State v. Johnson

HOLLANDER, Judge. Gary Lee Johnson, appellee, was sentenced to a term of imprisonment as a result of a criminal conviction he received in the Circuit Court for Montgomery County (Judge Paul H. Weinstein, presiding). During his incarceration, Johnson required medical treatment and nursing care related to his condition as a quadriplegic.’ After Johnson was released from prison, he sued the State, appellant, in the Circuit Court for Montgomery County, alleging negligence in connection with the medical care that he received while he was in prison. The circuit court (Judge D. Warren Donohue, presiding) found the State liable for negligence and awarded Johnson $25,000 in damages.

On appeal to this Court, the State presents two issues for our review, which we have rephrased slightly for clarity: 1. Did the Circuit Court err as a matter of law in finding that State personnel had a legal duty to develop a “plan” for Johnson’s treatment while he was an inmate in the Maryland State Penitentiary? 2. Even if the State owed a duty to develop such a plan, was the court clearly erroneous in finding the State Hable for negligence under the Maryland Tort Claims Act? ⁵⁷ We answer the first issue in the affirmative and, therefore, we decline to address the second question. Accordingly, for the reasons discussed below, we shall vacate the decision of the circuit court and remand to that court for further proceedings consistent with this opinion.

Factual Background Johnson has been a quadriplegic since 1972, when he suffered spinal cord injuries in a swimming accident. As a result, he has no muscle control or feeling in his body below his neck and shoulders and must use a super pubic cystostomy (“catheter”), which is inserted in his bladder, to discharge urine. Because of his paralysis, appellee requires daily nursing care, which includes skin, bowel, and catheter care, as well as range of motion exercises for his joints. On December 4, 1986, Johnson was convicted on drug related charges and sentenced to serve two concurrent terms of five years and three years.

The Division of Correction (“DOC”) placed appellee in the Maryland Penitentiary Hospital. At the relevant time, PHP Healthcare Corporation (“PHP”) had a contract with the State to provide all health care services to inmates in the custody of the DOC. 1 All of the medical services hereinafter mentioned were provided by PHP. On February 17, 1988, after his release from prison, Johnson notified the State Treasurer’s Office of his claim against the State, pursuant to the Maryland Tort Claims Act (“MTCA”), Md.Ann.Code, State Gov’t art. (“S.G.”), §§ 12-101 to 12-501 (1984).

Subsequently, on September 26, 1989, Johnson filed a negligence suit alleging, inter alia, that while in the State’s custody from December 1986 until December 1987, the State “abused” him by fracturing his arm and “failed to properly render necessary care and treatment to maintain the ⁵⁸ Plaintiffs physical condition, although it knew or should have known that such treatment was vital to his health.” He sought damages for emotional and physical injury caused as a result of the State’s negligent and careless treatment of him while he was incarcerated. At trial, appellee testified generally to DOC’s neglect of his medical condition. But, with the exception of one nurse, he did not identify any particular health care provider. Appellee said that, while he was at the Penitentiary, the State failed to provide him with range of motion exercises and proper skin care to prevent blisters and bed sores.

Additionally, he said that the nurses failed to clean and change the bandages around his catheter, which leaked, and that they neglected Johnson’s painful bowel problem. Also, on one occasion when Johnson’s bladder became exposed, he claimed that a doctor in the prison used his finger to push the bladder back into appellee’s body, thereby causing appellee’s bladder to bleed and become inflamed. Appellee also explained that, in light of the inadequate nursing care, he asked the circuit court to reconsider his sentence. Thereafter, at a hearing on February 20, 1987, appellee informed the court of his concerns about his medical care, but the court did not then modify his sentence. 2 Johnson further testified that, for approximately one week after the sentence reduction hearing, the nurses in the prison intentionally failed to provide him with needed nursing care.

When nursing care commenced, he claimed that it was still inadequate. At this time, the nurses continued to neglect Johnson’s bowel problem and his catheter, which leaked regularly. Appellee also said that, on April 30, 1987, during a therapy session, Eugene Wooden, a nurse who worked in the prison, fractured Johnson’s humerus when he accidentally applied inappropriate force to Johnson’s arm, despite appellee’s appar ⁵⁹ ent discomfort and pain. Johnson further stated that, after he received a plastic arm cast at the Johns Hopkins University Hospital, the nurses exacerbated his injury and his pain by lifting him under his shoulder and by rolling him on his upper arm to move him to his wheelchair.

On May 26, 1987, Johnson was transferred to the DOC facility in Hagerstown, where he was placed in the medical unit. Johnson testified that the nurses there did not provide needed therapy, mistreated his arm injury, and failed to care properly for his bowels, bladder condition, and catheter. Johnson also testified that, in December 1987, because of the DOC’s persistent neglect of his health, he again petitioned the circuit court to reconsider his sentence. On December 21, 1987, that court held another hearing and considered Johnson’s allegations about the prison’s inadequate medical care.

At the hearing, Richard Delaney, M.D., who was Johnson’s treating physician since his accident, testified on Johnson’s behalf. The court reduced Johnson’s sentence to one year, thereby releasing appellee from the State’s custody. 3 Additionally, appellee stated that, after his release, he suffered from increased health problems. These problems included poor range of motion because of calcium build-up in his joints and a persistent “pulling of a muscle-type” pain in his shoulder, which required medication. At trial, Johnson’s “base file” and prison medical records were introduced into evidence.

The medical records primarily consisted of reports of daily medical care, progress notes from doctors and nurses, radiology and lab reports, as well as emergency room records. In addition, in support of his claim, appellee presented the testimony of Dr. Delaney, who stated that, in order to maintain physical health, a quadriplegic must receive a daily regi ⁶⁰ men of nursing care that includes care of the skin, bowel, and catheter, as well as range of motion exercises. Dr. Delaney testified: It is mostly supportive nursing care. Since he can’t do anything for himself, including just move about in bed, he requires skin care.

He is subject to pressure sores---- So he requires skin care, a certain amount of massage, and use of various creams and things from time to time to keep his skin moist and viable. He requires range of motion to keep his joints subtle [sic]. He requires bowel care, because he would become constipated easily if his diet and bowels weren’t taken care of properly. He has a super pubic cystostomy, which is a tube that is placed directly through the abdomen into the bladder.

That requires care, because it is subject to infection. He has had several infections despite care. Moreover, based on Johnson’s testimony, Dr. Delaney said that the State did not meet these minimal requirements of care for Johnson when he was incarcerated. He stated: I do believe that Mr. Johnson’s care was not up to what we would normally consider standard care for a quadriplegic patient....

Because standard care of a quadriplegic patient would encompass, you know, all of the things that we had discussed before, skin care, bowel care, catheter care, joint care____ [I]t is standard care that you have a program to take care of all of these things, that the program is followed. It is just my impression from what I heard that the program wasn’t followed. (Emphasis added). On cross examination, Dr. Delaney explained that he “wasn’t aware there was a program to care for Johnson.

That is what I meant to say.” Eugene Wooden, a registered nurse, was the State’s only witness. He testified only to the fact that, at the relevant time, he was an employee of PHP, which operated under a contract with the State. Additionally, the State offered a ⁶¹ letter that Dr. Delaney wrote to Johnson’s counsel in September 1988, after he reviewed appellee’s prison medical records. In the letter, Dr. Delaney concluded: Reviewing these records en masse indicates that Mr. Johosn [sic] received what I would consider routine medical care, at least according to the documentation that I see in the records.

The one question that does come to my mind is the fact that the fracture happened at all. It should be well known that quadriplegics, such as Mr. Johnson, routinely develop osteoporosis and that there is an increased vigilance required to prevent such things as fractures during range of motion exercises. The State provided no additional evidence of its own about the quality of care that appellee received during his incarceration. Nonetheless, it denied liability, claiming: (1) appellee failed to file a timely claim with the State Treasurer, pursuant to S.G. § 12—106(b); (2) the claim was barred by sovereign immunity because the PHP employees were not “State personnel” for whose actions the State is liable under the MTCA; and (3) appellee failed to meet the condition precedent of filing a Statement of Claim with the Health Claims Arbitration Office (“HCAO”), pursuant to Md.Code Ann., Cts. & Jud.Proc. art.

(“C.J.”), § 3-2A-02. In a ruling from the bench, the court found the State liable for negligence under the MTCA. The judge stated: What I find from the evidence in this case is as follows: I find that the State of Maryland had a duty to come up with a plan for the care, treatment, and confinement of the plaintiff, who at the time he was sentenced was a quadriplegic. I feel a fair reading of the complaint raises that as part of his claim.

And based upon the facts presented, the conclusion that I come to is that the State had a duty to do that, a reasonable plan for the plaintiff. I further find that as a matter of fact it failed to do that. I base that finding upon the evidence of the plaintiff himself, whose testimony in that regard to a large extent, was if not ⁶² entirely, was uncontradicted, and I find his testimony in that regard credible. I also base that conclusion on a review of the records that were offered into evidence.

And I also base that conclusion on the inference that I draw from the action taken by Judge Weinstein in releasing the defendant—sorry, in reducing his sentence at the December 1987 hearing. I further find that as a result of the State’s failure to come up with a plan, that the plaintiff was injured, and that those injuries in part at least were incurred from the period of August 21 until December of 1987 when he was released. So, in other words, I find that plaintiff has alleged a duty, has proven a duty that the plaintiff alleged to breach, and has proven a breach, and I further find from the evidence that as result of that breach the plaintiff has alleged and proven by a preponderance of the evidence an injury. The court further concluded that the State could not delegate to PHP its responsibility to create a plan for Johnson’s care.

The court said: I find that initially, and I rest my decision on this theory, the State had a duty to come up .with a plan, and that the negligence was not in the execution of a plan, but rather, which may have been done by non-State personnel, but rather the failure was in there being no plan at all, and that was the State’s duty. I don’t think the State argues that it delegated that duty. But to whatever extent that argument is made, I find that to be a non-delegable duty. And that therefore, the State’s argument that the claim should not be allowed because it didn’t involve State personnel is denied.

In light of the MTCA’s requirement that a claim for injury must be filed within 180 days of the occurrence of the injury, S.G. § 12—106(b)(1), the court only permitted recovery for the time period between August 21, 1987 and appellee’s release on December 21, 1987. Further, the court rejected the State’s sovereign immunity defense, based on its determination that the State was negligent because of its own failure to prepare a ⁶³ plan, without regard to the alleged negligence of PHP in providing health care. Additionally, the court held that it had jurisdiction over Johnson’s claim, although the claim had not first been filed with the HCAO, pursuant to C.J. § 3-2A-04. The court predicated this conclusion on its finding that it “is not so much that there was an improper execution of the plan, which would certainly have been in part a medical plan, and involved medical treatment, and therefore raised an issue of ... whether it should go before the Health Claims Arbitration Board, but rather was the failure to come up with any plan at all.” Discussion The parties agree that the State has a duty to provide reasonable medical care and treatment to inmates in its custody. 4 The State argues, however, that it satisfied this obligation by hiring PHP to deliver medical services to prison inmates.

But, as we have observed, the circuit court did not impose liability on the basis of the medical care that was furnished. Rather, the circuit court determined that the State’s duty to Johnson extended beyond its obligation to provide medical services, for which it may have contracted with PHP. Instead, the court held that the State owed appellee a separate duty to create a “plan” for his care and treatment. We agree with the State that the trial court erred in its construction of the scope of the State’s duty to Johnson while he was incarcerated.

Consequently, we vacate the court’s decision and remand this case for further proceedings. We explain. Based on the MTCA, appellee sued the State for negligence with respect to his care. Johnson alleged, inter alia, that the State failed “to properly render necessary care and treatment ⁶⁴ to maintain the plaintiffs physical condition, although it knew or should have known that such treatment was vital to his health.” Significantly, appellee did not assert in his complaint that the State breached its duty of care by failing to formulate a treatment plan for him.

Moreover, Johnson does not claim that the State was negligent in selecting PHP as a health care provider or by failing to monitor the quality of PHP’s care. Nor has Johnson alleged that, by withholding constitutionally required medical services, he was subjected to cruel and unusual punishment, in violation of the Eighth Amendment to the United States Constitution. See Estelle v. Gamble, 429 U.S. 97 , 97 S.Ct. 285 , 50 L.Ed.2d 251 , (1976); 5 Sawyer v. Sigler, 320 F.Supp. 690, 693 (P.1970 Neb.), aff'd., 445 F.2d 818 (1971). Rather, Johnson’s suit, based on his specific allegations, constitutes a negligence claim, and we shall analyze it in that light.

To establish his claim against the State, Johnson must show that: (1) the State owed a duty of care to him; (2) the State breached that duty; (3) Johnson sustained injury; and (4) the injury was proximately caused by the State’s breach of duty. See Rosenblatt v. Exxon, 335 Md. 58, 76 , 642 A.2d 180 (1994). We focus initially on the element of “duty.” The issue of duty “is an issue of law, to be determined by the court.” Id. See also W. Page Keeton, et al., Prosser and Keeton on the Law of Torts § 45, at 320 (5th ed. 1984); Restatement (Second) of Torts (1977) § 328B & cmts. e-f.

Consequently, the circuit court’s “interpretations of law enjoy no presumption of correctness on review [and we] must apply ⁶⁵ the law as [we] understan[d] it to be.” Rohrbaugh v. Estate of Stern, 305 Md. 443 , 446 n. 2, 505 A.2d 113 (1986). Ordinarily, courts will not impose an affirmative duty to protect the interests of another, absent a special relationship between the parties. See Prosser § 56, at 373-75. That special relationship existed here; when the State incarcerates an individual, the inmate is entirely dependent on the State, which has exclusive control over the care and confinement of prison inmates.

See Prosser § 56, at 376 (the special relationship between a jailer and his prisoner justifies imposing a duty to protect prisoners). Accordingly, we agree with the parties that the State owes a duty to provide reasonable health care to its prisoners. Of particular importance to this case, we conclude that the State may discharge its duty by employing its own qualified health care providers or,