Hahn v. Suburban Hosp. Ass'n, Inc.

Alpert, J., delivered the opinion of the Court. In this case of alleged medical málpractice, we are called upon for the first time to determine the sufficiency of evidence necessary to rebut the statutory presumption of correctness of an arbitration award issued by a Health Claims Arbitration Panel. Such an award was issued in the instant case in favor of the widower, 1 children and estate of Gloria Hahn (appellants) against Suburan Hospital Association, Inc. (appellee) for a medical malpractice claim. In the Circuit Court for Montgomery County the trial judge overruled-appellants’ motion for a directed verdict and determined there was sufficient evidence to generate a question of fact for the jury to resolve as to the negligence of the appellee.

The jury, in returning a verdict in favor of appellee, •obviously was convinced that the statutory presumption had been rebutted, and that Suburban Hospital was not negligent. We conclude that on the evidence presented, reasonable minds might have differed as to whether. Suburban ⁶⁸⁷ Hospital complied with the appropriate standard of care and shall therefore affirm. I. Factual Background At 1:31 p.m. on March 21, 1977 Gloria Hahn was pronounced dead in the emergency room of Suburban Hospital in Bethesda, Maryland.

Approximately 15 hours earlier, on March 20th, she had been taken by her brother to the emergency room of that hospital complaining of chest pain under her left breast which had been bothering her for about a week. She was examined by Dr. John Scott who was under contract with Suburban to provide medical services to emergency room patients. As part of the examination, he interviewed the patient and although not a cardiologist, caused an electrocardiogram (EKG) to be taken. He subsequently read the EKG tracing himself.

Based upon his examination of Mrs. Hahn and his interpretation of the EKG, Dr. Scott told Mrs. Hahn "I don’t think there is anything here that is life-threatening and if you will promise me to see Dr. Cohn [her family physician] as soon as possible, I’ll let you go home.” He testified "I gave her a sedative, 10 milligrams of valium, and she went home.” The EKG tracing was first seen by a cardiologist, Dr. Frederick Caldwell, at about 3:00 P.M., 90 minutes after Mrs. Hahn was pronounced dead. Dr. Caldwell, who was one of several physicians under contract with Suburban to read EKG tracings, read the tracing to suggest "active ischemic process,” which indicated the possibility of a myocardial infarction occurring at the time the EKG was being administered. Having observed from the hospital record that Mrs. Hahn had been sent home, he proceeded to notify the emergency room physician of the possibility that she needed further care, in order that she could be recalled to the hospital. Unfortunately, she was already dead.

II

The Procedural Background On or about May 15, 1980, as a result of claims filed ⁶⁸⁸ because of Mrs. Hahn’s death, a Health Claims Arbitration Panel issued the following "award”: HEALTH CLAIMS ARBITRATION AWARD I. LIABILITY 1. Defendant Suburban Hospital is liable to Claimants for compensatory damages. 2. Defendant Suburban Hospital Association (is)_(is not) _X liable to Claimants for punitive damages. 3. Defendant Scott (is)_(is not) X liable to Claimants for compensatory damages. 4.

Defendant Scott (is) _ (is not) X_ liable to Suburban Hospital on Suburban Hospital’s Crossclaim against Doctor Scott.

II

DAMAGES The Panel awards damages to the Claimants as follows: Total Comp. Comp. Damages Punitive Damages Damages Scott Suburban Suburban William Hahn $3.000.00 _ 0 All _TL Norman Eugene Hines 1.000.00 0__" _0 Lisa Marie Hines 2,000.00 0__" _0 Deena Marie Hahn 5.000. 00 0 " 0 Dawn Mary Hahn 5.000. 00 0__" 0 Patricia Hahn 5.000. 00 0 " 0 Tracy Colleen Hahn 5.000. 00 0__" 0 Pursuant to Cts. & Jud. Proc.

Code Ann. §3-2A-06, all of the plaintiffs and Suburban rejected the findings of the Arbitration Panel. On August 13, 1980, the Plaintiffs (William Hahn, individually and as personal representative of the estate of Gloria Hahn, deceased, and Dennis M.- Ettlin, guardian ad ⁶⁸⁹ litem for Deena Marie Hahn, Dawn Mary Hahn, Patricia Hahn, Tracy Colleen Hahn, Norman Eugene Hines and Lisa Marie Hines) filed suit against Suburban Hospital Association, Inc. and John E. Scott, M.D. seeking "to nullify the award of the arbitrators in HCA No. 78-84, filed on May 15, 1980..and alleging, inter alia: [T]hat the Defendant Scott was negligent, deviated from the standard of care and was guilty of medical negligence in his care and treatment of Gloria Hahn on March 20, 1977, specifically including but not limited to the following: Failure to correctly diagnose Gloria Hahn’s medical illness on March 20, 1977; failure to properly and correctly read and interpret Gloria Hahn’s electrocardiogram tracing on March 20, 1977; failure to consult with a physician competent to correctly read and interpret Gloria Hahn’s electrocardiogram tracing on March 20, 1977; failure to contact Gloria Hahn’s family physician on March 20, 1977, as required by the rules and regulations of the hospital; failure to properly treat the medical illness of Gloria Hahn; failure to adequately monitor Gloria Hahn in the emergency room or to recommend admission to the hospital for purposes of monitoring and treatment; that the Defendant Suburban Hospital Association, Inc., represented to Gloria Hahn that the Defendant Scott and the staff of the emergency room at Suburban Hospital were its agents and employees, and the Defendant Suburban Hospital is liable to Plaintiffs for all acts of negligence of the Defendant Scott under the doctrine of respondeat superior; that the Defendant Suburban Hospital Association, Inc. was independently negligent, deviated from the standard of care and was guilty of medical negligence in its care and treatment of Gloria Hahn, specifically including but not limited to the following: Failure to provide an emergency room physician qualified and competent to correctly read ⁶⁹⁰ and interpret electrocardiogram tracings of emergency room cardiac patients; failure to provide adequate equipment and facilities to correctly read and interpret electrocardiogram tracings of emergency room cardiac patients; failure to provide for timely review by qualified physicians of electrocardiograms taken in the emergency room; failure to monitor compliance with hospital and emergency room rules and regulations by emergency room staff and physicians. The Plaintiffs also alleged: [T]hat on March 21, 1977, Plaintiffs’ decedent Gloria Hahn suffered a myocardial infarction at her home; that the Montgomery County Rescue Squad mobile intensive care unit was summoned and responded; that upon their arrival the paramedics instituted appropriate medical care including defibrillation of Gloria Hahn’s heart ’and began to transport her to the emergency room at Suburban Hospital; that en route to Suburban Hospital it was necessary for the paramedics to contact the emergency room physicians at Suburban Hospital in order to receive authority to again defibrillate Gloria Hahn’s heart in order to preserve her life; that the paramedics were unable to contact the emergency room at the hospital because personnel of the emergency room had intentionally and deliberately turned off the radio communications between the mobile intensive care unit and the emergency room; that because the paramedics were unable to contact the emergency room physician they were not authorized to again defibrillate Gloria Hahn’s heart and she was pronounced dead at the hospital; that the Defendant Suburban Hospital Association, Inc. is guilty of gross, wanton and reckless disregard of its duty to Gloria Hahn and its obligations to her under the standard of care by reason of the intentional act of its servant and ⁶⁹¹ employee in the emergency room in turning off the communications radio; that prior to March 21,1977, the Defendant Suburban Hospital Association, Inc. knew that hospital personnel in the emergency room had on other prior occasions turned off the communications radio and that paramedic units en route to the hospital with emergency patients had been unable to contact the hospital; that despite this prior knowledge the Defendant Suburban Hospital Association, Inc. negligently failed to take any action to insure that the communications between the hospital and the paramedics would be maintained; that the failure of the Defendant Suburban Hospital Association, Inc. to correct the situation and to insure that the communications radio remained on was conscious and deliberate and undertaken with full knowledge and understanding of the danger posed to the lives of patients being transported to the hospital. On March 15,1982 the case came on for trial before Judge John J. Mitchell and a jury.

At the close of the Plaintiffs case, the trial judge directed a verdict in favor of the defendant Dr. Scott, and denied Suburban’s motion for directed verdict. At the close of the defendant’s case the trial judge once again denied Suburban’s motion for directed verdict. Plaintiffs motion for directed verdict at the end of the entire case was denied and the case was submitted to the jury for their deliberation. On March 30, 1982 at 3:05 P.M. the jury returned a verdict.

Responding to the Court’s question: "Do you find that the Defendant, Suburban Hospital Association, Incorporated is liable to the Plaintiffs for compensatory damages?” the foreman of the jury answered "No.” Plaintiffs moved for Judgment N.O.V. and for Partial New Trial. The Motion was denied and judgments were entered for the defendants. 2 This appeal followed and appellants raise the following questions: ⁶⁹² I. Did the Defendant present sufficient evidence to meet its burden to prove that the arbitration award was not correct?

II

Did the trial court err in failing to direct a verdict on the issue of liability in favor of plaintiffs against Suburban and in failing to grant plaintiffs’ motion for judgment N.O.V. and partial new trial when plaintiffs’ uncontradicted expert testimony established that the hospital failed to meet the applicable standard of care and that the hospital’s failure was the proximate cause of decedent’s death?

III

The Issues A. The Statutory Presumption That the Arbitration Award is Presumed to be Correct Appellant correctly observes that: This case is the first occasion for this Court to consider the Maryland Health Care Malpractice Claims Statute, Maryland Code (1974, 1982 Cum. Supp.), Sections 3-2A-01 to 3-2A-09 of the Courts Article, particularly sub-section (d) of Section 3-2A-06, which provides: (d) Admissibility of award; presumption of correctness. — Unless vacated by the court pursuant to subsection (c), the arbitration award is admissible as evidence in the judicial proceeding. The award shall be presumed to be correct, and the burden is on the party rejecting it to prove that it is not correct. 3 We hold that since the Health Claims Arbitration Panel found Suburban Hospital liable to the appellants for compensatory damages, the burden of proof on the issue of negligence shifted at trial to Suburban by virtue of sub-section (d) above. Procedurally, the Maryland Workmen’s Compensation Law is analogous.

Md. Ann. Code ⁶⁹³ art. 101, § 56 (c) provides in pertinent part"... the decision of the Commission shall be prima facie correct and the burden of proof shall be upon the party attacking the same.” Similar to a Workmen’s Compensation appeal, sub-section (d) of §3-2A-06 places the burden of proof upon the party rejecting the award, whether he be plaintiff or defendant. It establishes no new rule when the plaintiff happens to be the party rejecting the award, as the burden was always upon the plaintiff to prove his case by a preponderance of the evidence. But the statute shifts the burden from the plaintiff to the defendant where the defendant, in effect, loses before the Health Claims Arbitration Panel and rejects the award, requiring the defendant in such a case (after filing an action to nullify the award) to satisfy a jury by a preponderance of evidence that the plaintiff is not entitled to the award made by the Panel. See, Stewart & Co. v. Howell, 136 Md. 423 , 110 A. 899 (1920).

Thus, in the instant case the burden was cast upon Suburban to overcome the presumption that the award of the Panel is correct and it must do this to the satisfaction of the trier of the facts. Under the circumstances, Suburban had to prove by a preponderance of the evidence that it was not negligent, that indeed, it did comply with the appropriate standards of care as discussed infra. By the same token, the plaintiffs were required to prove by a preponderance of the evidence that the damages awarded by the Panel were inadequate. Where the facts making up negligence are conceded, undisputed or uncontroverted, and the inferences to be drawn therefrom are plain, definite and undisputed (which is not the case here, as the issue of compliance with appropriate standards of care was controverted), their legal significance is a matter of law to be determined by the court, but where the facts, or inferences therefrom, or both, are in dispute, such questions are to be determined by a jury and the jury is entitled to weigh and evaluate the evidence, and may disbelieve evidence, even though it is uncontradicted. ⁶⁹⁴ See, Talley v. Department of Correction, 230 Md. 22, 28 , 185 A.2d 352 (1962).

B. Sufficiency of the Evidence Plaintiffs contend that "Suburban Hospital had the burden of proving the arbitration award incorrect and it failed to meet that burden.” They argue that although "[f]ive physicians associated with Suburban testified in this case... . None of these men testified as to the standard of care which Suburban was required to meet at the time Mrs. Hahn was treated ... [and] None of them testified to whether or not Suburban’s treatment of Mrs. Hahn measured up to the appropriate standard of care, whatever it was.”