Martinez v. Johns Hopkins Hospital
212 Md. App. 634
| Md. Ct. Spec. App. | 2013Background
- Martinez (a minor) sued The Johns Hopkins Hospital for malpractice, alleging delayed C-section caused his cerebral palsy and other injuries; jury awarded $55 million (lost wages, future medical, non-economic damages).
- Trial court reduced lost wages and applied Maryland cap on non-economic damages, lowering that award to $680,000; both parties appealed (Martinez and Hospital).
- At pretrial, Martinez obtained a motion in limine barring evidence about the standard of care for the non‑party nurse‑midwife (Midwife Muhlhan) and any finding that she breached that standard; the court allowed only testimony about the midwife’s acts and hospital reactions, not that those acts were negligent.
- Hospital defended on theory that the midwife’s pre‑hospital care (IM Pitocin, fundal pressure, episiotomy at low station, attempting home delivery) might have been the sole proximate cause, and sought to introduce standard‑of‑care testimony on that basis; the court excluded that evidence.
- Trial also included disputed testimony that the hospital never offered general anesthesia; the court admitted some testimony about whether the option was offered though no informed‑consent claim had been pled.
- The Court of Special Appeals held the trial court abused its discretion in excluding midwife‑standard‑of‑care evidence (denying Hospital a fair trial) and also erred in admitting evidence that general anesthesia was not offered; reversed and remanded for new trial.
Issues
| Issue | Martinez (Plaintiff) Argument | Johns Hopkins (Defendant) Argument | Held |
|---|---|---|---|
| Admissibility of evidence re: midwife standard of care and breach | Not necessary; Hospital could argue causation based on facts without labeling midwife negligent; exclusion proper to avoid prejudice and confusing jury with non‑party negligence | Evidence of midwife negligence and breach is directly relevant to Hospital’s complete‑denial defense and timing explanations; exclusion deprived Hospital of fair trial | Reversed: exclusion was error; evidence of midwife standard of care and breach was relevant and probative and its exclusion likely caused unjust verdict — new trial required |
| Admission of testimony that general anesthesia was not offered | Evidence relevant to show patient did not refuse anesthesia and to rebut Hospital’s asserted delays | Such testimony effectively injects an unpled informed‑consent theory; admitting it was prejudicial and improper without pleading informed‑consent claim | Reversed in part: trial court abused discretion by admitting evidence framed as failure to “offer” general anesthesia; risk of jury confusion and prejudice — limit on remand advised |
| Constitutionality of Maryland cap on non‑economic damages | Cap violates separation of powers under Maryland Declaration of Rights; reduction improper | Cap is well‑settled constitutional Maryland law; reduction appropriate | Moot in light of new trial; court did not decide constitutionality on merits (previous Maryland precedent upholds Cap) |
| Preservation and harmless‑error arguments | Exclusion harmless because hospital presented causation testimony about midwife acts | Preclusion prevented Hospital from proving midwife negligence; not harmless given plaintiff’s portrayal that midwife’s care was appropriate | Exclusion not harmless; defendant entitled to present non‑party negligence evidence when asserting sole proximate cause; new trial required |
Key Cases Cited
- DRD Pool Serv., Inc. v. Freed, 416 Md. 46, 5 A.3d 45 (Md. 2010) (questions of constitutional law reviewed de novo; precedent on Maryland caps noted)
- Reed v. State, 353 Md. 628, 728 A.2d 195 (Md. 1999) (final in limine rulings preserve appellate review without proffer)
- Prout v. State, 311 Md. 348, 535 A.2d 445 (Md. 1988) (when a motion in limine ruling is final, no need to proffer excluded evidence)
- Sard v. Hardy, 281 Md. 432, 379 A.2d 1014 (Md. 1977) (doctrine of informed consent and its suspension in true emergencies)
- Archambault v. Soneco/Ne., Inc., 287 Conn. 20, 946 A.2d 839 (Conn. 2008) (defendant entitled to present evidence a non‑party’s negligence was sole proximate cause; empty‑chair defense supports admissibility)