137 A.3d 299
Md. Ct. Spec. App.2016Background
- June 4, 2010: John S. Park, M.D., read a head CT and brain MRI/MRA of Lance Copsey as normal after Copsey presented with neurologic symptoms; Park testified his reads showed no acute infarct.
- June 9, 2010: A repeat MRI interpreted by Vijay Viswanathan, M.D., showed a new right lateral medullary signal concerning for acute infarction; notification and follow-up were delayed and inconsistent among treating physicians (Blum, Alkaitis, Viswanathan).
- Early June 10, 2010: Copsey suffered a massive stroke and later died; plaintiffs sued for wrongful death and survival claims against multiple physicians, alleging failure to timely diagnose and treat an evolving stroke.
- Pretrial settlements/dismissals removed several treating physicians (Blum, Alkaitis, Viswanathan) from the case; Park proceeded to trial as sole defendant and denied liability.
- Plaintiffs moved in limine to exclude (1) evidence of the subsequent physicians’ negligence and (2) evidence of their prior status as defendants/settlements; the trial court denied both motions and gave a superseding-cause jury instruction.
- Jury found for Park on negligence; on appeal plaintiffs argued the court erred in admitting evidence about subsequent providers and in instructing on superseding causation.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Admissibility of evidence about negligence of subsequent treating physicians | Subsequent providers’ negligence cannot be a superseding cause as a matter of law where harms are indivisible; evidence is irrelevant and prejudicial after settlements/dismissals | Evidence of subsequent negligence is relevant because Park denied liability and the jury must see a complete factual picture; superseding-cause is for the jury when facts admit multiple inferences | Court did not abuse discretion: evidence admissible where defendant asserts complete denial; not moot because plaintiffs contend contamination of jury’s view of Park’s care |
| Superseding-cause jury instruction | Instruction improper because successive medical negligence cannot cut off liability for an initial negligent misreading that contributed to an indivisible death | Proper because subsequent independent negligent acts may be unforeseeable and thus superseding; proximate cause is generally a jury question where multiple inferences exist | Instruction proper: record contained prima facie evidence permitting a rational jury to find subsequent care might be a superseding cause; question for jury |
Key Cases Cited
- Martinez ex rel. Fielding v. The Johns Hopkins Hospital, 212 Md. App. 634 (2013) (evidence of nonparty negligence admissible when defendant asserts complete denial of liability)
- Thomas v. Corso, 265 Md. 84 (1972) (proximate cause and concurrent negligence; subsequent caretakers’ actions may be considered but do not automatically exonerate initial tortfeasor)
- Mehlman v. Powell, 281 Md. 269 (1977) (denial of directed verdict affirmed where jury could find subsequent acts were not superseding causes)
- Pittway Corp. v. Collins, 409 Md. 218 (2009) (proximate cause and superseding-cause principles; jury decides when facts allow multiple inferences)
- Bazzle v. State, 426 Md. 541 (2012) (legal standard for when evidence supports a requested jury instruction)
- Siggers v. Barlow, 906 F.2d 241 (6th Cir. 1990) (example where delayed notification and subsequent physician failings were treated as intervening acts bearing on causation)