Copsey v. Park

Greene, J. In this case, Jenny J. Copsey, the widow of Lance D. Copsey, individually and as the personal representative of the Estate of Lance D. Copsey, deceased, along with the minor children and mother of the decedent are the petitioners. They allege that the respondents, John S. Park, M.D. (“Dr. Park”) and his employer, Brown, Croft and Frazier, P.A. (“Annapolis Radiology”), were negligent when Dr. Park interpreted radiological images on June 4, 2010, leading to Lance D. Copsey’s (“Mr. Copsey”) fatal stroke on June 10, 2010.

Initially, the petitioners sued Dr. Park and three subsequent treating physicians, along with their employers. Prior to trial, however, the petitioners partially settled their claims and dismissed two of the doctors and their employer. A day after trial had begun, the petitioners also dismissed the remaining subsequent treating physician. The trial judge denied the petitioners’ motions in limine which opposed the admission of evidence regarding the non-parties’ statuses as former defendants and Dr. Park’s raising the defense that the negligence of subsequent treating ¹⁴⁸ physicians was an intervening and superseding cause of Mr. Copsey’s death.

We shall hold that evidence of non-party negligence was relevant and necessary in providing Dr. Park a fair trial as it tended to show he was not negligent; thus, the alleged prejudice did not outweigh its probative value. Further, causation was an issue for the jury to determine and Dr. Park presented sufficient evidence for a reasonable jury to conclude that he was not negligent; and if found to be negligent, his negligence was superseded by the independent and extraordinary negligence of others. Accordingly, we shall affirm the judgment of the Court of Special Appeals which held that both of the motions in limine were properly denied because the Martinez case permits the introduction into evidence of non-party negligence and causation. Martinez ex rel.

Fielding v. Johns Hopkins Hosp., 212 Md.App. 634 , 70 A.3d 397 (2013). FACTUAL AND PROCEDURAL BACKGROUND Mr. Copsey had several risk factors for stroke including moderate obesity, hypercholesterolemia, 1 hypertension, and a smoking habit. On February 4, 2010, Mr. Copsey was presented to the Anne Arundel Medical Center (“AAMC”) emergency room after slipping, falling, and hitting the back of his head while playing racquetball. He complained of nausea and a headache.

The hospital released him after treatment and a reportedly normal cranial CT scan. Three months later, on May 26, 2010, Mr. Copsey returned to the AAMC emergency room. He complained of recurring episodes of dizziness since the morning of May 26. Another CT scan revealed normal results.

He was referred to his internal medicine physician, Aditya Chopra, M.D. (“Dr. Chopra”), for a follow-up appointment. ¹⁴⁹ On June 1, 2010, Mr. Copsey saw Dr. Chopra. Mr. Copsey complained of difficulty walking, nausea, headaches, and persistent vertigo. Dr. Chopra prescribed a generic brand of Dramamine and antibiotics and suggested Mr. Copsey consult an ophthalmologist and, if the symptoms did not improve, also advised him to see an ear, nose, and throat doctor.

Mr. Copsey did meet with an ophthalmologist, on June 2, 2010, who determined there was no ophthalmological etiology for his diplopia 2 and recommended a neurologic consultation and a neuroradiologic evaluation. On June 4, 2010, Mr. Copsey returned to see Dr. Chopra who performed both of the recommended neurological assessments and found signs of neurological problems and thus advised Mr. Copsey to return to the emergency room for immediate attention. On that afternoon, Mr. Copsey returned to the AAMC emergency room. He told Charles Iliff, M.D.

(“Dr. Iliff’), that he had vertigo occurring for about a week, numbness in the right side of his face, right arm, and right leg, headaches, mild shortness of breath, mild diplopia, and trouble walking. Dr. Iliffs examination of Mr. Copsey was normal, but after consulting with a neurologist, Larry Blum, M.D. (“Dr. Blum”), a CT scan and a brain MRI/MRA 3 were conducted. On the same date, a radiologist, Dr. Park, interpreted the CT scan at 4:02 p.m. and the MRI/MRA at 6:45 p.m.

Dr. Park reported an allegedly normal CT scan and MRI/MRA. Specifically, he found: ¹⁵⁰ There is no evidence of acute intracranial hemorrhage, infarction, mass effect, or midline shift. No abnormal extra-axial fluid collections are identified. The ventricles, sulci, and cisterns are normal.

There is no acute injury to the skull base or calvarium. There is normal anatomy of the circle of Willis with no evidence of aneurysm, anteriovenous malformation, or abnormal vessel cut-off. No hemodynamically significant steno-sis is identified. Incidental note is made of fenestration of the left vertebral artery.

There is no evidence of acute intracranial hemorrhage, infarction, mass effect, or midline shift. No abnormal extra-axial fluid collections are identified. The ventricles, sulci, and cisterns are normal. The flow voids at the skull base are normal.

There is no acute injury to the skull base or calvarium. On June 5, 2010, Dr. Blum independently reviewed the MRI and MRA images after Dr. Park and also confirmed there were no abnormalities. Dr. Blum believed Mr. Copsey’s symptoms were merely evidence of migraines. Mr. Copsey was discharged on June 6, 2010, and diagnosed with migraines, cluster migraines, vertigo, hypercholesterolemia, mildly elevated blood pressure, and hypertension; his discharge summary indicated he was “otherwise doing fíne.” On June 7, 2010, Mr. Copsey was seen by Dr. Chopra for outpatient evaluation.

Mr. Copsey indicated he had no chest pain, dizziness, shortness of breath, cough, nausea, vomiting, diarrhea, constipation, aches or pains, headache, or burning urination. Dr. Chopra noted that Mr. Copsey had no neurological issues and told him to go back to the emergency room or follow-up with Dr. Blum if his symptoms returned. His symptoms did return towards the end of the day, but he did not return to see Dr. Blum at AAMC for a follow-up evaluation until June 9, 2010. At the follow-up, Mr. Copsey stated that his symptoms, including diplopia and headaches, had returned and that he had begun experiencing hiccups and trouble swallowing.

Mr. ¹⁵¹ Copsey’s neurological exam was normal, but the new symptoms concerned Dr. Blum. Thus, he ordered an urgent interpretation of a new brain MRI, writing “*STAT:i!” on the order form and telling Mr. Copsey to return to him with the results. Dr. Blum’s requisition to the radiologist specified an urgent call back from the radiologist. Vijay Viswanathan, M.D.

(“Dr. Viswanathan”), in the radiology department, interpreted the MRI at 4:02 p.m. and noted: 1. Ill-defined new band-like signal abnormality within the right lateral medulla which is nonspecific but is concerning for acute infarction. This is a new finding since the prior study dated June 4, 2010. 2. This could be suggestive of lateral medullary syndrome/Wallenberg syndrome. 3.

Left vertebral artery abnormal flow void which is nonspecific. It is difficult to appreciate the connection between right medullary abnormality and left vertebral artery abnormality. Clinical correlation advised. 4. No evidence of intraorbital pathology.

I discussed these findings with Dr. Alkaitis, covering physician for Dr. Blum at 1030 p.m., 6-9-10. An “infarction” is brain-cell death caused by insufficient flow of blood. Dr. Viswanathan dictated the report at 4:42 p.m., but it was not until 10:30 p.m. that Dr. Viswanathan notified the on-call neurologist, Damanhuri Alkaitis, M.D., (“Dr. Alkaitis”) of the findings. Dr. Viswanathan did not report these results to Dr. Blum, as he was asked to do, or anyone else at AAMC or to Mr. Copsey.

Mr. Copsey returned to see Dr. Blum around 6 p.m. with the images. In his report, Dr. Blum reflected that the radiology department never called him despite his request for an urgent call back. However, Dr. Blum could have accessed Dr. Viswanathan’s findings earlier by checking the Medical Center’s computer database or by contacting the radiology department. He reviewed the images himself and found no abnormalities.

Thus, Dr. Blum released Mr. Copsey from the hospital. Mr. Copsey had already been released by the time Dr. Vis- ¹⁵² wanathan notified Dr. Alkaitis of the MRI results at 10:80 p.na. Mr. Copsey was not informed that a lateral medullary infarct had been discovered nor did Dr. Viswanathan or Dr. Alkaitis take any action in contacting Mr. Copsey, his family, or arranging for an ambulance to transport Mr. Copsey back to the hospital emergency room for treatment that night. On June 10, 2010 at approximately 4:00 a.m., Mr. Copsey suffered a stroke when he woke up to use the bathroom.

His wife took him to the AAMC emergency room after she found him on the floor of their home unable to get up. A CT scan conducted at approximately 6:07 a.m. revealed a right medul-lary hypodensity, reflective of an acute stroke. Mr. Copsey’s condition worsened by approximately 11:00 a.m. He was then transferred to Johns Hopkins Hospital (“JHH”).

JHH diagnosed Mr. Copsey with bilateral vertebral dissections; multiple acute brainstem and cerebellar strokes; hyperlipidemia; and head trauma from the racquetball fall in February. On June 12, 2010, Mr. Copsey underwent angioplasty and received a stent in his right vertebral artery. However, the following day he became unresponsive. After treatments failed, Mr. Copsey’s condition continued to deteriorate.

He died on June 18, 2010. The petitioners filed survival and wrongful death actions on September 27, 2011, in the Circuit Court for Anne Arundel County against Dr. Park and Annapolis Radiology, Dr. Vis-wanathan and his employer, Anne Arundel Diagnostic Imaging, Inc., and Dr. Blum and Dr. Alkaitis, and their employer, Bay Area Neurology, LLC (“Bay Area”). According to the petitioners, between June 4 and June 10, each doctor involved in the treatment negligently failed to timely diagnose Mr. Copsey’s evolving stroke. They sought to hold all of the doctors involved jointly and severally liable for the death of Mr. Copsey.

The petitioners reached pre-trial settlements with the defendants, Dr. Blum, Dr. Alkaitis, and Bay Area Neurology. Those defendants were dismissed from the action. On September 17, 2014, a day after the trial had begun, the ¹⁵³ petitioners voluntarily dismissed Dr. Viswanathan and his employer, Anne Arundel Diagnostic Imaging, Inc. Thus, Dr. Park and his employer, Annapolis Radiology, were ultimately the only defendants left in the case to stand trial. On August 26, 2014, the petitioners moved in limine, to prevent introduction of certain evidence, prior to trial.

The first motion was to exclude all evidence relating to Dr. Blum’s and Dr. Alkaitis’ prior statuses as defendants and the pre-trial settlements. The second was to preclude Dr. Park from raising as a defense that the negligence of subsequent treating physicians was an intervening and superseding cause of Mr. Cop-sey’s alleged injuries. After hearing arguments from both parties on the first day of trial, the Honorable Paul G. Goetzke, presiding, denied both of the motions. 4 Trial Prior to trial, the petitioners’ attorney wrote a letter to their expert witness, Dr. Caren Jahre (“Dr. Jahre”), a radiologist/neuroradiologist, discussing all of Mr. Copsey’s history, the studies performed, his symptoms, and the cause of death. The respondents suggested that Dr. Adam Hecht (“Dr. Hecht”), a neurologist and Dr. Jahre’s partner, may have read this letter, but Dr. Hecht testified at trial that he could not recall whether or not he had read the letter.

Moreover, Dr. Jahre indicated in her de bene esse deposition testimony that she could not recall if she looked at the letter before her review, but also stated that she only does blind reviews when an attorney directs it, which was not done here, and that she did know in advance of conducting her review to look for ¹⁵⁴ vertebral artery occlusions. Dr. Hecht and Dr. Jahre testified that the June 4 MRA showed abnormalities in the left vertebral artery (“LVA”) and the right vertebral artery (“RVA”), which should have been detected by Dr. Park. A defense witness, Dr. Susan O’Sullivan (“Dr. O’Sullivan”), a radiologist, pointed out that an objective blind review is meant to prevent bias from a hindsight review where a radiologist knows exactly what to look for when reviewing a study. 5 Two of the defense experts, Dr. Alan Hyman (“Dr. Hyman”) and Dr. O’Sullivan, conducted blind reviews and did not notice any problems or abnormalities that went unnoticed by Dr. Park. Dr. Hyman, an assistant clinical professor of neuroradiology at Mt.

Sinai Medical School, found the MRI/MRA, including the LVA and RVA, from the June 4 results to be normal. Both of the defense experts concluded that Dr. Park had acted within the standard of care. Michael Horowitz, M.D. (“Dr. Horowitz”), a neurosurgeon and the petitioners’ causation expert, testified that if Dr. Blum, Dr. Alkaitis, or Dr. Viswanathan had obtained medical attention for Mr. Copsey on June 9, one day before his stroke, the stroke could have been prevented.

Guy Rordorf, M.D. (“Dr. Rordorf’), an expert witness for the petitioners, also testified that had Dr. Blum, Dr. Viswanathan, and Dr. Alkaitis given Mr. Copsey medical attention on June 9, his major stroke on June 10 would have been avoided and his life saved. Further, expert witnesses on both sides testified regarding the negligence of all three of the subsequent treating doctors in their care of Mr. Copsey: Dr. Blum: Expert witnesses opined that Dr. Blum’s treatment of Mr. Copsey was below the standard of care. Dr. ¹⁵⁵ Rordorf testified that Dr. Blum was negligent on June 9 when he reviewed the MRI results on his own, did not wait for the STAT test results he had ordered from the radiology department, and sent Mr. Copsey home.

Dr. Rordorf noted that Mr. Copsey presented symptoms of stroke which should have been apparent. Another one of the petitioners’ witnesses, Dr. Horowitz, stated that a reasonable neurologist would have acted to treat Mr. Copsey’s symptoms immediately. As to June 4, Dr. Owen Samuels (“Dr. Samuels”), the respondents’ witness, testified that it was not reasonable for Dr. Blum to rely solely on Dr. Park’s interpretations of the MRI/MRA on June 5 because a stroke is a clinical diagnosis and Mr. Copsey was exhibiting apparent stroke-like symptoms. Dr. Viswanathan: Despite receiving notice from Dr. Blum to contact him, Dr. Viswanathan did not contact Dr. Blum after Dr. Viswanathan obtained the radiology scans on June 9 shortly after 4:00 p.m.

He only contacted Dr. Alkaitis, who was substituting for Dr. Blum, six hours later that night, after Mr. Copsey had already been released by Dr. Blum. Dr. Hecht stated that Dr. Viswanathan’s actions fell below the standard of care for a treating radiologist and every effort should have been made to contact the patient’s physician immediately after discovering these alarming results. Dr. Alkaitis: Dr. Hecht also testified that Dr. Alkaitis’ conduct fell below the standard of care for a physician when he received news of Mr. Copsey’s condition from Dr. Viswana-than at 10:30 p.m. on the night of June 9, but did not take further action. Dr. Rordorf testified that he was surprised that Dr. Alkaitis did nothing because it is the responsibility of a neurologist in such a situation to call the patient to let them know of a critical MRI finding.

Further, Dr. Rordorf indicated that Dr. Alkaitis should have had the patient rushed to the emergency room and should have called the emergency room to notify them that a patient with a stroke would be coming in for emergency treatment. Dr. Rordorf testified that such treatment would have saved Mr. Copsey’s life. ¹⁵⁶ The case was tried before a jury from September 16, 2014 through September 24, 2014. On September 24, 2014, the jury returned a verdict in favor of the defendant, Dr. Park. The jury found that Dr. Park did not breach the standard of care and acted as a reasonable physician under the circumstances.

The petitioners filed a timely appeal. The Court of Special Appeals affirmed the Circuit Court as explained in its opinion filed on May 31, 2016. The intermediate appellate court applied Martinez to uphold the introduction of evidence of a non-party’s negligence and causation. Copsey v. Park, 228 Md.App. 107, 121 , 137 A.3d 299, 307 (2016).

In addition, the court held that a reasonable jury could have found that the negligence of the subsequent treating physicians were both intervening and superseding causes contributing to Mr. Copsey’s death. 228 Md.App. at 124 , 137 A.3d at 309 . Jenny J. Copsey, et al. filed a petition for writ of certiorari in this Court. We granted certiorari to answer the following questions: 1. Did the trial court err in admitting evidence of the negligence of non-party, subsequent treating physicians, including evidence that they were once defendants in the instant suit? 2.

Did the trial court err in instructing the jury on superseding cause when the negligence of all the treating physicians amounted to one indivisible injury, that being death? Copsey v. Park, 449 Md. 408 , 144 A.3d 704 (2016). We answer each question in the negative and hold that a defendant generally denying liability may present evidence of a non-party’s negligence and causation as an affirmative defense. It was not error to admit evidence of the negligence of the non-party subsequent treating physicians.

Evidence of a non-party’s negligence was relevant and necessary in providing Dr. Park a fair trial; the potential prejudice did not outweigh the probative value of the evidence. We further hold that causation was an issue for the jury to determine. The evidence presented by Dr. Park tended to show that he was ¹⁵⁷ not negligent and that if he were negligent, the negligent omissions of the other three subsequent treating physicians were intervening and superseding causes of the harm to the patient. Therefore, we shall affirm the judgment of the Court of Special Appeals.

STANDARD OF REVIEW We have held that “on review, we will not disturb the trial court’s evidentiary rulings absent error or a clear abuse of discretion.” Thomas v. State, 429 Md. 85, 97 , 55 A.3d 10, 17 (2012) (citations omitted). “Such exercise of discretion will be accorded every reasonable presumption of correctness and will not be upset except in a clear case of abuse.” Cure v. State, 421 Md. 300, 331 , 26 A.3d 899, 917 (2011) (citations and internal quotation marks omitted). Further, the Maryland Rules provide that “all relevant evidence is admissible. Evidence that is not relevant is not admissible.” Md. Rule 5-402. Moreover, “evidence may be excluded if its probative value is substantially outweighed by the danger of unfair prejudice, confusion of the issues, or misleading the jury, or by considerations of undue delay, waste of time, or needless presentation of cumulative evidence.” Md. Rule 5-403.

At the outset, we note that the admission of evidence is committed to the considerable and sound discretion of the trial court. In that regard, all relevant evidence is generally admissible. A corollary to that rule is that irrelevant evidence is not admissible. Md. Rule 5-402.

To be relevant, evidence must tend to establish or refute a fact at issue in the case. Md. Rule 5—401. Once a finding of relevancy has been made, we are generally loath to reverse a trial court unless the evidence is plainly inadmissible under a specific rule or principle of law or there is a clear showing of an abuse of discretion. Merzbacher v. State, 346 Md. 391, 404-05 , 697 A.2d 432, 439 (1997) (citations omitted). ¹⁵⁸ DISCUSSION The petitioners contend that by admitting the evidence of the non-parties’ negligence, and denying both of the motions in limine, the trial court admitted evidence which was irrelevant and immaterial to the issue of whether Dr. Park violated the standard of care in his treatment and whether that breach was a proximate cause of Mr. Copsey’s death.

The evidence also deflected, according to the petitioners, the jury’s attention from Dr. Park’s performance and injected notions into the consciousness of the jurors that the “guilty” parties had once been defendants who had settled and therefore Dr. Park must not have been negligent. The petitioners also assert that the judgment of the Court of Special Appeals should be reversed because the Martinez decision requires review by this Court as well as the improper application of the doctrine of intervening and superseding causes in the context of a medical negligence action involving acts of multiple concurrent tortfeasors. Petitioners argue that each of the physicians contributed to the six-day delay that proximately caused Mr. Copsey’s death. In other words, their delay worked, in conjunction with one another, to cause Mr. Copsey’s death and thus they are jointly and severally liable.

The petitioners maintain that if Dr. Park had diagnosed Mr. Copsey’s evolving stroke on June 4, 2010, and referred him for appropriate treatment, it is more probable than not that he would not have died. Further, the petitioners maintain that the subsequent negligence of the other physicians, Dr. Blum, Dr. Yiswana-than, and Dr. Alkaitis, in also failing to timely diagnose and treat Mr. Copsey’s condition was foreseeable and was not the superseding cause of Mr. Copsey’s death. The respondents, on the other hand, contend that admitting the evidence sought to be excluded by the two motions in limine was proper. They posit that it is the authority of the jury to weigh evidence and make the determination of superseding causation.

Moreover, the negligence of the other doctors between June 9-10 broke the chain of causation between Dr. Park’s reading of the radiological images on June 4 and the stroke Mr. Copsey suffered on June 10. Further, ¹⁵⁹ they argue that under the guise of preventing a “distraction” the petitioners want a rule that gives them veto power over Dr. Park’s defense. Moreover, under a “battle of the experts” theory, the respondents indicate that the jury found Dr. Park’s expert witnesses more credible because their experts reviewed the CT scan and MRI/MRA images blindly, whereas petitioners’ experts were informed of where to locate abnormalities before making an assessment of whether Dr. Park was negligent in his reading of the results. A jury, the respondents maintain, would be more likely than not to find it more trustworthy when experts view the images in the same manner that Dr. Park would have, versus experts who view the images through bias.

Finally, according to the respondents, the extraordinary failures of the three subsequent physicians (two neurologists and one radiologist), each of whom failed to avert Mr. Copsey’s impending major stroke just hours before it occurred, despite knowing the acute risk, superseded any alleged error by Dr. Park which had occurred days earlier. They assert that the sequential subsequent negligence of these three doctors, Dr. Blum, Dr. Viswanathan, and Dr. Alkaitis, was astonishing and unforeseeable because Dr. Park could not have anticipated that three subsequent treating doctors, not relying on his report, would all act below the standard of care. Motion in Limine: Prohibiting Dr. Park from Presenting Evidence Relating to Dr. Blum’s and Dr. Alkaitis’ Prior Statuses as Defendants or Pre-trial Settlements Martinez was the first Maryland decision to address a non-party’s negligence in a medical malpractice action and held that evidence of a non-party’s negligence should not be excluded in a medical injury case. 212 Md.App. at 663, 666 , 70 A.3d at 413, 415 . In Martinez, the Court of Special Appeals discussed the admissibility into evidence of a prior third-party’s negligence when the defendant generally denies liability. 212 Md.App. at 665 , 70 A.3d at 414 .

Ms. Fielding, the plaintiff pregnant woman who sued on behalf of her baby, Enzo Martinez, was ten days overdue and chose to have a natural ¹⁶⁰ birth with the assistance of a registered nurse midwife. 212 Md.App. at 640 , 70 A.3d at 400 . The baby was occiput posteri- or (instead of facing forward, the baby was facing inward towards the mother’s spine) and Ms. Fielding was in labor for over 19.5 hours before the midwife eventually called an ambulance. 212 Md.App. at 640-41 , 70 A.8d at 400-01. Throughout that time, the midwife applied fundal pressure, injected the plaintiff multiple times with Pitocin (“a hormone that increases the strength and frequency of contractions”), performed an episiotomy, and had the plaintiff cleanse herself with a probi-otic treatment as an alternative to antibiotics. Id.

The hospital physicians determined that an “urgent” Caesarean section, rather than an “emergency” Caesarean section, needed to be performed. 6 212 Md.App. at 642 , 70 A.3d at 401 . The baby was not delivered in good health and was diagnosed with cerebral palsy, retardation, and other disorders. 212 Md.App. at 643 , 70 A.3d at 402 . The plaintiff sued the hospital and “filed a pre-trial motion in limine seeking to exclude testimony regarding ... Midwife Muhlhan’s alleged [negligence].” 212 Md.App. at 645 , 70 A.3d at 403 .

The trial court granted the motion and reasoned that any negligence that may have been committed by the midwife, a non-party, was not relevant to the hospital’s negligence in treating the plaintiff once she arrived. 212 Md.App. at 647-48 , 70 A.3d at 405 . The Court of Special Appeals reversed and held that “evidence of both negligence and causation attributable to a non-party is relevant where a defendant asserts a complete denial of liability” and “the [hjospital was entitled to try to convince the jury that not only was it not negligent and not the cause of [baby] Martinez’s injuries, but that [the midwife] was negligent and did cause the injuries.” 212 Md.App. at 665 , 70 A.3d at 414-15 (italics omitted). In fact, the ¹⁶¹ court held that the Hospital was denied a fair trial in not being able to present evidence of the negligent non-party (testimony as to what the standard of care was for the midwife and that there was a breach of that standard). 212 Md.App. at 658, 679 , 70 A.3d at 411, 423 (“In our view, the jury was provided a materially incomplete picture, and the Hospital was unnecessarily constrained in presenting its defense that Midwife Muhlhan was the sole cause of [baby] Martinez’s injuries. Accordingly, we hold that the error here had a substantial likelihood of causing an unjust verdict.”).

The court also stated: [Ms. Fielding] argues that even if the evidence at issue is deemed relevant, the probative value is “vastly outweighed by potential for unfair prejudice, confusion of the issues, and waste of time. ...” We disagree. Indeed, the probative value of the evidence of the midwife standard of care, and Midwife Muhlhan’s breach of that standard of care, if any, during her treatment of Ms. Fielding, outweighs any potential for unfair prejudice, confusion, or waste of time. Martinez, 212 Md.App. at 672-73 , 70 A.3d at 419 . The petitioners argue that Martinez does not apply here because the negligence in that case was antecedent and the issue of superseding cause was not involved.

It is true that in Martinez, the alleged negligence by the midwife, the non-party, preceded the hospital’s alleged negligence. Ultimately, however, the issues involved in Martinez dealt with a defendant presenting evidence of a non-party’s negligence and causation similar to the issues in the case at bar. Subsequent superseding events on June 9-10 followed Dr. Park’s alleged negligence and were classic intervening events that Dr. Park could not have reasonably foreseen. Dr. Park was able to present evidence of the negligence of the other treating physicians at the same hospital.

Similarly, in addition to claiming that the other treating physicians were superseding causes, Dr. Park also completely denied any liability. Not unlike Martinez, evidence of a third-party’s negligence is admissible because without the evidence “the jury [would have been] given a materially incomplete picture of the facts, which ¹⁶² [would have] denied [Dr. Park] a fair trial.” 212 Md.App. at 666 , 70 A.3d at 415 . The petitioners also argue that allowing the defendants to point the finger at non-parties will distract the jury and a jury may speculate that the actual “guilty” parties who were once part of the case settled with the injured party and left the “innocent” party to stand alone. However, as the respondents note, this point of view ignores the fact that a jury may also speculate that an “innocent” party settled for a low figure, while a “guilty” party decided to remain and go to trial.

We do not believe these concerns have merit because the issues of liability and damages are matters left to the considered determination of the trier of fact. The trier of fact takes into consideration all of the relevant and material evidence in the case and determines the weight to be given to that evidence. In addition, upon request, the trial judge may give cautionary instructions to the jury as needed to allay either parties’ fears that the jurors would be prone to speculation. See E. Shore