, 131 Md.App. 342, 354 (2000). Because of the complex nature of medical malpractice cases, expert testimony is normally required to establish breach of the standard of care and causation. Id.
The expert testimony must show causation to a "reasonable degree of probability." Id. at 355. Reasonable probability exists when there is more evidence in favor of the causation than against it. Id.
Barnes, 210 Md.App. at 481. Defendants contend that Plaintiffs offered only one witness on the standard of care issue - Dr. Lisa Morikado - and Plaintiffs' separate causation witness did not testify as to Dr. Morikado's standard of care, but to his own standard of care. Dr. Morikado testified that Dr. Christenson breached the standard of care when he discharged Ms. Ford from CMH when her blood pressure was consistently above 140/90 and she complained of a headache and feeling "tingly." According to Dr. Morikado, those are symptoms of preeclampsia, and Dr. Christenson was wrong either not to admit her to the hospital or, alternatively, to discharge Ms. Ford without giving her medication to bring her blood pressure below 140/90.
Much of the focus of the depositions concerned Dr. Morikado's second option: failing to bring down Ms. Ford's blood pressure before discharging her. Dr. Morikado testified that "our standard of care guidelines through almost all of our textbooks... is that you don't send someone home with a blood pressure of 140 over 90 unless they're completely asymptomatic." (ECF No. 69-10, at 25, Trans. 92:18-22). Dr. Morikado testified that Hydralazine and Labetalol were two medications that treat high blood pressure in this situation. When asked how much of either medication would have been required for Ms. Ford, Dr. Morikado stated that she did not know because people have different responses to them. Dr. Morikado was asked how quickly the medications would have brought down the blood pressure to 140/90, and she stated that "both of those medications... have rapid onset. So it could have been five minutes.... Of course, I would probably watch her for a half hour, an hour, and make sure they stayed down." (ECF No. 69-10, at 20, Trans. 69:24 - 70:6). Later, Defense counsel honed in on Dr. Morikado's standard of care opinion:
Q: So can you tell me, just so I understand your standard of care opinion, assuming that he put her on medication, brought her blood pressure down to 140 over 90, he could discharge her on oral labetalol and follow up with her OB[/GYN] within 24 hours -
Q: - yes?
A: Correct. Assuming he talked with the OB -
Q: Labetalol -
A: If he talked with the OB and finds out that they can see her tomorrow morning, recheck her pressure, and with the - the caveat that if her head - if her headache goes up, she needs to go back in, all those caveats, yes, I think she - he could have done that.
Q: If it is clear to the physician, Dr.
Christianson... that the patient's blood pressure has now been brought down to 140 over 90, the standard of care would allow him to discharge this patient on oral labetalol or some other form of antihypertensive, with the understanding that she was going to be seen in close follow-up by her obstetrician -
Q: - correct?
A: And if not by her obstetrician... coming ...