Roy v. Dackman

LEAHY, J. Jakeem Roy (“Roy” or “Appellant”) was exposed to lead before he reached age two, according to his blood tests taken on September 17, 1997. Roy filed a complaint through his mother, Latisha Hillery, in the Circuit Court for Baltimore City on June 29, 2011, against the owners of the two-story brick row house on 2525 Oswego Avenue where he lived for a short period as a baby, and where, he claims, he was exposed to lead paint. Roy asserts that as a result of the acts and omissions of the owners of the row house, Elliot and Sandra Dackman, Jacob Dackman & Sons, L.L.C., and Brina Corporation (“the Dackmans” or “Appellees”), he was exposed to quantities of chipping, peeling, and flaking lead-based paint powder and dust which was a direct and proximate cause of injuries he maintains he sustained from lead poisoning. This appeal is from the circuit court’s grant of summary judgment in the Dackmans’ favor.

Roy presents three issues for our review, which we have rephrased as follows: 1. Did the circuit court err when it excluded pediatrician’s testimony that Roy suffered injuries from exposure to ⁴⁵⁸ lead paint and that 2525 Oswego Avenue was a substantial contributing cause of Roy’s injuries? 2. Did the circuit court err in granting summary judgment in favor of Appellees based on the exclusion of pediatrician’s testimony and Appellant’s failure to present expert medical evidence? 3. Did the circuit court err in finding that the circumstantial evidence presented was insufficient to defeat summary judgment?

We find on all three questions that the circuit court did not err and we affirm its grant of summary judgment. The court appropriately excluded the proffered expert testimony of Appellant’s pediatrician because he was not qualified as an expert for the same reasons we found him not qualified in City Homes v. Hazelwood, 210 Md.App. 615 , 63 A.3d 713 cert. denied, 432 Md. 468 , 69 A.3d 476 (2013), and because there was insufficient evidence to form the factual predicate to support his testimony. The circumstantial evidence presented (and upon which the pediatrician relied) was also insufficient to independently establish a prima facie case for causation consistent with Hamilton, et al. v. Kirson, et ux., 439 Md. 501, 520 , 96 A.3d 714 (2014), and the three lead paint causation links articulated in Ross v. Housing Auth. of Baltimore City, 430 Md. 648, 668 , 63 A.3d 1 (2013). Roy’s Complaint 1 The amended complaint (“complaint”) 2 alleges that Roy “ingested and consumed paint chips and dust containing lead ⁴⁵⁹ and lead pigments while living at the property,” and that the Dackmans “fail[ed] to comply with laws, rules, regulations and ordinances of the State of Maryland and City of Baltimore that prohibit flaking, loose or peeling paint, ... the use of paint with lead pigment, and the rental of dwellings that contain flaking, loose, or peeling paint.” 3 As a consequence, the complaint states Roy “suffered lead poisoning ... was subjected to painful testing and treatment ... and has suffered permanent brain damage resulting in developmental and behavioral injuries.” The complaint further alleges that the Dackmans observed the condition of 2525 Oswego Avenue and therefore had reason to know of the inherently unreasonable danger to which they exposed their tenants, Roy and his family, to whom they owed a duty to use ordinary care to ensure the property was safe and free of any lead contamination.

Counts I, II, and V declare that Roy’s lead poisoning and injuries are the direct, foreseeable and proximate result of the Dackmans’ negligence. Counts II, IV, and VI claim the Dackmans engaged in unfair and deceptive trade practices in violation of Maryland law by leasing the property to Roy and his family, without notice or warning of its hazardous condition, and while concealing the true condition of the property. 4 ⁴⁶⁰ Roy’s Childhood Residences Roy was born in the City of Baltimore, Maryland, on April 26, 1996. He resided at 2801 Virginia Avenue, Apartment C8, for approximately the first eight months to one year of his life. The record is equivocal on the date Roy and his family moved to 2525 Oswego Avenue.

Roy contends that he resided at 2525 Oswego Avenue from the “fall of 1996 through November 1998” in his brief submitted to the court; however, the complaint alleges in paragraph four that Roy resided at the property from “approximately 1997 to approximately 1998.” Roy’s mother, Latisha Hillery, testified during her deposition that Roy moved into the premises in the fall 1996; however, Roy’s Answers to Interrogatories indicate that Roy lived at 2525 Oswego Avenue from January 1997 to 1998. Business records submitted by the Dackmans indicate that the property was undergoing significant renovations from January 7, 1997 through April 3, 1997. These renovations included extensive cleaning, painting, repairing the roof and skylights, repairing ten windows, replacing doors and door frames, repairing walls and sheet rock throughout the house, and installing metal on the window sills. The Dackmans contend that the property would not have been occupied during that time.

The record also contains several work orders for minor repairs on the property dated May 2, 1997, one including a note that a new tenant was moving in at the beginning of May 1997. Roy and his family vacated the house in November of 1998, following damage caused by a house fire next door. Ms. Hillery testified that she moved with Roy and her other children, Jamal and Jaquincia, to 3710 Hayward Avenue in Baltimore City. Lead Paint Tests The Baltimore City Health Department (“Health Department”) was one of the first municipal agencies in the world to officially recognize the problem of lead poisoning in children related to flaking and peeling lead paint in 1931. 5 Since that ⁴⁶¹ time, the Health Department has advocated for and maintained programs to address this public health concern, including: lead-based paint usage prohibitions, rental property inspections, and strict risk abatement procedures.

Inspections are conducted by licensed inspection contractors on behalf of the Maryland Department of the Environment (“MDE”) pursuant to the Maryland Lead Risk Reduction in Housing Law. Code of Maryland Regulations (“COMAR”) 26.16.01. The law requires that any rental dwelling unit constructed prior to 1950 be registered with MDE and inspected prior to new tenant occupancy. Maryland Code (1982, 2013 Repl.Vol.), Environment Article (“Envir.”), § 6-811 et seq. ⁴⁶² The Dackmans assert that they had the property inspected by the State and that the Baltimore City Health Department has no record of any violations of Baltimore City ordinances relating to lead paint at 2525 Oswego Avenue.

The MDE Lead Paint Risk Reduction Inspection Certificate issued for 2525 Oswego Avenue on April 22, 1997, indicates that the property was in compliance with the Full Risk Reduction standards. A further inspection conducted by MDE on September 14, 1999, also found the property to be in full compliance. Although there are several lead paint inspection categories, the inspections completed at 2525 Oswego Avenue were Full Risk Reduction inspections. 6 Pursuant to the pre-trial scheduling order in the case on appeal, Roy employed ARC Environmental Inc. (“ARC”) to conduct testing at 2525 Oswego Avenue. ARC prepared a Lead-based Paint Survey Report in September of 2012.

However, because the property was vacant and boarded at the time of testing, only the exterior of the premises was tested. 7 ⁴⁶³ Those test results indicated the positive presence of lead-based paint on the exterior first floor window sill, wall surface, handrail, porch posts, basement window sash, and basement door threshold of 2525 Oswego Avenue. Blood Lead Levels Although it is unknown what Roy’s blood lead level (“BLL”) was prior to living at 2525 Oswego Avenue, reports by the Maryland Department of Health and Mental Hygiene indicate that he had elevated levels from late 1997 through 1999. His blood levels tested as follows: Sample Date Blood Lead Level 09/17/97 15 ug/dl 11/19/97 10 ug/dl 05/15/98 10 ug/dl 12/07/99 9 ug/dl Roy’s first documented elevated BLL occurred on September 17, 1997. 8 This initial elevated reading prompted a followup screening on November 19, 1997. The second screening indicated that Roy’s BLL had fallen from 15 ug/dl to 10 ug/dl.

Additional screening results show that Roy’s BLL remained at 10 ug/dl for the duration of his tenancy at 2525 Oswego Avenue. ⁴⁶⁴ Proposed Expert Testimony The proffered expert who was the subject of the dispositive motion was Dr. Eric Sundel (“Dr. Sundel”), a board-certified pediatrician with more than 20 years of experience. Dr. Sundel was retained by counsel for Roy to provide an opinion on whether Roy had been exposed to toxic lead levels at 2525 Oswego Avenue and whether that exposure resulted in injury. In 2012, Dr. Sundel reviewed Roy’s medical and school records. He also reviewed the SDAT sheet and exterior ARC report for 2525 Oswego Avenue.

Based on his review of those documents, he prepared a report dated October 17, 2012, in which he noted that the house at 2525 Oswego Avenue was constructed in 1920 and that “Jakeem’s mother recalls chipping, flaking and peeling paint on the windows and window frames when she first moved in.” He noted that Roy’s school records revealed that Roy was “very oppositional with staff’ and “very hyper.” He noted that Roy had neuropsychological testing performed in January, 2012, and that “his full-scale IQ was 78, which fell in the borderline impaired range of intellectual function.” Dr. Sundel stated in this report: From multiple studies, it has been established that the major source of lead poisoning for children in the United States is the hand-to-mouth ingestion of dust and chips from deteriorating lead paint on interior surfaces in older homes. Hand-to-mouth activity is most common in the first six years of life. According to the EPA, 97% of homes in the United States build before 1940 are likely to contain lead. In 1991, the CDC advised that blood lead levels of 10 mcg/dl or greater should prompt public health action to minimize the risk of neurological and other damage.

In 2012, the CDC advised that this blood lead level be lowered to 5 mcg/dl. To date, no safe lower limit of detectable blood lead has been determined. With respect to Roy’s specific history, Dr. Sundel concluded: In summary, Jakeem Roy had three elevated blood lead levels while residing at 2525 Oswego Avenue from about 8 months of age to just over two years of life. The house at ⁴⁶⁵ 2525 Oswego Avenue was built in 1920, when virtually all homes were painted with lead-based paint.

Furthermore, ARC testing performed in 2012 of this house’s exterior confirmed the presence of lead-based paint. Dr. Sundel opined that Roy had been exposed to lead while residing at 2525 Oswego Avenue resulting in “loss of IQ points, as well as other deficits including, impaired attention, problems with memory, and problems with coordination,” and that “these harmful effects are expected to be permanent.” Dr. Sundel’s deposition testimony, taken November 13, 2012, established that he had extensive practice in pediatric medicine. But his testimony also revealed that although he was familiar with some relevant studies and literature on pediatric lead poisoning, he had never diagnosed or studied an individual with injuries or issues related to lead. Dr. Sundel testified as to his significant experience as a pediatric hospitalist “clinically managing the inpatients, the hospitalized pediatric patients, as well as seeing children in the emergency department.” During his career, however, Dr. Sundel’s single experience with lead poisoning was his participation in the treatment of a child for lead poisoning during his first or second year of residency at Columbia Presbyterian Babies Hospital in either 1985 or 1986.

Dr. Sundel had never authored or contributed to any publications regarding lead exposure. Regarding the medical effects of exposure to lead-based paint, Dr. Sundel had no background in neurology, neuropsy-chology, or medical toxicology upon which to base his conclusion that exposure resulted in a loss of IQ points for Roy. Dr. Sundel admitted he did not administer IQ tests and did not know how such tests are scored. He had never conducted or participated in any studies assessing the cognitive effects or consequences of lead poisoning.

Finally, in the matter before us, Dr. Sundel did not conduct a medical history of Roy and did not examine Roy. Dr. Sundel explained in his April 11, 2013, affidavit: ⁴⁶⁶ Lead exposure has no signature of physical characteristics that would assist in the diagnosis of lead poisoning. It is, therefore, not necessary for me, or any other pediatrician, to actually conduct a physical examination of Mr. Roy who is currently 16 years of age to determine if he was suffering any injuries due to lead. The second expert offered by Roy was Industrial Hygienist Robert K. Simon, Ph.D.

(“Dr. Simon”). 9 In his June 2, 2012, report, Dr. Simon opined that “2525 Oswego Avenue, Baltimore, MD 21218 was the location at which Jakeem Roy was initially, and coritinu[ally] exposed to lead-based paint hazards.” Dr. Simon admitted during his deposition, however, that his opinion was based entirely on records provided to him by Appellant’s counsel: Q. And doctor, you’ve never inspected or tested the property in this case, 2525 Oswego Avenue; is that correct? A. Correct. Q. You have never visited the property? A. No. Q. Have you had any conversations with any family members of the plaintiff in this case?

A. No. Q. Have you had any conversations with any of the experts designated in this case by either the plaintiff or the defendants? A. No. Q. Doctor, can we agree that your opinions in this case are based entirely on records provided to you by Nicholl’s law office? A. Correct. ⁴⁶⁷ Dr. Simon also testified that he neither tested nor considered any other properties as a possible source of Roy’s lead exposure. Motion to Exclude and for Summary Judgment On January 2, 2013, the Dackmans filed a “Motion to Exclude Plaintiffs Experts and Motion for Summary Judgment” (hereinafter “Motion for Summary Judgment”). 10 The Dackmans sought to exclude both of Roy’s expert witnesses, Dr. Sundel and Dr. Simon, on the basis that they lack the qualifications and sufficient factual bases required by Maryland Rule 5-702.

After a full hearing before the circuit court on February 20, 2013, the motions were denied. Shortly thereafter, this Court published its opinion in Hazelwood , a case involving facts very similar to those sub judice, in which we reversed and remanded, finding that the circuit court abused its discretion in permitting the same pediatrician, Dr. Sundel, to testify as an expert on childhood lead exposure and poisoning because he was not qualified and lacked a sufficient factual basis for his opinions. Hazelwood, supra, 210 Md.App. at 684-91 , 63 A.3d 713 . The Dackmans then renewed their Motion for Summary Judgment.

On May 6, 2013, the Circuit Court for Baltimore City heard argument on the motions. In its May 7, 2013, order, the circuit court granted the renewed motion, finding that Dr. Eric Sundel “is not qualified to provide expert opinion as the source of lead exposure that resulted in [Roy’s] elevated lead levels,” nor is he qualified to provide an expert opinion “as to causation ie. that [Roy] incurred injuries as a result of lead exposure.” The court found that without the testimony of a medical expert, Roy could not demonstrate “the link between [his elevated] blood lead levels and the injuries allegedly suffered by the plaintiff.” ⁴⁶⁸ Additional facts will be presented as they pertain to the issues discussed. DISCUSSION I. Exclusion of Dr. Sundel’s Testimony Roy contends that the circuit court erred and abused its discretion in excluding Dr. Sundel’s testimony. Roy argues that Dr. Sundel, as a longtime pediatrician who is familiar with some of the current lead paint poisoning literature and studies, is qualified as a medical expert by his “knowledge, skill, experience, training or education.” Md. Rule 5-702.

Roy further asserts that Dr. Sundel’s review of Roy’s medical records, relevant property records, and the exterior ARC report provides a sufficient factual basis for his testimony. The Dackmans respond that Dr. Sundel (1) has never diagnosed or treated a patient with lead poisoning; (2) is not a certified lead risk assessor; (3) has never published any articles or participated in any studies related to lead; (4) has not examined Roy; (5) has no experience in testing for lead; (6) did not know whether the water at any of Roy’s residences had been tested for lead; and (7) did not know or inquire whether 2525 Oswego Avenue had been renovated or rehabilitated prior to Roy’s tenancy. A. Standard of Review Generally, evidentiary rulings admitting or excluding expert testimony are reviewed under an abuse of discretion standard, and the trial court’s determination is only reversible where it is founded on an error of law, or where the trial court has clearly abused its discretion. Hazelwood, 210 Md.App. at 675-76 , 63 A.3d 713 (2013); Taylor v. Fishkind, 207 Md.App. 121, 137 , 51 A.3d 743 (2012), cert. denied, 431 Md. 221 , 64 A.3d 497 (2013).

Here, as in Hamilton v. Kirson, the evidence ⁴⁶⁹ presented by Roy on causation was the same evidence the experts relied upon to form their opinions. 11 Hamilton v. Kirson, No. 1530, Sept. Term, 2011, slip op. at 14-15 (Md.Ct. Spec.App. Apr. 30), cert. granted, 433 Md. 513 , 72 A.3d 172 (2013) (hereinafter “Kirson ”). The Court of Appeals clarified that when a circuit court “grants a summary judgment motion on the grounds that the plaintiffs expert lacks a sufficient factual basis of admissible facts and the admissible evidence (if any) is insufficient independently to prove causation, the circuit court is making a decision on the admissibility of the expert’s testimony as part of its summary judgment decision,” which “is reviewed on appeal without deference.” Hamilton, slip op. at 17-18, n. 11 (citing Giant Food, Inc. v. Booker, 152 Md.App. 166, 176-78 , 831 A.2d 481 (2003)). Further, “ordinarily an appellate court will review a grant of summary judgment only upon the grounds relied upon by the trial court.” Id., slip op. at 20 (citing Bishop v. State Farm, 360 Md. 225, 234 , 757 A.2d 783 (2000)). Thus, we review the grant of the motion for summary judgment in this case to determine whether the trial court’s decision was legally correct and give no deference to the underlying determinations.

Id., slip op. at 19 (citing Tyler v. City of Coll. Park, 415 Md. 475, 498 , 3 A.3d 421 (2010); Beatty v. Trailmaster Products, Inc., 330 Md. 726, 737 , 625 A.2d 1005 (1993)). B. Law and Analysis Expert testimony may be admitted if the court determines that the testimony will assist the trier of fact in understanding the evidence or determining an issue of fact. Maryland Rule 5-702 outlines the factors a court must evaluate when considering the admission of expert testimony.

The rule provides: ⁴⁷⁰ Expert testimony may be admitted, in the form of an opinion or otherwise, if the court determines that the testimony will assist the trier of fact to understand the evidence or to determine a fact in issue. In making that determination, the court shall determine (1) whether the witness is qualified as an expert by knowledge, skill, experience, training, or education, (2) the appropriateness of the expert testimony on the particular subject, and (3) whether a sufficient factual basis exists to support the expert testimony. Md. Rule 5-702. The instant case presents questions on both the first and third of these delineated factors.

Factor 1 — Qualification The first requirement is that an expert be sufficiently qualified, having “special knowledge of the subject on which he is to testify that he can give the jury assistance in solving a problem for which their equipment of average knowledge is inadequate.” Casualty Ins. Co. v. Messenger, 181 Md. 295, 298, 29 A.2d 653 (1943); Md. Rule 5-702(1). In summarizing the case law, the Court of Appeals has instructed that “a witness may be competent to express an expert opinion if he is reasonably familiar with the subject under investigation regardless of whether this special knowledge is based upon professional training, observation, actual experience, or any combination of these factors.” Rodman v. Harold, 279 Md. 167, 167-68 , 367 A.2d 472 (1977). An expert’s knowledge on a subject “may be derived from ‘observation or experience, standard books, maps of recognized authority, or any other reliable sources,’ including ‘the experiments and reasoning of others, communicated by personal association or through books or other sources.’ ” Wants v. Afzal, 197 Md.App. 675, 683 , 14 A.3d 1244 (2011) (quoting Rodman, 279 Md. at 169 , 367 A.2d 472 ).

A witness need not be personally involved in the activity about which he is to testify. Id. (quoting Radman, 279 Md. at 171 , 367 A.2d 472 ). Nor is it required that an expert be a specialist to be competent to testify regarding medical matters under Rule 5- ⁴⁷¹ 702.

Id. at 685, 14 A.3d 1244 (citing Ungar v. Handelsman, 325 Md. 135, 146 , 599 A.2d 1159 (1992)). In Hazelwood , as in the matter before us now, we examined whether the same witness, Dr. Sundel, was qualified to offer an expert opinion in a lead paint case. We could “discern no basis on which to conclude that Dr. Sundel had specialized knowledge concerning childhood lead poisoning,” and “[n]othing about Dr. Sundel’s work generally as a pediatrician [led] to the conclusion that he was qualified to render the expert opinions he offered in [that] case.” Hazelwood, 210 Md.App. at 686 , 63 A.3d 713 . In accordance with those findings, we held that Dr. Sundel was not qualified to offer expert opinion in a lead paint case and that it was an abuse of discretion for the circuit court to allow such testimony.

At the May 6, 2013, hearing in the instant case on the renewed motion for summary judgment, the circuit court acknowledged that Roy “ha[s] a problem with the [Hazel- wood] case.” The court also noted that the findings in Hazelwood — that Dr. Sundel had not received any specialized training, had no experience in treating children with lead poisoning and had no experience identifying the source of childhood lead exposure — were the same arguments presented by the Dackmans. The court observed, “[i]t would seem to me it would be an abuse of my discretion if in fact this were on all fours [with Hazelwood ] and I said nonetheless, I’m going to allow Dr. Sundel to testify.” The court then appropriately inquired as to what additional training, certification, or other supplementation to Dr. Sundel’s background could be offered since Hazelwood that would qualify him as an expert in the instant case. Roy’s counsel indicated that Dr. Sundel had recently attended seminars on the process of testing a house for lead and cited Dr. Sundel’s affidavit as establishing his additional bases for qualification. In his affidavit, Dr. Sundel asserts that since the Hazelwood case, he has “reviewed approximately 20 other matters that included environmental testing, ... attended a seminar conducted by LeadTec regarding the use of XRF ⁴⁷² testing instruments and interpretation of test results,” and “reviewed deposition testimony of former sanitarians of the Baltimore City Health Department and defense expert, Patrick Connor.” Nothing in the record, however, indicates that Dr. Sundel received any further specific medical training or any certifications regarding lead or lead paint related injuries and illnesses, or treated any additional patients with lead poisoning.

In its May 7, 2013, order granting summary judgment, the court pronounced: “this court has not found any material differences between evidence offered in support of Dr. Sundel’s expertise in Hazelwood and evidence offered in the present case.” Factor 3 — Sufficient Factual Basis Md. Rule 5-702(3) also requires a sufficient factual basis to support the offered expert testimony. For an opinion to assist the trier of fact, the trier of fact must be able to evaluate the reasoning underlying that opinion. Ross v. Housing Auth. of Baltimore City, 430 Md. 648, 663 , 63 A.3d 1 (2013). The opinion of even the most highly qualified expert has no probative force unless a sufficient factual basis to support a rational conclusion is shown.

Hazelwood, 210 Md. App. at 678-79 , 63 A.3d 713 . Again, the Hazelwood opinion, through its detailed exposition of the facts and the law, provides a platform for analyzing the basis for Dr. Sundel’s opinions. In Hazelwood , as in this case, Dr. Sundel was not the treating physician, and the factual basis for his opinions “boil[ed] down to his review of the records provided to him by appellee’s counsel,” including the ARC Environmental report. Id. at 688 , 63 A.3d 713 .

In both cases, Dr. Sundel failed to investigate other properties where the plaintiff resided or consider other potential sources of lead exposure. Id. Although there is no dispute that an expert may base an opinion on data and facts not directly ascertained by him but contained in the reports and studies of others, those bases must permit reasonably accurate conclusions, not mere conjecture. Id. at 692 , 63 A.3d 713 (citing Milton Co. v. Council of ⁴⁷³ Unit Owners of Bentley Place Condo., 121 Md.App. 100, 120 , 708 A.2d 1047 (1998)).

In this case, Dr. Sundel opines that the source of Roy’s lead exposure was 2525 Oswego Avenue based on: 1) deposition testimony from Latisha Hillery regarding the presence of peeling paint; 2) the ARC report results for the exterior of the premises; and 3) the age of the home. Dr. Sundel also opines that exposure to lead-based paint at the house on 2525 Oswego Avenue resulted in a loss of IQ points for Roy, despite his admissions that he has no background in neuropsychology; does not administer IQ tests; does not know how such tests are scored; did not conduct a medical history of Roy; and did not examine Roy. The bases advanced for Dr. Sundel’s opinions are consonant with those presented in Hazelwood , in which we stated that “it is evident that Dr. Sundel’s testimony amounted to no more than speculation.” Hazelwood, 210 Md.App. at 689 , 63 A.3d 713 . As the circuit court observed, the instant case is “on all fours” with Hazelwood regarding Dr. Sundel’s qualifications and the factual basis for his testimony.

We find the circuit court was legally correct in excluding the expert testimony of Dr. Sundel.

II

Causation Roy, relying on Dow v. L & R Properties, Inc., 144 Md.App. 67, 75 , 796 A.2d 139 (2002), contends that even in the absence of expert testimony, causation in a lead-based paint case may be proved entirely through circumstantial evidence. Roy’s contention is incorrect. In Dow , the issue raised in Appellee’s Motion for Summary Judgment was specifically that “[t]he [Appellants] ha[d] identified no expert to testify that lead paint existed on the premises .... [and] [n]o expert was identified to testify regarding any lead inspection or testing of the premises....” Id. at 70 , 796 A.2d 139 . In Dow , we held that the appellant presented sufficient circumstantial evidence in response to the appellee’s motion for summary judgment to generate a genuine dispute as to the material fact ⁴⁷⁴ of whether the paint in the rental property owned by defendant contained lead.

Id. at 74 , 796 A.2d 139 . We were “satisfied that appellants could properly establish that the paint in question was lead-based” and was the only possible source of the appellant’s lead poisoning. Id. at 74-75 , 796 A.2d 139 . Thus, our decision in Dow addressed establishing the presence of lead at the property and did not address medical causation.

The Court of Appeals in Hamilton reasserted its analysis in Ross — that the theory of causation in lead paint cases may be conceived as a series of three separate links: (1) The link between the defendant’s property and the plaintiffs exposure to lead; (2) the link between specific exposure to lead and the elevated blood lead levels, and (3) the link between those blood lead levels and the injuries allegedly suffered by the plaintiff. Hamilton, slip op. at 26 (emphasis omitted) (quoting Ross, 430 Md. at 668 , 63 A.3d 1 ). 12 In the matter sub judice, the May 7, 2013, order of the circuit court granting summary judgment states: FOUND that in order to prove his case, [Roy] must show the link between [his elevated] blood lead levels and the injuries allegedly suffered[.] FOUND