STANLEY SUGARMAN, ET AL.
CHAUNCEY LILES, JR.
Court for Baltimore City Case No. 24-C-14-005808
Graeff, Friedman, Thieme, Raymond G., Jr. (Senior Judge,
Specially Assigned), JJ.
Liles, Jr., appellee, filed a complaint against Ivy Realty,
Inc. and Stanley Sugarman (collectively "Ivy
Realty"), appellants, in the Circuit Court for Baltimore
City, alleging injury and damages caused by lead paint
exposure at a residence (the "Property") managed,
maintained, operated, and controlled by Ivy Realty. At trial,
the parties stipulated that, due to Ivy Realty's
negligence, Mr. Liles was exposed to deteriorating paint at
the Property, and his exposure to lead paint substantially
contributed to two documented elevated blood lead levels. The
only remaining questions for the jury, therefore, were
whether Mr. Liles' lead exposure caused injury, and if
so, what, if any, damages were incurred.
Liles presented four expert witnesses at trial to testify to
his alleged injury and damages. At the close of his case, and
again at the close of all evidence, Ivy Realty moved for
judgment, asserting that the expert testimony was speculative
and lacked a factual basis to support the causation and
damages opinions, and the evidence was insufficient to
establish that Mr. Liles had suffered a legally compensable
injury. The court denied the motions. The jury ruled in favor
of Mr. Liles, and judgment was entered against Ivy Realty in
the amount of $1, 277, 610.
appeal, appellant presents three questions for this
Court's review, which we have rephrased and consolidated,
1. Was there sufficient evidence for the trial court to
submit the case to the jury on the issue whether Mr.
Liles' lead exposure caused injury?
2. Was there sufficient evidence for the trial court to
submit the case to the jury on the issue whether any injury
caused by the lead exposure resulted in damages?
reasons set forth below, we shall affirm the judgment of the
AND PROCEDURAL BACKGROUND
Liles' Medical and Educational History
Liles was born on February 17, 1998. When Mr. Liles was two
and one-half years old, he had a blood lead level of 11
mcg/dL, and at age three, it was 10 mcg/dL.Mr. Liles'
medical records indicate that, at two years old, he suffered
a seizure due to appendicitis. He had an emergency
appendectomy and was hospitalized for two weeks, but he made
a full recovery. In high school, Mr. Liles suffered a broken
thumb. The thumb healed completely, and he suffered no long
term effects from that injury.
Mr. Liles was nine years old, several close family members
died within a one-year time period. Mr. Liles experienced
grief and anxiety, for which he received counseling. No
developmental concerns were documented within his medical
records. The records indicated that Mr. Liles was
"bright, cooperative and . . . functioning at the
appropriate grade level (3rd)." His level of
academic performance was assessed at "above
elementary school, Mr. Liles performed consistently at or
above grade level until his 4th and 5th grade school years,
when he had increased absences following the death of his
family members and his treatment for anxiety. As a result of
his performance, Mr. Liles attended summer school, and he
received academic support, including "one on one
support, " "small grouping, "
"individualized help on his math skills and test taking
practice, " "extra response time, "
"extended time to complete assignments, " and
"repetition of directions." In middle school, Mr.
Liles raised his grades into the "70s, 80s, and
2016, Mr. Liles graduated from Baltimore City College High
School ("City College"), a prestigious college
preparatory school that requires admittees to pass an
entrance examination. Mr. Liles described his grades at City
College as terrible, stating that he had "a mid-C
average, " and the "only A's" he received
were in foreign language, "weight training, gym class,
Liles blamed his poor grades in high school on his inability
to focus, stating that he gets distracted a lot, does not
like sitting still, and "just can't grasp things as
fast as other people do." These issues started when he
was young, but "as the work got harder, [he]
couldn't get it." He stated that his parents had
both done well in school, and they encouraged him to do well,
which was his goal, but he "couldn't." His
weighted Grade Point Average ("GPA") upon
graduation from City College was 3.3, although his unweighted
GPA was 2.1. He was ranked 194 out of 301 students.
Liles tested at or above grade level on all Maryland School
Assessment testing and passed his High School Assessment
tests. His scores on the PSAT were in the 20th, 24th, and
54th percentiles during his 9th, 10th, and 11th grade years,
high school, Mr. Liles was accepted to West Virginia
University ("WVU") and Bowie State University
("BSU"). He decided to attend BSU because it was
less expensive and closer to home. Mr. Liles stated that he
would "not be able to focus" at WVU and would be
easily distracted away from his family, without supervision.
respect to Mr. Liles' family members, his mother, Daronda
Liles, is a high school graduate, with some college
experience. His father, Chauncey Liles, Sr., is a high school
graduate employed as a truck driver. Mr. Liles has four siblings.
The oldest three siblings all completed high school, and one
is enrolled at the University of Maryland, Eastern Shore
studying pre-med. His youngest sibling is still in grade
Liles' Expert Witnesses
Robert Kraft, a licensed psychologist, testified as an expert
in neuropsychology, the "relationship between behavior
and the central nervous system
functioning." A clinical neuropsychology assessment is
performed on an individual to "determine an
individual's strengths and weaknesses in their brain
functioning . . . to determine if they have any sort of
neurodevelopmental disorder or brain-related impairments that
may impact them, and to identify what those are."
Brain-related impairments are not physically visible through
neuroimaging, and it requires "specialized assessments
in order to identify them." The assessment involves
observing the individual, taking a history, and giving a
"battery of tests that are designed to be presented
under specific conditions and that an individual is expected
to display specific behavior in response to these
Kraft's neuropsychological examination of Mr. Liles
consisted of an interview, as well as a number of
neuropsychological tests that Dr. Kraft administered to
assess intelligence, memory, learning, academic achievement,
executive functioning, attention, language, visual-spatial
and perceptual motor functioning, and effort. Mr. Liles has a
"full scale IQ of 94, " which "falls into an
average range, " and his "performance on math was
in the solid average range of the 61st percentile." Dr.
Kraft stated, however, that having an average range IQ score
does not mean that there is no evidence of brain impairment,
and that Mr. Liles' "two index scores that are most
sensitive to attention and concentration" were
"significantly lower than his performance in perceptual
reasoning, " which indicated the presence of "mild
impairment." Specifically, Dr. Kraft stated that Mr.
Liles had mild deficits "with respect to auditory
encoding of information in the working memory, and
information processing speed, " both of which "are
factors of attention." In regard to both of these
factors, Mr. Liles scored 86, which is statistically in the
18th percentile, and was "significantly lower than his
performance in perceptual reasoning, " which was
The discrepancy between the index scores and the IQ test was
wide enough that it "is not considered to happen by
chance alone, " but rather, it suggests "that there
is some process that is responsible for the
Kraft explained that auditory encoding is a person's
"ability to hold information in mind for immediate
manipulation and to make some sort of output with that
information that you're holding in memory." For
example, a waiter or waitress who takes orders without
writing the orders down is using auditory encoding.
Individuals "use auditory encoding in every aspect of
life, " and that information is stored until the
individual has completed the task, and then the information
can be forgotten.
speed is an individual's "ability to independently
focus and complete a task in a self-directed manner."
For example, a student who sits down to study, or an adult
who sits down to read a book or complete a writing task,
requires information processing speed. Mr. Liles' ability
"to do that independently . . . is lower than it should
be based on his intellectual functioning and suggests a mild
impairment in that area." Dr. Kraft suggested that Mr.
Liles' mild deficit could be accommodated, stating that,
although Mr. Liles "may take a little longer than the
average peer, " he typically completes tasks "with
accuracy and not a lot of compulsive errors."
Kraft agreed that Mr. Liles did not suffer from any deficits
in IQ, executive function, the visual-spatial realm, speech
and language, or fine and gross motor skills. Mr. Liles
scored high average to average on another test for auditory
attention, scoring higher than 75% of the general population
on one subtest and in the 50th percentile on another. Dr.
Kraft described the tests on which Mr. Liles scored the
highest as "logical memory tasks and visual reproduction
tasks, " both of which "involve learning the
information and storing it." Dr. Kraft further described
Mr. Liles' "language skills [as] average or better,
" and his "comprehension of instructions, which is
a receptive language kind of task, " as "in the
average range." Mr. Liles' "[v]erbal fluency
was high average."
of his evaluation, Dr. Kraft reviewed Mr. Liles' school
records. Mr. Liles began to show some mild educational
problems in fourth grade, and he was provided with math
tutoring. In fifth grade, Mr. Liles "performed more
poorly, " and the teacher's notes indicated that Mr.
Liles was provided with accommodations, including
"one-on-one teacher supports, " "extra
response time, " and "extended time to complete
assignments, " which Dr. Kraft thought was significant
"because those are the exact accommodations that would
be afforded to an individual who's having attention
problems, particularly involving their ability to process
information in a timely manner, " which was
"consistent with" Dr. Kraft's findings during
the evaluation. Dr. Kraft was aware that Mr. Liles had
suffered deaths in his family during the fourth and fifth
grades, and had been receiving counseling, but he opined that
Mr. Liles would have needed accommodations regardless of this
Kraft noted that Mr. Liles could have obtained B's in
school because the "deficits are mild, and they may not
always show up in every school year." In that regard, he
stated that Mr. Liles may have had "courses that are
easier than others, teachers that he click[ed] with better
than others, and not necessarily need[ed] accommodations or
[had] to struggle to adapt to the deficits." In other
words, Mr. Liles' "deficits aren't always
apparent in terms of how he would function at school . . . .
if he's able to adapt and accommodate in some way for
Blackwell-White, who was admitted as an expert in pediatrics
and childhood lead poisoning, had seen hundreds of children
in her practice that had elevated blood lead
levels. She explained that lead is a neurotoxin,
"a substance which causes damage to the central nervous
system, " i.e., the "brain and the way the brain
functions." Children are more susceptible to brain
injuries from neurotoxins because their brain is rapidly
developing, and lead exposure interferes with the
neurotransmitter which transmits messages from "one
neuron to another" through the myelin sheath. The
"learning pathways" are disrupted, which "in
real-speak [means] that "attention is going to be
affected. You're not going to have a nice message go from
one neuron to another." The damage that happens to a
child's brain from lead poisoning is permanent.
Blackwell-White stated that the Centers for Disease Control
("CDC"), which "issue[s] standards and
protocols for diagnosis and treatment of children who have
elevated blood lead levels, " has set the current
reference level at five micrograms per deciliter of
blood-lead, i.e., 5 mcg/dL. Previously, in the "early
80s, " the reference level was 25 mcg/dL. It was lowered
to 15 mcg/dL, then to 10 mcg/dL, and most recently, in 2012,
it was lowered to 5 mcg/dL. The reference level was lowered
based on medical literature and many studies indicating that
blood lead levels under 10 mcg/dL were damaging to children.
Blackwell-White reviewed Mr. Liles' medical records,
which indicated that his blood lead levels around the year
2000 were 10 mcg/dL and 11 mcg/dL. The reference level for
the CDC at that time was less than 10 mcg/dL.
Blackwell-White also discussed the Environmental Protection
Agency's ("EPA") Integrated Science Assessment
("EPA-ISA") on lead. The EPA is a regulatory agency
that surveys the impact of health concerns to the population,
and it reviewed years of literature regarding "the
impact of lead on the environment and on the
population." Dr. Blackwell-White testified that the
EPA-ISA found that there is a causal relationship between
childhood lead exposure and certain cognitive problems,
including "attentional problems in children - impulse
control . . . . and hyperactivity." She explained that
these problems were found in children with lead levels
between 7 mcg/dL and 14 mcg/dL, and "cognitive IQ point
loss was caused by early lead exposure." Mr. Liles'
blood lead levels were 10 and 11, "within the
range." Dr. Blackwell-White testified that "many
studies" link lead exposure in childhood to loss of IQ
points, citing two leading studies that "looked at the
impact of IQ loss in children for lead levels under 10."
reaching her opinion in this case, Dr. Blackwell-White
relied, in part, on the EPA-ISA's determination of a
causal relationship between lead exposure and cognitive
defects. After reviewing Mr. Liles' medical records, Dr.
Blackwell-White opined that Mr. Liles suffered lead poisoning
as a child. The basis for that opinion was Mr. Liles' two
elevated lead levels at ages two and one-half and three.
Blackwell-White also reviewed Dr. Kraft's
neuropsychological evaluation reports, on which she relied
heavily. Dr. Kraft's report indicated that Mr. Liles had
cognitive impairments in processing speed and auditory
encoding, measures of attention. Dr. Blackwell-White
testified that, in her opinion, Mr. Liles "suffered
brain damage as a result of his early lead exposure, "
and the cognitive deficits identified by Dr. Kraft were
permanent and caused by Mr. Liles' exposure to lead.
Blackwell-White noted that one of the other leading studies,
"the International Pooled Analysis by Dr. Bruce
Lanphear" (the "Lanphear Study"), concluded
that lead, independently of "other things going on in
these children's lives, " was responsible for IQ
loss. Based on the Lanphear Study, Dr. Blackwell-White opined
that Mr. Liles had lost four IQ points as a result of his
elevated blood lead levels.
cross-examination, Dr. Blackwell-White agreed that a history
of emotional distress potentially could put a child at risk
for cognitive difficulties. She further testified that the
EPA-ISA is not typically relied upon by pediatricians in
their clinical practice, and she "came across it through
her work as an expert in litigation." She acknowledged
that the CDC had also reviewed the epidemiological literature
that was available in 2012, but it did not make any
statements of causality. Indeed, the CDC stated in 1991
"that adverse effects of blood levels of 10 to 14 are
subtle and are not likely to be recognized or measurable in
the individual child."
asked whether the causal connection found by EPA-ISA between
lead and attention included the specific attention deficits
found by Dr. Kraft, i.e., "auditory encoding and
processing speed, " Dr. Blackwell-White stated:
Not only the EPA, but a good much of the lead literature
involving children speaks to attention. They don't parse
it out as to what kind of attention. They are using the
umbrella term "attention". And so it is in my
opinion that the deficits that Dr. Kraft found are part of
that umbrella term "attention".
Blackwell-White opined that every child exposed to lead loses
IQ points. This opinion was based completely on the
epidemiological literature, which is "all we have."
She cited the Lanphear Study, concluding that exposure to up