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Crystal v. Midatlantic Cardiovascular Associates, P.A.

Court of Special Appeals of Maryland

March 29, 2016


Krauser, C.J., Berger, Leahy, JJ. [*]


Krauser, C.J.

Jan Crystal, appellant, filed a claim with the Health Care Alternative Dispute Resolution Office, against appellees: Midatlantic Cardiovascular Associates, P.A. ("Midatlantic"); St. Joseph Medical Center, Inc. ("SJMC"); and Mark G. Midei, M.D. ("Dr. Midei"), based upon the implantation of an allegedly unnecessary stent in Crystal's left anterior descending coronary artery (which we shall, as the parties do, refer to as the "LAD.") When arbitration was waived, Crystal filed a complaint in the Circuit Court for Baltimore County, alleging medical malpractice, fraud by intentional misrepresentation, and fraud by concealment.[1] The claim of medical malpractice was alleged as to all three health care providers, but the claim of fraud by misrepresentation was brought against only Dr. Midei, and the claim of fraud by concealment was directed at only SJMC.

After discovery was concluded by the parties, the circuit court granted appellees' motions for summary judgment, concluding that there was no evidence to support Crystal's claim of fraud by intentional misrepresentation, against Dr. Midei, or his claim of fraud by concealment, against SJMC. It, then, as a consequence of having disposed of Crystal's fraud claims, granted summary judgment as to his remaining medical malpractice claims against Midatlantic, SJMC, and Dr. Midei, as Crystal's fraud claims, having been disposed of on summary judgment, could no longer be deemed to have tolled the statute of limitations, which had long since run on his medical malpractice claims.

From those rulings, Crystal noted this appeal, contending that the court had erred in granting appellees' motions for summary judgment as to all of his claims, and thus his claims of fraud and medical malpractice should be resurrected by this Court. For the reasons set forth below, we shall affirm.



In October of 2004, after experiencing chest pain, shortness of breath, and a feeling of tightness in his chest, Crystal underwent a "cardiac catheterization, "[2] a procedure used to evaluate and diagnose cardiovascular conditions. During that procedure, it was discovered that there was a "stenosis"-that is, an abnormal narrowing[3]-of Crystal's LAD. The level of stenosis in that artery had reached 95%. To address that condition, a stent was placed in Crystal's LAD.

Yet, notwithstanding the successful completion of that procedure, Crystal continued to experience shortness of breath. Consequently, his cardiologist recommended that he undergo another cardiac catheterization. That second catheterization was to be performed by appellee, Dr. Midei, a cardiologist with appellee, Midatlantic.[4]

Before undergoing this procedure, however, Crystal signed, on November 4, 2004, [5] a "Cardiac Catheterization Laboratory Procedure Consent Form, " which authorized Dr. Midei "to perform one or more" of a number of medical procedures, including a "heart catheterization, " a "coronary angiography, " and a "stent implantation." Specifically, it stated, in pertinent part:

I consent to and authorize Dr. Mark Midei and his/her assistants to perform one or more of the following procedures:
Heart catheterization and coronary angiography, possible coronary angioplasty-type procedures (angioplasty, atherectomy, stent placement . . .), and possible peripheral angiography. Please read the explanations below.
* * *
Heart catheterization with coronary angiography is a diagnostic
procedure to define the presence, nature, and extent of heart disease. The physician inserts a small tube or catheter into an artery and/or vein in the leg or arm and advances it to the heart. The physician will inject dye through the catheter, take pictures of the arteries or grafts to the heart, and measure pressures in the heart. The results of this test will help determine if medication, an angioplasty-type procedure, or bypass surgery is the best treatment.
* * *
Coronary or peripheral angioplasty-type procedures (angioplasty,
atherectomy, stent placement) are therapeutic procedures to open blockages in coronary or peripheral arteries or bypass grafts. The physician will perform coronary or peripheral angiography, then advance a thin guidewire across the blockage and then select the most appropriate procedure(s) to open the blockage . . . . Stent implantation is a procedure where the physician inserts a metal stent (mesh-like tube) at the site of the blockage which is left in place to hold the artery open.
* * *

Notably, the form did not contain any requisite degree of blockage that would require or preclude the implantation of a stent, but instead left the decision, of whether to place a stent, to the medical judgment of Dr. Midei.

Notwithstanding Crystal's pre-operative consent to the procedure, it was Crystal's claim that Dr. Midei, though not required to do so, informed him, during the course of the procedure, but before the implantation of the stent, of the level of stenosis in his LAD. According to Crystal, Dr. Midei, before placing the stent, advised him, as he lay on the operating table, that the stenosis in question had reached 70% (though the laboratory report he later prepared suggested an even higher level of stenosis, that is, 80%) and that he would need a stent to avoid a complete blockage of the artery. Dr. Midei then placed another stent in Crystal's LAD.

At his deposition, nearly ten years later, Crystal, in recalling the deliverance of that advisement by Dr. Midei, testified as follows:

[Counsel]: Prior to the beginning of the cardiac catheterization procedure that [Dr. Midei] performed on November 22, do you remember talking to him?
[Crystal]: Just in the lab.
[Counsel]: I understand. On that morning before he started the catheterization procedure, do you ...

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