Crawford v. Leahy

KARWACKI, Judge. In this case we are once more called upon to construe the Health Care Malpractice Claims Act, Maryland Code (1989, 1991 Cum.Supp.) §§ 3-2A-01 through 3-2A-09 of the Courts and Judicial Proceedings Article (the Act). The narrow question presented is whether an award of the health claims arbitration panel in favor of the claimant on the merits can be subdivided into an award finding liability and an award assessing damages, permitting the claimant to seek judicial review of only the amount of damages awarded. We shall answer that question in the negative and affirm the judgment of the trial court.

I Helen Denise Crawford alleged that she was injured as a result of malpractice by Dr. William R. Leahy and his professional association, Neurological Medicine, P.A. (collectively “Dr. Leahy”). Mrs. Crawford and her husband 1 (Crawfords), filed a claim against Dr. Leahy, pursuant to the Act. After a hearing before a health claims arbitration panel, the Crawfords obtained an award of $37,768 against Dr. Leahy.

The panel’s decision was rendered on a preprinted form which compelled the arbitrators to set forth separately their decisions regarding liability, damages, and costs, as required by the Act. 2 ¹⁶³ Dissatisfied with the amount of damages, the Crawfords filed a pleading in the Circuit Court for Prince George’s County entitled “Notice of Action to Nullify Award as to Damages Only,” attempting to reject the award of the panel as it related to damages only in an effort to prevent de novo judicial review of the arbitration panel’s liability determination. The Crawfords simultaneously filed a complaint, as required by Maryland Rule BY4, alleging that Dr. Leahy had been negligent in his care and treatment of Mrs. Crawford. The Crawfords demanded a jury trial “on all issues herein.” In response, Dr. Leahy filed a “Motion to Strike or, in the Alternative, for Complete Rejection of the Arbitration Award.” In that pleading, Dr. Leahy asserted that the Act required that the Crawfords reject the liability finding in their favor as well as the damages determination or, alternatively, that the Crawfords’ notice of rejection should be deemed to have rejected the entire award. Concluding that there is “no authority to allow an appeal from Health Claims Arbitration on the issue of damages alone,” Judge William H. McCullough granted Dr. Leahy’s motion to strike, giving the Crawfords leave to file an amended notice of action to nullify award and complaint.

Thereafter, the Crawfords filed an “Amended Notice of Action to Nullify Award,” stating that they “reject the award of the Health Claims Arbitration panel as it relates to liability and damages.” The Crawfords also filed an “Amended Complaint” that was identical to the originally filed complaint; both pleadings contained allegations of negligence. Dr. Leahy answered, denying liability. ¹⁶⁴ Ten months later, after extensive discovery regarding matters relevant to both liability and damages, and ten days before trial, the Crawfords, in another attempt to limit the trial solely to the issue of damages, moved for reconsideration of the court’s earlier decision. The Crawfords suggested that “[t]he ‘all or nothing’ approach adopted by Judge McCullough requires plaintiffs to prove a non sequitur, that is, that the liability finding in their favor is ‘not correct.’ ” Dr. Leahy opposed this motion, noting that once the award is rejected by either party, the case proceeds de novo, so that the jury necessarily considers the issue of Dr. Leahy’s liability. Dr. Leahy reiterated his prior arguments that neither the statute nor the rules permit piecemeal rejection of an award as asserted by the Crawfords.

Judge James P. Salmon, who was to preside at the trial, denied the motion for reconsideration. The case proceeded to trial before a jury. In support of their claims, the Crawfords presented evidence which included not only the arbitration award, but also extensive expert testimony on the issue of Dr. Leahy’s alleged negligence. The case was submitted to the jury on specific issues pursuant to Md.Rule 2-522.

The jury returned a special verdict finding that Dr. Leahy was not negligent with regard to his care and treatment of Mrs. Crawford. The Crawfords timely appealed to the Court of Special Appeals from the judgment entered on that special verdict. We issued a writ of certiorari on our own motion, prior to argument before the Court of Special Appeals, to consider the important issue raised by this appeal. II When the General Assembly originally adopted the Act by Ch. 235 of the Acts of 1976, it mandated that all claims for medical malpractice be submitted to an arbitration panel ¹⁶⁵ prior to pursuing them by an action in court. 3 Nevertheless, we have explained: “The mandatory arbitration requirement does not divest courts of subject matter jurisdiction over health claims, but rather ‘ “creates a condition precedent to the institution of a court action.” ’ Tranen [v. Aziz ], 304 Md. [605] at 612, 500 A.2d [636] at 639 [(1985)] (quoting Oxtoby v. McGowan, 294 Md. 83, 91 , 447 A.2d 860, 865 (1982)).

Upon fulfillment of the condition precedent, malpractice claims may be heard in court. “The final step in the arbitration process, an essential prerequisite to institution of judicial proceedings, is the filing of a notice of rejection with the director of the Arbitration Office. Tranen, 304 Md. at 612, 500 A.2d at 639; § 3-2A-06(a). Failure to file notice of rejection permits the arbitration award to become final and binding. Tranen, 304 Md. at 613, 500 A.2d at 640; § 3-2A-05(h). “The 'exclusive step by which the aggrieved party may initiate proceedings in court,’ Tranen, 304 Md. at 612, 500 A.2d at 639, is the action to nullify the award.

Section 3-2A-06(b). Although called an action to nullify, the proceeding is not analogous to an appeal from an administrative decision. Rather, the action is essentially a separate common law tort action with the added element that the arbitration process must be complete. See Attorney General v. Johnson, 282 Md. 274 , 385 A.2d 57 , appeal dismissed, 439 U.S. 805 , 99 S.Ct. 60 , 58 L.Ed.2d 97 (1978).” Ott v. Kaiser-Georgetown Health Plan, 309 Md. 641, 645-46 , 526 A.2d 46, 49 (1987). ¹⁶⁶ A. Whether the Act permits rejection of the panel’s award soley as to damages is an issue of statutory construction and as such is ordinarily determined by reference to legislative intent.

When we seek to ascertain and effectuate legislative intent, “we look first to the words of the statute, read in light of the full context in which they appear, and in light of external manifestations of intent or general purpose available through other evidence.” Cunningham v. State, 318 Md. 182, 185 , 567 A.2d 126, 127 (1989). See State v. Bricker, 321 Md. 86, 92 , 581 A.2d 9, 12 (1990); Davis v. State, 319 Md. 56, 60 , 570 A.2d 855, 857 (1990); Kaczorowski v. City of Baltimore, 309 Md. 505, 513 , 525 A.2d 628, 632 (1987). In doing so, we give the language of the statute its natural and ordinary signification, bearing in mind the statutory aim and objective. Harford County v. University, 318 Md. 525, 529 , 569 A.2d 649, 651 (1990); NCR Corp. v. Comptroller, 313 Md. 118, 124-25 , 544 A.2d 764, 767 (1988); Boulden v. Mayor, 311 Md. 411, 414 , 535 A.2d 477, 479 (1988); In Re Ramont K., 305 Md. 482, 484 , 505 A.2d 507, 508 (1986).

Moreover, we approach the analysis of the language from a “commonsensical,” rather than a technical perspective, United States v. Universal Corp., 344 U.S. 218, 221 , 73 S.Ct. 227, 229 , 97 L.Ed. 260, 264 (1952); Dickerson v. State, 324 Md. 163, 171 , 596 A.2d 648, 652 (1991), always seeking to avoid giving the statute a strained interpretation or one that reaches an absurd result. Potter v. Bethesda Fire Dep’t, 309 Md. 347, 353 , 524 A.2d 61, 64 (1987); Schweitzer v. Brewer, 280 Md. 430, 438-39 , 374 A.2d 347, 352 (1977). Applying these principles to the language of the Act, the arbitration award on the merits clearly is comprised of two essential and related determinations: liability and damages. § 3-2A-05(e), (h). These combined determinations on the merits constitute the “award” of an arbitration panel as defined by the Act.

Id. Under § 3-2A-05(e) of the Act, the health claims arbitration panel issues an “award” consisting ¹⁶⁷ of “determinations” regarding liability and, if applicable, damages: “Determinations. — The arbitration panel shall first determine the issue of liability with respect to a claim referred to it. If the arbitration panel determines that the health care provider is not liable to the claimant or claimants the award shall be in favor of the health care provider. If the arbitration panel determines that a health care provider is liable to the claimant or claimants, it shall then consider, itemize, assess, and apportion appropriate damages against one or more of the health care providers that it has found to be liable.

The award shall itemize ... any damages ...” § 3-2A-05(e) (emphasis added). Thus, the language of the Act carefully differentiates not only between the singular and the plural, but also between the liability and damage determinations and the award. The Act consistently and repeatedly refers to the panel’s determinations on the merits as “an award.” The ordinary and reasonable meaning of the explicit use of the term “award” in this statute is that the panel’s award on the merits is a single award, which includes both a determination of liability and a determination of damages. The Crawfords’ construction would make the terms “determinations” and “award” synonymous and interchangeable.

Nothing in the statute supports such a construction. See Board of Educ., Garrett Co. v. Lendo, 295 Md. 55, 63 , 453 A.2d 1185, 1189 (1982) (a court may not insert, omit, or ignore words to make a statute express intentions not evident in its original form). Finally, § 3-2A-06(a) of the Act states that “[a] party may reject an award ... for any reason.” 4 ¹⁶⁸ The Crawfords’ construction also would require us to construe the word “an” preceding “award” as surplusage. Notwithstanding the plain and unambiguous language of the statute, the Crawfords contend that the “arbitration panel’s determination is comprised of multiple awards,” and that a party may limit its rejection to the panel’s determination of damages alone.

The Crawfords offer no statutory analysis in support of their position. Their contention that the Act permits piecemeal rejection of one or more portions of the arbitration award would require judicial amendment of the Act to read: “Any party may reject either the panel’s liability determination or the panel’s damages determination, or both, for any reason.” No language in the statute supports such an amendment. According to § 3-2A-06(a) of the Act, it is only the arbitration panel’s “award” that may be rejected and, as such, there is no basis in law for a rejection of only the damages determination portion of the award on the merits. Simply stated, once an award is rejected by either party, regardless of the specific determination that is disputed, “the matter is tried all over.” Maryland Civil Pattern Jury Instructions § 27:2, at 595 (2d ed. 1984), quoted in Newell v. Richards, 323 Md. 717, 734 , 594 A.2d 1152, 1160-61 (1991). 5 In sum, the plain ¹⁶⁹ language of the Act supports the trial court’s conclusion that the panel’s award is indivisible for purposes of judicial review.

Consequently, when the award is rejected, the action to nullify that award must present the issue of liability as well as the issue of damages for determination in the malpractice action in court. B. In addition to the lack of support in the language of the Act for its construction as urged by the Crawfords, there is no case law permitting rejection of only the damage determination of an arbitration award. Nevertheless, the Craw-fords take solace in our recent decision in Central Collection v. Gettes, 321 Md. 671 , 584 A.2d 689 (1991). Gettes , however, provides no support for segregating an award on the merits into an award finding liability and an award assessing damages.

In fact, in Gettes we explicitly avoided either deciding or intimating a decision on the specific issues raised by the Crawfords here: “By treating an adverse allocation of costs as a separate award against a party who prevails on the merits, we do not intimate any view on whether awards on the merits may be segregated into awards finding liability and awards assessing damages. We are mindful of Chief Judge Gilbert’s dictum for the Court of Special Appeals in Osheroff v. Chestnut Lodge, Inc. [ 62 Md.App. 519 , 490 A.2d 720 ]: ‘Once the arbitration process has concluded, any party to the proceeding may, for any reason, reject the panel’s determination of liability, damages, or both, and invoke court review.’ Ultimate resolution of that question must await another day when the issue is squarely presented. For example, a claimant may reject the award and file an action to nullify, complaining only of inadequate damages, while the health care provider does not reject and bring any action to nullify the adverse award that determines liability as well as damages. Query: In the action to nullify in the circuit court, may the health care provider insist, over objection, on intro ¹⁷⁰ ducing evidence exculpatory as to liability?

May the health care provider have the issue of liability submitted to the jury?” Id. at 680 n. 3, 584 A.2d at 693 n. 3 (citation omitted). 6 Gettes was a collection action brought by the State against a health care provider to recover the costs of arbitrating a health care claim. 7 Although Dr. Gettes prevailed on the merits both in arbitration and at trial, the arbitration panel assessed one-half of the arbitration costs against him. Dr. Gettes “did not seek any form of direct judicial review of the panel’s adverse award of partial costs.” Id. at 673 , 584 A.2d at 690 . Eight years later, after repeated demands for payment of the arbitration costs, the State filed suit against Dr. Gettes in the District Court. On appeal, we held that “for purposes of judicial review of a panel’s allocation of costs, an adverse allocation of costs should be treated under the Act as an award, separate from the determination of the merits of the malpractice claim.” Id. at 679-80 , 584 A.2d at 693 (footnote omitted).

We reasoned that “[cjonceptualizing the panel’s determination as comprising multiple awards is consistent with principles of justiciability, and particularly with the adversariness requirement for an action in court,” id. at 678 , 584 A.2d at 692 , because those principles require that the party aggrieved by an adverse panel decision take affirmative steps to overturn it. The Crawfords concede that the holding in Gettes is inapposite to the instant case, but contend that “reversal of ¹⁷¹ the judgment in favor of Dr. Leahy is compelled by the same ‘principles of justiciability/ ... that led the [Gettes ] Court to hold that a health claims arbitration panel’s determination is comprised of multiple awards, at least as to its costs and merits decisions.” The Crawfords’ reliance on the rationale of Gettes is misplaced. First, the Crawfords’ stated concerns for “justiciability” and “adversariness” ignore that, unlike Dr. Gettes, Dr. Leahy immediately and successfully challenged the Crawfords’ novel attempt at rejection of the damages award only to ensure that the issue of Dr. Leahy’s liability would be submitted to the jury. In contrast, Dr. Gettes made no attempt by an action to nullify or otherwise to challenge the panel’s allocation of costs against him.

Additionally, the Crawfords entirely fail to consider how the “nature and scope of review” applicable to decisions on the merits “affect the conceptual number of awards.” Gettes, 321 Md. at 679 , 584 A.2d at 693 . Although Gettes does construe the costs allocation as separate from the award on the merits, we in no way suggested by our reasoning that the award on the merits is divisible into separate awards of liability and damages. Rather, Gettes rests on and in fact highlights the substantive distinction between an assessment of costs and an award by the arbitration panel on the merits. Our rationale was based squarely on the statutory and practical differences between an “award allocating costs” and an “award on the merits”: “[I]n arbitrations under the Act, we do not deal with a system in which costs follow the result____ There is no automatic connection between the obligation for arbitration costs, as determined by the panel, and the result on the merits, either in arbitration or in any subsequent malpractice action in court.” Id. at 676 , 584 A.2d at 691 .

Further, we emphasized that “the arbitration costs allocation in arbitrated claims under the Act is a discretionary function of the arbitration panel,” and, as such, costs assessments are subject to judicial ¹⁷² review “only on very limited grounds.” 8 Id. at