Barber v. Catholic Health Initiatives, Inc.

HOLLANDER, J. This medical malpractice appeal requires us to consider, inter alia, whether a Certificate of Qualified Expert (the “Certificate”), as originally filed or as supplemented, satisfied Md.Code (2002 RepLVol.), § 3-2A-04(b) of the Courts and ³¹⁶ Judicial Proceedings Article (“C.J.”). 1 The matter is rooted in a negligence action filed in the Circuit Court for Baltimore County, alleging survival and wrongful death claims arising from the death of Carolyn Barber, who underwent a repeat coronary bypass on November 24, 2000, and died on the same date. An autopsy revealed that Ms. Barber’s pulmonary artery had been punctured. On November 19, 2003, Jason Allen Barber, as Personal Representative of the Estate of Carolyn Barber, and Jason and Andrew Barber, as surviving sons of Ms. Barber, appellants, filed a Statement of Claim with the Health Claims Arbitration Office (“HCAO”) 2 against six physicians and six entities, identified collectively as “Health Care Providers,” all appellees here. They are Catholic Health Initiatives, Inc.; St. Joseph Medical Center, Inc.; St. Joseph Medical Center Foundation, Inc.; Cardiac Surgery Associates, P.A.; Cardiac Anesthesia Associates, P.A.; Redmond C. Stewart Finney, Jr., M.D.; Lope T. Villa, Jr., M.D.; Lope T. Villa, Jr., M.D., P.A.; Garth Raymond McDonald, M.D.; Paul Gerard Burns, M.D.; David R. Larach, M.D.; and Ursula Adourian, M.D. 3 Thereafter, appellants timely filed their Certificate, in which the text refers to the “Health Care Providers,” but does not rename each appellee. ³¹⁷ After waiving arbitration, appellants filed suit against the appellees on May 12, 2004.

A few months later, on July 15, 2004, this Court issued its decision in D’Angelo v. St. Agnes Healthcare, Inc., 157 Md.App. 631 , 853 A.2d 813 , cert. denied, 384 Md. 158 , 862 A.2d 993 (2004), ruling that the certificate at issue in that case was defective. By that point, several of the appellees in this case had already answered the suit, without challenging appellants’ Certificate. After D’Angelo , however, almost all of the appellees moved to dismiss, claiming that the Certificate did not comply with Maryland law, as articulated in D’Angelo , because it failed to identify each defendant in the caption or body of the Certificate. 4 Opposing the motion, appellants maintained that the Certificate plainly referred to all of the defendants previously named in the Statement of Claim filed with the HCAO. Following a hearing held on January 31, 2005, the circuit court granted the motions.

Its ruling is reflected in an Order of February 2, 2005. On February 11, 2005, appellants filed a “Motion for Reconsideration, or in the Alternative, Motion for Leave to file Supplemental Certificate of Qualified Expert, Nunc Pro Tunc,” which the circuit court denied on March 15, 2005. On appeal, appellants pose two questions, which we quote: I. Did the Circuit Court err in granting the Appellees’ Motion to Dismiss?

II

Did the Circuit Court err or abuse its discretion in denying Appellants’ request to file a supplemental Certificate of Qualified Expert pursuant to Md. Cts. & Jud. Proc.Code Ann. § 3-2A-04(b)(5)? For the reasons set forth below, we conclude that the court erred in dismissing the suit on the ground that the Certificate failed to name each defendani/appellee. Therefore, we shall reverse and remand for further proceedings. 5 ³¹⁸ I. FACTUAL AND PROCEDURAL SUMMARY Appellants filed a “Claim Form” with the HCAO on November 19, 2008.

Under the section entitled “HEALTH CARE PROVIDER(S),” and continuing on an addendum with another title of “Health Care Provider(s),” appellants identified each of the appellees by full name and address. On the same date, appellants filed a “Statement of Claim” with the HCAO, pursuant to the Health Care Malpractice Claims statute, C.J. §§ 3-2A-01 to 3-2A-09, in which they again specifically named all twelve appellees in the caption. At the end of the caption, all twelve were identified collectively as “Health Care Providers.” In addition, all twelve were again mentioned in the text of the Statement of Claim, where they were referred to as “Health Care Providers.” 6 On or about February 12, 2004, i.e., within 90 days of filing the Statement of Claim, appellants filed a “Request for Exten ³¹⁹ sion of Time in which to File Claimants’ Certificate of Qualified Expert.” Although they sought an extension until May 17, 2004, appellants filed their “Claimants’ Certificate Of A Qualified Expert,” along with an accompanying medical report signed by Kenneth M. LeDez, M.B., Chg., FRC, 7 on February 17, 2004. Because the Certificate is central to the dispute, we have reproduced its caption: JASON ALLEN BARBER, as Personal * HCA No.: 2008-613 Representative of the Estate * of CAROLYN BARBER, Deceased * and Individually, as * surviving Son of CAROLYN L. BARBER * 6320 Greenspring Avenue, # 205 * Baltimore, MD 21209 * * and * * ANDREW BARBER, Individually, * as Surviving Son of CAROLYN * BARBER, Deceased * 304 Forrest Street * Baltimore, Maryland 21202 * * Claimants * * vs. * * CATHOLIC HEALTH INITIATIVES, INC., a/k/a CATHOLIC HEALTH INITIATIVES, et al * * * * Health Care Providers * (Emphasis added.) The body of the Certificate provides, in part: I HEREBY CERTIFY that I have reviewed the medical records and/or other documentation pertaining to the histo ³²⁰ ry, conditions, injuries, and death of Carolyn Barber, as such relate to the incidents involved herein.

I HEREBY CERTIFY that there were departures from and/or violations of the standards of medical care rendered to Carolyn Barber by the Health Care Providers. Such departures and/or violations were the direct and proximate cause of injury to Carolyn Barber, and were a substantial factor in causing her death. (Emphasis added.) The accompanying certificate of service listed all twelve appellees. Dr. LeDez’s medical report of February 16, 2004, is also noteworthy.

There, he wrote, in part: I have reviewed the medical records and other pertinent materials regarding Carolyn Barber. I have concluded that the care rendered by the Health Care Providers fell below and deviated from the accepted medical standards for health care providers of similar training and experience. Furthermore, it is my opinion that such Health Care Providers’ actions or omissions did proximately cause injury to Carolyn Barber, and was a substantial factor in causing her death. (Emphasis added.) Appellants subsequently elected to waive arbitration pursuant to C.J. § 3-2A-06B.

Thereafter, as noted, they filed their negligence suit against the appellees on May 12, 2004. 8 Dr. Finney, St. Joseph Medical Center, Inc., Dr. Villa; Dr. Villa P.A., Dr. McDonald; and Cardiac Surgery Associates, Inc. all answered the Complaint, without raising any challenge to the adequacy of the Certificate. 9 Cardiac Anesthesia Asso ³²¹ dates, P.A. and Dr. Adourian filed a “Motion to Dismiss.” Doctor Larach filed a “Motion To Strike The Certificate Of Merit Signed By Kenneth M. LeDez, M.D. And To Dismiss David R. Larach, M.D.” Thereafter, Cardiac Surgery Associates, P.A., Dr. Finney; Dr. Villa,; Dr. McDonald; as well as their professional associations, also filed a “Motion to Dismiss.” The appellees relied on our then recent decision in D’Angelo, 157 Md.App. 631 , 853 A.2d 813 , arguing that the Certificate did not comply with the requirements of C.J. § 3-2A-04, because appellants failed to name each appellee, either in the caption or the text. In their response, appellants sought to distinguish D’Angelo , and argued that the Certificate fully complied with the statute. Nevertheless, they submitted an affidavit from Dr. LeDez, dated November 23, 2004, clarifying that, by using the term “Health Care Providers” in the Certificate, he was referring to all of the appellees. LeDez averred, in part: 3.

After reviewing the records, on February 17, 2004, I signed a Certificate of Qualified Expert, in which I certified that “there were departures from and/or violations of the standards of medical care rendered to Carolyn Barber by the Health Care Providers”. At the time I signed the Certificate of Qualified Expert, by “Health Care Providers”, I meant the physicians, Lope T. Villa, Jr., M.D.; Redmond C. Stewart Finney, Jr., M.D.; Garth Raymond McDonald, M.D.; Paul Gerard Burns, M.D.; David Larach, M.D.; and Ursula Adourian, M.D. I also meant Lope T. Villa, Jr., M.D., P.A.; Cardiac Surgery Associates, P.A.; Cardiac Anesthesia Associates, P.A.; St. Joseph Medical Center, Inc., a/k/a Saint Joseph Medical Center Catholic Health Initiatives, Inc., a/k/a Catholic Health Initiatives; and St. Joseph Medical Center Foundation, Inc., which at that time, I ³²² understood to be responsible for the actions of the physicians. (Emphasis added.) In a “Supplemental Affidavit” of January 25, 2005, Dr. LeDez further averred, in part: 2. Subsequent to my review of the records and prior to signing the Certificate of Qualified Expert, I discussed the matter with Jeffrey S. Goldstein.

Mr. Goldstein advised me that in the Statement of Claim filed by Ms. Barber’s family, Lope T. Villa, Jr., M.D., Redmond C. Stewart Finney, Jr., M.D., Garth Raymond McDonald, M.D., Paul Gerard Burns, M.D., David Larach, M.D., and Ursula Adourian, M.D., were named as Health Care Providers. Mr. Goldstein further advised me that these physicians were agents and/or employees of Lope T. Villa, Jr., M.D., P.A., Cardiac Surgery Associates, P.A., Cardiac Anesthesia Associates, P.A., St. Joseph Medical Center, Inc., a/k/a Saint Joseph Medical Center, Catholic Health Initiatives, Inc., a/k/a Catholic Health Initiatives, and St. Joseph Medical Center Foundation, Inc., and that those entities were responsible for the actions of the physicians. Mr. Goldstein also advised me that those entities were also named as Health Care Providers in the Statement of Claim. 3. Accordingly, at the time I signed the Certificate of Qualified Expert I knew that Lope T. Villa, Jr., M.D., Redmond C. Stewart Finney, Jr., M.D., Garth Raymond McDonald, M.D., Paul Gerard Burns, M.D., David Larach, M.D., Ursula Adourian, M.D., Lope T. Villa, Jr., M.D., P.A., Cardiac Surgery Associates, P.A., Cardiac Anesthesia Associates, PA., St. Joseph Medical Center, Inc., a/k/a Saint Joseph Medical Center, Catholic Health Initiatives, Inc., a/k/a Catholic Health Initiatives, and St. Joseph Medical Center Foundation, Inc., were the Health Care Providers named in the Statement of Claim filed by the family of ³²³ Carolyn Barber, and by “the Health Care Providers”, I meant all of those physicians and entities.

(Emphasis added.) The court conducted a motion hearing on January 31, 2005, at which the following transpired: [THE COURT]: The basis of the motion is that a certificate of merit was not filed that specified how the individual physicians and/or hospital breached the applicable standard of care; is that it in a nutshell? [COUNSEL FOR CARDIAC SURGERY ASSOCIATES & DR. FINNEY]: Not exactly, Your Honor. The D’Angelo case, if I may, also requires that each individual health care provider be named on the certificate, not just how they violated, but each individual health care provider must be named so that Plaintiffs aren’t given just a carte blanche to sue whomever they want with the health care providers. [THE COURT]: What’s different between that and what I said, that each individual health care provider — it’s not specified how they breached the standard of care in this case, what difference would that make? [COUNSEL FOR CARDIAC SURGERY ASSOCIATES & DR. FINNEY]: I guess what I was saying is, it’s not just how they violated— [THE COURT]: But they didn’t do that, right?

They didn’t say how this doctor breached the standard of care, that doctor breached the standard of care, that doctor breached the standard of care or St. Joseph’s Hospital breached the standard of care, right? They didn’t do that? [COUNSEL FOR CARDIAC SURGERY ASSOCIATES & DR. FINNEY]: Correct. [THE COURT]: They’re saying in their Certificate of Merit all health care providers breached the standard of care? [COUNSEL FOR CARDIAC SURGERY ASSOCIATES & DR. FINNEY]: Correct. [THE COURT]: So what’s the difference? ³²⁴ [COUNSEL FOR CARDIAC SURGERY ASSOCIATES & DR.

FINNEY]: My point is, it’s not just — in other words, they don’t have to say all health eare providers deviated by A, B, C, D, it’s also that they have to spell out which physicians or health care— [THE COURT]: I don’t see the difference in what you’re saying, and I’m saying academically that may be interesting if they didn’t specify how each health care provider breached the standard of care, then they haven’t complied with the requirements of D’Angelo . [COUNSEL FOR CARDIAC SURGERY ASSOCIATES & DR. FINNEY]: I agree. Thereafter, appellants’ counsel argued: Specifically if I may address Your Honor’s first point, I think if you ask every single defense counsel in this room, they will tell you, admit, that it is not required that a certificate specify how the health care provider deviated from the standard of care, rather what they’re saying is that you have to say that a specific health care provider did deviate. They’re not here saying that you have to say how.

Their point here is that their claim is that DAngelo requires that I name by name by no other method the actual individuals who deviated____ Your Honor, the issue in this case is does — there’s two issues. The first issue is, does our certificate of qualified expert which says the capital H, capital C, capital P, Health Care Providers, and obtained three months after we filed the statement of claim, does that identify who the health care providers are? Well, when [the] D’Angelo case first came down, I looked at my certificate. I said, well, I said capital H, capital C, capital P, Health Care Providers, which is an identification of a discrete group of individuals and entities at that point. ³²⁵ But if anyone ever wants to say that under D’Angelo I have not complied, the certificate does not comply, which had never been said to me before in many years of practice, I will obtain an affidavit from Dr. LeDez, since I had had a discussion with Dr. LeDez before he signed the Certificate of Qualified Expert, and he will say by health care providers I meant all of these health care providers who were named in the Complaint.

They were a specific group of doctors who were involved in a redo coronary bypass surgery. It was only the surgeons and only the anaesthesiologists, all of whom Dr. LeDez had felt had deviated from the standard of care. When I called him to ask him if he would sign an affidavit, because obviously the motion was filed, he agreed to do so. I obtained the affidavit from Dr. LeDez specifying that by Health Care Providers, capital H, capital C, capital P, I knew I meant and listed the entities and the doctors in this case.

I obtained a second affidavit from Dr. LeDez and this time said, yeah, I discussed it with Mr. Goldstein, at the time I signed the certificate of qualified expert I knew that the named health care providers were blah, blah, blah, blah and by the capital H, capital C, capital P, Health Care Providers, I meant all twelve of those health care providers, the six individual surgeons and anesthesiologists who were in the surgery and the entities by whom I had advised him were vicariously responsible for the actions.... (Emphasis added.) Dr. Adourian’s counsel responded: [I]t’s clear that the individual Defendants, the health care providers as to whom there is an allegation of negligence, must be named and that’s where this certificate falls down. ³²⁶ [T]hey do have to be named, and that’s what, that’s what D’Angelo holds. And D’Angelo very specifically rejects the notion that you can name them as a class.... Counsel for Dr. Finney and Cardiac Surgery added: “[T]he real problem is who is named individually.

It’s the individuals [who] must be named individually.” The following exchange ensued: THE COURT: It seems to me that the intent of the Legislature clearly was that a Certificate of Merit was to say this doctor committed malpractice by deviating from this, did this, did that, did whatever____ Now, what we are fighting about is, does this Certificate of Merit comply under D’Angelo? It doesn’t. It clearly doesn’t. You can’t say, here is the group, they all committed malpractice.

You can’t do it, all of the doctors, not naming them individually. All of the doctors that treated them committed malpractice, you can’t do that. [APPELLANTS’ COUNSEL]: I didn’t say that, Your Hon- or. [THE COURT]: Pretty close to that. [APPELLANTS’ COUNSEL]: Let me show you, if I could, my Certificate of Qualified Expert. And they acknowledged that if you list the names, that’s sufficient. The certificate, which is attached as Exhibit B-2 and also attached to there is at the very bottom you see that it says by the health care providers. [THE COURT]: That’s what you can’t do, D’Angelo says you can’t do. [APPELLANTS’ COUNSEL]: Your Honor ...

I assure you, that what the Court of Special Appeals was doing in D’Angelo was figuring out what this certificate meant. And what they figured out in D’Angelo , Your Honor, was that ³²⁷ certificate meant nothing. It doesn’t mean anything. Had you asked Dr. LeDez the exact same questions that the defense counsel ... asked the certifiers in the D’Angelo case, Dr. LeDez would say, I think these entities are the ones that deviated from the standard of care by health care providers, that’s what I meant.

When they asked these people in the D’Angelo case about the foregoing, they didn’t know anything about it. In fact, they hadn’t even reviewed all of the medical records at the time they signed it. The bottom line is, Your Honor, that what the Court was doing in DAngelo was looking to see if you look at the statute, and Your Honor read the statute, and of course the statute doesn’t say anything about naming names, the statute says, you have to say that a Defendant deviated from the standard of care and that the deviation caused the injury. Your Honor, this says specifically, this certificate says, that the capital H, capital C, capital P, Health Care Providers, the very people who were named in the case.

It can’t be anyone else. The bottom line is that there’s no question if you look at the Affidavit of Dr. LeDez that when he said the health care providers he meant the individuals named in this case .... You have two affidavits ... an affidavit and supplemental affidavit from Dr. LeDez, Your Honor, that both affirmatively answer the questions that the doctors were asked in the D’Angelo case, and I might query this, Your Honor, in a case where there’s one health care provider and the certificate says the capital H, capital C, capital P, Health Care Providers, the health care provider deviated from the standard of care, can there be any question that that’s a certificate as required by D’Angelo .... ³²⁸ Your Honor, at the time that I filed the certificate, the Complaint, the Statement of Claim is already filed. [THE COURT]: I understand your argument. I am absolutely convinced that this Certificate of Merit does not comply with D’Angelo .

I’m convinced of that. So I’ve heard the argument. I don’t accept it. I think that what D’Angelo requires is that the health care provider that is deemed to have violated the standard of care be named.

It’s clear in this Certificate of Merit nobody is named. It just says by the health care providers. I don’t think that complies with the requirements of D’Angelo. Well, I’ve ruled on that.

Now, as I understand it, the allegations of negligence in this case are alleged to have occurred in November of 2000, right? [APPELLANTS’ COUNSEL]: Yes. [THE COURT]: Okay. [APPELLANTS’ COUNSEL]: Yes, correct. [THE COURT]: So the statute runs November of 2005. [APPELLANTS’ COUNSEL]: It ran November of 2003, Your Honor. [THE COURT]: Okay, what is, is. That’s the ruling. (Emphasis added.) The court’s “Ruling,” docketed on February 2, 2005, stated: Having considered the argument of counsel and the pleadings previously filed, it is the ruling of the court that Defendants’ Motions to Dismiss for Failure to File a Certificate of Merit under Courts and Judicial Proceedings, Sec. 3-2A-04 (Paper Nos. 29000, 31000, and 33000) is GRANTED. The certificate of merit filed in this case does not comply with the requirements of D’Angelo v. St. Agnes Healthcare, Inc., 157 Md.App. 631 , 853 A.2d 813 . ³²⁹ It is undisputed that limitations had expired when the suit was dismissed.

Therefore, the dismissal was, in effect, a dismissal with prejudice. On February 11, 2005, appellants filed a “Motion for Reconsideration or, in the Alternative Motion for Leave to File Supplemental Certificate of Qualified Expert, Nunc Pro Tunc,” arguing: 3. Pursuant to Ann.Code of Md., Cts. and Jud. Proc.

Art. § 3-2A-04 (b)(l)(i), dismissal of a claim for failure to file a Certificate of Qualified Expert is without prejudice. However, given the expiration of the statute of limitations, the dismissal of this case would necessarily effectively be a dismissal, -with prejudice, as Plaintiffs’ subsequent filing would be time-barred. 4. Inasmuch as Plaintiffs’ Certificate of Qualified Expert was filed five months before the Court of Special Appeals rendered its decision in D’Angelo v. St. Agnes Healthcare, Inc., 157 Md.App. 631 , 853 A.2d 813 (2004), Plaintiffs, as well as the Director of the Health Claims Arbitration Office, reasonably thought that the Certificate filed on behalf of the Barbers was a proper certificate pursuant to Md. Cts. and Jud. Proc.

Art., § 3-2A-04(b). Accordingly, instead of dismissing the claim for failure to file a valid Certificate of Qualified Expert, or granting the Claimants an additional 90 days, pursuant to § 3-2A-04 (b)(l)(ii), the Director issued an Order of Transfer of this claim to this Honorable Court. If Plaintiffs’ Certificate was obviously insufficient, or it [sic] they had failed to file a Certificate at all, the remedy would have been as such, i.e., to give an additional 90 days. 5. Obviously, had the D’Angelo case been decided prior to Plaintiffs having filed their Certificate in this case, Plaintiffs would not be in this predicament.

They would have listed the names of the Health Care Providers in their Certificate instead of saying “the Health Care Providers”, which Plaintiffs contend identifies them but, as this Court has held, clearly does not list their names. 6. In addition, as explained at length in Plaintiffs’ original response to Defendants’ Motions to Dismiss, the factual ³³⁰ predicate of D’Angelo is simply not the same or even close to that of this case. 8. In the alternative, given that the Plaintiffs were never afforded the additional 90 days that they were entitled to pursuant to § 3-2A-04 (b)(1)(h), Plaintiffs would submit that this Honorable Court grant them leave to file a Supplemental Certificate of Qualified Expert, in the form attached hereto as Exhibit 1, with the Health Claims Arbitration Office, nunc pro tunc. 9. Such an extension would also be permissible under § 3-2A-04(5), which provides “an extension of the time allowed for a filing a[sic] certificate of a qualified expert under this subsection shall be granted for good cause shown.” In opposing the motion, appellees argued, inter alia, that it was untimely, as it was filed “almost one year after the original certificate was filed and nine months after the statutory maximum.” They argued that “the statutory period for filing the certificate of qualified expert has expired and cannot be extended.” Appellees explained that, if appellants were entitled to an extension under C.J. § 3-2A-04(b)(l)(ii), the panel chairman was limited to allowing an extension of 90 days (for a total of 180 days in which to file the Certificate).

Under C.J. § 3-2A-04 (b)(1)(h), because the Statement of Claim was filed on November 29, 2003, the Certificate was due, at the latest, by May 17, 2004. Furthermore, they pointed out that, under C. J. § 3-2A-04(b)(5), appellants were required to seek an additional extension before the expiration of 180 days on May 17, 2004, and it had to be based on good cause. Because appellants failed to make a timely request, appellees argued that dismissal was mandatory under C.J. § 3-2A-04(b)(l). In their view, the circuit court lacked jurisdiction to extend the time for filing a certificate of qualified expert beyond 180 days, if the motion for an ³³¹ extension is filed after the 180 day period---- Thus, the time for filing a substantively valid certificate has lapsed and the Motion for Leave to File Supplemental Certificate is untimely.

Any certificate filed after May 17, 2004 is also untimely and must be stricken. On February 28, 2005, while appellants’ motion was pending, appellants filed a Notice of Appeal. Then, on March 15, 2005, the court denied the Motion for Reconsideration, stating: While this Court recognizes that the outcome of this ruling is harsh, this Court is bound by the decision of the Court of Special Appeals’ [sic] in D’Angelo v. St. Agnes Health Care [Healthcare] Inc., 157 Md.App. 631, 852 [853] A.2d 813 (2004) cert. denied, 384 Md. 158 , 862 A.2d 993 (2004) and this Court is unable to distinguish this case from the holding in D’Angelo . Appellants filed a second Notice of Appeal on April 14, 2005.

Then, on May 5, 2005, this Court remanded the case to allow the circuit court to clarify whether its “ruling of February 2, 2005 applies to all defendants, and if not, then (a) which defendants does it apply to, and (b) should final judgment as to fewer than all defendants or all claims nonetheless be entered pursuant to Maryland Rule 2-602(b).... ” By Order filed June 9, 2005, the circuit court stated: As requested by the Court of Special Appeals’ Order of May 5, 2005, this is to clarify that this Court’s prior ruling that the Certificate of Merit filed in this case does not comply with the requirements of D’Angelo v. St. Agnes Healthcare [Healthcare], Inc., 157 Md.App. 631 [, 853 A.2d 813 ] 2004 requires that the Complaint be dismissed in its entirety as to all defendants. Thereafter, on June 29, 2005, appellants filed a third Notice of Appeal. DISCUSSION A. The statutory scheme is central to our analysis. We focus on Title 3, Subtitle 2A (“Health Care Malpractice Claims”) of ³³² the Courts and Judicial Proceedings Article. 10 Title 3, Subtitle 2A established a non-binding arbitration process to resolve medical injury claims lodged against health care providers.

At the relevant time, such claims were initially filed with what was then known as the HCAO. Under the Health Care Malpractice Claims statute, arbitration before the HCAO (or its successor) is “a condition precedent to maintaining a suit in circuit court.” McCready Memorial Hospital v. Hauser, 330 Md. 497, 512 , 624 A.2d 1249 (1993). C.J. § 3-2A-01(e) defines a “health care provider” to include hospitals and physicians. 11 C.J. § 3-2A-04 is also pertinent. At the relevant time, it provided, in part: § 3-2A-04.

Filing of claim; appointment of arbitrators; arbitrators’ immunity from suit. ³³³ (a) Filing of claim and response — (1) A person having a claim against a health care provider for damage due to a medical injury shall file his claim with the Director, and, if the claim is against a physician, the Director shall forward copies of the claim to the State Board of Physician Quality Assurance and the Medical and Chirurgical Faculty of the State of Maryland. (b) Filing and service of certificate of qualified expert.— Unless the sole issue in the claim is lack of informed consent: (1) (i) Except as provided in subparagraph (ii) of this paragraph, a claim filed after July 1, 1986, shall be dismissed, without prejudice, if the claimant fails to file a certificate of a qualified expert with the Director attesting to departure from standards of care, and that the departure from standards afeare is the proximate cause of the alleged injury, within 90 days from the date of the complaint. The claimant shall serve a copy of the certificate on all other parties to the claim or their attorneys of record in accordance with the Maryland Rules. (ii) In lieu of dismissing the claim, the panel chairman shall grant an extension of no more than 90 days for filing the certificate required by this paragraph, if: 1.

The limitations period applicable to the claim has expired; and 2. The failure to file the certificate was neither willful nor the result of gross negligence. (2) A claim filed after July 1,1986, may be adjudicated in favor of the claimant on the issue of liability, if the defendant disputes liability and fails to file a certificate of a qualified expert attesting to compliance with standards of care, or that the departure from standards of care is not the proximate cause of the alleged injury, within 120 days from the date the claimant served the certificate of a qualified ³³⁴ expert set forth in paragraph (1) of this subsection on the defendant. (3) The attorney representing each party, or the party proceeding pro se, shall file the appropriate certificate with a report of the attesting expert attached.

Discovery is available as to the basis of the certificate. (5) An extension of the time allowed for filing a certificate of a qualified expert under this subsection shall be granted for good cause shown. (Emphasis added.) 12 In pertinent part, C. J. § 3-2A-05 states: § 3-2A-05. Arbitration of claim.

(j) Authority to lengthen or shorten time limitation. — Except for time limitations pertaining to the filing of a claim or response, the Director or the panel chairman, for good cause shown, may lengthen or shorten the time limitations prescribed in subsections (b) and (g) of this section and § 3-2A-04 of this article. Pursuant to C.J. § 3-2A-04 (b)(l)(i), a claim is subject to dismissal if the claimant fails to file with the Director of HCAO, within 90 days after filing the claim, a certificate of ³³⁵ qualified expert attesting to: 1) the defendant’s departure from the standard of care, and 2) that the deviation in care was the proximate cause of the injury. To relieve the harshness of that provision, the General Assembly enacted an amendment to the statute in 1989, reflected in C.J. § 3-2A-04 (b)(1)(h), by which, “[i]n lieu of dismissing the claim, the panel chairman shall grant an extension of no more than 90 days for filing the certificate ...,” if limitations has expired as to the claim and the “failure to file the certificate was neither willful nor the result of gross negligence.” As the Court explained in Roth v. Dimensions Health Corp., 332 Md. 627, 638 , 632 A.2d 1170 (1993), the amendment was “a curative act, intended to prevent the dismissal of potentially meritorious claims based upon an inadvertent failure to file the certificate of a qualified expert within 90 days of the original complaint.” That same section was modified again in 2004 to expressly permit the court (in addition to the panel chair) to extend by 90 days the time for filing the certificate. Two other statutory provisions are pertinent with regard to the time for filing a certificate.

C.J. § 3-2A-04(b)(5) provides that an extension “shall be granted for good cause shown.” In addition, in the context of arbitration, upon a showing of “good cause,” C.J. § 3-2A-05(j) permits the HCAO Director or panel chair to lengthen or shorten the time limitations of C.J. 3-2A-04 (and other provisions, not relevant here). In this case, we are not concerned with whether the Certificate was timely filed. Rather, we are concerned with the sufficiency of a timely filed Certificate. By the time the claim of invalidity was first raised, the 180 day extension period under C.J. § 3-2A-04 (b)(1)(h) had already expired.

Moreover, as we have seen, C.J. § 3-2A-04(b)(5) speaks of a good cause extension to file a certificate, but here the Certificate had been timely filed. If the content of the Certificate is deemed defective, we are then faced with the issues of whether it could be amended by affidavit of the attesting expert, or whether appellants were entitled to a good cause extension to file a new Certificate. The statute is silent as to whether, when, or how a defective certificate may be amended or cured, ³³⁶ or if, instead, it is void ab initio. Moreover, the good cause question leads to a host of other questions, including the proper timing of such a request and the authority of the court, as opposed to the Director or panel chair, to grant such an extension.

B. Appellants argue that the court erred because their Certificate “conformed” to C.J. § 3-2A-04(b). Characterizing the wording of C.J. § 3-2A-04 (b)(l)(i) as “clear and unambiguous,” they insist that it does not “require that the allegedly negligent Health Care Providers be identified by their proper name.” Relying on “the plain wording of the statute,” they argue that “all that a Claimant’s certificate needs to contain is an attestation from an expert witness that there was a departure from the standards of care and that the departure from the standards of care was a proximate cause of the alleged injury.” Appellants add: “There is no requirement under the statute that the certificate name or label the specific individuals to whom the certificate applies.” Therefore, appellants insist that the Certificate “should not have been rejected by the Circuit Court.” According to appellants, the use of the phrase “Health Care Providers” in the Certificate satisfied any requirement of specificity, because it clearly was a reference to a corresponding and discrete group “named, listed, and identified” in the Statement of Claim as the “Health Care Providers.” In other words, they posit that “Health Care Providers” was a defined term and a shorthand reference to the “parties to the litigation,” as was “set forth plainly and unambiguously in the statement of claim.” Appellants add: These are the same Health Care Providers who were named as Defendants when the case was filed in the Circuit Court. The listing of each Health Care Provider in the caption of the Statement of Claim identifies the licensed professionals alleged to be negligent. The Health Care Providers named in the Statement of Claim and listed in the caption were ³³⁷ referred to as “the Health Care Providers” just as they were referred to as “the Defendants” in the Circuit Court.

This is consistent with Maryland Rule 1-301.... In addition, appellants argue: Appellants’ certificate states that “the Health Care Providers” breached the standard of care and therefore the certificate clearly identifies the licensed professionals against whom it applies. Anyone who read this file, or the Health Claims Arbitration Office file, or the Circuit Court file, would know to whom the Certificate refers when it states “the Health Care Providers.” For anyone to argue otherwise would be an absurdity. Appellants continue: The individual Health Care Providers who were sued in the case and individually listed in the case caption were collectively referred to in the certificate by their collective title “the Health Care Providers.” This is no different than referring to a party in a pleading or at trial as their status in the case: Plaintiff or Defendant.

To hold that this is insufficient to identify a specific individual would require that all references in the future to a party in pleadings, discovery, and trial would have to be to the party’s proper name and not to their standing in the case. To further confirm what was meant in this case, Dr. LeDez signed two affidavits that affirm that his use of “Health Care Providers” in the certificate referred to each and all of the Health Care Providers listed in the Statement of Claim. The Circuit Court’s holding in this case turns common sense and Maryland law on their collective heads. Moreover, appellants contend that D’Angelo is distinguishable from the case sub judice.

They explain: In D’Angelo , Plaintiffs’ certifying expert witnesses certified that they had reviewed the medical records of the health care providers named in the claim when, in fact, no claim had been filed and they testified that when they signed their certificates prior to filing of the Statement of Claim, they did not know who was going to be sued, D’Angelo, 157 ³³⁸ Md.App. at 640 [ 853 A.2d 813 ]. In the instant case, Dr. LeDez had reviewed the records and held the required opinion concerning the named Health Care Providers prior to the submission of the Certificate and accompanying report. Unlike D’Angelo , Dr. LeDez was aware prior to signing his Certificate of Qualified Expert, who were named as Health Care Providers. Thus, appellants assert: “There is no dispute that the Defendants who are named in the Complaint are the same health care providers that Dr. LeDez certified were negligent.” Unlike D’Angelo , where the “caption listed a Health Care Provider who was never named in the Statement of Claim as a Health Care Provider,” appellants point out that here “a Health Care Provider who was sued in the case is listed in the caption on the certificate.” Appellants also observe that the D’Angelo certificate “simply stated that T have concluded that the foregoing medical providers failed to comply with the standards of care____D’Angelo, 157 Md. App. at 637 , 853 A.2d 813 (emphasis omitted).

They argue that, unlike in this case, there were no “foregoing medical providers” in D’Angelo , because the statement of claim had not yet been filed there. Appellants also point out that in D’Angelo , unlike in this case, the “Certificates of Qualified Expert were not accompanied by a report as required by § 3-2A-04(b)(3).” According to appellants, this Court considered that omission significant in holding the Certificate deficient in D’Angelo . In addition, appellants complain that the circuit court erred or abused its discretion in denying their revisory motion, and in failing to grant “an extension of time to file a new Certificate of Qualified Expert.” Further, they complain that the circuit court ignored “the draconian effect of dismissing the case without prejudice where the statute of limitations had expired (making it a dismissal with prejudice)____” Citing Navarro-Monzo v. Washington Adventist Hospital, 380 Md. 195 , 844 A.2d 406 (2004), discussed infra, appellants suggest that, under C.J. § 3-2A-04(b)(5), “a request for an ³³⁹ extension of time to file a certificate of qualified expert for good cause shown may be requested beyond the time set forth to file a certificate as set forth in [C.J.] § 3-2A-04(b)(l).” Therefore, appellants assert: “Given the drastic nature of D’Angelo , good cause exists in this case, and the Circuit Court erred by not granting Appellants an extension of time.” Appellees counter that the court properly granted the motions to dismiss, because the Certificate was invalid; it “did not identify any individual health care providers as having deviated from accepted standards of care, and thus failed to conform to the requirements of the rule in DAngelo----” They assert: Dr. LeDez’s Certificate states, in effect, that there were some departures from standards of care by the health care providers which caused Carolyn Barber injury, but he does not attest that all of the health care providers deviated from accepted standards of care, nor does he attest which, if any, of the deviations from accepted standards of care by these unidentified health care providers actually caused injuries to the Plaintiffs’ decedent. Complaining that only Catholic Health Initiatives, Inc. was listed in the Certificate’s caption, the Physician appellees argue: [I]it is not sufficient under the statute to simply identify a corporate entity which, at most, is vicariously liable for the acts of a health care provider in order to satisfy the requirement of naming one or more specific health care providers in the certificate of merit, as articulated in D’Angelo .

In a multiple-defendant case, as here, where no specific health care providers are identified in the body of the certificate, and the only defendant identified in the caption is an employer, this does not satisfy the requirements of § 3-2A-04(b)(l) to maintain a claim against any defendant. Only an individual health care provider, by some act or omission, can depart from the standard of care. An employer, and certainly a holding company, whose liability on the ³⁴⁰ claim can only be vicarious, has not committed any act or omission constituting a departure from the standard of care. The gate-keeping function of the certificate of merit requirement is not satisfied by naming only a holding company in the caption of a claim that includes multiple individual health care providers as defendants, without identifying in the body of the certificate the individual defendant or defendants who, in the certifying expert’s opinion, departed from the standard of care.

Similarly, the Medical Center appellees contend: A Certificate attesting to “a departure from the standards of care,” without ascribing the departure to the persons named in the claim, is inadequate. The actions of two or more persons may have caused an injury. A claimant may, for tactical reasons, choose to sue less than all of those persons. A certificate attesting to “a breach”, without identifying the allegedly negligent person, makes it impossible to determine if the expert is certifying a breach by the person or persons named in the claim, or instead some non-defendant. [A] certificate which only attests to “a” departure, without linking the departure to the defendant(s), does not serve the statutory purpose.

As to appellants’ argument that Dr. LeDez’s affidavits cured any deficiencies in the Certificate, appellees insist that “there is nothing in the statutes or D’Angelo to validate” the argument that the “Affidavits somehow ‘relate back’” to the original filing. They rely on Debbas v. Nelson, 389 Md. 364 , 885 A.2d 802 (2005), in which the Court determined that a certificate that is facially valid when filed may not be invalidated later by an expert’s subsequent change of view in regard to a deviation from accepted standards of care. According to appellees, the converse is also true: a certificate that is invalid when filed cannot be cured after the fact. ³⁴¹ Further, appellees assert that appellants’ “alternative ‘Motion for Leave to File Supplemental Certificate of Qualified Expert, Nunc Pro Tunc’ was not properly before the court because it was filed after entry of judgment at the trial court level against the plaintiffs.” 13 They explain that appellants did not timely make any motion pursuant to C.J. § 3-2A-04 (b)(5) or § 3-2A-05 (j), for an extension of time in which to file a new Certificate on the basis of “good cause.” They add that it is “doubtful whether, under the version of § 3-2A-04(b)(4) applicable to this action (filed prior to January 1, 2005), a Circuit Court could pass an order extending the time for filing a certificate of qualified expert for good cause or otherwise.” Appellees explain: Prior to the extensive amendments to § 3-2A-04 included within Chapter 5 of the 2004 Maryland Laws, First Special Session, the Statute generally restricted the powers to grant extensions for the filing of a certificate of qualified expert to the Panel Chair or Director of the Health Claims Arbitration Office, as applicable. The power to grant such extensions were first explicitly granted to a Circuit Court in the amendments to this Section that were included with Chapter 5, Laws of 2004, First Special Session.

Accordingly, appellees contend: This is consistent with § 3-2A-06B of the Courts & Judicial Proceedings Article, as it existed prior to the changes wrought in the 2004 Special Session, essentially permitting unilateral waiver of arbitration only