We have before us a question of law certified by the United States Court of Appeals for the Fourth Circuit pursuant to the Maryland Uniform Certification of Questions of Law Act, Maryland Code (1974, 2006 RepLVoL), § § 12-601 to 12-613 of the Courts and Judicial Proceedings Article (“CJ”). The question arises from a medical malpractice suit that Katherine Lewis filed in the United States District Court for the District of Maryland (“District Court”) against her former psychiatrist, Dr. Jeremy P. Waletzky, for injuries she allegedly sustained as a result of medications he prescribed to her.
Medical malpractice cases in Maryland are governed by the Health Care Malpractice Claims statute (herein “the Act”), CJ §§ 3-2A-01 through 3-2A-10.
1
As will be explained in more detail
infra,
Lewis did not comply with various administrative filing requirements set forth in the Act before filing her complaint in the District Court. Under Maryland law, those administrative filing requirements are a condition precedent to initiating suit in Maryland state courts and federal courts located in Maryland.
Carroll v. Konits,
Before the District Court, Waletzky filed a motion to dismiss the complaint, arguing that Lewis was required to have complied with the Act’s filing requirements. Lewis responded that she was not subject to the Act because the injury occurred in Washington, D.C. (hereinafter “D.C.”) and therefore D.C. law governed her malpractice suit. Resolution of that matter implicates choice-of-law principles, to which the District Court, sitting in diversity jurisdiction, was required to apply Maryland’s choice-of-law principles.
See, e.g., Day & Zimmermann, Inc. v. Challoner,
Following argument and briefing, the District Court filed a written opinion granting Waletzky’s motion to dismiss. The District Court considered the filing requirements of the Act to be substantive tort law; the court therefore focused on Maryland’s application of
lex loci delicti.
That rule directs a court to “apply the [substantive tort] law of the place where the tort or wrong was committed.”
See Lab. Corp. of Am. v. Hood,
On appeal, the United States Court of Appeals for the Fourth Circuit (hereinafter “Court of Appeals”) determined that the choice-of-law issue involves a question of unresolved Maryland law and, thus, should be decided by this Court. The Court of Appeals certified the following question to this Court:
Does Maryland recognize the public policy exception, or any other exception, to lex loci delicti based on the Maryland Health Care Malpractice Claims Act ... which requires a plaintiff to comply with certain mandatory administrative filings prior to filing a medical malpractice lawsuit in a Maryland court?
I.
As we have mentioned, this litigation involves a claim of alleged medical malpractice. The Court of Appeals has provided us with the underlying facts of the federal suit:
Lewis alleges the following facts in her complaint which, for purposes of this appeal, are not disputed....
Lewis, once a resident of [Washington, D.C.] and currently a resident of Minnesota was formerly a patient of Waletzky. Waletzky, at all times relevant, was a physician licensed to practice in the State of Maryland and had his office in Chevy Chase or Bethesda, Maryland. From approximately October 2000 until January 2005, Waletzky was Lewis’ psychiatrist and treated her at his Chevy Chase office. Waletzky prescribed several psychotropic medications to Lewis, including antidepressants and stimulants, and also prescribed antipsychotic and/or neuroleptic drugs. All of the prescribed medications were filled in pharmacies in [Washington, DC] and ingested by Lewis while she was in [Washington, DC].
During the treatment period, Waletzky did not diagnose Lewis with any serious mental disorder and never made any diagnosis of Lewis’ psychiatric condition. After taking the prescribed antipsychotics, Lewis began experiencing adverse side effects and discontinued her use of these medications. Immediately after experiencing these adverse side effects, Lewis suffered, for the first time in her life, an anxiety attack. She contacted Waletzky who instructed her to continue taking the antipsychotic medications and wrote her additional prescriptions in order for her to “taper off’ the antipsychotic medications. While she was “tapering off’ the antipsychotic medications, Lewis continued to experience adverse side effects, includingextreme jaw tension and clenching, anxiety, and other effects. After completely withdrawing from the antipsychotic drugs, Lewis’ side effects persisted and worsened, and she was eventually diagnosed with a permanent neurological disorder known as Tardive Dyskinesia/Dystonia caused by the antipsychotics she had taken.
(internal citations omitted).
II.
Given the question before us, we need not discuss at length all the various provisions of the Act 3 ; instead we focus on the provisions of the Act pertinent to the question we must answer. In effect since 1976, the Act created the Health Care Alternative Dispute Resolution Office (“HCADRO”) for the purpose of establishing and administering an arbitration process for medical malpractice claims prior to court action.
The Act includes various procedural provisions that a plaintiff pursuing a medical malpractice action must satisfy before being able to prosecute his or her claim in a court of Maryland. See CJ § 3-2A-02 (“Exclusiveness of procedures”). 4 In the years following its enactment, the Act has been modified so that today, and at the time of the present case, arbitration may be waived unilaterally by either the plaintiff or the health care provider by filing a written election with the Director of HCADRO indicating the party’s desire to do so. See CJ § 3-2A-06B. 5
“[W]e have repeatedly held that adherence to the [Act’s] procedures is necessary to maintain a claim that is subject to the [Act].”
Kearney,
The District Court, applying the law of Maryland, dismissed Lewis’s claim for failure to comply with the filing requirements of the Act, precipitating her appeal to the Court of Appeals and, in turn, that court’s question to us.
III.
A.
A federal court, in a diversity action, must apply the substantive law of the state in which it sits, including that state’s choice-of-law principles.
See, e.g., Hood,
The Court of Appeals, in crafting the certified question as it does, recognizes Maryland’s adherence to lex loci delicti. What the certified question does not ask, at least not in so many words, is whether Maryland would apply lex loci delicti in the present case. In their briefs and at oral argument before this Court, the parties focused their attention on whether the public policy exception to lex loci delicti should be invoked. By so arguing, the parties necessarily assumed that the filing requirement is part of Maryland’s substantive law.
We, however, do not make the same assumption. Our choice-of-law rules mandate a threshold determination of whether the Act’s filing requirement is substantive law or a procedural matter.
Heffernan,
B.
To resolve the substantive-procedural dichotomy for choice-of-law purposes, we look first to our cases in which we have applied the doctrine of lex loci delicti. Our research has not uncovered a single case in which the doctrine has been applied to a provision of law similar to that at issue in the case before us. The cases we discuss below, however, reveal that the Act’s filing requirements are distinguishable from the various provisions of law that we have treated as involving matters of substantive tort law.
We have applied
lex loci delicti
on prior occasions to enforce the substantive law of the place of injury. We have done so, for example, to enforce the Guest Statutes of other jurisdictions. In
White,
the plaintiff brought a tort claim in Maryland to recover for injuries resulting from a car accident that occurred in Michigan.
244
Md. at 351,
We also have applied the doctrine to cases involving claims for loss of consortium. In
Harford Mut. Ins. Co. v. Bruchey,
Other scenarios in which Maryland Courts have applied
lex loci delicti
analysis include: (1) whether a Maryland court would enforce a foreign jurisdiction’s ban on wrongful birth actions,
see Hood,
We most recently affirmed our commitment to
lex loci delicti
in
Heffernan,
1. In a case involving a claim for benefits pursuant to the uninsured/underinsured provisions of an automobile insurance contract executed in Maryland, where the car accident occurred in Delaware, should Maryland or Delaware law be applied to determine what the claimants would be “entitled to recover” because of the accident?
2. If Delaware law governs the tort issues of this case under lex loci delicti, would Maryland’s public policy exception to that doctrine nonetheless require application of:
a. Maryland’s statutory cap on non-economic damages, ... where the insured and the insurer both reside inMaryland, the covered automobiles are garaged in Maryland, and the contract was executed and administered in Maryland?
b. Maryland’s contributory negligence principles?
Id.
at 604,
With regard to the first question, we determined that the contractual language, “that the law entitles you,” did not raise a question of contractual interpretation, but, instead, of tort liability and damages.
Id.
at 619-20,
We answered both parts of the second question in the negative, holding that the statutory cap on non-economic damages and the principle of contributory negligence were matters of substantive tort law and the respective public policy undergirding each was insufficient to override
lex loci delicti. Id.
at 635-36,
C.
With the exception of
Heffeman,
the cases we have discussed thus far involved provisions of law that were, without question, matters of substantive law, for which
lex loci delicti
applied. Consequently, we had no reason to scrutinize the substantive-procedural dichotomy. There is, however, one case from the intermediate appellate court that provides guidance on that distinction. That case is
Jacobs v. Adams,
In
Jacobs,
the intermediate appellate court had before it three tort cases filed in Maryland circuit courts involving automobile accidents that occurred in D.C.
Id.
at 783,
To answer that question, the Court of Special Appeals had to decide, among other
A logical resolution to this problem was suggested by Professors William Richman and William Reynolds, who said, “[fjorum interest and convenience ... should dictate the classification of an issue as ‘procedural.’ Put differently, if neither the forum’s interest nor judicial convenience is involved, no reason exists to treat the problem as ‘procedural.’ ” W. Richman & W. Reynolds, Understanding Conflict of Laws 116 (1984). We agree. There is no reason to classify an issue as procedural, and hence controlled by the law of the forum, unless it affects the manner in which the forum administers justice. If the law of the state wherein an accident occurred does not grant the affected parties the right to bring a suit, then there is no need for the application of any procedural laws. It is only after the rights of parties have been established by the laws of the situs that the forum may determine how those rights shall be exercised.
Jacobs,
D.
From the cases we have discussed, we can reduce the provisions of law to which we have applied lex loci delicti (i.e., the provisions of law that we have deemed matters of substantive tort law) to three broad categories. First, we have applied lex loci delicti to provisions of law that recognize or bar a cause of action. Second, we have applied the doctrine to provisions of law which define the elements of a claim. And third, we have applied the doctrine to provisions of law that limit or prescribe the way in which damages are calculated. In each situation, the provision of law is linked inextricably to the nature and existence of the underlying right.
Though our review of Maryland’s choice-of-law rules indicates that this Court has not had the opportunity to provide a lengthy commentary on the matter of procedure for choice-of-law purposes, we have explained that Maryland law controls “the inferences to be drawn from the evidence, the sufficiency of the evidence, the inferences from it to go to the jury and other procedural matters.”
Vernon v. Aubinoe,
We believe that the Court of Special Appeals’s analysis in
Jacobs
establishes the appropriate analytical framework in distinguishing substantive from procedural provisions of law. We agree that “[i]t is only after the rights of parties
“Another type of rule often called procedural actually is designed to govern access to the courts, and necessarily governs access only to courts of the state having the rule. A state can control access to its own courts.... A state may say, for example, that a plaintiff may not sue for damages on account of personal injuries unless he gives notice to the defendant of the injury within a specified time, and such a rale may preclude suits even on extrastate injuries if the specified notice be not given.”
Robert A. Leflar, American Conflicts Law § 122, p. 243-44 (3d ed. 1977) (footnotes omitted). In sum, we shall describe procedural provisions of law as those that generally “restrict, limit, define, qualify, or otherwise simply modify” an existing cause of action. Put differently, procedural matters are those that simply affect the manner in which the forum administers justice.
E.
With this legal framework in mind, we turn next to identify on which side of the procedural-substantive divide the Act’s filing requirements reside. It is plain from the outset that the filing requirements do not fit neatly among any of the three “categories” to which we have applied
lex loci delicti.
We have described § 3-2A-04(b)(l)’s certificate of qualified expert as “an indispensable part of [the process to reduce the number of medical malpractice court suits] because it helps weed out non-meritorious claims.”
Kearney,
Any remaining doubt as to the nature of the filing provisions for choice-of-law purposes is resolved by the plain language of CJ § 3-2A-10,
11
by which the General Assembly has pronounced the filing requirements to be procedural. That
Except as otherwise provided in §§ 3-2A-08A [enabling a defendant, subject to certain time constraints, to make “an offer of judgment” without risk that such offer be used against him or her should it be rejected] and 3-2A-09 [setting a cap on non-economic damages in all medical malpractice cases] of this subtitle, the provisions of this subtitle shall be deemed procedural in nature and may not be construed to create, enlarge, or diminish any cause of action not heretofore existing, except the defense of failure to comply with the procedures required under this subtitle.
CJ § 3-2A-10 (emphasis added). Defining the Act’s filing requirements as procedural, for choice-of-law purposes, gives effect to the General Assembly’s clear advisement that, with the exception of CJ §§ 3-2A-08A and 3-2A-09, “the provisions of this subtitle shall be deemed procedural in nature and may not be construed to create, enlarge, or diminish any cause of action not heretofore existing.” CJ § 3-2A-10.
In sum, we hold that the filing provisions at issue in this case are procedural provisions of Maryland law. And, under Maryland law, Lewis would be required to comply with the filing requirements.
IV.
In conclusion, the doctrine of lex loci delicti does not apply under the circumstances present here. For the reasons we have explained, we hold that the filing requirements at issue are procedural, mandating application of those requirements under Maryland choice-of-law principles, as the law of the forum. We would require Lewis to comply with the Act’s filing requirements.
CERTIFIED QUESTION OF LAW ANSWERED AS SET FORTH ABOVE. COSTS TO BE DIVIDED EQUALLY BETWEEN THE PARTIES.
MURPHY and ADKINS, JJ., dissent.
ADKINS, J., dissenting, in which MURPHY, J., joins.
Respectfully, I dissent. At the core of the American judicial system lies the notion that litigants have the right to be heard by the court that passes judgment on their case. This is reflected in the principle that we will not consider or decide cases on an issue that was not briefed by the parties.
See Menefee v. State,
The Majority opinion deprives these litigants of that right by deciding an issue not raised by the certified question, not briefed by the parties, and not mentioned at oral argument. As the majority acknowledges, the parties “focused their attention on whether the public policy exception to
lex loci delicti
should be invoked.
I submit that the decision to decide this non-certified question is not only inconsistent with general principles of fairness, but also inconsistent with our jurisprudence relating to an analogous certification rule that permits the Court of Special Appeals to certify a question of law to this Court.
See
Maryland Rule 8-304(c). In
Barnett v. State,
This Court has power under Rule 815, “Procedure in Certified Cases from Court of Special Appeals,” to modify a question so certified. That power to modify was intended to give this Court as much flexibility in answering the substance of a question certified by the Court of Special Appeals as would a provision expressly authorizing question modification contained in an order of certification from a federal court[.] 1
We were careful to qualify our exercise of the power to modify, however, by considering fairness to the parties:
So long as there is no prejudice to either party, this Court’s exercise of the power to modify is not restricted to the time when the application for certification is granted. In the instant matter both parties have briefed the substantive issue of waiver, in addition to their positions respecting interpretation of Rule 4-231(c)(l). We therefore modify the certified question to read: “Did Barnett waive all rights involving presence so that the State could try him in absentia?” (Emphasis added.)
Id.
at 204,
The latter is not an open and shut matter. A similar issue was addressed in
Davison v. Sinai Hosp. of Balt., Inc.,
I conclude the parties should be given the opportunity to address whether the Act is procedural or substantive for purposes of a choice-of-law analysis, before we throw the case out of court based on our resolution of that issue.
Judge MURPHY authorizes me to state that he joins in the views expressed in this dissent.
Notes
. For purposes of this opinion we assume that Lewis’s claim meets the threshold requirements of the Act, which applies only to claims against Maryland health care providers for medical injuries for which the damages sought exceed "the limit of the concurrent jurisdiction of the District Court.” CJ § 3-2A-02(a).
. Pursuant to the Maryland Certified Uniform Questions Act, we accept the statement of facts provided by the certifying court.
See, e.g., AGV Sports Grp., Inc. v. Protus IP Solutions, Inc.,
. For a summary of the Act and its history, see Judge Harrell's opinion for this Court in
Breslin v. Powell,
. Subsection (a)(2) of that section provides in relevant part: "An action or suit [to which the Act applies] may not be brought or pursued in any court of this State except in accordance with [the Act].”
. Section 3-2A-06B, entitled "Waiver of arbitration after filing certificate of qualified expert,” provides in relevant part as follows:
(a) In general.—Arbitration of a claim with the Health Care Alternative Dispute Resolution Office may be waived by the claimant or any defendant in accordance with this section, and the provisions of this section shall govern all further proceedings on any claim for which arbitration has been waived under this section.
(b) Waiver by claimant.—(1) Subject to the time limitation under subsection (d) of this section, any claimant may waive arbitration at any time after filing the certificate of qualified expert required by § 3-2A-04(b) of this subtitle by filing with the Director a written election to waive arbitration signed by the claimant or the claimant’s attorney of record in the arbitration proceeding.
(2) The claimant shall serve the written election on all other parties to the claim in accordance with the Maryland Rules.
(3) If the claimant waives arbitration under this subsection, all defendants shall comply with the requirements of § 3-2A-04(b) of this subtitle by filing their certificates at the Health Care Alternative Dispute Resolution Office or, after the election, in the appropriate circuit court or United States District Court.
(c) Waiver by defendant.—(1) Subject to the time limitation under subsection (d) of this section, any defendant may waive arbitration at any time after the claimant has filed the certificate of qualified expert required by § 3-2A-04(b) of this subtitle by filing with the Director a written election to waive arbitration signed by the defendant or the defendant’s attorney of record in the arbitration proceeding.
(2) The defendant shall serve the written election on all other parties to the claim in accordance with the Maryland Rules.
(3) If a defendant waives arbitration under this subsection, the defendant shall comply with the requirements of § 3-2A-04(b) of this subtitle by filing the certificate at the Health Care Alternative Dispute Resolution Office, or, after the election, in the appropriate circuit court or United States District Court.
(d) Time for filing.—(1) A waiver of arbitration by any party under this section may be filed not later than 60 days after all defendants have filed a certificate of qualified expert under § 3-2A-04(b) of this subtitle.
(2) Any waiver of arbitration after the date specified in paragraph (1) of this subsection shall be in accordance with the provisions of § 3-2A-06A of this subtitle.
(e) Effect of election.—After filing, the written election shall be binding upon all parties.
(f) Filing of complaint; service; dismissal—(1) Within 60 days after the filing of an election to waive arbitration by any party, the plaintiff shall file a complaint and a copy of the election to waive arbitration in the appropriate circuit court or the United States District Court.
(2) After filing the complaint, the plaintiff shall serve a summons and a copy of the complaint upon all defendants or the attorney of record for all parties in the health claims arbitration proceeding.
(3) Failure to file a complaint within 60 days of filing the election to waive arbitration may constitute grounds for dismissal of the complaint upon:
(i) A motion by an adverse party; and
(ii) A finding of prejudice to the adverse party due to the delay in the filing of the complaint.
(g) Joinder of additional health care providers.—After the filing of an election to waive arbitration under this section, if a party joins an additional health care provider as a defendant in an action, the party shall file a certificate of qualified expert required by § 3-2A-04(b) of this subtitle with respect to the additional health care provider.
(h) Procedure.—In any case subject to this section, the procedures of § 3~2A-06(f) of this subtitle shall apply.
. Section 3-2A-04(a) provides as follows:
(a) Filing of claim and response.—(l)(i) A person having a claim against a health care provider for damage due to a medical injury shall file the claim with the Director and, if the claim is against a physician, the Director shall forward copies of the claim to the State Board of Physicians.
(ii) The Director shall cause a copy of the claim to be served upon the health care provider by the appropriate sheriff in accordance with the Maryland Rules.
(iii) The health care provider shall file a response with the Director and serve a copy on the claimant and all other health care providers named therein within the time provided in the Maryland Rules for filing a responsive pleading to a complaint.
(iv) The claim and the response may include a statement that the matter in controversy falls within one or more particular recognized specialties.
(2) A third-party claim shall be filed within 30 days of the response of the third-party claimant to the original claim unless the parties consent to a later filing or a later filing is allowed by the panel chairman or the court, as the case may be, for good cause shown.
(3) A claimant may not add a new defendant after the arbitration panel has been selected, or 10 days after the prehearing conference has been held, whichever is later.
(4) Until all costs attributable to the first filing have been satisfied, a claimant may not file a second claim on the same or substantially the same grounds against any of the same parties.
. Section 3-2A-04(b) provides in relevant part:
(b) Filing and service of certificate of qualified expert.—Unless the sole issue in the claim is lack of informed consent:
(l)(i) 1. Except as provided in item (ii) of this paragraph, a claim or
action filed after July 1, 1986, shall be dismissed, without prejudice, if the claimant or plaintiff fails to file a certificate of a qualified expert with the Director attesting to departure from standards of care, and that the departure from standards of care is the proximate cause of the alleged injury, within 90 days from the date of the complaint; and
2. The claimant or plaintiff shall serve a copy of the certificate on all other parties to the claim or action or their attorneys of record in accordance with the Maryland Rules; and
(ii) In lieu of dismissing the claim or action, the panel chairman or the court shall grant an extension of no more than 90 days for filing the certificate required by this paragraph, if:
1. The limitations period applicable to the claim or action has expired; and
2. The failure to file the certificate was neither willful nor the result of gross negligence.
. When determining which law controls the enforceability and construction of a contract, we apply
lex loci contractus. See Kramer v. Bally's Park Place, Inc.,
. Federal courts long ago resolved the question whether, for purposes of
Erie R.R. Co.
v.
Tompkins,
. That language mirrored language employed in Maryland Code (1997, 2006 Repl.Vol.), § 19-509(c) of the Insurance Article, which establishes the mandatory baseline coverage for uninsured motorist provisions.
Heffernan,
. We note that "the cardinal rule of [statutory interpretation] is to ascertain and effectuate the intent of the Legislature.”
Headen v. Motor Vehicle Admin.,
. Rule 8-304(c) is similar, but not identical to the old 815(b). The former reads as follows:
Rule 8-304. Certification from Court of Special Appeals.
(c) Disposition of Certification. The Court of Appeals may refuse the certification or may issue a writ of certiorari that (1) accepts the certification as submitted, (2) modifies the questions of law certified, (3) includes the entire action although only a question of law was certified, or (4) limits review to only a question of law although the entire action was certified. The Clerk of the Court of Appeals shall send the order refusing certification or the writ of certiorari to the Court of Special Appeals and to the parties.
